Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

J. Meiler; W. Becker

doi:10.1055/s-0038-1623872

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2001; 40(03): 59-70
DOI: 10.1055/s-0038-1623872

Originalarbeiten – Original Articles

Schattauer GmbH

Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

Nuklearmedizinische Diagnostik bei Patienten mit Fieber unklarer Genese (FUO)

J. Meiler

¹Abteilung Nuklearmedizin, Zentrum Radiologie, Georg-August-Universität Göttingen, Deutschland

,

W. Becker

¹Abteilung Nuklearmedizin, Zentrum Radiologie, Georg-August-Universität Göttingen, Deutschland

› Author Affiliations

Abstract

Summary

Fever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

Zusammenfassung

Fieber bei immunkompetenten und nicht neutropenischen Patienten, das über mindestens 2-3 Wochen persistiert, und dessen Ursache sich trotz einwöchiger adäquater Diagnostik nicht ermitteln lässt, wird als »Fieber unbekannter Ursache« (oder englisch: FUO = »fever of unknown origin«) bezeichnet. Die meisten dieser Patienten (50-60%) weisen autoimmune Erkrankungen, Kollagenosen oder Malignóme auf. Lediglich bei 20-40% der Fälle finden sich Entzündungen und Infektionserkrankungen. Somit unterscheiden sich Patienten mit FUO deutlich von Patienten mit neutropenischen oder postoperativen Fieberzuständen die in der Regel auf akute entzündliche Prozesse zurückzuführen sind. Formal besitzen in-vitro oder in-vivo radioaktiv markierte Leukozyten eine hohe Sensitivität und Spezifität bei der Diagnostik einer granulozytären Entzündung. Da bei FUO-Patienten die Prävalenz purulenter Entzündungen aber gering ist, tragen markierte Leukozyten nur selten zur Abklärung der endgülligen Fieberursache bei und sollten eher bei der Suche nach einem Ausgangsherd bei einer okkulten Sepsis eingesetzt werden. Ga-67-Citrat ist gegenwärtig das einzige kommerziell verfügbare Radiopharmakon zur Szintigraphie, das sowohl eine Anzahl von Tumoren aber auch granulo-zytäre, autoimmune und granulomatöse Entzündungen darzustellen vermag. Die Anzahl diagnostischer Szintigraphien mit dieser Methode liegt außerhalb Deutschlands höher als der Einsatz markierter Leukozyten. F-18-2-Fluor-2’-Deoxyglucose (FDG) wird zunehmend in der Tumordiagnostik mittels PET eingesetzt. In aktivierten Entzündungszellen konnten ähnliche pathophysiolo-gische Besonderheiten nachgewiesen werden. Erste Ergebnisse mittels FDG-PET, bzw. koinzidenzfähigen Gamma-Kameras haben gezeigt, dass FDG als der wahrscheinlich vielversprechendste Tracer bei der nuklearmedizinischen Diagnostik von FUO zu gelten hat. Dies ist einerseits Folge einer überlegenen Kinetik des Radio-pharmakons und andererseits Folge des höheren örtlichen Auflösungsvermögens der PET im Vergleich zur konventionellen SPECT.

