PubMed · 12668708
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C J Boos, P Allen, R More, T Lancaster, M Dawes. 2003. Fever six weeks after trauma.. https://doi.org/10.1258/jrsm.96.4.187
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18-F-fluoro-D-deoxyglucose positron emission tomography (FDG PET) has become an established imaging tool in clinical oncology, cardiology and neurology and is now entering the field of clinical infectious diseases. The purpose of this article is to review the currently available, albeit limited, literature on FDG PET in the diagnosis of various infections and fever of unknown origin. Those indications for which FDG PET offers added value over more available techniques like labelled leucocyte scanning, gallium scanning and magnetic resonance imaging are especially highlighted. FDG PET seems to have an incremental value in the assessment of chronic osteomyelitis, especially in the axial skeleton, as well as in the diagnostic workup of fever of unknown origin and HIV complications. Cost-effectiveness studies are needed to define its place in the current diagnostic strategies of these pathologies.
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Investigators have used various techniques and radionuclides such as 51Cr and 32P-diisofluorophosphate to label blood cells and to study cell survival. Early studies also used these radionuclides to label human leucocytes for cell survival by in-vitro counting. But external imaging could not be done with these agents. Starting with the use of the gamma-emitting radionuclide (111)In-oxine for in-vitro labelling of phagocytic leucocytes, external imaging became possible. This method was the basis of visualisation of cell distribution within the body. Because an abscess consists primarily of leucocytes, leucocytes labelled with (111)In localise within the abscess and are detectable by imaging. Nowadays other radiopharmaceuticals with other underlying uptake mechanisms are also used to detect inflammatory or infectious foci in patients. Nuclear medicine can be most useful in patients with fever of unknown origin, where a focus has to be defined, or in patients where a lesion is known by clinical symptoms or by a radiological imaging and the differentiation between infection and other pathologies has to be made.