Comparison of 18F-FDG PET/CT and 67Ga-SPECT for the diagnosis of fever of unknown origin: a multicenter prospective study in Japan

• Published in: Annals of nuclear medicine 2021, Vol.35 (1), p.31-46
• Main Authors: Kubota, Kazuo, Tanaka, Noriko, Miyata, Yoko, Ohtsu, Hiroshi, Nakahara, Tadaki, Sakamoto, Setsu, Kudo, Takashi, Nishiyama, Yoshihiro, Tateishi, Ukihide, Murakami, Koji, Nakamoto, Yuji, Taki, Yasuyuki, Kaneta, Tomohiro, Kawabe, Joji, Nagamachi, Shigeki, Kawano, Tsuyoshi, Hatazawa, Jun, Mizutani, Youichi, Baba, Shingo, Kirii, Kazukuni, Yokoyama, Kunihiko, Okamura, Terue, Kameyama, Masashi, Minamimoto, Ryogo, Kunimatsu, Junwa, Kato, On, Yamashita, Hiroyuki, Kaneko, Hiroshi, Kutsuna, Satoshi, Ohmagari, Norio, Hagiwara, Akiyoshi, Kikuchi, Yoshimi, Kobayakawa, Masao
• Format: Article
• Language: English
• Subjects: Adverse events; Computed tomography; Diagnosis; Emission analysis; Evaluation; Fever; Fluorine isotopes; Image acquisition; Imaging; Infectious diseases; Inflammatory diseases; Malignancy; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Original Article; Photon emission; Positron emission; Positron emission tomography; Radiology; Sensitivity analysis; Single photon emission computed tomography; Tomography
• ISSN: 0914-7187; 1864-6433; 1864-6433
• DOI: 10.1007/s12149-020-01533-z

Objective The aim of this multicenter prospective study was to compare the sensitivity of 18 F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67 Ga 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 67 Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67 Ga-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 67 Ga-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 67 Ga-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 67 Ga-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 67 Ga-SPECT (57%, P