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Case Reports
. 2018 Oct;52(5):380-383.
doi: 10.1007/s13139-018-0534-9. Epub 2018 Jul 18.

Usefulness of Respiratory-Gated 18F-FDG PET/CT in Detecting Upper Abdominal Fever Focus

Sungwoo Bae  1 , Ji-In Bang  2 , Yoo Sung Song  1 , Won Woo Lee  1   3
Affiliations
Case Reports

Usefulness of Respiratory-Gated 18F-FDG PET/CT in Detecting Upper Abdominal Fever Focus

Sungwoo Bae et al. Nucl Med Mol Imaging. 2018 Oct.

Abstract

Respiratory-gated 18F-fluorodeoxygluocse (18F-FDG) PET/CT has been successfully used to better localize malignancies in the lung or upper abdominal organs. However, clinical usefulness of respiratory-gated 18F-FDG PET/CT in detection of fever focus has not been reported yet. A 68-year-old male patient with a history of living donor liver transplantation and biliary stenting was referred for 18F-FDG PET/CT due to fever of unknown origin (FUO). To find the accurate fever focus, respiratory-gated and non-gated 18F-FDG PET/CT was performed. Respiratory-gated PET/CT readily revealed prominent hypermetabolic lesion in the distal common bile duct (CBD) area where previous surgical graft was in situ. Maximum standardized uptake value (SUVmax) and SUV ratio (SUR) were greater in the gated PET/CT (SUVmax 5.4 and SUR 3.5) than in the non-gated PET/CT (SUVmax 4.6 and SUR 3.0). Fever dramatically subsided after removal of the graft in the CBD. This case report implies that respiratory-gated 18F-FDG PET/CT can visualize upper abdominal fever focus with better contrast than the conventional non-gated method.

Keywords: Computed tomography; Fever of unknown origin; Fluorodeoxyglucose 18F; Positron emission tomography; Respiratory-gated imaging techniques.

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Conflict of interest statement

Sungwoo Bae, Ji-In Bang, Yoo Sung Song, and Won Woo Lee declare that there is no conflict of interest. There was no funding source in this study.The study was approved by our Institutional Review Board and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.The need for patient’s informed consent was waived by the IRB.

Figures

Fig. 1
Fig. 1
Non-gated versus gated 18F-FDG PET/CT. a Axial CT showing a surgical graft in the common bile duct area. b, d, and f Non-gated PET and PET/CT at the same level of the axial CT. c, e, and g Respiratory-gated PET and PET/CT showing prominent hypermetabolism at the graft insertion site
Fig. 2
Fig. 2
The infected surgical graft. a Endoscopic image showing the graft inserted in the common bile duct (CBD). Arrow points the graft in the CBD. b Removed infected graft
See this image and copyright information in PMC

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