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Diagnostic yield of FDG-PET/CT in fever of unknown origin: a systematic review, meta-analysis, and Delphi exercise

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T. Bharucha, A. Rutherford, S. Skeoch, A. Alavi, M. Brown, J. Galloway, R. Miller, M. Llewelyn, N. Jenkins, J. Lambourne, C. Cosgrove, E. Moore, C. Conlon, C. NicFhogartaigh, D. Agranoff, A. Ustianowski, B. Parker, N. Gullick, N. Snowden, D. Jayne & 15 more M. Bukhari, K. Davies, W. Stewart, K. Ardeshna, M. Sajir, J. Bomanji, H. Athar, W. Wong, A. Eccles, M. Subesinghe, N. Patel, F. Chowdhury, J. Buscombe, S. Dizdeveric, D. Marks

Original languageEnglish
Pages (from-to)764-771
Number of pages8
JournalClinical Radiology
Volume72
Issue number9
Early online date7 Jun 2017
DOIs
Accepted/In press18 Apr 2017
E-pub ahead of print7 Jun 2017
PublishedSep 2017

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Abstract

Aim: To perform a systematic review, meta-analysis and Delphi exercise to evaluate diagnostic yield of combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography and computed tomography (FDG-PET/CT) in fever of unknown origin (FUO).

Materials and methods: Four databases were searched for studies of FDG-PET/CT in FUO 1/1/2000–1/12/2015. Exclusions were non-English language, case reports, non-standard FDG radiotracer, and significant missing data. Quality was assessed by two authors independently using a standardised tool. Pooled diagnostic yield was calculated using a random-effects model. An iterative electronic and face-to-face Delphi exercise generated interspeciality consensus.

Results: Pooled diagnostic yield was 56% (95% confidence interval [CI]: 50–61%, I2=61%) from 18 studies and 905 patients. Only five studies reported results of previous imaging, and subgroup analysis estimated diagnostic yield beyond conventional CT at 32% (95% CI: 22–44%; I2=66%). Consensus was established that FDG-PET/CT is increasingly available with an emerging role, but there is prevailing variability in practice.

Conclusion: There is insufficient evidence to support the value of FDG-PET/CT in investigative algorithms of FUO. A paradigm shift in research is needed, involving prospective studies recruiting at diagnosis of FUO, with updated case definitions and hard outcome measures. Although these studies will be a significant undertaking with multicentre collaboration, their completion is vital for balancing both radiation exposure and costs against the possible benefits of utilising FDG-PET/CT.

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