Diagnostic Utility of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Infectious Diseases: A Retrospective Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2025 Feb 26

PMID 40007923

Authors

Tania Garcia-Zaragoza

Francisco Jover-Diaz

Jorge Peris-Garcia

Elisabet Delgado-Sanchez

Jose Verdu-Rico

Blanca Lumbreras

Affiliations

Soon will be listed here.

Abstract

Aim: This study aims to evaluate the utility of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) test for various infectious indications, analyze its diagnostic value, and assess its correlation with suspected diagnoses. Additionally, secondary endpoints include evaluating the test's usefulness in clinical management and identifying predictors of PET/CT positivity.

Methods: A retrospective descriptive observational study was conducted on in-hospital patients who underwent 18F-FDG PET/CT for suspected infections.

Results: A total of 89 patients were reviewed. The predominant symptoms were fever (68.5%) and respiratory symptoms (38.2%). The most common prior complementary tests were microbiological (89.9%) and imaging (94.4%). Indications for PET/CT included fever of unknown origin (27%), focal infections (20.2%), bacteremia (34.8%), and immunocompromised patients (18%). Diagnostic confirmation was achieved in 60.7% of cases. The test's usefulness (confirmation and unexpected findings) was 76.4%. Only 9.5% of patients without an initial diagnosis after PET/CT received a confirmatory diagnosis later. The subgroup analysis revealed that fever of unknown origin was associated with a lower probability of confirmation and usefulness, whereas focal infection was linked to a higher likelihood of diagnostic confirmation. However, these associations did not persist in multivariate analysis due to the limited sample size.

Conclusion: Our study aims to optimize the diagnostic profitability of the 18F-FDG PET/CT test for specific infectious disease indications by analyzing previous literature. In our experience, the PET/CT test demonstrated a high percentage of diagnostic confirmation for patients with focal infections. In contrast, its diagnostic yield was significantly lower for prolonged fever of unknown origin.

References

Garcia J . Febrile syndrome of unknown origin: Indications for F-FDG PET/CT in inflammatory and infectious processes. Radiologia. 2016; 59(3):253-263. DOI: 10.1016/j.rx.2016.07.007. View

Suanzes P, Willekens R, Puig-Asensio M, Pizzi M, Roque A, Barios M . Impact of F-FDG-PET/CT on the management of Staphylococcus aureus bacteraemia: a retrospective observational study. Enferm Infecc Microbiol Clin (Engl Ed). 2022; 41(1):3-10. DOI: 10.1016/j.eimce.2021.11.011. View

Pijl J, Kwee T, Slart R, Glaudemans A . PET/CT Imaging for Personalized Management of Infectious Diseases. J Pers Med. 2021; 11(2). PMC: 7920259. DOI: 10.3390/jpm11020133. View

Eynath Y, Halperin E, Buchrits S, Gafter-Gvili A, Bernstine H, Catalano O . Predictors for spontaneous resolution of classical FUO in patients undergoing PET-CT. Intern Emerg Med. 2022; 18(2):367-374. DOI: 10.1007/s11739-022-03171-x. View

Medvedeva N, Radcliffe C, Malinis M, Chen M, Azar M . Real-world assessment of the clinical utility of whole body 18F-FDG PET/CT in the diagnosis of infection. PLoS One. 2022; 17(11):e0277403. PMC: 9662742. DOI: 10.1371/journal.pone.0277403. View

Betrains A, Moreel L, Wright W, Blockmans D, Vanderschueren S . Negative 18F-FDG-PET imaging in fever and inflammation of unknown origin: now what?. Intern Emerg Med. 2023; 18(6):1865-1869. DOI: 10.1007/s11739-023-03293-w. View

Glaudemans A, Gheysens O . Expert opinions in nuclear medicine: Finding the "holy grail" in infection imaging. Front Med (Lausanne). 2023; 10:1149925. PMC: 10008957. DOI: 10.3389/fmed.2023.1149925. View

