C Martin1, C Castaigne, M Tondeur, P Flamen, S De Wit. 1. Infectious Diseases Department, Saint-Pierre University Hospital, 100 Brussels, Belgium. charlotte_martin@stpierre-bru.be
Abstract
OBJECTIVES: The aim of the study was to evaluate prospectively the usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in investigation of fever of unknown origin (FUO) in HIV-positive patients and to determine whether HIV viraemia impacts on FDG-PET/CT performance. METHODS: The FDG-PET/CT results of 20 HIV-infected patients with FUO were analysed and compared with the FDG-PET/CT results of 10 HIV-infected viraemic patients without FUO. The performance of FDG-PET/CT for identifying the aetiology of FUO was assessed. Final diagnosis for FUO was based on histopathology, microbiological assays, or clinical and imaging follow-up. RESULTS: FDG-PET/CT contributed to the diagnosis or exclusion of a focal aetiology of the febrile state in 80% of patients with FUO. The presence of increased FDG uptake in the central lymph node has 100% specificity for focal aetiology of fever, even in viraemic patients. The absence of hypermetabolic central lymph nodes in FUO patients has 100% negative predictive value for focal disease. Lymph node biopsy in central hypermetabolic areas allowed, in 100% of cases, identification of underlying disease in patients with FUO. Biopsy of peripheral lymph nodes should be performed in lymph nodes with maximum standardized uptake value (SUVmax) ≥ 6-8 (sensitivity 62.5%; specificity 75%) and avoided in lymph nodes with SUVmax = 0-4 (specificity 0%). High HIV viraemia does not prevent correct interpretation of FDG-PET/CT. CONCLUSIONS: As in HIV-negative patients, we confirm the usefulness of FDG-PET/CT in investigation of FUO in HIV-positive patients even if they are viraemic.
OBJECTIVES: The aim of the study was to evaluate prospectively the usefulness of fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in investigation of fever of unknown origin (FUO) in HIV-positivepatients and to determine whether HIV viraemia impacts on FDG-PET/CT performance. METHODS: The FDG-PET/CT results of 20 HIV-infectedpatients with FUO were analysed and compared with the FDG-PET/CT results of 10 HIV-infected viraemicpatients without FUO. The performance of FDG-PET/CT for identifying the aetiology of FUO was assessed. Final diagnosis for FUO was based on histopathology, microbiological assays, or clinical and imaging follow-up. RESULTS:FDG-PET/CT contributed to the diagnosis or exclusion of a focal aetiology of the febrile state in 80% of patients with FUO. The presence of increased FDG uptake in the central lymph node has 100% specificity for focal aetiology of fever, even in viraemic patients. The absence of hypermetabolic central lymph nodes in FUO patients has 100% negative predictive value for focal disease. Lymph node biopsy in central hypermetabolic areas allowed, in 100% of cases, identification of underlying disease in patients with FUO. Biopsy of peripheral lymph nodes should be performed in lymph nodes with maximum standardized uptake value (SUVmax) ≥ 6-8 (sensitivity 62.5%; specificity 75%) and avoided in lymph nodes with SUVmax = 0-4 (specificity 0%). High HIV viraemia does not prevent correct interpretation of FDG-PET/CT. CONCLUSIONS: As in HIV-negative patients, we confirm the usefulness of FDG-PET/CT in investigation of FUO in HIV-positivepatients even if they are viraemic.
Authors: Mark N Polizzotto; Corina Millo; Thomas S Uldrick; Karen Aleman; Millie Whatley; Kathleen M Wyvill; Deirdre O'Mahony; Vickie Marshall; Denise Whitby; Roberto Maass-Moreno; Seth M Steinberg; Richard F Little; Robert Yarchoan Journal: J Infect Dis Date: 2015-03-31 Impact factor: 5.226