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October 13, 2022

J15 A/B MAC Contractor Advisory Committee (CAC) Meeting Regarding Pet Scans for Inflammation and Infection – Evidence Review Questions and Articles

The article list is limited to higher quality studies available (SR/MA/RCT/larger prospective studies) 2014-current. It is not comprehensive and additional literature will be reviewed and considered if LCD is pursued. Additional references welcomed from panelist as well.

Fever of Unknown Origin (FUO)

Do you agree that fever of unknown origin is defined as a temperature higher than 38.3 degrees C (100.9 degrees F) lasting greater than three weeks with no obvious source despite proper investigation?

If no- what would you change in definition?
What is the diagnostic accuracy for PET scans for FUO? How concerned are you about false positive and negative rates? What conditions may interfere with accurate results of PET scans?
There is several SR/MA that shows that PET scans can help identify the source in fever of unknown origin- how do you rate the quality of this evidence? What limitations exist and does it impact conclusions? Any additional literature to add- especially RCTs or head-to-head comparisons?
What is standard imaging performed for fever of unknown origin? Does the evidence show any benefit to of PET scan over current standard of care imaging for FUO? Is PET scan part of any standard of care algorithms and if not, why is it excluded?
Is there evidence to demonstrate that PET scan for inflammation improves patient outcomes in cases of FUO? Is there potential harm to use of PET scans for FUO?
Are there situations that pet scan may be the only diagnostic study that can detect this condition? Why or why not?

Articles[1-6]

Cardiac Conditions

What do you rate the quality of evidence for the role of pet scan in the diagnosis of infective endocarditis?
What is the quality of evidence for the role of pet scan in the diagnosis of cardiac sarcoidosis?
What is the quality of evidence for the role of pet scan in the diagnosis of infection of cardiovascular implantable electronic devices infections (CIED) such as ICD or pacemakers?
Is there evidence that pet scan is beneficial over current standard of care imaging?
What limitations must be considered? What conditions may interfere with accurate results of PET scans?
Are there situations that pet scan may be the only diagnostic study that can detect this condition? Why or why not?

Articles[7-13]

Hip Arthroplasty

How do you rate the quality of evidence for a role of pet scan for diagnosis of prosthetic infection after arthroplasty?
How does this compare to standard of care diagnostic modalities? What is your preferred test for potential prosthetic infections and why?
Are there situations that pet scan may be the only diagnostic study that can detect this condition? Why or why not?
How long does somebody need to wait after surgery before considering a pet scan? What other procedures or conditions may interfere with pet scan results?

Articles [14-18]

Chronic Osteomyelitis

What do you rate the quality of evidence for the role of pet scan in the diagnosis of chronic osteomyelitis?
Is there evidence that this is beneficial over current standard of care imaging?
What limitations must be considered? What conditions may interfere with accurate results of PET scans?
Are there situations that pet scan may be the only diagnostic study that can detect this condition? Why or why not?

Articles [19, 20]

General

Are the additional conditions of inflammation and infection in which there is evidence to support a role of PET scan? If yes, please provide references.
1. Takeuchi, M., et al., Association of 18F-FDG PET or PET/CT results with spontaneous remission in classic fever of unknown origin: A systematic review and meta-analysis. Medicine, 2018. 97(43): p. e12909.
2. Takeuchi, M., et al., Nuclear Imaging for Classic Fever of Unknown Origin: Meta-Analysis. Journal of nuclear medicine: official publication, Society of Nuclear Medicine, 2016. 57(12): p. 1913-1919.
3. Kan, Y., et al., Contribution of 18F-FDG PET/CT in a case-mix of fever of unknown origin and inflammation of unknown origin: a meta-analysis. Acta radiologica (Stockholm, Sweden: 1987), 2019. 60(6): p. 716-725.
4. Bharucha, T., et al., Diagnostic yield of FDG-PET/CT in fever of unknown origin: a systematic review, meta-analysis, and Delphi exercise. Clin Radiol, 2017. 72(9): p. 764-771.
5. Besson, F.L., et al., Contribution of (18)F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis. European journal of nuclear medicine and molecular imaging, 2016. 43(10): p. 1887-95.
6. Pijl, J.P., et al., Limitations and Pitfalls of FDG-PET/CT in Infection and Inflammation. Semin Nucl Med, 2021. 51(6): p. 633-645.
7. Yan, J., et al., The role of 18F-FDG PET/CT in infectious endocarditis: a systematic review and meta-analysis. Int J Clin Pharmacol Ther, 2016. 54(5): p. 337-42.
8. Otto, C.M., et al., 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021. 143(5): p. e72-e227.
9. Juneau, D., et al., Positron Emission Tomography and Single-Photon Emission Computed Tomography Imaging in the Diagnosis of Cardiac Implantable Electronic Device Infection: A Systematic Review and Meta-Analysis. Circulation Cardiovascular imaging, 2017. 10(4).
10. Juneau, D., et al., Molecular Imaging for the diagnosis of infective endocarditis: A systematic literature review and meta-analysis. Int J Cardiol, 2018. 253: p. 183-188.
11. Habib, G., et al., 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015. 36(44): p. 3075-3128.
12. Albano, D., et al., Meta-Analysis of the Diagnostic Performance of (18)F-FDG-PET/CT Imaging in Native Valve Endocarditis. JACC Cardiovasc Imaging, 2021. 14(5): p. 1063-1065.
13. Aitken, M., et al., Diagnostic Accuracy of Cardiac MRI versus FDG PET for Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology, 2022. 304(3): p. 566-579.
14. Verberne, S.J., P.G. Raijmakers, and O.P. Temmerman, The Accuracy of Imaging Techniques in the Assessment of Periprosthetic Hip Infection: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am, 2016. 98(19): p. 1638-1645.
15. Tubb, C.C., G.G. Polkowksi, and B. Krause, Diagnosis and Prevention of Periprosthetic Joint Infections. J Am Acad Orthop Surg, 2020. 28(8): p. e340-e348.
16. Signore, A., et al., Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging, 2019. 46(4): p. 971-988.
17. Jin, H., et al., Diagnostic performance of FDG PET or PET/CT in prosthetic infection after arthroplasty: a meta-analysis. The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of, 2014. 58(1): p. 85-93.
18. Basu, S., et al., FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clin Nucl Med, 2014. 39(7): p. 609-15.
19. Llewellyn, A., et al., Imaging for detection of osteomyelitis in people with diabetic foot ulcers: A systematic review and meta-analysis. Eur J Radiol, 2020. 131: p. 109215.
20. Lauri, C., et al., Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET. Diabetes care, 2017. 40(8): p. 1111-1120.