Keywords

Fever of unknown origin - FUO - scintigraphy - PET

Schlüsselwörter

Fieber unklarer Genese - FUO - Szintigraphie - PET

Full Text

References

Literatur
1 Bakheet SM, Powe J. Fluorine-18-fluoro-deoxyglucose uptake in rheumatoid arthritis-associated lung disease in a patient with thyroid cancer. J Nucl Med 1998; 39: 234-6.
2 Barghouti S, Everett KDE, Speert DP. Nonop-sonic phagocytosis of Pseudomonas aeruginosa requires faciJitated transport of D-glucose by macrophages. J Immunol 1995; 154: 3420-8.
3 Becker W. Immunoscintigraphy of infectious lesions. in: Immunoscintigraphy: facts and fiction, proceedings of the international symposium on immunoscintigraphy. Göttingen, November 1989; hrsg. v. Münz DL, Emrich D. Elsevier Science Publishers B. V.; Amsterdam: 1990: 159-70.
4 Becker W. Entzündungsdiagnostik mit autologen Leukozyten und murinen monoklonalen Antikörpern. Nuklearmedizin 1992; 15: 273-86.
5 Becker W. (1993): Nuklearmedizinische Methoden; in: Diagnostik chronisch entzündlicher Darmerkrankungen. hrsg. v. Fischbach W, Becker W. Georg Thieme Verlag; Stuttgart: 1993: 69-91.
6 Becker W. (1994): Entzündungen. in Nuklearmedizin. hrsg. v. Bült U. Schicha H u.a.; Georg Thieme Verlag; Stuttgart: 1994: 404-18.
7 Becker W. The contribution of nuclear medicine to the patient with infection. Eur J Nucl Med 1995; 22: 1195-211.
8 Becker W, Dölkemeyer U, Gramatzki MU, Schneider MU, Scheele J, Wolf F. Use of immunoscintigraphy in the diagnosis of fever of unknown origin. Eur J Nucl Med 1993; 20: 1078-83.
9 Becker W, Goldenberg DM, Wolf F. The use of monoclonal antibodies and antibody fragments in the imaging of infectious lesions. Semin Nucl Med 1994; 24: 142-53.
10 Becker W. Differentialindikation für verschiedene radioaktive Arzneimittel bei unterschiedlichen entzündlichen Erkrankungen. Nuklearmedizin 1999; 38: 243.
11 Berland B, Gleckman RA. Fever of unknown origin in the elderly. A sequential approach to diagnosis. Postgrad Med 1992; 92: 197-200 203-5,209-10.
12 Bissuel F, Leport C, Perronne C, Longuet P, Vilde JL. Fever of unknown origin in HIV-infected patients: a critical analysis of a retrospective series of 57 cases. J Intern Med 1994; 236: 529-35.
13 Bosslet K, Lüben G, Schwarz A, Hundt E, Harthus HP, Seiler FR, Muhrer C, Klöppel G, Kayser K, Sedlacek HH. Immunohistoche-mical Localiziation and Molecular Charac-teris-tics of three monoclonal Antibody-defined Epitopes detectable on Carcinoem-bryonic antigen (CEA). Int J Cancer 1985; 36: 75-84.
14 Buonomo C, Treves ST. Gallium scanning in children with fever of unknown origin. Pediatr Radiol 1993; 23: 307-10.
15 Brown RS, Wahl RL. Overexpression of glut-1 glucose transporter in human breast cancer. Cancer 1993; 72: 2979-85.
16 Borregaard N, Herlin T. Energy metabolism of human neutrophils during phagocytosis. J Clin Invest 1982; 70: 550-7.
17 Botsch H. Gallium-szintigraphie. Springer Verlag; Heidelberg-New York-Tokio: 1985
18 Carroll B, Silverman PM, Goodwin DA, Dougall IR. Ultrasonography and indium 111 white blood cell scanning for the detection of intraabdominal abscesses. Radiology 1981; 140: 155-60.
19 Chakrabarti R, Jung CY, Lee TP, Liu H, Mookerjee BK. Changes in glucose transport and transporter isoforms during the activation of human peripheral blood lymphocytes by phytohemagglutinin. J Immunol 1994; 152: 2660-8.
20 Chan SM, Hoffer PB, Marie N, Duray P. Inhibition of Ga-67 uptake in melanoma by a anti-human tranferrin receptor monoclonal antibody. J Nucl Med-Proceedings of the 34th annual meeting 1987; 28: 1303-7.
21 Chung CJ, Hicklin OA, Payan JM, Gordon L. Indium-ill-labeled leukocyte scan in detection of synthetic vascular graft infection: the effect of antibiotic treatment. J Nucl Med 1991; 32: 13-5.
