[18F]FDG PET/CT in fever and inflammation of unknown origin, bacteremia, and sepsis: an umbrella review of diagnostic accuracy and clinical impact.
Chiara Martinello, Cesare M Iacovitti, Marco Cuzzocrea et al.
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In 30 seconds
This umbrella review assessed 14 published systematic reviews of [18F]FDG PET/CT for adult and pediatric fever or inflammation of unknown origin, bacteremia, sepsis, and related infectious or inflammatory scenarios. Across the included reviews, sensitivity was 81–94% in adult FUO/IUO, with diagnostic yield of 56–75%; sensitivity in bacteremia and sepsis was 94%, particularly among critically ill patients. PET/CT findings were associated with management changes in 20–48% of patients. The review also considered cost-effectiveness and concluded that selective use in higher-risk populations may be advantageous.
Key findings
- In adult FUO/IUO, reported sensitivity was 81–94% and diagnostic yield was 56–75%.
- In pediatric FUO, sensitivity was 83%, specificity 77.6%, and area under the curve 0.83.
- In bacteremia and sepsis, sensitivity reached 94%, particularly in critically ill patients.
- Management changes were reported in 20–48% of patients; numbers-needed-to-scan were 3-6 in complex bacteremia.
Why it matters
The review suggests that [18F]FDG PET/CT can help identify infectious or inflammatory foci across several difficult diagnostic settings and may influence subsequent management. Its reported performance and potential economic value support considering the modality in selected patients, while the range of results across populations underscores the importance of matching imaging use to clinical context.
What to keep in mind
The review synthesizes published systematic reviews rather than reporting a new primary study; the authors call for standardized imaging protocols and prospective comparative studies to clarify optimal indications.