Elizabeth H. Dibble MD, Presenter: Nothing to Disclose

Don C. Yoo MD, Abstract Co-Author: Consultant for Endocyte

Richard B. Noto MD, Abstract Co-Author: Stockholder, General Electric Company Research support, Molecular Insight Pharmaceuticals, Inc Research support, Eli Lilly

1. Review the epidemiology, etiologies, & workup of fever without a source (FWS) 2. Review the role of imaging, with a focus on PET/CT, in the diagnosis & management of FWS with representative images from multiple etiologies of FWS 3. Review imaging costs to radiology departments, with a focus on radiopharmaceutical costs, in the workup of FWS

I. FWS: definition, etiologies, standard workup II. Chest Imaging: radiographs, CT (pneumonia, lymphadenopathy (LAD), inflammation) III. Abdomen/Pelvis Imaging: CT, ultrasound, MRI (occult abscess, LAD, inflammation) IV. Whole Body Imaging: nuclear imaging A. Gallium-67: Inflammation/infection, especially spinal. Limitations: GI excretion limits abdomen/pelvis pathology evaluation B. Indium-111 tagged WBC: Detection/exclusion of abnormal granulocyte localization. Limitations: neutropenia, non-granulocytic processes (e.g. neoplasm, inflammation), low counts make SPECT difficult, expensive radiopharmaceutical C. Technetium-99m tagged WBC. Benefit: same-day study, SPECT feasible. Limitations: GI excretion, expensive radiopharmaceutical D. PET/CT: Useful in diagnosing infection, malignancy, & inflammatory conditions with high uptake in inflammatory cells, granulation tissues, tumors V. Departmental Costs: CMS reimbursement rates (inpatient vs. outpatient), radiopharmaceutical costs

http://abstract.rsna.org/uploads/2014/14008220/14008220_czxh.pdf

Dibble, E, Yoo, D, Noto, R, Role of PET/CT in the Workup of Fever without a Source.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14008220.html