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CC BY-NC-ND 4.0 · World J Nucl Med 2021; 20(03): 237-246
DOI: 10.4103/wjnm.WJNM_99_20
Original Article

Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation

Sohini Das
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Sowmya Sathyendra
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Julie Hephzibah
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Reka Karuppusami
1   Department Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Karthik Gunasekaran
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Nylla Shanthly
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Angel Miraclin
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
,
Ramya Iyadurai
Departments of Medicine and Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Abstract

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.

Keywords

Fever of unknown origin - positron emission tomography - computed tomography - positron emission tomography - computed tomography in fever of unknown origin

Financial support and sponsorship

Nil.




Publikationsverlauf

Eingereicht: 14. Juli 2020

Angenommen: 03. August 2020

Artikel online veröffentlicht:
24. März 2022

© 2021. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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