TY - JOUR
T1 - Comparison of 18F-FDG PET/CT and 67Ga-SPECT for the diagnosis of fever of unknown origin
T2 - a multicenter prospective study in Japan
AU - Kubota, Kazuo
AU - Tanaka, Noriko
AU - Miyata, Yoko
AU - Ohtsu, Hiroshi
AU - Nakahara, Tadaki
AU - Sakamoto, Setsu
AU - Kudo, Takashi
AU - Nishiyama, Yoshihiro
AU - Tateishi, Ukihide
AU - Murakami, Koji
AU - Nakamoto, Yuji
AU - Taki, Yasuyuki
AU - Kaneta, Tomohiro
AU - Kawabe, Joji
AU - Nagamachi, Shigeki
AU - Kawano, Tsuyoshi
AU - Hatazawa, Jun
AU - Mizutani, Youichi
AU - Baba, Shingo
AU - Kirii, Kazukuni
AU - Yokoyama, Kunihiko
AU - Okamura, Terue
AU - Kameyama, Masashi
AU - Minamimoto, Ryogo
AU - Kunimatsu, Junwa
AU - Kato, On
AU - Yamashita, Hiroyuki
AU - Kaneko, Hiroshi
AU - Kutsuna, Satoshi
AU - Ohmagari, Norio
AU - Hagiwara, Akiyoshi
AU - Kikuchi, Yoshimi
AU - Kobayakawa, Masao
N1 - Funding Information:
This work was supported in part by a Grant from the National Center for Global Health and Medicine (24–203, 26–116 and 29–1038). Acknowledgements
Funding Information:
No potential conflicts of interest were disclosed. We thank all the research collaborators, research coordinators, radiochemistry staff, nuclear medicine technologists, third-party monitors at each facility, third-party auditors, the Japan Clinical Research Assist Center, Tokyo, Japan, and all the patients who agreed to participate in the study. The members of this study are listed below. Contributors to the research group of the Japanese multi-center FDG-PET/CT study for FUO (JPET-FUO)* Primary Investigator: Ryogo Minamimoto (from April 2016). Former primary investigator: Kazuo Kubota (from 2012 to March 2016). Central office: National Center for Global Health and Medicine, Tokyo 162?8655 Japan. Protocol committee: Masao Kobayakawa (C.), Noriko Tanaka, Yasuhiro Tanaka, Shizue Izumi, Kazuo Kubota. Statistician: Noriko Tanaka (C.), Joe Matsuoka, Yosuke Inaba. Data management: Yasuhiro Tanaka, Hiroshi Ohtsu, Akemi Yasuhara and JCRAC Data Center National Center for Global Health and Medicine. Image Quality Control: Kei Sato, Hironori Kajiwara. Secretariat: Yoko Miyata (C.), Yukie Ando, Aiko Tomita, Kaoru Sugawara, Kahori Miyake. Clinical research coordinator: Hiromi Wada, Otoe Hirai, Mari Terada. Monitoring: Yuichi Nozaki, Kiyoshi Takase, Haruhiko Sakamoto, Naoko Goto, Yasuo Naito. Audit: Yumi Matsushita, Akira Kitagawa, Haruhisa Kubota. Central image interpretation committee: Hiroaki Kurihara, Masamichi Koyama, Shinichi Taura.
Publisher Copyright:
© 2020, The Japanese Society of Nuclear Medicine.
