World Journal of Nuclear Medicine

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 20  |  Issue : 3  |  Page : 237--246

Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation


Sohini Das1, Sowmya Sathyendra1, Julie Hephzibah1, Reka Karuppusami2, Karthik Gunasekaran1, Nylla Shanthly1, Angel Miraclin1, Ramya Iyadurai1 
1 Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr Sowmya Sathyendra
Department of Medicine, Unit 3, Christian Medical College, Vellore - 632 004, Tamil Nadu
India

Positron emission tomography–computed tomography (PET-CT) has been used as an imaging modality in workup of fever of unknown origin (FUO). The aim of our study is to evaluate the diagnostic utility of PET-CT in FUO workup in a resource-limited setting. We also looked at laboratory parameters as predictors of contributory PET-CT scans and propose an algorithm for evaluation of FUO in resource-limited tropical regions. This retrospective observational study included patients admitted for FUO workup under general medicine in a teaching hospital in South India from June 2013 to May 2016. PET-CT was done when the patient remained undiagnosed after a detailed clinical assessment and first- and second-tier investigations. Among 43 patients included in our study, a definite diagnosis was established in 74% (32). Noninfectious inflammatory diseases, infections, malignancies, and miscellaneous diseases were diagnosed in 37.2% (16/43), 23.3% (10/43), 9.3% (4/43), and 4.7% (2/43), respectively. Tuberculosis was the single most common disease seen in 20.9% (9/43). PET-CT scans were contributory toward establishment of final diagnosis in 90.7% (39/43). High C-reactive protein (CRP) and aspartate aminotransferase (AST) levels were associated with contributory PET-CT scans (P = 0.006 and 0.011, respectively). PET-CT delineating organ/tissue for diagnostic biopsy was associated with final diagnosis of infectious disease (P = 0.001). Sensitivity, specificity, and positive and negative predictive value of PET-CT scans were 76.9% (20/26), 33.3% (2/6), 83% (20/24), and 25% (2/8), respectively. High CRP and AST were predictors of contributory PET-CT scans. PET-CT scans have high sensitivity and positive predictive value when used in evaluation of FUO. Although it is a useful tool in FUO workup, especially in the diagnosis of tropical infections, PET-CT should be done after a comprehensive clinical assessment and basic investigations.


How to cite this article:
Das S, Sathyendra S, Hephzibah J, Karuppusami R, Gunasekaran K, Shanthly N, Miraclin A, Iyadurai R. Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation.World J Nucl Med 2021;20:237-246


How to cite this URL:
Das S, Sathyendra S, Hephzibah J, Karuppusami R, Gunasekaran K, Shanthly N, Miraclin A, Iyadurai R. Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation. World J Nucl Med [serial online] 2021 [cited 2021 Oct 16 ];20:237-246
Available from: http://www.wjnm.org/article.asp?issn=1450-1147;year=2021;volume=20;issue=3;spage=237;epage=246;aulast=Das;type=0