Wright W, Auwaerter P, Dibble E, Rowe S, Mackowiak P . Imaging a Fever-Redefining the Role of 2-deoxy-2-[18F]Fluoro-D-Glucose-Positron Emission Tomography/Computed Tomography in Fever of Unknown Origin Investigations. Clin Infect Dis. 2020; 72(7):1279-1286. DOI: 10.1093/cid/ciaa1220. View

Jain L, Mackenzie S, Bomanji J, Shortman R, Noursadeghi M, Edwards S . F-Fluorodeoxyglucose positron emission tomography-computed tomography imaging in HIV-infected patients with lymphadenopathy, with or without fever and/or splenomegaly. Int J STD AIDS. 2017; 29(7):691-694. DOI: 10.1177/0956462417745960. View

10.

Minamimoto R . Optimal use of the FDG-PET/CT in the diagnostic process of fever of unknown origin (FUO): a comprehensive review. Jpn J Radiol. 2022; 40(11):1121-1137. PMC: 9616755. DOI: 10.1007/s11604-022-01306-w. View

11.

Hess S . [F]FDG-PET/CT in patients with bacteremia: Clinical impact on patient management and outcome. Front Med (Lausanne). 2023; 10:1157692. PMC: 10095558. DOI: 10.3389/fmed.2023.1157692. View

12.

van Leerdam E, Gompelman M, Tuinte R, Aarntzen E, Berrevoets M, Maat I . Individualizing the use of [F]FDG-PET/CT in patients with complicated Staphylococcus aureus bacteremia: experiences from a tertiary care center. Infection. 2021; 50(2):491-498. PMC: 8942890. DOI: 10.1007/s15010-021-01740-4. View

13.

Douglas A, Thursky K, Slavin M . New approaches to management of fever and neutropenia in high-risk patients. Curr Opin Infect Dis. 2022; 35(6):500-516. DOI: 10.1097/QCO.0000000000000872. View

14.

van Rijsewijk N, IJpma F, Wouthuyzen-Bakker M, Glaudemans A . Molecular Imaging of Fever of Unknown Origin: An Update. Semin Nucl Med. 2022; 53(1):4-17. DOI: 10.1053/j.semnuclmed.2022.07.002. View

15.

Wang W, Cheng Z, Zhu J, Xing M, Zheng C, Wang S . Combined clinical parameters improve the diagnostic efficacy of F-FDG PET/CT in patients with fever of unknown origin (FUO) and inflammation of unknown origin (IUO): A prospective study in China. Int J Infect Dis. 2020; 93:77-83. DOI: 10.1016/j.ijid.2020.01.030. View

16.

Zhu W, Cao W, Zheng X, Li X, Li Y, Chen B . The diagnostic value of F-FDG PET/CT in identifying the causes of fever of unknown origin. Clin Med (Lond). 2020; 20(5):449-453. PMC: 7539723. DOI: 10.7861/clinmed.2020-0268. View

17.

Weitzer F, Nazerani Hooshmand T, Pernthaler B, Sorantin E, Aigner R . Diagnostic value of F-18 FDG PET/CT in fever or inflammation of unknown origin in a large single-center retrospective study. Sci Rep. 2022; 12(1):1883. PMC: 8813902. DOI: 10.1038/s41598-022-05911-7. View

18.

Petersdorf R, Beeson P . Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961; 40:1-30. DOI: 10.1097/00005792-196102000-00001. View

19.

Mahajna H, Vaknin K, Ben Shimol J, Watad A, Abu-Much A, Mahroum N . The Utility of 18FDG-PET/CT in Diagnosing Fever of Unknown Origin: The Experience of a Large Tertiary Medical Center. Int J Environ Res Public Health. 2021; 18(10). PMC: 8157390. DOI: 10.3390/ijerph18105360. View

20.

Ghanem-Zoubi N, Abu-Elhija J, Kagna O, Mustafa-Hellou M, Qasum M, Haber D . Predictors of infectious foci on FDG PET/CT in Staphylococcus aureus bacteremia. Sci Rep. 2023; 13(1):14063. PMC: 10462707. DOI: 10.1038/s41598-023-41336-6. View