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KONSTİTÜSYONEL SEMPTOMLARI OLAN HASTALARDA 18F-FDG-PET/BT’NİN TANIYA KATKISININ ARAŞTIRILMASI

Year 2023, Volume: 86 Issue: 2, 145 - 151, 30.03.2023

Mustafa Altınkaynak Nevzat Kahveci Yağmur Göksoy Solak Emine Göknur Işık Sebile Nilgün Erten Bülent Saka Timur Akpınar

https://doi.org/10.26650/IUITFD.1183149

Abstract

Amaç: Konstitüsyonel semptomları nedeniyle tetkik edilen hastalarda 18F-FDG-PET/BT’nin tanıya katkısı ve ayırıcı tanıdaki rolü araştırıldı. Gereç ve Yöntem: Ocak 2017 ile Aralık 2019 tarihleri arasında İstanbul Tıp Fakültesi’nde konstitüsyonel semptomlarla tetkik edilen ve 18F-FDG-PET/BT çekilen 144 hasta retrospektif olarak incelendi. Görüntülerin değerlendirilmesinde FDG’nin vücuttaki fizyolojik tutulum bölgeleri dışında saptanan tutulumlar pozitif kabul edildi. Tüm hastaların klinik, laboratuvar ve PET/ BT görüntüleme sonuçları geriye dönük incelendi. Hastaların son tanıları malignite, enfeksiyon, romatizmal hastalıklar ve diğer olmak üzere 4 grupta toplandı. Hastalarda PET/BT pozitifliğinin tanıya katkısı araştırıldı. Bulgular: Çalışmaya 59’u (%41) kadın 85’i (%59) erkek olmak üzere 144 hasta dahil edildi. Toplam yaş ortalamaları 58,0±17,2 idi. Hastaların semptom süresi ortalama 4,01±4,46 ay olarak saptandı ve %95,1’inde (n=137) hastalık teşhisi saptanmasına rağmen, %4,9’unda (n=7) herhangi bir hastalık teşhis edilemedi. 18F-FDG-PET/BT bu hastaların %86.8’inde tanıya katkı sağladı. Hastalık teşhis edilebilen olgu grubu incelendiğinde %57,7 (n=79) oranı ile en sık maligniteler; %16,1 (n=22) oranı ile romatizmal hastalıklar, %13,9 (n=19) enfeksiyonlar ve %12,4 (n=17) diğer hastalık gruplarının yer aldığı görüldü. 18F-FDGPET/ BT’nin hastalık teşhisinde %97,5 sensitivite, %31,8 spesifite, %88,8 pozitif prediktif değer ve %70 negatif prediktif değere sahip olduğu görüldü. Sonuç: Konsitüsyonel semptomları olan hastaların tanısında 18F-FDG-PET/BT, duyarlılığının ve pozitif prediktif değerinin yüksek olması nedeniyle değerli bir görüntüleme yöntemidir ve tanısal süreçte kullanılması gereken önemli görüntüleme protokollerden biridir.

Keywords

18F-FDG-PET/BT konstitüsyonel semptomlar tanı malignite

References

  • 1. Lokich JJ. Management of Constitutional Symptoms. In: Lokich JJ, editor. Primer of Cancer Management. Dordrecht: Springer Netherlands 1978, 156-63. [CrossRef] google scholar
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  • 6. Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015;42(2):328-54. [CrossRef] google scholar
  • 7. Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG. Fever of unknown origin: the Value of FDG-PET/CT. Seminars in Nuclear Medicine 2018;48(2):100-7. [CrossRef] google scholar
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  • 15. Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G. PET/CT for the staging and follow-up of patients with malignancies. Eur J Radiol 2009;70(3):382-92. [CrossRef] google scholar
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  • 23. Sonoda L, Ghosh-Ray S, Karamagkioli K, Sonoda K, Khalifa M, Mistry T. The usefulness of 18F-FDG PET/CT in the management of fever of unknown origin - Prospective multicentral study. J Nucl Med 2014;55(supplement 1):1968. google scholar
  • 24. Wang Z, Chen JQ, Liu JL, Qin XG, Huang Y. FDG-PET in diagnosis, staging and prognosis of pancreatic carcinoma: a meta-analysis. World J Gastroenterol. 2013;19(29):4808-17. [CrossRef] google scholar
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  • 27. Kubota K, Yamashita H, Mimori A. Clinical value of FDG-PET/CT for the evaluation of rheumatic diseases: Rheumatoid arthritis, polymyalgia rheumatica, and relapsing polychondritis. Semin Nucl Med 2017;47(4):408-24. [CrossRef] google scholar
  • 28. Hotta M, Minamimoto R, Kaneko H, Yamashita H. Fluorodeoxyglucose PET/CT of arthritis in rheumatic diseases: A pictorial review. Radiographics 2020;40(1):223-40. [CrossRef] google scholar
  • 29. Umekita K, Takajo I, Miyauchi S, Tsurumura K, Ueno S, Kusumoto N, et al. [18F]fluorodeoxyglucose positron emission tomography is a useful tool to diagnose the early stage of Takayasu’s arteritis and to evaluate the activity of the disease. Mod Rheumatol 2006;16(4):243-7. [CrossRef] google scholar
  • 30. Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis. Neth J Med 2003;61(10):323-9. google scholar
  • 31. Georga S, Exadaktylou P, Petrou I, Katsampoukas D, Mpalaris V, Moralidis EI, et al. Diagnostic value of 18F-FDGPET/CT in patients with FUO. J Clin Med 2020;9(7):2112. [CrossRef] google scholar
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THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS

