Nuclear imaging for classic fever of unknown origin: Meta-analysis

Motoki Takeuchi, Issa J. Dahabreh, Takashi Nihashi, Mitsunaga Iwata, George M. Varghese, Teruhiko Terasawa

研究成果: Article

19 引用 (Scopus)

抄録

Several studies have assessed nuclear imaging tests for localizing the source of fever in patients with classic fever of unknown origin (FUO); however, the role of these tests in clinical practice remains unclear. We systematically reviewed the test performance, diagnostic yield, and management decision impact of nuclear imaging tests in patients with classic FUO. Methods: We searched PubMed, Scopus, and other databases through October 31, 2015, to identify studies reporting on the diagnostic accuracy or impact on diagnosis and management decisions of 18F-FDG PET alone or integrated with CT (18F-FDG PET/CT), gallium scintigraphy, or leukocyte scintigraphy. Two reviewers extracted data. We quantitatively synthesized test performance and diagnostic yield and descriptively analyzed evidence about the impact on management decisions. Results: We included 42 studies with 2,058 patients. Studies were heterogeneous and had methodologic limitations. Diagnostic yield was higher in studies with higher prevalence of neoplasms and infections. Nonneoplastic causes, such as adult-onset Still's disease and polymyalgia rheumatica, were less successfully localized. Indirect evidence suggested that 18F-FDG PET/CT had the best test performance and diagnostic yield among the 4 imaging tests; summary sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90), specificity 0.52 (95%CI, 0.36-0.67), and diagnostic yield 0.58 (95%CI, 0.51-0.64). Evidence on direct comparisons of alternative imaging modalities or on the impact of tests on management decisions was limited. Conclusion: Nuclear imaging tests, particularly 18F-FDG PET/CT, can be useful in identifying the source of fever in patients with classic FUO. The contribution of nuclear imaging may be limited in clinical settings in which infective and neoplastic causes are less common. Studies using standardized diagnostic algorithms are needed to determine the optimal timing for testing and to assess the impact of tests on management decisions and patient-relevant outcomes.

元の言語English
ページ(範囲)1913-1919
ページ数7
ジャーナルJournal of Nuclear Medicine
57
発行部数12
DOI
出版物ステータスPublished - 01-12-2016

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Fever of Unknown Origin
Fluorodeoxyglucose F18
Meta-Analysis
Routine Diagnostic Tests
Confidence Intervals
Radionuclide Imaging
Fever
Adult-Onset Still's Disease
Polymyalgia Rheumatica
Gallium
PubMed
Leukocytes
Databases
Infection
Neoplasms

