Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

2001 ◽  
Vol 40 (03) ◽  
pp. 59-70 ◽  
Author(s):  
W. Becker ◽  
J. Meiler
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Tumor Imaging ◽  
White Blood Cells ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Recurrent Fever ◽  
Nuclear Medicine Imaging

SummaryFever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

scholarly journals OP0293 USE OF WHOLE-BODY MAGNETIC RESONANCE TO IDENTIFY POTENTIAL DIAGNOSTIC CLUES IN CHILDREN WITH FEVER OF UNKNOWN ORIGIN (FUO)

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 182-183
Author(s):  
S. Signa ◽  
R. Caorsi ◽  
G. Stagnaro ◽  
F. Minoia ◽  
P. Picco ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Whole Body ◽  
Recurrent Fever ◽  
Eosinophilic Fasciitis ◽  
Entire Body ◽  
The Mean ◽  
Diagnostic Clue

Background:Whole-body magnetic resonance imaging (WBMRI) is a fast and accurate method to detect diseases throughout the entire body without exposure to ionizing radiation. Possible emerging applications for this technique include rheumatologic field and evaluation of fever of unknown origin (FUO).Objectives:To evaluate the ability of WBMRI to identify significant potential diagnostic clue (PDC) in patients presenting a non specific inflammatory clinical picture.Methods:We retrospectively collected cases of pediatric patients followed in a single pediatric rheumatology center who underwent WBMRI between January 2010 and December 2015 for the following indications: i) FUO (temperature greater than 38.3°C for more than three weeks or failure to reach diagnosis after one week of investigations), iii) recurrent fever (febrile episodes separated by periods of normal temperature), iii) Inflammation of unknown origin, IUO (an illness of at least 3 weeks’ duration, with raised inflammatory markers and fever below 38.3°C).WBMRI studies were acquired with coronal and sagittal planes (slice thickness 5mm) with acquisition of several image sets with automatic direct image realignment after acquisition creating a whole-body scan.Sequences include short τ inversion recovery (STIR) and T1-weighted. All studies have been evaluated twice, the second time according to a predefined checklist, defined by an experienced radiologist, considering systematically single /multifocal bone lesion, bone marrow, joint effusion, soft tissues, adenopathies, parenchymal and vessels looking for PDC. We considered as a Potential Diagnostic Clue each alteration of the examined district that can potentially guide the diagnosis. Each alteration found is a PDC. We retrospectively evaluated patients’ clinical history and final diagnosis and we classified the PDCs identified during both first evaluation and re-evaluation as: Not useful (the identified PDC did not guide the diagnosis and is not coherent with the final diagnosis), consistent (the identified PDC is congruent with the patient’s final diagnosis) or diagnostic (the identification of the considered PDC strongly orient the final diagnosis).Results:We collected 104 patients who underwent WBMRI; 24 (23%) of them presenting FUO, 28 (27%) presenting recurrent fever and 52 (50%) presenting IUO. The mean age of onset symptoms was 6 years and nine months (range: 2 weeks old- 17 years and 6 months). The mean age of execution of WBMRI was 9 years (range: 5 months old- 19 years). After the whole diagnostic work-out a final diagnosis was achieved in 44 patients (42%).PDCs were identified at the first evaluation in 78/104 cases (75%). In 22 cases (21%) the identified PDCs were consistent with the diagnosis, whereas in 9 cases (8.5%) the identified PDCs were considered diagnostic. Globally we can consider that at first evaluation PDCs were somehow contributory to the diagnosis in 31 cases (30%; 6 JIA, 7 systemic infections, 5 monogenic inflammatory diseases, 4 ALPS, 2 Goldbloom’s Syndrome,2 Vasculitis,1 eosinophilic fasciitis, 1 hystiocytosis, 3 oncologic diagnosis).Blind re-evaluation of WBMRI allowed the identification of additional PDCs in 52 patients (12 of them previously negative). In 10 cases the PDC found after re- evaluation were consistent with the final diagnosis (2 JIA, one infectious disease, one neuroblastoma, 3 ALPS, 1 monogenic inflammatory disease, 1Takayasu arteritis, 1 Goldbloom’s syndrome).Conclusion:WBMRI can be a powerful diagnostic tool in patients with FUO. A predefined checklist increases sensitivity of WBMRI in the identification of PDC.Disclosure of Interests:Sara Signa: None declared, Roberta Caorsi: None declared, Giorgio Stagnaro: None declared, Francesca Minoia: None declared, Paolo Picco: None declared, Angelo Ravelli: None declared, Maria Beatrice Damasio: None declared, Marco Gattorno Consultant of: Sobi, Novartis, Speakers bureau: Sobi, Novartis