PY - 2021/1
Y1 - 2021/1
N2 - Objective: The aim of this multicenter prospective study was to compare the sensitivity of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67Ga single photon emission computed tomography (SPECT) for the identification of the site of greatest importance for the final diagnosis of the cause of fever of unknown origin (FUO). Methods: The study participants consisted of patients with an axillary temperature ≥ 38.0 °C on ≥ 2 occasions within 1 week, with repeated episodes for ≥ 2 weeks prior to providing consent, and whose final diagnosis after undergoing specific examinations, including a chest-to-abdomen CT scan, was uncertain. All the patients underwent FDG-PET/CT imaging first, followed by 67Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67Ga-SPECT examinations were reviewed by the central image interpretation committee (CIIC), which was blinded to all other clinical information. The sensitivities of FDG-PET/CT and 67Ga-SPECT were then evaluated with regard to identifying the site of greatest importance for a final diagnosis of the cause of the fever as decided by the patient’s attending physician. The clinical impacts (four grades) of FDG-PET/CT and 67Ga-SPECT on the final diagnosis were evaluated. Results: A total of 149 subjects were enrolled in this study between October 2014 and September 2017. No adverse events were identified among the enrolled subjects. Twenty-one subjects were excluded from the study because of deviations from the study protocol. Among the 128 remaining subjects, a final diagnosis of the disease leading to the appearance of FUO was made for 92 (71.9%) subjects. The final diagnoses in these 92 cases were classified into four groups: noninfectious inflammatory disease (52 cases); infectious disease (31 cases), malignancy (six cases); and other (three cases). These 92 subjects were eligible for inclusion in the study’s analysis, but one case did not meet the PET/CT image acquisition criteria; thus, PET/CT results were analyzed for 91 cases. According to the patient-based assessments, the sensitivity of FDG-PET/CT (45%, 95% CI 33.1–58.2%) was significantly higher than that for 67Ga-SPECT (25%, 95% CI 15.5–37.5%) (P = 0.0029). The clinical impact of FDG-PET/CT (91%) was also significantly higher than that for 67Ga-SPECT (57%, P < 0.001). Conclusions: FDG-PET/CT showed a superior sensitivity to 67Ga-SPECT for the identification of the site of greatest importance for the final diagnosis of the cause of FUO.
AB - Objective: The aim of this multicenter prospective study was to compare the sensitivity of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67Ga single photon emission computed tomography (SPECT) for the identification of the site of greatest importance for the final diagnosis of the cause of fever of unknown origin (FUO). Methods: The study participants consisted of patients with an axillary temperature ≥ 38.0 °C on ≥ 2 occasions within 1 week, with repeated episodes for ≥ 2 weeks prior to providing consent, and whose final diagnosis after undergoing specific examinations, including a chest-to-abdomen CT scan, was uncertain. All the patients underwent FDG-PET/CT imaging first, followed by 67Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67Ga-SPECT examinations were reviewed by the central image interpretation committee (CIIC), which was blinded to all other clinical information. The sensitivities of FDG-PET/CT and 67Ga-SPECT were then evaluated with regard to identifying the site of greatest importance for a final diagnosis of the cause of the fever as decided by the patient’s attending physician. The clinical impacts (four grades) of FDG-PET/CT and 67Ga-SPECT on the final diagnosis were evaluated. Results: A total of 149 subjects were enrolled in this study between October 2014 and September 2017. No adverse events were identified among the enrolled subjects. Twenty-one subjects were excluded from the study because of deviations from the study protocol. Among the 128 remaining subjects, a final diagnosis of the disease leading to the appearance of FUO was made for 92 (71.9%) subjects. The final diagnoses in these 92 cases were classified into four groups: noninfectious inflammatory disease (52 cases); infectious disease (31 cases), malignancy (six cases); and other (three cases). These 92 subjects were eligible for inclusion in the study’s analysis, but one case did not meet the PET/CT image acquisition criteria; thus, PET/CT results were analyzed for 91 cases. According to the patient-based assessments, the sensitivity of FDG-PET/CT (45%, 95% CI 33.1–58.2%) was significantly higher than that for 67Ga-SPECT (25%, 95% CI 15.5–37.5%) (P = 0.0029). The clinical impact of FDG-PET/CT (91%) was also significantly higher than that for 67Ga-SPECT (57%, P < 0.001). Conclusions: FDG-PET/CT showed a superior sensitivity to 67Ga-SPECT for the identification of the site of greatest importance for the final diagnosis of the cause of FUO.
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U2 - 10.1007/s12149-020-01533-z
DO - 10.1007/s12149-020-01533-z
M3 - Article
C2 - 33037581
AN - SCOPUS:85092337693
SN - 0914-7187
VL - 35
SP - 31
EP - 46
JO - Annals of Nuclear Medicine
JF - Annals of Nuclear Medicine
IS - 1
ER -
