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The utility of PET/CT in diagnosing fever of unknown origin: The experience of a large tertiary medical center
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  • Hussein Mahagna,
  • Keren Vaknin,
  • Abdulla Watad,
  • Arsalan Abu-Much,
  • Naim Mahroum,
  • Ora Shovman,
  • Jennifer Ben Shimol,
  • Yehuda Shoenfeld,
  • Howard Amital,
  • Tima Davidson
Hussein Mahagna
Sheba Medical Center
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Keren Vaknin
Sheba Medical Center
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Abdulla Watad
Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Arsalan Abu-Much
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Naim Mahroum
Sheba Medical Center
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Ora Shovman
Sheba Medical Center
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Jennifer Ben Shimol
Edith Wolfson Medical Center
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Yehuda Shoenfeld
Tel-Aviv University
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Howard Amital
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Tima Davidson
Sheba Medical Center at Tel Hashomer
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Abstract

Background: Fever of unknown origin (FUO) is a diagnostic challenge. Positron emission tomography with computed tomography (PET/CT) is expensive and not widely available. We aimed to evaluate the diagnostic yield of PET/CT in the workup of FUO, and identify the patients for whom this test is most useful. Methods: We reviewed the records of all patients admitted to Sheba Medical Center from 2013 to 2017 who were underwent PET/CT for the evaluation of FUO. Results: Of the 128 patients included, PET/CT was helpful in revealing the cause of FUO in 61 (48%). A final diagnosis was made in 95 (74%) patients. Of the 128 PET/CT tests conducted for the workup of FUO, 61 (48%) had true positive results, 25 (20%) false positive results, 24 (19%) true negative results, and 18 (14%) false negative results. In a multivariate analysis, helpfulness of PET/CT was independently associated with weight loss and low hemoglobin. The calculated test sensitivity was 77%, specificity was 49%, positive predictive value was 71% and negative predictive value was 57%. Conclusion: PET/CT is valuable in the diagnostic workup of FUO. When used as a complementary test, it was helpful in diagnosing almost half the patients, and especially in those with low hemoglobin and weight loss.

Peer review status:UNDER REVIEW

24 Aug 2020Submitted to International Journal of Clinical Practice
24 Aug 2020Assigned to Editor
24 Aug 2020Submission Checks Completed
31 Aug 2020Reviewer(s) Assigned