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

これを引用

Takeuchi, M., Dahabreh, I. J., Nihashi, T., Iwata, M., Varghese, G. M., & Terasawa, T. (2016). Nuclear imaging for classic fever of unknown origin: Meta-analysis. Journal of Nuclear Medicine, 57(12), 1913-1919. https://doi.org/10.2967/jnumed.116.174391
Takeuchi, Motoki ; Dahabreh, Issa J. ; Nihashi, Takashi ; Iwata, Mitsunaga ; Varghese, George M. ; Terasawa, Teruhiko. / Nuclear imaging for classic fever of unknown origin : Meta-analysis. :: Journal of Nuclear Medicine. 2016 ; 巻 57, 番号 12. pp. 1913-1919.
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abstract = "Several studies have assessed nuclear imaging tests for localizing the source of fever in patients with classic fever of unknown origin (FUO); however, the role of these tests in clinical practice remains unclear. We systematically reviewed the test performance, diagnostic yield, and management decision impact of nuclear imaging tests in patients with classic FUO. Methods: We searched PubMed, Scopus, and other databases through October 31, 2015, to identify studies reporting on the diagnostic accuracy or impact on diagnosis and management decisions of 18F-FDG PET alone or integrated with CT (18F-FDG PET/CT), gallium scintigraphy, or leukocyte scintigraphy. Two reviewers extracted data. We quantitatively synthesized test performance and diagnostic yield and descriptively analyzed evidence about the impact on management decisions. Results: We included 42 studies with 2,058 patients. Studies were heterogeneous and had methodologic limitations. Diagnostic yield was higher in studies with higher prevalence of neoplasms and infections. Nonneoplastic causes, such as adult-onset Still's disease and polymyalgia rheumatica, were less successfully localized. Indirect evidence suggested that 18F-FDG PET/CT had the best test performance and diagnostic yield among the 4 imaging tests; summary sensitivity was 0.86 (95{\%} confidence interval [CI], 0.81-0.90), specificity 0.52 (95{\%}CI, 0.36-0.67), and diagnostic yield 0.58 (95{\%}CI, 0.51-0.64). Evidence on direct comparisons of alternative imaging modalities or on the impact of tests on management decisions was limited. Conclusion: Nuclear imaging tests, particularly 18F-FDG PET/CT, can be useful in identifying the source of fever in patients with classic FUO. The contribution of nuclear imaging may be limited in clinical settings in which infective and neoplastic causes are less common. Studies using standardized diagnostic algorithms are needed to determine the optimal timing for testing and to assess the impact of tests on management decisions and patient-relevant outcomes.",
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Takeuchi, M, Dahabreh, IJ, Nihashi, T, Iwata, M, Varghese, GM & Terasawa, T 2016, 'Nuclear imaging for classic fever of unknown origin: Meta-analysis', Journal of Nuclear Medicine, 巻. 57, 番号 12, pp. 1913-1919. https://doi.org/10.2967/jnumed.116.174391

Nuclear imaging for classic fever of unknown origin : Meta-analysis. / Takeuchi, Motoki; Dahabreh, Issa J.; Nihashi, Takashi; Iwata, Mitsunaga; Varghese, George M.; Terasawa, Teruhiko.

:: Journal of Nuclear Medicine, 巻 57, 番号 12, 01.12.2016, p. 1913-1919.

研究成果: Article

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AU - Takeuchi, Motoki

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N2 - Several studies have assessed nuclear imaging tests for localizing the source of fever in patients with classic fever of unknown origin (FUO); however, the role of these tests in clinical practice remains unclear. We systematically reviewed the test performance, diagnostic yield, and management decision impact of nuclear imaging tests in patients with classic FUO. Methods: We searched PubMed, Scopus, and other databases through October 31, 2015, to identify studies reporting on the diagnostic accuracy or impact on diagnosis and management decisions of 18F-FDG PET alone or integrated with CT (18F-FDG PET/CT), gallium scintigraphy, or leukocyte scintigraphy. Two reviewers extracted data. We quantitatively synthesized test performance and diagnostic yield and descriptively analyzed evidence about the impact on management decisions. Results: We included 42 studies with 2,058 patients. Studies were heterogeneous and had methodologic limitations. Diagnostic yield was higher in studies with higher prevalence of neoplasms and infections. Nonneoplastic causes, such as adult-onset Still's disease and polymyalgia rheumatica, were less successfully localized. Indirect evidence suggested that 18F-FDG PET/CT had the best test performance and diagnostic yield among the 4 imaging tests; summary sensitivity was 0.86 (95% confidence interval [CI], 0.81-0.90), specificity 0.52 (95%CI, 0.36-0.67), and diagnostic yield 0.58 (95%CI, 0.51-0.64). Evidence on direct comparisons of alternative imaging modalities or on the impact of tests on management decisions was limited. Conclusion: Nuclear imaging tests, particularly 18F-FDG PET/CT, can be useful in identifying the source of fever in patients with classic FUO. The contribution of nuclear imaging may be limited in clinical settings in which infective and neoplastic causes are less common. Studies using standardized diagnostic algorithms are needed to determine the optimal timing for testing and to assess the impact of tests on management decisions and patient-relevant outcomes.

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