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Use of immunoscintigraphy in the diagnosis of fever of unknown origin

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Abstract

Fever of unknown origin (FUO) has been defined as an elevation in temperature (38°C) for at least 2–3 weeks despite intensive investigation. The value of immunoscintigraphy with the technetium-99m-labelled anti-granulocyte antibody anti-NCA-95 (BW 250/183, IgG1) was studied retrospectively in 34 consecutive patients with FUO. Every effort was made to confirm a diagnosis, including methods such as ultrasonography, computed tomography, magnetic resonance imaging, bacteriological tests, surgical intervention and clinical follow-up. In 58.8% of the patients, an infectious cause for the fever was found, in 30.2% of the patients, a benign or malignant haematological disease, pancreatitis or thyrotoxicosis was found. No cause for fever could be found in 11%. The overall diagnostic sensitivity and specificity of immunoscintigraphy for infection were 40% and 92% respectively. The positive predictive value was calculated to be 88% and the negative predictive value was calculated to be 52%. False-negative scans were especially noted in patients with endocarditis, pneumonia and small brain abscesses, where the lesions did not exceed a diameter of 0.5 cm. If patients with endocarditis were excluded, the imaging sensitivity and specificity were increased to 57% and 95%. This study demonstrates that 99mTc-anti-NCA-95 scanning is able to localize infectious causes of FUO, other than endocarditis.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Erlangen-Nuremberg, Erlangen, Germany

    Wolfgang Becker, Udo Dölkemeyer & Friedrich Wolf

  2. Department of Medicine III, Institute of Clinical Immunology and Rheumatology, University of Erlangen-Nuremberg, Erlangen, Germany

    Martin Gramatzki

  3. Department of Medicine I, University of Erlangen-Nuremberg, Erlangen, Germany

    Michael Ulrich Schneider

  4. Department of Surgery, University of Erlangen-Nuremberg, Erlangen, Germany

    Johannes Scheele

Authors
  1. Wolfgang Becker
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  2. Udo Dölkemeyer
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  3. Martin Gramatzki
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  4. Michael Ulrich Schneider
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  5. Johannes Scheele
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  6. Friedrich Wolf
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Correspondence to: W. Becker. Department of Nuclear Medicine, University of Erlangen-Nuremberg, Krankenhausstrasse 12, D91054 Erlangen, Germany

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Becker, W., Dölkemeyer, U., Gramatzki, M. et al. Use of immunoscintigraphy in the diagnosis of fever of unknown origin. Eur J Nucl Med 20, 1078–1083 (1993). https://doi.org/10.1007/BF00173486

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  • DOI: https://doi.org/10.1007/BF00173486

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