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


Bharucha, T; Rutherford, A; Skeoch, S; Alavi, A; Brown, M; Galloway, J; FDG-PET/CT in fever of unknown origin working group, ; , COLLABORATORS; Miller, R; Llewelyn, M; Jenkins, N; Lambourne, J; Cosgrove, C; Moore, E; Conlon, C; NicFhogartaigh, C; Agranoff, D; Ustianowski, A; Parker, B; Gullick, N; Snowden, N; Jayne, D; Bukhari, M; Davies, K; Stewart, W; Ardeshna, K; Sajir, M; Bomanji, J; Athar, H; Wong, W; Eccles, A; Subesinghe, M; Patel, N; Chowdhury, F; Buscombe, J; Dizdeveric, S; Marks, D; (2017) Diagnostic yield of FDG-PET/CT in fever of unknown origin: a systematic review, meta-analysis, and Delphi exercise. Clinical radiology. ISSN 0009-9260 DOI: https://doi.org/10.1016/j.crad.2017.04.014

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Abstract

To perform a systematic review, meta-analysis and Delphi exercise to evaluate diagnostic yield of combined 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography and computed tomography (FDG-PET/CT) in fever of unknown origin (FUO). 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. Pooled diagnostic yield was 56% (95% confidence interval [CI]: 50-61%, I(2)=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%; I(2)=66%). Consensus was established that FDG-PET/CT is increasingly available with an emerging role, but there is prevailing variability in practice. 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.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 28600002
Web of Science ID: 408048500010
URI: http://researchonline.lshtm.ac.uk/id/eprint/3962238

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