Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin.

Jelle L G Haitsma Mulier; Bram van Leer; Joanne J Beijer-Verduin; Harm-Jan S de Grooth; Jules Lavalaye; Peter G Noordzij; Nena Pater; Stefan E Pool; Thijs C D Rettig; Cornelis P van Stee; Janesh Pillay; Hans Balink; Olaf L Cremer; Arthur J A T Braat; Lennie P G Derde

doi:10.1186/s13054-026-06005-w

Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin.

Jelle L G Haitsma Mulier
, Bram van Leer
, Joanne J Beijer-Verduin
, Harm-Jan S de Grooth
, Jules Lavalaye
, Peter G Noordzij
, Nena Pater
, Stefan E Pool
, Thijs C D Rettig
, Cornelis P van Stee
, Janesh Pillay
, Hans Balink
, Olaf L Cremer
, Arthur J A T Braat
, Lennie P G Derde

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background
[18F]-fluorodeoxyglucose Positron Emission Tomography combined with Computed Tomography ([18F]FDG PET/CT) is widely used to detect focal inflammation. However, its diagnostic performance and utility in the ICU remain unclear. We aimed to identify factors influencing diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation.

Methods
We retrospectively evaluated [18F]FDG PET/CT scans performed in adult ICU patients across four Dutch hospitals (2013–2023). The primary endpoint was diagnostic yield: new conclusive diagnoses and/or therapy changes within 72 h. Secondary endpoints were scan quality and adequacy of myocardial suppression. Logistic regression was used to identify determinants of each endpoint.

Results
We analyzed 169 scans for 162 clinical indications in 151 patients. A conclusive diagnosis was established for 109 indications (67%), including 79 new diagnoses (49%), most frequently involving the musculoskeletal system (n = 39; 24%) and the respiratory tract (n = 31; 19%). [18F]FDG PET/CT prompted a therapy change in 70 indications (43%). Diabetes (aOR 0.35 [95% CI: 0.15–0.80]) and partial-body imaging versus total-body imaging (aOR 0.48 [CI 0.24–0.99]) were associated with fewer new diagnoses. A longer pre-scan ICU stay predicted therapy change (aOR 1.03 [1.01–1.05]). Higher BMI (aOR 1.08 [1.00–1.17]) and lower serum creatinine (log-transformed aOR 0.36 [0.20–0.68]) were associated with improved scan quality. Male sex (aOR 0.45 [0.21–0.96]) and pre-scan unfractionated heparin (aOR 0.43 [0.19–0.98]) were associated with suboptimal myocardial suppression.

Conclusions
[18F]FDG PET/CT has a high diagnostic yield in critically ill patients. Diagnostic yield, scan quality and myocardial suppression are influenced by patient characteristics and preparation. Optimizing these factors may further enhance its utility in the ICU.

Original language	English
Article number	256
Journal	Critical care (London, England)
Volume	30
Issue number	1
Early online date	10 Apr 2026
DOIs	https://doi.org/10.1186/s13054-026-06005-w
Publication status	Published - 2026

Keywords

Diagnostic yield
ICU
Infection of unknown origin
Preparation
[18F]FDG PET/CT

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Haitsma Mulier, J. L. G., van Leer, B., Beijer-Verduin, J. J., de Grooth, H.-J. S., Lavalaye, J., Noordzij, P. G., Pater, N., Pool, S. E., Rettig, T. C. D., van Stee, C. P., Pillay, J., Balink, H., Cremer, O. L., Braat, A. J. A. T., & Derde, L. P. G. (2026). Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin. Critical care (London, England), 30(1), Article 256. https://doi.org/10.1186/s13054-026-06005-w

