Purpose

Patients with fever and inflammation of unknown origin (FUO/IUO) are clinically challenging due to variable clinical presentations with nonspecific symptoms and many differential diagnoses. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[¹⁸F]fluoro-D-glucose ([¹⁸F]FDG) is increasingly used in FUO and IUO, but the optimal diagnostic strategy remains controversial. This consensus document aims to assist clinicians and nuclear medicine specialists in the appropriate use of [¹⁸F]FDG-PET/CT in FUO and IUO based on current evidence.

Methods

A working group created by the EANM infection and inflammation committee performed a systematic literature search based on PICOs with “patients with FUO/IUO” as population, “[¹⁸F]FDG-PET/CT” as intervention, and several outcomes including pre-scan characteristics, scan protocol, diagnostic yield, impact on management, prognosis, and cost-effectiveness.

Results

We included 68 articles published from 2001 to 2023: 9 systematic reviews, 49 original papers on general adult populations, and 10 original papers on specific populations. All papers were analysed and included in the evidence-based recommendations.

Conclusion

FUO and IUO remains a clinical challenge and [¹⁸F]FDG PET/CT has a definite role in the diagnostic pathway with an overall diagnostic yield or helpfulness in 50–60% of patients. A positive scan is often contributory by directly guiding treatment or subsequent diagnostic procedure. However, a negative scan may be equally important by excluding focal disease and predicting a favorable prognosis. Similar results are obtained in specific populations such as ICU-patients, children and HIV-patients.

中文翻译：

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EANM 关于使用 [18F]FDG PET/CT 治疗发热和不明原因炎症的共识文件

目的

发烧和不明原因炎症 (FUO/IUO) 的患者由于临床表现多样、非特异性症状和许多鉴别诊断而具有临床挑战性。 2-脱氧-2-[ ¹⁸ F]氟-D-葡萄糖 ([ ¹⁸ F]FDG) 正电子发射断层扫描/计算机断层扫描 (PET/CT) 越来越多地用于 FUO 和 IUO，但最佳诊断策略仍存在争议。本共识文件旨在根据现有证据，协助临床医生和核医学专家在 FUO 和 IUO 中适当使用 [ ^{18 F]FDG-PET/CT。}

方法

EANM 感染和炎症委员会创建的一个工作组基于 PICO 进行了系统的文献检索，以“FUO/IUO 患者”为人群，“[ ¹⁸ F]FDG-PET/CT”作为干预措施，以及包括预治疗在内的多项结果。扫描特征、扫描协议、诊断率、对管理的影响、预后和成本效益。

结果

我们纳入了 2001 年至 2023 年发表的 68 篇文章：9 篇系统综述、49 篇关于一般成年人群的原创论文和 10 篇关于特定人群的原创论文。所有论文均经过分析并纳入基于证据的建议中。

结论

FUO 和 IUO 仍然是一个临床挑战，[ ¹⁸ F]FDG PET/CT 在诊断途径中具有明确的作用，对 50-60% 的患者具有总体诊断率或有用性。阳性扫描通常有助于直接指导治疗或后续诊断程序。然而，阴性扫描对于排除病灶和预测良好的预后可能同样重要。在 ICU 患者、儿童和艾滋病毒患者等特定人群中也获得了类似的结果。