Role of Positron Emission Tomography-Computed Tomography Scan in Reaching Definite Diagnosis in Patients With Fever of Unknown Origin and Inflammation of Unknown Origin in Rheumatology Outpatient Clinic.

IF 1.7 Q3 RHEUMATOLOGY
Open Access Rheumatology-Research and Reviews Pub Date : 2025-02-05 eCollection Date: 2025-01-01 DOI:10.2147/OARRR.S499694
Umut Yılmaz Koreli, Ege Sinan Torun, Mine Adaş
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Abstract

Introduction: Patients with fever of unknown origin (FUO) and/or inflammation of unknown origin (IUO) challenge clinicians in daily rheumatology practice. Positron emission tomography-computed tomography (PET/CT) is being used in the diagnostic workup of patients with FUO and/or IUO. This study aims to evaluate the clinical utility and diagnostic performance of PET/CT in the rheumatology outpatient clinic among FUO and IUO patients.

Methods: Patients admitted to Prof. Dr. Cemil Taşcıoğlu City Hospital Internal Medicine Rheumatology Outpatient Clinic between February 2022 and September 2023 with FUO and/or IUO and for whom PET/CT scan was performed were included. Initial acute phase reactants, PET/CT results, definite diagnosis and follow-up of patients without a definite diagnosis were retrospectively evaluated.

Results: Thirty patients were included. Fifteen patients received a final diagnosis. Diagnoses were ankylosing spondylitis (n=4), rheumatoid arthritis (n=1), systemic lupus erythematosus (n=3), giant cell arteritis (n=1), adult onset Still disease (n=1), undifferentiated connective tissue disease (n=1), undifferentiated vasculitis (n=1) and crystal arthropathy (n=1), Hodgkin lymphoma (n=1) and cryptococcosis (n=1). PET/CT's diagnostic accuracy was 66.7%, sensitivity was 100% but specificity was 33%. In 15 patients a definite diagnosis was not reached but in most of these patients, fever did not recur and acute phase reactants regressed either spontaneously or with empiric treatment.

Discussion: PET/CT reliably helps 50% FUO/IUO patients in receiving definite diagnosis. PET/CT's high sensitivity implies that negative results can reliably exclude malignancies in most cases. However, due to its low specificity, positive test may not always imply a serious underlying condition. Majority of the definite diagnoses were rheumatic diseases with a very low proportion of infections and malignancies. This is mainly due to the detailed initial evaluations that are performed in internal medicine clinics. Future studies with more patients will better define the role of PET/CT in FUO/IUO patients in rheumatology clinics.

正电子发射断层扫描-计算机断层扫描在风湿病门诊不明原因发热和不明原因炎症患者明确诊断中的作用。
不明原因发热(FUO)和/或不明原因炎症(IUO)患者在日常风湿病学实践中对临床医生提出了挑战。正电子发射断层扫描-计算机断层扫描(PET/CT)正被用于FUO和/或IUO患者的诊断工作。本研究旨在评估PET/CT在风湿病门诊FUO和IUO患者中的临床应用和诊断性能。方法:纳入2022年2月至2023年9月期间在Cemil博士Taşcıoğlu城市医院内科风湿病门诊就诊的FUO和/或IUO患者,并对其进行PET/CT扫描。回顾性评价急性期初始反应物、PET/CT结果、明确诊断和随访无明确诊断的患者。结果:纳入30例患者。15名患者接受了最终诊断。诊断为强直性脊柱炎(n=4)、类风湿关节炎(n=1)、系统性红斑狼疮(n=3)、巨细胞动脉炎(n=1)、成人发病Still病(n=1)、未分化结缔组织病(n=1)、未分化血管炎(n=1)和晶体关节病(n=1)、霍奇金淋巴瘤(n=1)和隐球菌病(n=1)。PET/CT诊断准确率为66.7%,敏感性为100%,特异性为33%。在15例患者中,没有得到明确的诊断,但在大多数患者中,发烧没有复发,急性期反应物自发或经验性治疗消退。讨论:PET/CT可靠地帮助50%的FUO/IUO患者得到明确的诊断。PET/CT的高灵敏度意味着阴性结果在大多数情况下可以可靠地排除恶性肿瘤。然而,由于其特异性较低,阳性检测并不一定意味着严重的潜在疾病。多数确诊为风湿病,感染和恶性肿瘤比例极低。这主要是由于在内科诊所进行了详细的初步评估。未来更多患者的研究将更好地确定PET/CT在风湿病临床FUO/IUO患者中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
0.00%
发文量
34
审稿时长
16 weeks
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