Fever of unknown origin:: prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET

被引:139
作者
Meller, J
Altenvoerde, G
Munzel, U
Jauho, A
Behe, M
Gratz, S
Luig, H
Becker, W
机构
[1] Univ Gottingen, Dept Nucl Med, D-37075 Gottingen, Germany
[2] Univ Gottingen, Dept Med Stat, D-3400 Gottingen, Germany
关键词
fever of unknown origin; gallium-67; citrate; F-18]2 '-deoxy-2-fluoro-D-glucose; double-head coincidence camera; single-photon emission tomography;
D O I
10.1007/s002590000341
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Gallium-67 citrate is currently considered as the tracer of first choice in the diagnostic workup of fever of unknown origin (FUO). Fluorine-18 2'-deoxy-2-fluoro-D-glucose (FDG) has been shown to accumulate in malignant tumours but also in inflammatory processes. The aim of this study was to prospectively evaluate FDG imaging with a double-head coincidence camera (DHCC) in patients with FUO in comparison with planar and single-photon emission tomography (SPET) Ga-67 citrate scanning. Twenty FUO patients underwent FDG imaging with a DHCC which included transaxial and longitudinal whole-body tomography. In 18 of these subjects, Ga-67 citrate whole-body and SPET imaging was performed. The Ga-67 citrate and FDG images were interpreted by two investigators, both blinded to the results of other diagnostic modalities. Forty percent (8/20) of the patients had infection, 25% (5/20) had auto-immune diseases, 10% (2/20) had neoplasms and 15% (3/20) had other diseases. Fever remained unexplained in 10% (2/20) of the patients. Of the 20 patients studied, FDG imaging was positive and essentially contributed to the final diagnosis in 11 (55%). The sensitivity of transaxial FDG tomography in detecting the focus of fever was 84% and the specificity, 86%. Positive and negative predictive values were 92% and 75%, respectively. Tf the analysis was restricted to the 18 patients who were investigated both with Ga-67 citrate and FDG, sensitivity was 81% and specificity, 86%. Positive and negative predictive values were 90% and 75%, respectively. The diagnostic accuracy of whole-body FDG tomography (again restricted to the aforementioned 18 patients) was lower (sensitivity, 36%; specificity, 86%; positive and negative predictive values, 80% and 46%, respectively). Ga-67 citrate SPET yielded a sensitivity of 67% in detecting the focus of fever and a specificity of 78%. Positive and negative predictive values were 75% and 70%, respectively. A low sensitivity (45%), bur combined with a high specificity (100%), was found in planar Ga-67 imaging. Positive and negative predictive values were 100% and 54%, respectively. It is concluded that in the context of FUO, transaxial FDG tomography performed with a DHCC is superior to Ga-67 citrate SPET. This seems to be the consequence of superior tracer kinetics of FDG compared with those of Ga-67 citrate and of a better spatial resolution of a DHCC system compared with SPET imaging. In patients with FUO, FDG imaging with either dedicated PET or DHCC should be considered the procedure of choice.
引用
收藏
页码:1617 / 1625
页数:9
相关论文
共 33 条
  • [1] Abdel-Dayem HM, 1998, J NUCL MED, V39, P654
  • [2] BECKER W, 1993, EUR J NUCL MED, V20, P1078
  • [3] New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography
    Blockmans, D
    Maes, A
    Stroobants, S
    Nuyts, J
    Bormans, G
    Knockaert, D
    Bobbaers, H
    Mortelmans, L
    [J]. RHEUMATOLOGY, 1999, 38 (05) : 444 - 447
  • [4] CHAKRABARTI R, 1994, J IMMUNOL, V152, P2660
  • [5] THE ROLE OF INDIUM-LABELED LEUKOCYTE IMAGING IN PYREXIA OF UNKNOWN ORIGIN
    DAVIES, SG
    GARVIE, NW
    [J]. BRITISH JOURNAL OF RADIOLOGY, 1990, 63 (755) : 850 - 854
  • [6] Guhlmann A, 1998, J NUCL MED, V39, P2145
  • [7] GUTOWSKI T D, 1992, Journal of Nuclear Medicine, V33, P925
  • [8] HAWKER RJ, 1985, EUR J NUCL MED, V10, P172
  • [9] Ichiya Y, 1996, Ann Nucl Med, V10, P185
  • [10] CLINICAL-VALUE OF GA-67 SCINTIGRAPHY IN EVALUATION OF FEVER OF UNKNOWN ORIGIN
    KNOCKAERT, DC
    MORTELMANS, LA
    DEROO, MC
    BOBBAERS, HJ
    [J]. CLINICAL INFECTIOUS DISEASES, 1994, 18 (04) : 601 - 605