Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation
Positron emission tomography–computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as pred...
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doaj-10812004726544e6bf4ed669b7e57a892021-10-07T06:58:15ZengWolters Kluwer Medknow PublicationsWorld Journal of Nuclear Medicine1450-11471607-33122021-01-0120323724610.4103/wjnm.WJNM_99_20Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nationSohini DasSowmya SathyendraJulie HephzibahReka KaruppusamiKarthik GunasekaranNylla ShanthlyAngel MiraclinRamya IyaduraiPositron emission tomography–computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations.http://www.wjnm.org/article.asp?issn=1450-1147;year=2021;volume=20;issue=3;spage=237;epage=246;aulast=fever of unknown originpositron emission tomography–computed tomographypositron emission tomography–computed tomography in fever of unknown origin |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sohini Das Sowmya Sathyendra Julie Hephzibah Reka Karuppusami Karthik Gunasekaran Nylla Shanthly Angel Miraclin Ramya Iyadurai |
spellingShingle |
Sohini Das Sowmya Sathyendra Julie Hephzibah Reka Karuppusami Karthik Gunasekaran Nylla Shanthly Angel Miraclin Ramya Iyadurai Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation World Journal of Nuclear Medicine fever of unknown origin positron emission tomography–computed tomography positron emission tomography–computed tomography in fever of unknown origin |
author_facet |
Sohini Das Sowmya Sathyendra Julie Hephzibah Reka Karuppusami Karthik Gunasekaran Nylla Shanthly Angel Miraclin Ramya Iyadurai |
author_sort |
Sohini Das |
title |
Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation |
title_short |
Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation |
title_full |
Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation |
title_fullStr |
Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation |
title_full_unstemmed |
Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation |
title_sort |
utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation |
publisher |
Wolters Kluwer Medknow Publications |
series |
World Journal of Nuclear Medicine |
issn |
1450-1147 1607-3312 |
publishDate |
2021-01-01 |
description |
Positron emission tomography–computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations. |
topic |
fever of unknown origin positron emission tomography–computed tomography positron emission tomography–computed tomography in fever of unknown origin |
url |
http://www.wjnm.org/article.asp?issn=1450-1147;year=2021;volume=20;issue=3;spage=237;epage=246;aulast= |
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