@article{c8ba141a1f1348e18e94afda22473562,

title = "Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin.",

abstract = "Background [18F]-fluorodeoxyglucose Positron Emission Tomography combined with Computed Tomography ([18F]FDG PET/CT) is widely used to detect focal inflammation. However, its diagnostic performance and utility in the ICU remain unclear. We aimed to identify factors influencing diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation. Methods We retrospectively evaluated [18F]FDG PET/CT scans performed in adult ICU patients across four Dutch hospitals (2013{\textendash}2023). The primary endpoint was diagnostic yield: new conclusive diagnoses and/or therapy changes within 72 h. Secondary endpoints were scan quality and adequacy of myocardial suppression. Logistic regression was used to identify determinants of each endpoint. Results We analyzed 169 scans for 162 clinical indications in 151 patients. A conclusive diagnosis was established for 109 indications (67\%), including 79 new diagnoses (49\%), most frequently involving the musculoskeletal system (n = 39; 24\%) and the respiratory tract (n = 31; 19\%). [18F]FDG PET/CT prompted a therapy change in 70 indications (43\%). Diabetes (aOR 0.35 [95\% CI: 0.15{\textendash}0.80]) and partial-body imaging versus total-body imaging (aOR 0.48 [CI 0.24{\textendash}0.99]) were associated with fewer new diagnoses. A longer pre-scan ICU stay predicted therapy change (aOR 1.03 [1.01{\textendash}1.05]). Higher BMI (aOR 1.08 [1.00{\textendash}1.17]) and lower serum creatinine (log-transformed aOR 0.36 [0.20{\textendash}0.68]) were associated with improved scan quality. Male sex (aOR 0.45 [0.21{\textendash}0.96]) and pre-scan unfractionated heparin (aOR 0.43 [0.19{\textendash}0.98]) were associated with suboptimal myocardial suppression. Conclusions [18F]FDG PET/CT has a high diagnostic yield in critically ill patients. Diagnostic yield, scan quality and myocardial suppression are influenced by patient characteristics and preparation. Optimizing these factors may further enhance its utility in the ICU.",

keywords = "Diagnostic yield, ICU, Infection of unknown origin, Preparation, [18F]FDG PET/CT",

author = "\{Haitsma Mulier\}, \{Jelle L G\} and \{van Leer\}, Bram and Beijer-Verduin, \{Joanne J\} and \{de Grooth\}, \{Harm-Jan S\} and Jules Lavalaye and Noordzij, \{Peter G\} and Nena Pater and Pool, \{Stefan E\} and Rettig, \{Thijs C D\} and \{van Stee\}, \{Cornelis P\} and Janesh Pillay and Hans Balink and Cremer, \{Olaf L\} and Braat, \{Arthur J A T\} and Derde, \{Lennie P G\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

year = "2026",

doi = "10.1186/s13054-026-06005-w",

language = "English",

volume = "30",

journal = "Critical care (London, England)",

issn = "1466-609X",

publisher = "Springer Science + Business Media",

number = "1",

}

Haitsma Mulier, JLG, van Leer, B, Beijer-Verduin, JJ, de Grooth, H-JS, Lavalaye, J, Noordzij, PG, Pater, N, Pool, SE, Rettig, TCD, van Stee, CP, Pillay, J, Balink, H, Cremer, OL , Braat, AJAT & Derde, LPG 2026, 'Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin.', Critical care (London, England), vol. 30, no. 1, 256. https://doi.org/10.1186/s13054-026-06005-w

Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin. / Haitsma Mulier, Jelle L G; van Leer, Bram; Beijer-Verduin, Joanne J et al.
In: Critical care (London, England), Vol. 30, No. 1, 256, 2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin.

