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Nuklearmedizin 2001; 40(03): 59-70
DOI: 10.1055/s-0038-1623872
Originalarbeiten – Original Articles
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Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

Nuklearmedizinische Diagnostik bei Patienten mit Fieber unklarer Genese (FUO)
J. Meiler
1   Abteilung Nuklearmedizin, Zentrum Radiologie, Georg-August-Universität Göttingen, Deutschland
,
W. Becker
1   Abteilung Nuklearmedizin, Zentrum Radiologie, Georg-August-Universität Göttingen, Deutschland
› Author Affiliations
Further Information

Publication History

Eingegangen: 17 January 2001

26 January 2001

Publication Date:
10 January 2018 (online)

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Summary

Fever 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.

Zusammenfassung

Fieber bei immunkompetenten und nicht neutropenischen Patienten, das über mindestens 2-3 Wochen persistiert, und dessen Ursache sich trotz einwöchiger adäquater Diagnostik nicht ermitteln lässt, wird als »Fieber unbekannter Ursache« (oder englisch: FUO = »fever of unknown origin«) bezeichnet. Die meisten dieser Patienten (50-60%) weisen autoimmune Erkrankungen, Kollagenosen oder Malignóme auf. Lediglich bei 20-40% der Fälle finden sich Entzündungen und Infektionserkrankungen. Somit unterscheiden sich Patienten mit FUO deutlich von Patienten mit neutropenischen oder postoperativen Fieberzuständen die in der Regel auf akute entzündliche Prozesse zurückzuführen sind. Formal besitzen in-vitro oder in-vivo radioaktiv markierte Leukozyten eine hohe Sensitivität und Spezifität bei der Diagnostik einer granulozytären Entzündung. Da bei FUO-Patienten die Prävalenz purulenter Entzündungen aber gering ist, tragen markierte Leukozyten nur selten zur Abklärung der endgülligen Fieberursache bei und sollten eher bei der Suche nach einem Ausgangsherd bei einer okkulten Sepsis eingesetzt werden. Ga-67-Citrat ist gegenwärtig das einzige kommerziell verfügbare Radiopharmakon zur Szintigraphie, das sowohl eine Anzahl von Tumoren aber auch granulo-zytäre, autoimmune und granulomatöse Entzündungen darzustellen vermag. Die Anzahl diagnostischer Szintigraphien mit dieser Methode liegt außerhalb Deutschlands höher als der Einsatz markierter Leukozyten. F-18-2-Fluor-2’-Deoxyglucose (FDG) wird zunehmend in der Tumordiagnostik mittels PET eingesetzt. In aktivierten Entzündungszellen konnten ähnliche pathophysiolo-gische Besonderheiten nachgewiesen werden. Erste Ergebnisse mittels FDG-PET, bzw. koinzidenzfähigen Gamma-Kameras haben gezeigt, dass FDG als der wahrscheinlich vielversprechendste Tracer bei der nuklearmedizinischen Diagnostik von FUO zu gelten hat. Dies ist einerseits Folge einer überlegenen Kinetik des Radio-pharmakons und andererseits Folge des höheren örtlichen Auflösungsvermögens der PET im Vergleich zur konventionellen SPECT.

Keywords

Fever of unknown origin - FUO - scintigraphy - PET

Schlüsselwörter

Fieber unklarer Genese - FUO - Szintigraphie - PET
 

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