Year 2023, Volume: 86 Issue: 2, 145 - 151, 30.03.2023

Mustafa Altınkaynak Nevzat Kahveci Yağmur Göksoy Solak Emine Göknur Işık Sebile Nilgün Erten Bülent Saka Timur Akpınar

https://doi.org/10.26650/IUITFD.1183149

Abstract

Objective: The contribution of 18F-FDG-PET/CT to diagnosis and its role in differential diagnosis were investigated in patients examined for constitutional symptoms. Materials and Methods: The 18F-FDG-PET/CT scan results and clinical data were analyzed retrospectively in 144 patients with constitutional symptoms examined between January 2017 and December 2019 in our outpatient and inpatient clinics in Istanbul University Istanbul Faculty of Medicine Internal Medicine Department. The FDG uptake other than physiological FDG uptake was considered as PET-positive. Clinical, laboratory data, and 18F-FDGPET/ CT scan results were evaluated retrospectively from records. All patients were classified into four categories as malignancies, infectious diseases, rheumatic diseases and other diseases based on their definitive diagnoses. The contribution of 18F-FDG-PET/CT in establishing a definitive diagnosis was investigated. Results: The 144 patients comprised 85 (59.0%) men and 59 (41.0%) women with a mean age of 58.0±17.2 years. The mean duration of symptoms was 4.01±4.46 months. A definitive diagnosis was established in 95.1% (n=137) of the patients based on physical examination, imaging methods, laboratory tests, and other diagnostic tests. In comparison, no definitive diagnosis was established in the remaining 4.9% (n=7) of the patients. 18F-FDGPET/ CT contributed to diagnosis in 86.8% (n=119) of patients. The patients were classified into four categories based on their diagnoses: (i) malignancies (n=79; 57.7%), (ii) rheumatic diseases (n=22; 16.1%), (iii) infectious diseases (n=19; 13.9%), and (iv) other diseases (n=17; 12.4%). The sensitivity, specificity, and positive and negative predictive values of 18F-FDG-PET/CT in the diagnosis of constitutional symptoms were 97.5%, 31.8%, 88.8%, and 70%, respectively. Conclusion: We found that 18F-FDG-PET/CT is a valuable diagnostic tool in diagnosing patients with constitutional symptoms and provides high sensitivity and positive predictive value.