scholarly journals Imaging Diagnostics and Pathology in SARS-CoV-2-Related Diseases

2020 ◽  
Vol 21 (18) ◽  
pp. 6960 ◽  
Author(s):  
Manuel Scimeca ◽  
Nicoletta Urbano ◽  
Rita Bonfiglio ◽  
Manuela Montanaro ◽  
Elena Bonanno ◽  
...  
Keyword(s):  
Nuclear Medicine ◽  
Vascular System ◽  
Unknown Origin ◽  
Scientific Work ◽  
World Health ◽  
Imaging Data ◽  
Invasion Mechanisms ◽  
The World

In December 2019, physicians reported numerous patients showing pneumonia of unknown origin in the Chinese region of Wuhan. Following the spreading of the infection over the world, The World Health Organization (WHO) on 11 March 2020 declared the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak a global pandemic. The scientific community is exerting an extraordinary effort to elucidate all aspects related to SARS-CoV-2, such as the structure, ultrastructure, invasion mechanisms, replication mechanisms, or drugs for treatment, mainly through in vitro studies. Thus, the clinical in vivo data can provide a test bench for new discoveries in the field of SARS-CoV-2, finding new solutions to fight the current pandemic. During this dramatic situation, the normal scientific protocols for the development of new diagnostic procedures or drugs are frequently not completely applied in order to speed up these processes. In this context, interdisciplinarity is fundamental. Specifically, a great contribution can be provided by the association and interpretation of data derived from medical disciplines based on the study of images, such as radiology, nuclear medicine, and pathology. Therefore, here, we highlighted the most recent histopathological and imaging data concerning the SARS-CoV-2 infection in lung and other human organs such as the kidney, heart, and vascular system. In addition, we evaluated the possible matches among data of radiology, nuclear medicine, and pathology departments in order to support the intense scientific work to address the SARS-CoV-2 pandemic. In this regard, the development of artificial intelligence algorithms that are capable of correlating these clinical data with the new scientific discoveries concerning SARS-CoV-2 might be the keystone to get out of the pandemic.

Nuclear Medicine Imaging of Fever of Unknown Origin

2019 ◽  
pp. 199-211 ◽  
Author(s):  
Ilse J. E. Kouijzer ◽  
Chantal P. Bleeker-Rovers ◽  
Lioe-Fee de Geus-Oei
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Nuclear Medicine Imaging

scholarly journals Serum Amyloid A1/Toll-Like Receptor-4 Axis, an Important Link between Inflammation and Outcome of TBI Patients

Biomedicines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 599
Author(s):  
Víctor Farré-Alins ◽  
Alejandra Palomino-Antolín ◽  
Paloma Narros-Fernández ◽  
Ana Belen Lopez-Rodriguez ◽  
Céline Decouty-Perez ◽  
...  
Keyword(s):  
Injury Severity ◽  
White Blood Cells ◽  
Serum Amyloid ◽  
Toll Like Receptor ◽  
Toll Like Receptor 4 ◽  
Important Link ◽  
Tlr4 Mrna ◽  
Serum Amyloid A1

