Kazuo Kubota1,2, Noriko Tanaka3, Yoko Miyata4,5, Hiroshi Ohtsu6, Tadaki Nakahara7, Setsu Sakamoto8,9, Takashi Kudo10, Yoshihiro Nishiyama11, Ukihide Tateishi12, Koji Murakami7, Yuji Nakamoto13, Yasuyuki Taki14, Tomohiro Kaneta15, Joji Kawabe16, Shigeki Nagamachi17, Tsuyoshi Kawano15, Jun Hatazawa18, Youichi Mizutani17, Shingo Baba19, Kazukuni Kirii20, Kunihiko Yokoyama21, Terue Okamura22, Masashi Kameyama23, Ryogo Minamimoto4, Junwa Kunimatsu24, On Kato24, Hiroyuki Yamashita25, Hiroshi Kaneko25, Satoshi Kutsuna26, Norio Ohmagari26, Akiyoshi Hagiwara27, Yoshimi Kikuchi28, Masao Kobayakawa3,29. 1. Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan. kkubota@cpost.plala.or.jp. 2. Department of Radiology, Southern TOHOKU General Hospital, Koriyama City, 7-115 Yatsuyamada, Fukushima, 963-8563, Japan. kkubota@cpost.plala.or.jp. 3. Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan. 4. Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan. 5. Department of Radiology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan. 6. Clinical Epidemiology/JCRAC Data Center, Department of Data Science National Center for Global Health and Medicine Center for Clinical Sciences, Tokyo, Japan. 7. Department of Radiology, Keio University School of Medicine, Tokyo, Japan. 8. PET Center, Dokkyo Medical University Hospital, Tochigi, Japan. 9. Department of Diagnostic Radiology, Hyogo Cancer Center, Hyogo, Japan. 10. Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 11. Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan. 12. Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 13. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 14. Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan. 15. Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. 16. Department of Nuclear Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. 17. Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan. 18. Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan. 19. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 20. Department of Diagnostic Radiology, Yamagata University, Faculty of Medicine, Yamagata, Japan. 21. Department of Thyroidology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan. 22. PET Center, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan. 23. Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan. 24. Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan. 25. Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan. 26. Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan. 27. Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan. 28. AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan. 29. Medical Research Center, Fukushima Medical University, Fukushima, Japan.
Abstract
OBJECTIVE: The aim of this multicenter prospective study was to compare the sensitivity of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67Ga single photon emission computed tomography (SPECT) for the identification of the site of greatest importance for the final diagnosis of the cause of fever of unknown origin (FUO). METHODS: The study participants consisted of patients with an axillary temperature ≥ 38.0 °C on ≥ 2 occasions within 1 week, with repeated episodes for ≥ 2 weeks prior to providing consent, and whose final diagnosis after undergoing specific examinations, including a chest-to-abdomen CT scan, was uncertain. All the patients underwent FDG-PET/CT imaging first, followed by 67Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67Ga-SPECT examinations were reviewed by the central image interpretation committee (CIIC), which was blinded to all other clinical information. The sensitivities of FDG-PET/CT and 67Ga-SPECT were then evaluated with regard to identifying the site of greatest importance for a final diagnosis of the cause of the fever as decided by the patient's attending physician. The clinical impacts (four grades) of FDG-PET/CT and 67Ga-SPECT on the final diagnosis were evaluated. RESULTS: A total of 149 subjects were enrolled in this study between October 2014 and September 2017. No adverse events were identified among the enrolled subjects. Twenty-one subjects were excluded from the study because of deviations from the study protocol. Among the 128 remaining subjects, a final diagnosis of the disease leading to the appearance of FUO was made for 92 (71.9%) subjects. The final diagnoses in these 92 cases were classified into four groups: noninfectious inflammatory disease (52 cases); infectious disease (31 cases), malignancy (six cases); and other (three cases). These 92 subjects were eligible for inclusion in the study's analysis, but one case did not meet the PET/CT image acquisition criteria; thus, PET/CT results were analyzed for 91 cases. According to the patient-based assessments, the sensitivity of FDG-PET/CT (45%, 95% CI 33.1-58.2%) was significantly higher than that for 67Ga-SPECT (25%, 95% CI 15.5-37.5%) (P = 0.0029). The clinical impact of FDG-PET/CT (91%) was also significantly higher than that for 67Ga-SPECT (57%, P < 0.001). CONCLUSIONS: FDG-PET/CT showed a superior sensitivity to 67Ga-SPECT for the identification of the site of greatest importance for the final diagnosis of the cause of FUO.
OBJECTIVE: The aim of this multicenter prospective study was to compare the sensitivity of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67Ga single photon emission computed tomography (SPECT) for the identification of the site of greatest importance for the final diagnosis of the cause of fever of unknown origin (FUO). METHODS: The study participants consisted of patients with an axillary temperature ≥ 38.0 °C on ≥ 2 occasions within 1 week, with repeated episodes for ≥ 2 weeks prior to providing consent, and whose final diagnosis after undergoing specific examinations, including a chest-to-abdomen CT scan, was uncertain. All the patients underwent FDG-PET/CT imaging first, followed by 67Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67Ga-SPECT examinations were reviewed by the central image interpretation committee (CIIC), which was blinded to all other clinical information. The sensitivities of FDG-PET/CT and 67Ga-SPECT were then evaluated with regard to identifying the site of greatest importance for a final diagnosis of the cause of the fever as decided by the patient's attending physician. The clinical impacts (four grades) of FDG-PET/CT and 67Ga-SPECT on the final diagnosis were evaluated. RESULTS: A total of 149 subjects were enrolled in this study between October 2014 and September 2017. No adverse events were identified among the enrolled subjects. Twenty-one subjects were excluded from the study because of deviations from the study protocol. Among the 128 remaining subjects, a final diagnosis of the disease leading to the appearance of FUO was made for 92 (71.9%) subjects. The final diagnoses in these 92 cases were classified into four groups: noninfectious inflammatory disease (52 cases); infectious disease (31 cases), malignancy (six cases); and other (three cases). These 92 subjects were eligible for inclusion in the study's analysis, but one case did not meet the PET/CT image acquisition criteria; thus, PET/CT results were analyzed for 91 cases. According to the patient-based assessments, the sensitivity of FDG-PET/CT (45%, 95% CI 33.1-58.2%) was significantly higher than that for 67Ga-SPECT (25%, 95% CI 15.5-37.5%) (P = 0.0029). The clinical impact of FDG-PET/CT (91%) was also significantly higher than that for 67Ga-SPECT (57%, P < 0.001). CONCLUSIONS:FDG-PET/CT showed a superior sensitivity to 67Ga-SPECT for the identification of the site of greatest importance for the final diagnosis of the cause of FUO.
Entities:
Keywords:
67Ga-SPECT; Clinical impact; FDG-PET/CT; Fever of unknown origin; Multicenter study
Authors: M Yamaguchi; A Ohta; T Tsunematsu; R Kasukawa; Y Mizushima; H Kashiwagi; S Kashiwazaki; K Tanimoto; Y Matsumoto; T Ota Journal: J Rheumatol Date: 1992-03 Impact factor: 4.666