22 Ciaessens RA, Koenders EB, Boerman OC, Oyen WJ, Borm GF, van der Meer JW, Corstens FH. Dissociation of indium from indium-ill-labeled diethylene triamine penta-acetic acid conjugated non-specific polyclonal human immunoglobulin G in inflammatory foci. Eur J Nucl Med 1995; 22: 212-9.
23 Cook GJR, Maisey MN, Fogelman I. Normal variants, artefacts and interpretative pitfalls in PET imaging with 18-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med 1999; 26: 1363-78.
24 Cunha BA. Fever of unknown origin. Infect Dis Clin North Am 1996; 10: 111-27.
25 Datz FL, Thorne DA. Effect of antibiotic therapy on the sensitivity of indium-ill-labeled leukocyte scans. J Nucl Med 1986; 27: 1849-53.
26 Davies SG, Garvie NW. The role of Indium-labeled leukocyte imaging in pyrexia of unknown origin. Br J Radiol 1990; 63: 850-4.
27 De Bois MHW, Arndt JW, Speyer I, Pauwels EKJ, Breedveld FC. Technetium-99m labelled policlonal human immunoglobulin scintigraphy predicts rheumatoid arthritis in patients with arthralgia. Scand J Rheumatol 1996; 25: 155-8.
28 De Bois MHW, Arndt JWJak PP, Kluin PhM, van der Velde EA, Pauwels EKJ. Technetium-99m labelled policlonal human immunoglobulin G scintigraphy before and after intraarticular knee injection of triamcinolone hexacetonide in patients with rheumatoid arthritis. Nucl Med Commun 1993; 14: 883-7.
29 de Kleijn EM, van der Meer JW. Fever of unknown origin (FUO): report on 53 patients in a Durch University hospital. Neth J Med. 1995; 47: 54-60.
30 de Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group. Medicine 1997; a 76: 401-14.
31 de Kleijn EM, Oyen WJ, Corstens FH, van der Meer JW. Utility of indium-ill-labeled polyclonal immunoglobulin G scintigraphy in fever of unknown origin. The Netherlands FUO Imaging Group. J Nucl Med. 1997; b 38: 484-9.
32 Dompeling EC, Donnelly JP, Raemaekers JM, Deresinski SC, Feld R, De Pauw BE. Evolution of the clinical manifestations of infection during the course of febrile neutropenia in patients with malignancy. Infection 1998; 26: 349-54.
33 Endres S, van der Meer JWM, Dinarello CA. Zytokine in der Pathogenese des Fiebers. Internist 1989; 30: 358-61.
34 Evers J, Gross R. Leitsymptom Fieber. Dtsch Ärztebl 1985; 82: 1069-73.
35 Everett KDE, Barghouti S, Speert DP. In vitro culture of murine peritoneal and alveolar macrophages modulates phagocytosis of Pseudomonas aeruginosa and glucose transport. JLeucocBiol 1996; 59: 539-44.
36 Fukanaga T, Enomoto K, Okazumi S, Isono K. Analysis of glucose metabolism in patients with esophageal cancer by FDG-PET: estimation of hexokinase activity in the tumor and prediction of prediction of prognosis: clinical PET in Oncology. Proceedings 2nd Intl Symposion on PET in Oncology 1993. Singapore: Word Scienentific; p 87-90.
37 Gamelli RL, Liu H, He LK, Hofmann CA. Augmentations of glucose uptake and glucose transporter-1 in macrophages following thermal injury and sepsis in mice. J Leucoc Biol 1996; 59: 639-47.
38 Gratz S, Behr T, Schmitt HA, Wüstner M, Morguet A, Meiler J, Becker W. ^99mTI labeled antigranulocyte monoclonal antibody Fab’ fragments (LeukoScan^®) for diagnostic imaging of bone and soft tissue infections. J Nucl Med 1998; 39 Suppl, p 34.
39 Gratz S, Behr TM, Herrmann A, Meiler J, Conrad M, Zappel H, Becker W. Immunoscintigraphy (BW 250/183) in neonates and infants with fever of unknown origin. Nucl Med Commmun 1998; 19: 1037-45.
40 Gratz S, DOrner J, Oestmann JW, Opitz MT, Melier J, Grabbe E, Becker W. ⁶⁷Ga-citrate and ^99mTc-MDP for estimating the severity of vertebral osteoyelitis. Nucl Med Comm 2000; 21: 111-20.
41 Guhlmann A, Brecht Krauss D, Suger G, Glatting G, Kotzerke J, Kinzl L, Reske SN. Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis. J Nucl Med 1998; 39: 2145-52.