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability worldwide without any validated biomarker or set of biomarkers to help the diagnosis and evaluation of the evolution/prognosis of TBI patients. To achieve this aim, a deeper knowledge of the biochemical and pathophysiological processes triggered after the trauma is essential. Here, we identified the serum amyloid A1 protein-Toll-like receptor 4 (SAA1-TLR4) axis as an important link between inflammation and the outcome of TBI patients. Using serum and mRNA from white blood cells (WBC) of TBI patients, we found a positive correlation between serum SAA1 levels and injury severity, as well as with the 6-month outcome of TBI patients. SAA1 levels also correlate with the presence of TLR4 mRNA in WBC. In vitro, we found that SAA1 contributes to inflammation via TLR4 activation that releases inflammatory cytokines, which in turn increases SAA1 levels, establishing a positive proinflammatory loop. In vivo, post-TBI treatment with the TLR4-antagonist TAK242 reduces SAA1 levels, improves neurobehavioral outcome, and prevents blood–brain barrier disruption. Our data support further evaluation of (i) post-TBI treatment in the presence of TLR4 inhibition for limiting TBI-induced damage and (ii) SAA1-TLR4 as a biomarker of injury progression in TBI patients.

Recurrent Fever of Unknown Origin with Cimetidine-Induced Interstitial Nephritis

1983 ◽  
Vol 148 (6) ◽  
pp. 1132-1132 ◽  
Author(s):  
F. Detterbeck ◽  
R. Langenbach ◽  
J. Smith ◽  
D. M. Roxe
Keyword(s):  
Interstitial Nephritis ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Recurrent Fever

Hypoxia-sensitive bis(2-(2′-benzothienyl)pyridinato-N,C3′)iridium[poly(n-butyl cyanoacrylate]/chitosan nanoparticles and their phosphorescence tumor imaging in vitro and in vivo

Nanoscale ◽  
2013 ◽  
Vol 5 (24) ◽  
pp. 12633 ◽  
Author(s):  
Yun Zeng ◽  
Shaojuan Zhang ◽  
Menghui Jia ◽  
Yang Liu ◽  
Jin Shang ◽  
...  
Keyword(s):  
Tumor Imaging ◽  
Chitosan Nanoparticles

scholarly journals [99mTc]Tc-DB15 in GRPR-Targeted Tumor Imaging with SPECT: From Preclinical Evaluation to the First Clinical Outcomes

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5093
Author(s):  
Berthold A. Nock ◽  
Aikaterini Kaloudi ◽  
Panagiotis Kanellopoulos ◽  
Barbara Janota ◽  
Barbara Bromińska ◽  
...  
Keyword(s):  
Tumor Imaging ◽  
Pharmacokinetic Profile ◽  
Diglycolic Acid ◽  
Preclinical Evaluation ◽  
Peptide Receptor ◽  
Gastrin Releasing Peptide ◽  
Specific Uptake ◽  
Grpr Antagonist

Diagnostic imaging and radionuclide therapy of prostate (PC) and breast cancer (BC) using radiolabeled gastrin-releasing peptide receptor (GRPR)-antagonists represents a promising approach. We herein propose the GRPR-antagonist based radiotracer [99mTc]Tc-DB15 ([99mTc]Tc-N4-AMA-DGA-DPhe6,Sar11,LeuNHEt13]BBN(6-13); N4: 6-carboxy-1,4,8,11-tetraazaundecane, AMA: aminomethyl-aniline, DGA: diglycolic acid) as a new diagnostic tool for GRPR-positive tumors applying SPECT/CT. The uptake of [99mTc]Tc-DB15 was tested in vitro in mammary (T-47D) and prostate cancer (PC-3) cells and in vivo in T-47D or PC-3 xenograft-bearing mice as well as in BC patients. DB15 showed high GRPR-affinity (IC50 = 0.37 ± 0.03 nM) and [99mTc]Tc-DB15 strongly bound to the cell-membrane of T-47D and PC-3 cells, according to a radiolabeled antagonist profile. In mice, the radiotracer showed high and prolonged GRPR-specific uptake in PC-3 (e.g., 25.56 ± 2.78 %IA/g vs. 0.72 ± 0.12 %IA/g in block; 4 h pi) and T-47D (e.g., 15.82 ± 3.20 %IA/g vs. 3.82 ± 0.30 %IA/g in block; 4 h pi) tumors, while rapidly clearing from background. In patients with advanced BC, the tracer could reveal several bone and soft tissue metastases on SPECT/CT. The attractive pharmacokinetic profile of [99mTc]DB15 in mice and its capability to target GRPR-positive BC lesions in patients highlight its prospects for a broader clinical use, an option currently being explored by ongoing clinical studies.

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