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

Balink, H., Veeger, N. J. G. M., Bennink, R. J., Slart, R. H. J. A., Holleman, F., van Eck-Smit, B. L. F. & Verberne, H. J., Jun-2015, In : Nuclear Medicine Communications. 36, 6, p. 604-609 6 p.

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  • The predictive value of C-reactive protein and erythrocyte sedimentation rate

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OBJECTIVES: 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 (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 F-FDG PET/CT versus age, CRP, and ESR. The discriminative value of age, CRP, and ESR related to F-FDG PET/CT was examined using the net reclassification improvement (NRI).

RESULTS: A diagnosis was established in 331 patients; F-FDG PET/CT had a diagnostic accuracy of 89%. F-FDG PET/CT had the highest area under the curve (0.89, P<0.001). The addition of 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; 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 F-FDG PET/CT outcome.In addition, F-FDG PET/CT, compared with CRP and ESR, shows the highest discrimination of patients with possible disabling disease.

Original languageEnglish
Pages (from-to)604-609
Number of pages6
JournalNuclear Medicine Communications
Issue number6
Publication statusPublished - Jun-2015


  • C-reactive protein, erythrocyte sedimentation rate, F-18-FDG PET, CT, fever of unknown origin, inflammation of unknown origin, LARGE VESSEL VASCULITIS, MULTICENTER, MANAGEMENT, UTILITY

ID: 17017775