42 Gutowski TD, Fisher SJ, Moon S, Wahl RL. Experimental studies of [18F]-2-fluoro-2’-deoxy-D-glucose (FDG) in infection and in reactive lymph nodes. J Nucl Med 1992; 33: 925.
43 Habibian MR, Staab EV, Mathews HA. Gallium-67 citrate scans in febrile patients. JAMA 1975; 233: 1073-6.
44 Herry JY, Moisan A, Le Cloirec J, Bretagne JF, Darnault P, Cardin JL, Martin A. Indium 111 autologous granulocytes in the diagnosis of abscess and in the assessment of inflamatory bowel disease. Nucl Med Biol 1986; 13: 183-90.
45 Hilson AJW, Maisey MN. Ga-67 scanning in pyrexia of unknown origin. BMJ 1979; 279: 1330-1.
46 Higashi T, Tamaki N, Torizuka T, Nakamoto Y, Sakahara H, Kimura T, Honda T, Inokuma T, Katsushima S, Ohshio G, Imamura M, Konishi J. FDG uptake. GLUTI glucose transporter and cellularity in human pancreatic tumors. J Nucl Med 1998; 39: 1727-35.
47 Heussel CP, Kauczor HU, Heussel GE, Fischer B, Begrich M, Mildenberger P, Thelen M. Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 1999; 17: 796-805.
48 Heussel CP, Kauczor HU, Heussel GE, Derigs HG, Thelen M. Fokussuche bei neutropeni-schem Fieber. Radiologe 2000; 40: 88-101.
49 Hoffer P. Gallium: Mechanisms. J Nucl Med 1980; 21: 282-5.
50 Hoffer PB, Huberty J, Khayam-Bashi H. The association of Ga-67 and lactoferrin. J Nucl Med 1977; 18: 713-7.
51 Ichiya Y, Kuwabara Y, Sasaki Yoshida T, Akashi Y, Murayama S, Nakamura K, Fukumura T, Masuda K. FDG-PET in infectious lesions: detection and assessment of lesion activity. Ann Nucl Med 1996; 10: 185-91.
52 Ito Y, Okuyama S, Sato K, Takahashi K. Sato Kanno 1.67Ga tumor scanning and its mechanisms studied in rabbits. Radiology 1971; 100: 357-62.
53 Kelly MJ, Kalff V, Hicks RJ, Spicer WJ, Spelman DW. 111ln-oxine labelled leukocyte scintigraphy in the detection and localization of active inflammation and sepsis. Med J Aust 1990; 152: 352-7.
54 Knöchel JQ, Koehler PR, Lee TG, Welch DM. Diagnosis of abdominal abscesses with computed tomography, ultrasound, and in-111 leucocyte scans. Radiology 1980; 137: 425-32.
55 Knockaert DC, Mortelmans LA, Deroo MC, Bobbaers HJ. Clinical value of gallium-67 scintigraphy in the investigation of fever or inflammation of unknown origin in the ultrasound and computed tomography era. Acta Clin Belg 1989; 44: 91-8.
56 Knockaert DC, Vanneste LJ, Bobbaers HJ. Recurrent or episodic fever of unknown origin. Review of 45 cases and survey of the literature. Medicine 1993; 72: 184-96.
57 Knockaert DC, Mortelmans LA, De-Roo MC, Bobbaers HJ. Clinical value of gallium-67 scintigraphy in evaluation of fever of unknown origin. Clin Infect Dis 1994; 18: 601-5.
58 Knopp MV, Bischoff HG. Evaluation of pulmonary lesions with positron emission tomography. Radiologe 1994; 34: 599-1.
59 Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulocytes studied by microautoradiographv. J Nucl Med 1992; 33: 1972-80.
60 Larson EB, Featherstone HJ, Petersdorf MD. Fever of undetermined origin: diagnosis and follow-up of 105 cases. 1970-1980. Medicine 1982; 61: 269-92.
61 Lewis PJ, Salama A. Uptake of fluorine-18-fluorodeoxvglucose in sarcoidosis. J Nucl Med 1994; 35: 1647-9.
62 Lorenzen J, Bleckmann Münchow N, Buchert R, Bohuslavski H. Einsatz der F-18-FDG PET bei Patienten mit unklarem Fieber. Nuklearmedizin 1999; 38: A45. VI 11.
63 MacSweeney JE, Peters AM, Lavender JP. Indium labelled leucocyte scanning in pyrexia of unknown origin. Clin Radiol. 1990; 42: 414-7.
64 Martin-Comin J. Prats 1999.. Clinical implications of radiolabeled blood elements in inflammatory bowel disease. Q J Nucl Med. 1999; 43: 74-82.
65 McDougall R, Baumert JE, Lantieri RL. Evaluation of 111 -In Leukocyte Whole Body scanning. AJR 1979; 133: 849-54.
