The quarterly journal of nuclear medicine and molecular imaging : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... · 2026
[18F]FDG PET/CT in fever and inflammation of unknown origin, bacteremia, and sepsis: an umbrella review of diagnostic accuracy and clinical impact.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Martinello Chiara, Iacovitti Cesare M, Cuzzocrea Marco, Paone Gaetano, Treglia Giorgio
Аннотация
INTRODUCTION: Fever or inflammation of unknown origin (FUO/IUO), bacteremia, and sepsis represent challenging diagnostic scenarios in clinical practice. Over the past decade, multiple systematic reviews and meta-analyses have reported quantitative data regarding the diagnostic accuracy, clinical impact, and cost-effectiveness of fluorine-18 fluorodeoxyglucose positron emission tomography combined with computed tomography ([18F]FDG PET/CT) in these complex infectious and inflammatory conditions. We performed an umbrella review of published systematic reviews and meta-analyses to provide a comprehensive evidence-based summary of the diagnostic performance, clinical utility, and cost-effectiveness of [18F]FDG PET/CT across different patient populations and clinical scenarios.
EVIDENCE ACQUISITION: A comprehensive literature search of PubMed/MEDLINE and Cochrane Library databases was conducted to identify published evidence-based articles evaluating [18F]FDG PET/CT in adult FUO/IUO, pediatric FUO, bacteremia, sepsis, febrile neutropenia, and chronic Q fever. Quality assessment of included reviews was performed using the critical appraisal framework of the Oxford Centre for Evidence-Based Medicine (OCEBM).
EVIDENCE SYNTHESIS: A total of 14 published systematic reviews met the inclusion criteria. [18F]FDG PET/CT demonstrated high diagnostic sensitivity (81-94%) in adult FUO/IUO with diagnostic yield ranging from 56-75%. In pediatric FUO, sensitivity was 83% with specificity of 77.6% and area under the curve of 0.83. In bacteremia and sepsis, particularly in critically ill patients, [18F]FDG PET/CT achieved sensitivity of 94%. The imaging modality showed diagnostic utility in specialized populations including chronic Q fever (focus detection rate 79.5%), febrile neutropenia (83% added clinical value), and ICU patients (mean sensitivity 94.6%). Management modifications were observed in 20-48% of patients based on [18F]FDG PET/CT findings. Cost-effectiveness analysis supports selective use in high-risk patient populations, with numbers-needed-to-scan ranging from 3-6 in complex bacteremia.
CONCLUSIONS: Evidence from systematic reviews demonstrates that [18F]FDG PET/CT is a valuable diagnostic tool in FUO/IUO, bacteremia, sepsis, and related infectious/inflammatory conditions, with clinically significant impact on patient management. Strategic patient selection based on clinical risk factors optimizes cost-effectiveness. Future standardization of imaging protocols and prospective comparative studies are needed to define optimal clinical indications across different populations.
EVIDENCE ACQUISITION: A comprehensive literature search of PubMed/MEDLINE and Cochrane Library databases was conducted to identify published evidence-based articles evaluating [18F]FDG PET/CT in adult FUO/IUO, pediatric FUO, bacteremia, sepsis, febrile neutropenia, and chronic Q fever. Quality assessment of included reviews was performed using the critical appraisal framework of the Oxford Centre for Evidence-Based Medicine (OCEBM).
EVIDENCE SYNTHESIS: A total of 14 published systematic reviews met the inclusion criteria. [18F]FDG PET/CT demonstrated high diagnostic sensitivity (81-94%) in adult FUO/IUO with diagnostic yield ranging from 56-75%. In pediatric FUO, sensitivity was 83% with specificity of 77.6% and area under the curve of 0.83. In bacteremia and sepsis, particularly in critically ill patients, [18F]FDG PET/CT achieved sensitivity of 94%. The imaging modality showed diagnostic utility in specialized populations including chronic Q fever (focus detection rate 79.5%), febrile neutropenia (83% added clinical value), and ICU patients (mean sensitivity 94.6%). Management modifications were observed in 20-48% of patients based on [18F]FDG PET/CT findings. Cost-effectiveness analysis supports selective use in high-risk patient populations, with numbers-needed-to-scan ranging from 3-6 in complex bacteremia.
CONCLUSIONS: Evidence from systematic reviews demonstrates that [18F]FDG PET/CT is a valuable diagnostic tool in FUO/IUO, bacteremia, sepsis, and related infectious/inflammatory conditions, with clinically significant impact on patient management. Strategic patient selection based on clinical risk factors optimizes cost-effectiveness. Future standardization of imaging protocols and prospective comparative studies are needed to define optimal clinical indications across different populations.