Keywords

18F-FDG-PET/CT constitutional symptoms diagnosis malignancy

References

  • 1. Lokich JJ. Management of Constitutional Symptoms. In: Lokich JJ, editor. Primer of Cancer Management. Dordrecht: Springer Netherlands 1978, 156-63. [CrossRef] google scholar
  • 2. Roth AR, Basello GM. Approach to the adult patient with fever of unknown origin. Am Fam Physician 2003;68(11):2223-8. [CrossRef] google scholar
  • 3. Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics 2005;25(5):1357-68. [CrossRef] google scholar
  • 4. Akin EA, Kuhl ES, Zeman RK. The role of FDG-PET/CT in gynecologic imaging: an updated guide to interpretation and challenges. Abdom Radiol (NY) 2018;43(9):2474-86. [CrossRef] google scholar
  • 5. Bleeker-Rovers CP, Boerman OC, Rennen HJ, Corstens FH, Oyen WJ. Radiolabeled compounds in diagnosis of infectious and inflammatory disease. Curr Pharm Des 2004;10(24):2935-50. [CrossRef] google scholar
  • 6. Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. European Association of Nuclear Medicine (EANM). FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging 2015;42(2):328-54. [CrossRef] google scholar
  • 7. Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG. Fever of unknown origin: the Value of FDG-PET/CT. Seminars in Nuclear Medicine 2018;48(2):100-7. [CrossRef] google scholar
  • 8. Shaharir SS, Gordon C. Constitutional symptoms and fatigue in systemic lupus erythematosus. In: systemic lupus erythematosus. Academic Press 2021, 351-9. [CrossRef] google scholar
  • 9. Metalidis C, Knockaert DC, Bobbaers H, Vanderschueren S. Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance? Eur J Intern Med 2008;19(5):345-9. [CrossRef] google scholar
  • 10. Okuyucu K, Alagoz E, Demirbas S, Ince S, Karakas A, Karacalioglu O, et al. Evaluation of predictor variables of diagnostic [18F] FDG-PET/CT in fever of unknown origin. Q J Nucl Med Mol Imaging 2018;62(3):313-20. [CrossRef] google scholar
  • 11. Schönau V, Vogel K, Englbrecht M, Wacker J, Schmidt D, Manger B, et al. The value of (18)F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis 2018;77(1):70-7. [CrossRef] google scholar
  • 12. Jaruskova M, Belohlavek O. Role of FDG-PET and PET/CT in the diagnosis of prolonged febrile states. Eur J Nucl Med Mol Imaging 2006;33(8):913-8. [CrossRef] google scholar
  • 13. Godwin Jr HA, Zuger JH. Positron emission tomography (PET) in the evaluation of patients with cancer. Trans Am Clin Climatol Assoc 1999;110:181-94. google scholar
  • 14. Bleeker-Rovers CP, de Kleijn EM, Corstens FH, van der Meer JW, Oyen WJ. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 2004;31(1):29-37. [CrossRef] google scholar
  • 15. Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G. PET/CT for the staging and follow-up of patients with malignancies. Eur J Radiol 2009;70(3):382-92. [CrossRef] google scholar
  • 16. Maisey MN. Overview of clinical PET. Br J Radiol 2002;75(suppl_9):1-5. [CrossRef] google scholar
  • 17. Basu S, Hess S, Nielsen Braad PE, Olsen BB, Inglev S, H0ilund-Carlsen PF. The basic principles of FDG-PET/CT imaging. PET Clin 2014;9(4):355-70. [CrossRef] google scholar
  • 18. Nanni C. PET-FDG: Impetus. Cancers (Basel) 2020;12(4):1030. [CrossRef] google scholar
  • 19. Cairns RA, Harris IS, Mak TW. Regulation of cancer cell metabolism. Nat Rev Cancer 2011;11(2):85-95. [CrossRef] google scholar
  • 20. Berger KL, Nicholson SA, Dehdashti F, Siegel BA. FDG PET evaluation of mucinous neoplasms: correlation of FDG uptake with histopathologic features. AJR Am J Roentgenol 2000;174(4):1005-8. [CrossRef] google scholar
  • 21. Hofman MS, Hicks RJ. How we read oncologic FDG PET/ CT. Cancer Imaging 2016;16(1):35. [CrossRef] google scholar
  • 22. Tokmak H, Ergonul O, Demirkol O, Cetiner M, Ferhanoglu B. Diagnostic contribution of (18)F-FDG-PET/CT in fever of unknown origin. Int J Infect Dis 2014;19:53-8. [CrossRef] google scholar
  • 23. Sonoda L, Ghosh-Ray S, Karamagkioli K, Sonoda K, Khalifa M, Mistry T. The usefulness of 18F-FDG PET/CT in the management of fever of unknown origin - Prospective multicentral study. J Nucl Med 2014;55(supplement 1):1968. google scholar
  • 24. Wang Z, Chen JQ, Liu JL, Qin XG, Huang Y. FDG-PET in diagnosis, staging and prognosis of pancreatic carcinoma: a meta-analysis. World J Gastroenterol. 2013;19(29):4808-17. [CrossRef] google scholar
  • 25. Cengiz A, Göksel S, Yürekli Y. Diagnostic value of (18)F-FDG PET/CT in patients with carcinoma of unknown primary. Mol Imaging Radionucl Ther 2018;27(3):126-32. [CrossRef] google scholar
  • 26. Gambhir SS, Czernin J, Schwimmer J, Silverman DH, Coleman RE, Phelps ME. A tabulated summary of the FDG PET literature. J Nucl Med 2001;42(5 Suppl):1s-93s. google scholar
  • 27. Kubota K, Yamashita H, Mimori A. Clinical value of FDG-PET/CT for the evaluation of rheumatic diseases: Rheumatoid arthritis, polymyalgia rheumatica, and relapsing polychondritis. Semin Nucl Med 2017;47(4):408-24. [CrossRef] google scholar
  • 28. Hotta M, Minamimoto R, Kaneko H, Yamashita H. Fluorodeoxyglucose PET/CT of arthritis in rheumatic diseases: A pictorial review. Radiographics 2020;40(1):223-40. [CrossRef] google scholar
  • 29. Umekita K, Takajo I, Miyauchi S, Tsurumura K, Ueno S, Kusumoto N, et al. [18F]fluorodeoxyglucose positron emission tomography is a useful tool to diagnose the early stage of Takayasu’s arteritis and to evaluate the activity of the disease. Mod Rheumatol 2006;16(4):243-7. [CrossRef] google scholar
  • 30. Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis. Neth J Med 2003;61(10):323-9. google scholar
  • 31. Georga S, Exadaktylou P, Petrou I, Katsampoukas D, Mpalaris V, Moralidis EI, et al. Diagnostic value of 18F-FDGPET/CT in patients with FUO. J Clin Med 2020;9(7):2112. [CrossRef] google scholar
  • 32. Haidar G, Singh N. Fever of unknown origin. N Eng J Med 2022;386(5):463-77. [CrossRef] google scholar
There are 32 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section RESEARCH
Authors