66 McNeil BJ, Sanders R, Alderson PO, Hessel SJ, Finberg H, Siegelman SS, Adams DF, Abrams HL. A prospective study of computed tomography, ultrasound, and gallium imaging in patients with fever. Radiology 1981; 139: 647-53.
67 Meiler J, Ivancevic V, Conrad M, Gratz S, Münz DL, Becker W. Clinical value of immunoscintigraphy in patients with fever of unknown origin. J Nucl Med 1998; 39: 1248-53.
68 Melier J, Altenvoerde G, Munzel U, Jauho A, Behe M, Gratz S, Luig H, Becker W. Fever of unknown origin-prospective comparison of 18 FDG-imaging with a double head coincidence camera (DHCC) and Ga-67 citrate SPECT. Eur J Nucl Med 2000; 27: 1617-25.
69 Meiler J, Lehmann K, Altenvoerde G, Jauho A, Becker W. 18-FDG Uptake bei einer Patientin mit fibröser Thyreoiditis (Riedel-Thyreoiditis). Nuklearmedizin 2000; 39: N115.
70 Nijhof MW, Oyen WJG, van Kampen A, Ciaessens RAMJ, van der Meer JWM, Corstens FHM. Evaluation of infections of the locomotor system with “‘In-labelled human IgG scintigraphy. J Nucl Med 1997; 38: 1300-5.
71 Morguet AJ, Munz DL, Ivancevic V, Werner GS, Sandrock D. Bökemeier et al. Immunoscintigraphy using Technetium-99m-labelled anti-NCA-95 antigranulocyte antibodies as an adjunct to echocardiography in subacute infective endocarditis. J Am Coll Cardiol 1994; 23: 1171-8.
72 O’Doherty MJ, Barrington SF, Campbell M, Lowe J, Bradbeer CS. PET scanning and the human immunodeficiency virus-positive patient. J Nucl Med 1997; 38: 1575-83.
73 Osman S, Danpure HJ. The use of 2-[18F]flu-oro-2-deoxy-D-glucose as a potential in vitro agent for labelling human granulocytes for clinical studies by positron emission tomography. Int J Rad Appl Instrum B 1992; 19: 183-90.
74 Oyen WJ, Ciaessens RA, Raemaekers JM, de Pauw BE, van der Meer JW, Corstens FH. Diagnosing infection in febrile granulocytopenic patients with indium-Ill labeled human immunoglobulin. G. J Clin Oncol 1992; 10: 61-8.
75 Palestra ChJ, Torres MA. Radionuclide Imaging of nonosseous infection. Q J Nucl Med 1999; 43: 46-60.
76 Pätz Jr. EF, Lowe VJ, Hoffman JM, Paine SS, Burrowes P, Coleman RE, Goodman PC. Focal pulmonary abnormalities: Evaluation with F-l8 Fluorodeoxyglucose PET scanning. Radiology 1993; 188: 487-90.
77 Peters AM. Nuclear medicine imaging in fever of unknown origin. Q J Nucl Med 1999; 43: 61-73.
78 Petersdorf RG, Beeson PB. Fever of Unexplained Origin: report on 100 cases. Medicine 1961; 40: 1-30.
79 Reuland P, Winker KH, Heuchert T, Ruck R, Müller-Schauenburg W, Weller S, Feine U. Detection of Infection in Postoperative Orthopedic Patients with Technetium-99m-La-beled Monoclonal Antibodies against Granulocytes. J Nucl Med 1991; 32: 2209-14.
80 Rudland PS, Durbin H, Clingan D, de-Asua LJ. Iron salts and transferrin are specifically required for cell division of cultured 3T6 cells. Biophys Res Commun 1977; 75: 556-62.
81 Sansom H, Seddon B, Padley SP. Clinical utility of abdominal CT scanning in patients with HIV disease. Clin Radiol 1997; 52: 698-703.
82 Sasaki M, Ichiya Y, Kuwabara Y, Otsuka M, Tahara T, Fukumura T, Gunasekera R, Masuda K. Ringlike uptake of [18F] -FDG in brain abscess: a PET study. J Comput Assist Tomogr 1990; 14: 486-7.
83 Saverymuttu SH, Phillips G, Peters AM, Lavender JP. Indium-Ill autologous leucocyte scanning in lobar pneumonia and lung abscesses. Thorax 1985; 40: 925-30.
84 Saverymuttu SH, Peters AM, Lavender JP, Hodgson HJ, Chadwick VS. Indium-Ill autologous leucocytes in inflammatory bowel disease. Gut 1983; 24: 293-9.
85 Scharko AM, Perlman SB, Hinds 2nd PW, Hanson JM, Uno H, Pauza CD. Whole body positron emission tomography imaging of simian immunodeficiency virus-infected rhesus macaques. Proc Natl Acad Sei USA 1996; 93: 6425-30.
86 Schauwecker DS. Osteomyelitis: Diagnosis with in-l 11-labeled leucocytes. Radiology 1989; 171: 141-6.
