PDF(Pubmed)
Abstract：
OBJECTIVE: 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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
目的：因不明原因的发热和炎症(FUO/IUO)患者的临床表现不一，非特异性症状和许多鉴别诊断，在临床上具有挑战性。使用2-脱氧-2-[18F]氟-D-葡萄糖（[18F]FDG）的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。该共识文件旨在根据当前证据，协助临床医生和核医学专家在FUO和IUO中适当使用[18F]FDG-PET/CT。
方法：由EANM感染和炎症委员会创建的工作组基于以“FUO/IUO患者”为人群的PICOs进行了系统的文献检索，“[18F]FDG-PET/CT”作为干预措施，和几个结果，包括预扫描特征，扫描协议,诊断产量，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篇关于一般成年人的原始论文，和10篇关于特定人群的原创论文。对所有论文进行了分析，并将其纳入基于证据的建议中。
结论：FUO和IUO仍然是一个临床挑战，[18F]FDGPET/CT在诊断途径中具有明确的作用，在50-60％的患者中具有整体诊断效果或帮助。阳性扫描通常通过直接指导治疗或随后的诊断程序而起作用。然而,通过排除局灶性疾病和预测良好的预后,阴性扫描可能同样重要.在特定人群中获得了类似的结果，例如ICU患者，儿童和艾滋病毒患者。
方法：由EANM感染和炎症委员会创建的工作组基于以“FUO/IUO患者”为人群的PICOs进行了系统的文献检索，“[18F]FDG-PET/CT”作为干预措施，和几个结果，包括预扫描特征，扫描协议,诊断产量，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篇关于一般成年人的原始论文，和10篇关于特定人群的原创论文。对所有论文进行了分析，并将其纳入基于证据的建议中。
结论：FUO和IUO仍然是一个临床挑战，[18F]FDGPET/CT在诊断途径中具有明确的作用，在50-60％的患者中具有整体诊断效果或帮助。阳性扫描通常通过直接指导治疗或随后的诊断程序而起作用。然而,通过排除局灶性疾病和预测良好的预后,阴性扫描可能同样重要.在特定人群中获得了类似的结果，例如ICU患者，儿童和艾滋病毒患者。
