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The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin.

AbstractOBJECTIVES:
The objective of this study was to determine the predictive value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to a positive fluorine-18 fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) result in patients with inflammation of unknown origin and fever of unknown origin.
PATIENTS AND METHODS:
Individual data of 498 patients were retrieved from three retrospective studies. Receiver operating characteristic derived areas under the curve were used to assess (18)F-FDG PET/CT versus age, CRP, and ESR. The discriminative value of age, CRP, and ESR related to (18)F-FDG PET/CT was examined using the net reclassification improvement (NRI).
RESULTS:
A diagnosis was established in 331 patients; (18)F-FDG PET/CT had a diagnostic accuracy of 89%. (18)F-FDG PET/CT had the highest area under the curve (0.89, P<0.001). The addition of (18)F-FDG PET/CT to a diagnosis prediction model including age, CRP, and ESR resulted in an NRI of 42% (P<0.001). In the same model with CRP values below 20 mg/l or ESR values below 20 mm/h, the NRI was 64% (P<0.001) and 29% (P=0.059), respectively. In 30 of 91 patients with CRP less than 10 mg/l, a diagnosis could be established; (18)F-FDG PET/CT was 100% true negative only in patients with CRP levels less than 5 mg/l.
CONCLUSION:
In patients with fever of unknown origin or inflammation of unknown origin, compared with elevated ESR levels, elevated CRP levels more often indicate a true positive (18)F-FDG PET/CT outcome.In addition, (18)F-FDG PET/CT, compared with CRP and ESR, shows the highest discrimination of patients with possible disabling disease.
AuthorsHans Balink, Nic J G M Veeger, Roel J Bennink, Riemer H J A Slart, Frits Holleman, Berthe L F van Eck-Smit, Hein J Verberne
JournalNuclear medicine communications (Nucl Med Commun) Vol. 36 Issue 6 Pg. 604-9 (Jun 2015) ISSN: 1473-5628 [Electronic] England
PMID25738560 (Publication Type: Journal Article)
Chemical References
  • Fluorodeoxyglucose F18
  • C-Reactive Protein
Topics
  • Adult
  • Aged
  • Blood Sedimentation
  • C-Reactive Protein (metabolism)
  • Female
  • Fever of Unknown Origin (blood, diagnosis, diagnostic imaging, metabolism)
  • Fluorodeoxyglucose F18
  • Humans
  • Inflammation (blood, diagnostic imaging, metabolism)
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Positron-Emission Tomography
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Tomography, X-Ray Computed

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