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Mahajna H, Vaknin K, Ben Shimol J, Watad A, Abu-Much A, Mahroum N, Shovman O, Shoenfeld Y, Amital H, Davidson T. The Utility of 18FDG-PET/CT in Diagnosing Fever of Unknown Origin: The Experience of a Large Tertiary Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105360. [PMID: 34069883 PMCID: PMC8157390 DOI: 10.3390/ijerph18105360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 12/14/2022]
Abstract
Fever of unknown origin (FUO) poses a diagnostic challenge, and 18-fluorodexoyglucose positron emission tomography with computed tomography (18FDG-PET/CT) may identify the source. We aimed to evaluate the diagnostic yield of 18FDG-PET/CT in the work-up of FUO. The records of patients admitted to Sheba Medical Center between January 2013 and January 2018 who underwent 18FDG-PET/CT for the evaluation of FUO were reviewed. Following examination of available medical test results, 18FDG-PET/CT findings were assessed to determine whether lesions identified proved diagnostic. Of 225 patients who underwent 18FDG-PET/CT for FUO work-up, 128 (57%) met inclusion criteria. Eighty (62.5%) were males; mean age was 59 ± 20.3 (range: 18-93). A final diagnosis was made in 95 (74%) patients. Of the 128 18FDG-PET/CT tests conducted for the workup of FUO, 61 (48%) were true positive, 26 (20%) false positive, 26 (20%) true negative, and 15 (12%) false negative. In a multivariate analysis, weight loss and anemia were independently associated with having a contributary results of 18FDG-PET/CT. The test yielded a sensitivity of 70%, specificity of 37%, positive predictive value of 70%, and negative predictive value of 37%. 18FDG-PET/CT is a valuable tool in the diagnostic workup of FUO. It proved effective in diagnosing almost half the patients, especially in those with anemia and weight loss.
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Affiliation(s)
- Hussein Mahajna
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Keren Vaknin
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Jennifer Ben Shimol
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Department of Medicine, E. Wolfson Medical Center, Holon 5822012, Israel
| | - Abdulla Watad
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Arsalan Abu-Much
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Naim Mahroum
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Ora Shovman
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
| | - Yehuda Shoenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Ministry of Health of the Russian Federation, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Howard Amital
- Department of Medicine ‘B’, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; (H.M.); (K.V.); (A.W.); (A.A.-M.); (N.M.); (O.S.); (H.A.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; (J.B.S.); (Y.S.)
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
- Correspondence: ; Tel.: +972-3-5302986
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