What is the sensitivity and specificity of PET/CT compared with other diagnostic imaging modalities in determining the cause of pyrexia of unknown origin (PUO)? What is the clinical and cost effectiveness of PET/CT as a first-line investigation in patients with PUO?

Kelly J
Record ID 32013000488
English
Authors' objectives: The purpose of this scoping report is two-fold: - to evaluate the evidence supporting the recommendation in the RCP/RCR guidelines; and - to search for, and evaluate, any additional evidence available.
Authors' recomendations: 1. What is the sensitivity and specificity of PET/CT compared with other diagnostic imaging modalities in determining the cause of PUO? A moderate quality meta-analysis reported that PET/CT had a pooled sensitivity of 98.2% (95% CI 93.6 to 99.8) and specificity of 85.9% (95% CI 75.0 to 93.4%) for the detection of the cause of PUO. PET/CT was helpful in obtaining a final diagnosis in 62% of patients. Further, PET/CT showed high sensitivity for the evaluation of infection or inflammation, neoplasm and non-infectious inflammation. This meta-analysis has some limitations, which should be noted. The data on the use of PET/CT in paediatric patients with PUO are very limited, and confident conclusions cannot be drawn. Apart from one small study (from 2000) that compared PET with gallium scans, no literature was identified that compared the sensitivity and specificity of PET/CT with other diagnostic imaging modalities in determining the cause of PUO. 2. What is the clinical and cost effectiveness of PET/CT as a first-line investigation in patients with PUO? In the studies identified, the patients had already had a thorough initial work-up. In this patient group (ie in those in whom other diagnostic measures had failed), the existing evidence suggests that PET/CT can help identify the cause of PUO. However, from this preliminary scope of the literature, it is not possible to confidently support or refute PET/CT as a first-line investigation in patients with PUO. It is also not possible to say, based on the evidence alone, where in the diagnostic work-up it is most appropriate. No full economic evaluations were identified. Immediately prior to publication of this report, a meta-analysis was published. It reported on the sensitivity (but not specificity) of FDG-PET/CT in detecting the cause of PUO. It included 15 studies, incorporating 595 patients, and reported a sensitivity of 85% (95% CI 81 to 88%).This does not change the conclusions of this report.
Details
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Scotland, United Kingdom
MeSH Terms
  • Sensitivity and Specificity
Contact
Organisation Name: Scottish Health Technologies Group
Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998
Contact Name: his.shtg@nhs.scot
Contact Email: his.shtg@nhs.scot
Copyright: Healthcare Improvement Scotland
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