AU - Haitsma Mulier, Jelle L G

AU - van Leer, Bram

AU - Beijer-Verduin, Joanne J

AU - de Grooth, Harm-Jan S

AU - Lavalaye, Jules

AU - Noordzij, Peter G

AU - Pater, Nena

AU - Pool, Stefan E

AU - Rettig, Thijs C D

AU - van Stee, Cornelis P

AU - Pillay, Janesh

AU - Balink, Hans

AU - Cremer, Olaf L

AU - Braat, Arthur J A T

AU - Derde, Lennie P G

PY - 2026

Y1 - 2026

N2 - Background [18F]-fluorodeoxyglucose Positron Emission Tomography combined with Computed Tomography ([18F]FDG PET/CT) is widely used to detect focal inflammation. However, its diagnostic performance and utility in the ICU remain unclear. We aimed to identify factors influencing diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation. Methods We retrospectively evaluated [18F]FDG PET/CT scans performed in adult ICU patients across four Dutch hospitals (2013–2023). The primary endpoint was diagnostic yield: new conclusive diagnoses and/or therapy changes within 72 h. Secondary endpoints were scan quality and adequacy of myocardial suppression. Logistic regression was used to identify determinants of each endpoint. Results We analyzed 169 scans for 162 clinical indications in 151 patients. A conclusive diagnosis was established for 109 indications (67%), including 79 new diagnoses (49%), most frequently involving the musculoskeletal system (n = 39; 24%) and the respiratory tract (n = 31; 19%). [18F]FDG PET/CT prompted a therapy change in 70 indications (43%). Diabetes (aOR 0.35 [95% CI: 0.15–0.80]) and partial-body imaging versus total-body imaging (aOR 0.48 [CI 0.24–0.99]) were associated with fewer new diagnoses. A longer pre-scan ICU stay predicted therapy change (aOR 1.03 [1.01–1.05]). Higher BMI (aOR 1.08 [1.00–1.17]) and lower serum creatinine (log-transformed aOR 0.36 [0.20–0.68]) were associated with improved scan quality. Male sex (aOR 0.45 [0.21–0.96]) and pre-scan unfractionated heparin (aOR 0.43 [0.19–0.98]) were associated with suboptimal myocardial suppression. Conclusions [18F]FDG PET/CT has a high diagnostic yield in critically ill patients. Diagnostic yield, scan quality and myocardial suppression are influenced by patient characteristics and preparation. Optimizing these factors may further enhance its utility in the ICU.

AB - Background [18F]-fluorodeoxyglucose Positron Emission Tomography combined with Computed Tomography ([18F]FDG PET/CT) is widely used to detect focal inflammation. However, its diagnostic performance and utility in the ICU remain unclear. We aimed to identify factors influencing diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation. Methods We retrospectively evaluated [18F]FDG PET/CT scans performed in adult ICU patients across four Dutch hospitals (2013–2023). The primary endpoint was diagnostic yield: new conclusive diagnoses and/or therapy changes within 72 h. Secondary endpoints were scan quality and adequacy of myocardial suppression. Logistic regression was used to identify determinants of each endpoint. Results We analyzed 169 scans for 162 clinical indications in 151 patients. A conclusive diagnosis was established for 109 indications (67%), including 79 new diagnoses (49%), most frequently involving the musculoskeletal system (n = 39; 24%) and the respiratory tract (n = 31; 19%). [18F]FDG PET/CT prompted a therapy change in 70 indications (43%). Diabetes (aOR 0.35 [95% CI: 0.15–0.80]) and partial-body imaging versus total-body imaging (aOR 0.48 [CI 0.24–0.99]) were associated with fewer new diagnoses. A longer pre-scan ICU stay predicted therapy change (aOR 1.03 [1.01–1.05]). Higher BMI (aOR 1.08 [1.00–1.17]) and lower serum creatinine (log-transformed aOR 0.36 [0.20–0.68]) were associated with improved scan quality. Male sex (aOR 0.45 [0.21–0.96]) and pre-scan unfractionated heparin (aOR 0.43 [0.19–0.98]) were associated with suboptimal myocardial suppression. Conclusions [18F]FDG PET/CT has a high diagnostic yield in critically ill patients. Diagnostic yield, scan quality and myocardial suppression are influenced by patient characteristics and preparation. Optimizing these factors may further enhance its utility in the ICU.

KW - Diagnostic yield

KW - ICU

KW - Infection of unknown origin

KW - Preparation

KW - [18F]FDG PET/CT

U2 - 10.1186/s13054-026-06005-w

DO - 10.1186/s13054-026-06005-w

M3 - Article

C2 - 41957791

SN - 1466-609X

VL - 30

JO - Critical care (London, England)

JF - Critical care (London, England)

IS - 1

M1 - 256

ER -

Determinants of diagnostic yield and scan quality of [18F]FDG PET/CT in critically ill patients suspected of infection or inflammation of unknown origin.

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Keywords

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