¹⁸F-FDG-PET/CT in unexplained elevated inflammatory markers

 

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Summary

The diagnostic strategy in patients with fever or inflammation of unknown origin remains a major clinical challenge. The aim of this study was to evaluate the role of ¹⁸F-FDG-PET/CT in patients with unexplained elevated C-reactive protein with or without fever. Contribution of ¹⁸F-FDG-PET/CT to the final diagnosis was evaluated. In addition we determined whether a differentiation between patients with or without fever is clinically reasonable. Patients, methods: We retrospectively analysed 72 consecutive patients with unexplained elevated C-reactive protein levels (above 8mg/l) that underwent ¹⁸F-FDG-PET/ CT in our facility between 10/2009 and 11/2012. ¹⁸F-FDG-PET/CT was considered a so-called diagnostic scan when results decisively led to a final diagnosis and adequate therapy with a response of symptoms was initiated due to the PET/CT result. Results: In 60/72 patients (83%) a final diagnosis was established. Diagnoses included infections (58%), non-infectious inflammatory diseases (29%) and malignancies (8%). ¹⁸F-FDG-PET/CT was true positive in 47 cases (65%) and the diagnostic scan in 29 patients (40%). Sensitivity of ¹⁸F-FDG-PET/CT was 81% and specificity was 86%. Diagnostics, final diagnoses, ¹⁸F-FDG-PET/CT results, SUVmax, C-reactive protein levels and the diagnostic scan did not differ significantly between patients with fever and patients without fever. Conclusion: ¹⁸F-FDG-PET/CT is a useful method in the diagnostic workup of patients with inflammation of unknown origin. In our series there was no significant difference between patients with or without fever. Regarding ¹⁸F-FDG-PET/CT-imaging inflammation of unknown origin and unexplained fever can be joined to one entity.

Zusammenfassung

Die diagnostische Strategie bei Patienten mit Entzündungen unklarer Genese stellt eine große klinische Herausforderung dar. Das Ziel dieser Studie war die Evaluation der Rolle der ¹⁸F-FDG-PET/CT bei Patienten mit unklarer Erhöhung des C-reaktiven Proteins mit und ohne Fieber. Der Beitrag der ¹⁸F-FDG-PET/CT zur Enddiagnose sowie Unterschiede zwischen Patienten mit und ohne Fieber wurden untersucht. Patienten, Methoden: In dieser Arbeit wurden 72 Patienten mit unklarer Erhöhung des C-reaktiven Proteins (> 8mg / l), die zwischen 10/2009 und 11/2012 in unserer Abteilung mittels ¹⁸F-FDG-PET/CT untersucht wurden, retrospektiv ausgewertet. Die ¹⁸F-FDG-PET/CT wurde zudem als sogenannter „Diagnostischer Scan“ gewertet, wenn das ¹⁸F-FDG-PET/CT-Ergebnis entscheidend zur Enddiagnose beitrug und daraufhin eine adäquate Therapie initiiert wurde, welche zu einer Normalisierung des C-reaktiven Proteins führte. Ergebnisse: Bei 60 von 72 (82%) Patienten wurde eine endgültige Diagnose gestellt. Diagnosen beinhalteten Infektionen (58%), rheumatoide (29%) und maligne Erkrankungen (8%). Die ¹⁸F-FDG-PET/CT war in 47 Fällen (65%) richtig positiv und in 29 Fällen (40%) der Diagnostische Scan. Die Sensitivität der ¹⁸F-FDG-PET/CT betrug 81% und die Spezifität 86%. Diagnostik, Enddiagnosen, SUVmax, CRP und der Diagnostische Scan zeigten keine signifikanten Unterschiede zwischen Patienten mit und ohne Fieber. Schlussfolgerung: Die ¹⁸F-FDG-PET/CT ist eine wichtige Methode in der Diagnostik von Patienten mit erhöhten Entzündungsparametern unklarer Genese. In unserer Studie zeigte sich kein signifikanter Unterschied zwischen Patienten mit und ohne Fieber, sodass man bezüglich der ¹⁸F-FDG-PET/CT-Bildgebung unerklärtes Fieber und Entzündungen unklarer Genese zu einer Entität zusammenfassen kann.

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