Comparison of 18 F-FDG PET/CT and 67 Ga-SPECT for the diagnosis of fever of unknown origin: a multicenter prospective st
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ORIGINAL ARTICLE
Comparison of 18F‑FDG PET/CT and 67Ga‑SPECT for the diagnosis of fever of unknown origin: a multicenter prospective study in Japan Kazuo Kubota1,2 · Noriko Tanaka3 · Yoko Miyata1,4 · Hiroshi Ohtsu5 · Tadaki Nakahara6 · Setsu Sakamoto7,8 · Takashi Kudo9 · Yoshihiro Nishiyama10 · Ukihide Tateishi11 · Koji Murakami6 · Yuji Nakamoto12 · Yasuyuki Taki13 · Tomohiro Kaneta14 · Joji Kawabe15 · Shigeki Nagamachi16 · Tsuyoshi Kawano14 · Jun Hatazawa17 · Youichi Mizutani16 · Shingo Baba18 · Kazukuni Kirii19 · Kunihiko Yokoyama20 · Terue Okamura21 · Masashi Kameyama22 · Ryogo Minamimoto1 · Junwa Kunimatsu23 · On Kato23 · Hiroyuki Yamashita24 · Hiroshi Kaneko24 · Satoshi Kutsuna25 · Norio Ohmagari25 · Akiyoshi Hagiwara26 · Yoshimi Kikuchi27 · Masao Kobayakawa3,28 Received: 16 July 2020 / Accepted: 18 September 2020 © The Japanese Society of Nuclear Medicine 2020
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 signific
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