Patients with fever of unknown origin (FUO): diagnosis by nuclear medicineimaging

Citation
J. Meller et W. Becker, Patients with fever of unknown origin (FUO): diagnosis by nuclear medicineimaging, NUKLEARMED, 40(3), 2001, pp. 59
Citations number
110
Language
INGLESE
art.tipo
Review
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging
Volume
40
Issue
3
Year of publication
2001
Database
ISI
SICI code
Abstract
Fever of unknown origin (FUO) in immunocompetent and non neutropenic patien ts is defined os recurrent fever of 38,3 degrees C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. Th e underlying diseases of FUO are numerous and infection accounts for only 2 0-40% of them. The majority of FUO-potients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of al l cases. In this respect FOU in its classical definition is clearly separat ed from postoperative and neutropenic fever where inflammation and infectio n are more common. Although methods that use in-vitro or in-vivo labeled wh ite blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO -patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs ore more suited in evaluation o f the focus in occult sepsis. Ga-67 citrate is the only commercially availa ble gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-u p of FUO. The number of Go-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled W BCs. F-18-2 ' -deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by si milar mechanisms. First results of FDG imaging demonstrated, that FDG may b e superior to other nuclear medicine imaging modalities which may be explai ned by the preferable tracer kinetics of the small F-18-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conv entional gamma camera.