87 Schauwecker DS. The scintigraphic diagnosis of osteomyelitis. AJR 1992; 158: 9-18.
88 Schmidt KG, Rasmussen JW, Sørensen PG, Wedebye IM. Indium-Ill Granulocyte Scintigraphy in the Evaluation of Patients with Fever of Undetermined Origin. Scand J Infect Dis 1987; 19: 339-45.
89 Schulthess GK, Stumpe KDM, Engel-Bicik I. (b). Clinical PET imaging of inflammatory diseases. In: Clinical positron emission tomography (PET). Schulthess GK. (Ed.) Lippincott Williams&Wilkins; Philadelphia: 2000: S229-48.
90 Segarra I, Roca M, Baliellas C, Vilar L, Ricart Y, Mora J, Puchal R, Martin-Comin J. Granu-locyte-specific monoclonal antibody techneti-um-99m-BW 250/183 and indium-Ill oxine-labeled leucocyte scintigraphy in inflammatory bowel disease. Eur J Nucl Med 1991; 18: 715-9.
91 Shepherd PR, Kahn BB. Glucose transporters and insulin action: Implications for insulin resistance and diabetes mellitus. N Engl J Med 1999; 341: 248-57.
92 Smith JW. Southwestern Internal Medicine Conference: fever of undetermined origin: not what it used to be. Am J Med Sei 1986; 292: 56-64.
93 Sokoloff L, Reivich M, Kennedy C. et al. The (14C) deoxyglucose method for the measurement of local cerebral glucose utilisation: Theory, procedure and normal values in the conscious and anesthetized albino rat. J Neurochem 1977; 28: 897-916.
94 Su TS, Tsai TF, Chi CW, Han SH, Chou CK. Elevation of facilitated glucose-transporter messenger RNA in human hepatocellular carcinoma. Hepatology 1990; 11: 118-22.
95 Suga K, Nakagi K, Kuramitsu T, Itou K, Tanaka N, Uchisato H, Nakanishi T, Utsumi H, Yamada N. The role of gallium-67 imaging in the detection of foci in recent cases of fever of unknown origin. Ann Nucl Med 1991; 5: 35-40.
96 Syrjälä MT, Valtonen V, Liewendahl K, Myllylä G. Diagnostic significance of Indium-Ill granulocyte Scintigraphy in Febrile Patients. J Nucl Med 1987; 28: 155-60.
97 Tahara T, Ichiya Y, Kuwabara Y, Otsuka M, Miyake Y, Gunasekera R, Masuda K. High [18F]-fluorodeoxyglucose uptake in abdominal abscesses: a PET study. J Comput Assist Tomogr 1989; 13: 829-31.
98 Teates CD, Hunter JG. Gallium scanning as a screening test for inflammatory lesions. Radiology 1975; 116: 383-7.
99 Tudor GR, Finlay DB, Belton I. The value of indium-ill-labelled leucocyte imaging and ultrasonography in the investigation of pyrexia of unknown origin. Br J Radiol 1997; 70: 918-22.
100 Tzen KY, Oster ZH, Wagner Jr HN, Tsan MF. Role of ironbinding proteins and enhanced capillary permeability on the accumulation of gallium-67. J Nucl Med 1980; 21: 31-5.
101 Waki A, Kato H, Yano R, Sadato N, Yokoyama A, Ishii Y, Yonekura Y, Fujibayashi Y. The importance of glucose transport activity as the rate-limiting step of 2-deoxyglucose uptake in tumor cells in vitro. Nucl Med Biol 1998; 25: 593-7.
102 Warburg O. The metabolism of tumors. New York: Richard R Smith,; 1931
103 Weiner RE, Thakur ML. Imaging infection/inflammations. Q J Nucl Med 1999; 43: 2-8.
104 Weisdorf DJ, Craddock PR, Jacos HS. Glyco-genolysis versus glucose transport in human granulocytes: differential activation in phagocytosis and Chemotaxis. Blood 1982; 60: 888-93.
105 Winckelmann G. Diagnostisches Vorgehen bei Fieber unbekannter Ursache. Dtsch med Wschr 1989; 114: 103-6.
106 Wörmann B, van de Loo J. Fieber, Gewichtsverlust und seltene Paraneoplasien. Internist 1990; 31: 532-7.
107 Yamada S, Kubota K, Kubota R, Ido T, Tamahashi N. High accumulation of fluorine-18-fluorodeoxyclucose in turpentine-induced inflammatory tissue. J Nucl Med 1995; 36: 1301-6.
108 Younes M, Brown RW, Mody DR, Fernandez L, Laucirica R. GLUTI expression in human breast carcinoma: correlation with known prognostic markers. Anticancer Res 1995; 15: 2895-8.