18F-FDGPET/CT in fever of unknown origin and inflammation of unknown origin: a Chinese multi-center study

  • Qian WangEmail author
  • Ya-Ming LiEmail author
  • Yuan Li
  • Feng-Chun Hua
  • Quan-Shi Wang
  • Xiao-Li Zhang
  • Chao Cheng
  • Hua Wu
  • Zhi-Ming Yao
  • Wei-Fang Zhang
  • Qing-Yi Hou
  • Wei-Bing Miao
  • Xue-Mei Wang
Original Article



To evaluate the clinical value of 18F-FDG-PET/CT for the diagnosis of fever of unknown origin (FUO) and inflammation of unknown origin (IUO) in Chinese population, as well as the characteristics of PET/CT in different category of etiological disease.


A total of 376 consecutive patients with FUO/IUO who underwent FDG-PET/CT at 12 hospitals were retrospectively studied. FDG uptake was quantitatively and visually evaluated, by using SUVmax and a 4-grade scale respectively. A questionnaire survey to the clinicians was used to evaluate the significance of PET/CT in diagnosing of FUO/IUO. Data analysis included the etiological distribution in the study population, image characteristics in different category of diseases, and clinical significance of PET/CT.


In 376 studied patients, the infectious diseases accounted for 33.0% of patients, rheumatologic diseases for 32.4%, malignancies for 19.1%, miscellaneous causes for 6.6%, and cause unknown for 8.8%. However, the etiological distribution among hospitals was varied. In addition, the etiological disease composition ratio has changed over time in China. On PET/CT examinations, 358 (95.2%) of the patients had a positive finding. Within them, local high uptake lesion was found in 219 cases, and nonspecific abnormal uptake (NAU) was found in 187 cases. FDG uptake in malignant diseases was significantly higher than in other category diseases both on SUVmax and visual scores (t-value range from 4.098 to 5.612, all P value < 0.001). Based on a clinical questionnaire survey, PET/CT provided additional diagnostic information for 77.4% of patients, and 89.6% of patients benefited from PET/CT examination.


FDG PET/CT is a valuable tool for clinical diagnosis of FUO/IUO, and it is of great significance in further investigating the usefulness of PET/CT in non-neoplastic diseases.


Fever of unknown origin (FUO) Inflammation of unknown origin (IUO) Positron emission tomography Fluorodeoxyglucose 


Compliance with ethical standards

Conflict of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent does not apply as this is a review manuscript.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Nuclear MedicinePeking University People’s HospitalBeijingChina
  2. 2.Department of Nuclear MedicineThe First Hospital of China Medical UniversityShenyangChina
  3. 3.PET Center, Huashan HospitalFudan UniversityShanghaiChina
  4. 4.PET Center, Nanfang HospitalSouthern Medical UniversityGuangzhouChina
  5. 5.Department of Nuclear Medicine, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
  6. 6.Department of Nuclear Medicine, Changhai HospitalSecond Military Medical UniversityShanghaiChina
  7. 7.Department of Nuclear Medicine and Minnan PET CenterXiamen Cancer Hospital of the First Affiliated Hospital of Xiamen UniversityXiamenChina
  8. 8.Department of Nuclear MedicineBeijing Hospital, National Center of GerontologyBeijingChina
  9. 9.Department of Nuclear MedicinePeking University Third HospitalBeijingChina
  10. 10.PET Imaging Diagnostic CenterGuangdong General Hospital and Guangdong Academy of Medical SciencesGuangzhouChina
  11. 11.Department of Nuclear MedicineFirst Affiliated Hospital of Fujian Medical UniversityFuzhouChina
  12. 12.Department of Nuclear MedicineInner Mongolia Medical University Affiliated HospitalHohhotChina

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