Mustafa Altınkaynak 0000-0002-7768-2746

Nevzat Kahveci 0000-0001-7050-6101

Yağmur Göksoy Solak 0000-0002-2400-1978

Emine Göknur Işık 0000-0002-3786-8052

Sebile Nilgün Erten 0000-0002-1113-9310

Bülent Saka 0000-0001-5404-5579

Timur Akpınar 0000-0002-9591-4475

Publication Date March 30, 2023
Submission Date October 2, 2022
Published in Issue Year 2023 Volume: 86 Issue: 2

Cite

APA Altınkaynak, M., Kahveci, N., Göksoy Solak, Y., Işık, E. G., et al. (2023). THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS. Journal of Istanbul Faculty of Medicine, 86(2), 145-151. https://doi.org/10.26650/IUITFD.1183149
AMA Altınkaynak M, Kahveci N, Göksoy Solak Y, Işık EG, Erten SN, Saka B, Akpınar T. THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS. İst Tıp Fak Derg. March 2023;86(2):145-151. doi:10.26650/IUITFD.1183149
Chicago Altınkaynak, Mustafa, Nevzat Kahveci, Yağmur Göksoy Solak, Emine Göknur Işık, Sebile Nilgün Erten, Bülent Saka, and Timur Akpınar. “THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS”. Journal of Istanbul Faculty of Medicine 86, no. 2 (March 2023): 145-51. https://doi.org/10.26650/IUITFD.1183149.
EndNote Altınkaynak M, Kahveci N, Göksoy Solak Y, Işık EG, Erten SN, Saka B, Akpınar T (March 1, 2023) THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS. Journal of Istanbul Faculty of Medicine 86 2 145–151.
IEEE M. Altınkaynak, “THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS”, İst Tıp Fak Derg, vol. 86, no. 2, pp. 145–151, 2023, doi: 10.26650/IUITFD.1183149.
ISNAD Altınkaynak, Mustafa et al. “THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS”. Journal of Istanbul Faculty of Medicine 86/2 (March 2023), 145-151. https://doi.org/10.26650/IUITFD.1183149.
JAMA Altınkaynak M, Kahveci N, Göksoy Solak Y, Işık EG, Erten SN, Saka B, Akpınar T. THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS. İst Tıp Fak Derg. 2023;86:145–151.
MLA Altınkaynak, Mustafa et al. “THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS”. Journal of Istanbul Faculty of Medicine, vol. 86, no. 2, 2023, pp. 145-51, doi:10.26650/IUITFD.1183149.
Vancouver Altınkaynak M, Kahveci N, Göksoy Solak Y, Işık EG, Erten SN, Saka B, Akpınar T. THE DIAGNOSTIC ROLE OF 18F-FDG-PET/CT IN PATIENTS WITH CONSTITUTIONAL SYMPTOMS. İst Tıp Fak Derg. 2023;86(2):145-51.
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