EANM consensus document on the use of [18F]FDG PET/CT in fever and inflammation of unknown origin

Søren Hess; Edel Noriega-Álvarez; Lucia Leccisotti; Giorgio Treglia; Domenico Albano; Anne Roivainen; Andor W J M Glaudemans; Olivier Gheysens

doi:10.1007/s00259-024-06732-8

EANM consensus document on the use of [¹⁸F]FDG PET/CT in fever and inflammation of unknown origin

Eur J Nucl Med Mol Imaging. 2024 Apr 27. doi: 10.1007/s00259-024-06732-8. Online ahead of print.

Authors

Søren Hess^{1

2}, Edel Noriega-Álvarez³, Lucia Leccisotti^{4

5}, Giorgio Treglia^{6

7

8}, Domenico Albano⁹, Anne Roivainen^{10

11

12}, Andor W J M Glaudemans¹³, Olivier Gheysens¹⁴

Affiliations

¹ Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
² Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
³ Department of Nuclear Medicine, University Hospital of Guadalajara, Guadalajara, Spain.
⁴ Section of Nuclear Medicine, Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
⁶ Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
⁷ Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland.
⁸ Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
⁹ Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy.
¹⁰ Turku PET Centre, University of Turku, Turku, Finland.
¹¹ Turku PET Centre, Turku University Hospital, Turku, Finland.
¹² InFLAMES Research Flagship, University of Turku, Turku, Finland.
¹³ Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands. a.w.j.m.glaudemans@umcg.nl.
¹⁴ Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain, Brussels, Belgium.

PMID: 38676736
DOI: 10.1007/s00259-024-06732-8

Abstract

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.

Keywords: FDG; FUO; Fever of unknown origin; IUO; Infection; Inflammation; Inflammation of unknown origin; PET/CT.