PDF(Pubmed)
Abstract：
BACKGROUND: Suspected infection or inflammation of unknown origin in in-patients remains challenging. Literature on [18F]FDG-PET/CT is abundant in classic fever of unknown origin (FUO), but evidence is complex and may not always reflect clinical reality. This study explores the application of [18F]FDG-PET/CT in a diverse clinical population of in-patients with suspected infection not defined by stringent FUO-criteria.
METHODS: Retrospective chart review of consecutive in-patients who underwent [18F]FDG-PET/CT in the workup of suspected infection or inflammation from 1 July 2022 to 31 December 2022 was conducted. We evaluated indications, diagnostic yield, and clinical impact of [18F]FDG-PET/CT, and compared the findings of [18F]FDG-PET/CT and stand-alone CT. Univariate logistic regression assessed associations between [18F]FDG-PET/CT outcome and clinical parameters. Receiver operating characteristic curve (ROC) analysis evaluated diagnostic performance.
RESULTS: 77 patients met the inclusion criteria. [18F]FDG-PET/CT established a diagnosis in 35% of cases, ruled out focal infection in 26%, and thus was helpful in 61% of patients. It prompted 72 additional examinations resulting in seven incidental diagnoses, including two cancers. Antibiotic treatment was changed in 26% of cases. Regression analysis found white blood cell counts (WBC) associated with true positive outcomes. [18F]FDG-PET/CT was compared to stand-alone CT findings, and was concordant in 69% of cases.
CONCLUSIONS: Results were comparable to findings in more classic FUO. [18F]FDG-PET/CT was clinically helpful in 61% of cases but also prompted many additional examinations with relatively few clinically important findings. WBC count was a predictor of true positive outcome. CT and [18F]FDG-PET/CT were discordant in 31%, of cases, especially in cases of endocarditis and spondylodiscitis.
METHODS: Retrospective chart review of consecutive in-patients who underwent [18F]FDG-PET/CT in the workup of suspected infection or inflammation from 1 July 2022 to 31 December 2022 was conducted. We evaluated indications, diagnostic yield, and clinical impact of [18F]FDG-PET/CT, and compared the findings of [18F]FDG-PET/CT and stand-alone CT. Univariate logistic regression assessed associations between [18F]FDG-PET/CT outcome and clinical parameters. Receiver operating characteristic curve (ROC) analysis evaluated diagnostic performance.
RESULTS: 77 patients met the inclusion criteria. [18F]FDG-PET/CT established a diagnosis in 35% of cases, ruled out focal infection in 26%, and thus was helpful in 61% of patients. It prompted 72 additional examinations resulting in seven incidental diagnoses, including two cancers. Antibiotic treatment was changed in 26% of cases. Regression analysis found white blood cell counts (WBC) associated with true positive outcomes. [18F]FDG-PET/CT was compared to stand-alone CT findings, and was concordant in 69% of cases.
CONCLUSIONS: Results were comparable to findings in more classic FUO. [18F]FDG-PET/CT was clinically helpful in 61% of cases but also prompted many additional examinations with relatively few clinically important findings. WBC count was a predictor of true positive outcome. CT and [18F]FDG-PET/CT were discordant in 31%, of cases, especially in cases of endocarditis and spondylodiscitis.
摘要：
背景：住院患者中不明原因的可疑感染或炎症仍然具有挑战性。关于[18F]FDG-PET/CT的文献在经典不明原因发热（FUO）中非常丰富，但是证据很复杂，可能并不总是反映临床现实。这项研究探讨了[18F]FDG-PET/CT在严格的FUO标准未定义的可疑感染住院患者的不同临床人群中的应用。
方法：对2022年7月1日至2022年12月31日在可疑感染或炎症检查中接受[18F]FDG-PET/CT检查的连续住院患者进行回顾性图表回顾。我们评估了适应症，诊断产量，[18F]FDG-PET/CT的临床影响，并比较了[18F]FDG-PET/CT和独立CT的发现。单变量逻辑回归评估[18F]FDG-PET/CT结果与临床参数之间的关联。受试者工作特征曲线（ROC）分析评估了诊断性能。
结果：77例患者符合纳入标准。[18F]FDG-PET/CT在35％的病例中确定了诊断，26%的人排除了局灶性感染，因此对61%的患者有帮助。它促使72次额外检查，导致7次偶然诊断，包括两种癌症。26%的病例改变了抗生素治疗。回归分析发现白细胞计数（WBC）与真阳性结果相关。[18F]FDG-PET/CT与独立CT检查结果进行了比较，69%的病例是一致的。
结论：结果与更经典的FUO的结果相当。[18F]FDG-PET/CT在61％的病例中有临床帮助，但也提示了许多其他检查，但临床上重要的发现相对较少。白细胞计数是真实阳性结果的预测因子。31％的CT和[18F]FDG-PET/CT不一致，的情况下，尤其是在心内膜炎和脊椎盘炎的病例中。
方法：对2022年7月1日至2022年12月31日在可疑感染或炎症检查中接受[18F]FDG-PET/CT检查的连续住院患者进行回顾性图表回顾。我们评估了适应症，诊断产量，[18F]FDG-PET/CT的临床影响，并比较了[18F]FDG-PET/CT和独立CT的发现。单变量逻辑回归评估[18F]FDG-PET/CT结果与临床参数之间的关联。受试者工作特征曲线（ROC）分析评估了诊断性能。
结果：77例患者符合纳入标准。[18F]FDG-PET/CT在35％的病例中确定了诊断，26%的人排除了局灶性感染，因此对61%的患者有帮助。它促使72次额外检查，导致7次偶然诊断，包括两种癌症。26%的病例改变了抗生素治疗。回归分析发现白细胞计数（WBC）与真阳性结果相关。[18F]FDG-PET/CT与独立CT检查结果进行了比较，69%的病例是一致的。
结论：结果与更经典的FUO的结果相当。[18F]FDG-PET/CT在61％的病例中有临床帮助，但也提示了许多其他检查，但临床上重要的发现相对较少。白细胞计数是真实阳性结果的预测因子。31％的CT和[18F]FDG-PET/CT不一致，的情况下，尤其是在心内膜炎和脊椎盘炎的病例中。
