[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-studies-list:{\"conditionNormalized\":\"pyrexia\",\"overallStatus\":[\"RECRUITING\",\"AVAILABLE\",\"NOT_YET_RECRUITING\"],\"orderBy\":\"LastUpdateSubmitDate:desc\",\"size\":25,\"offset\":0}":3,"health-study-condition:pyrexia":27},{"pageToken":4,"total":5,"offset":6,"count":5,"results":7},null,1,0,[8],{"id":9,"slug":10,"hasResults":11,"nctId":12,"briefTitle":13,"officialTitle":14,"acronym":15,"eligibilityCriteria":16,"healthyVolunteers":11,"sex":17,"minAge":18,"maxAge":4,"enrollmentInfo":19,"targetDuration":4,"studyType":22,"phases":23,"briefSummary":25,"conditions":26,"keywords":28,"overallStatus":32,"whyStopped":4,"lastUpdateSubmitDate":33,"lastUpdatePostDateStruct":34,"startDateStruct":37,"completionDateStruct":39,"leadSponsor":41,"locationsCount":5},"100655902","comparison-of-fdg-petct-and-cect-cap-as-upfront-imaging-modality-for-the-diagnosis-of-pyrexia-of-unknown-origin-100655902",false,"NCT07816783","Comparison of FDG-PET\u002FCT and CECT-CAP as Upfront Imaging Modality for the Diagnosis of Pyrexia of Unknown Origin","Comparison of FDG-PET\u002FCT and CECT-CAP as Upfront Imaging Modality for the Diagnosis of Pyrexia of Unknown Origin : A Prospective Observational Study","CET-PET-PUO","Inclusion Criteria:\n\n* Age \\> 18 years\n* irrespective of gender.\n* Fever ≥38.3°C documented on ≥2 occasions AND duration ≥3 weeks or inpatient fever ≥1 week without diagnosis despite routine evaluation.\n* Routine investigations to be done before labelling PUO: Full history \\& examination, CBC, ESR\u002FCRP, LFTs, RFTs, blood and urine cultures, urinalysis, ANA, RF, chest X-ray, abdominal ultrasound\n\nExclusion Criteria:\n\n* Pregnancy.\n* Known case of immunosuppression\n* Contraindication or allergy to iodinated IV contrast (for CECT-CAP arm) that cannot be corrected\n* Prior FDG PET\u002FCT or CECT-CAP performed prior to randomization for the current febrile illness that would preclude randomization","ALL","18 Years",{"count":20,"type":21},132,"ESTIMATED","INTERVENTIONAL",[24],"NA","Pyrexia of unknown origin (PUO) remains one of the most challenging diagnostic problems in modern medicine. Despite advances in laboratory diagnostics, microbiological techniques, imaging modalities, and molecular testing, a significant proportion of patients continue to undergo multiple, prolonged, expensive, and often invasive evaluations before a definitive diagnosis is established. PUO is classically defined as fever ≥38.3°C documented on ≥2 occasions AND duration ≥3 weeks or inpatient fever ≥1 week without diagnosis despite routine evaluation.\n\nThe etiological spectrum of PUO is broad and heterogeneous. Causes are traditionally grouped into infections, malignancies, non-infectious inflammatory diseases, miscellaneous causes, and undiagnosed cases. Despite systematic evaluation, a definitive diagnosis is not achieved in a substantial proportion of patients, often ranging from 30-50% even in tertiary care centers. This persistent diagnostic uncertainty highlights the need for effective diagnostic strategies that can identify occult disease early and guide targeted investigations.\n\nImaging plays a pivotal role once baseline routine investigations fail to establish a diagnosis. Conventional contrast-enhanced computed tomography (CECT) of the chest, abdomen, and pelvis is frequently used due to its wide availability and ability to detect structural abnormalities such as abscesses, masses, and lymphadenopathy. However, CECT relies on anatomical changes and may fail to identify early inflammatory or infiltrative disease that lacks overt structural distortion.\n\nIn contrast, nuclear medicine modalities enable the identification of pathological processes at the cellular and molecular level. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) exploits abnormal glucose metabolism in inflammatory, infectious, and malignant tissues. When combined with PET\u002FCT, it enables precise anatomical localization of metabolically active lesions. Numerous studies have shown that FDG PET\u002FCT is valuable in the evaluation of PUO, especially when standard imaging modalities fail to yield a diagnosis.\n\nIn a retrospective study, FDG-PET\u002FCT outperformed CECT-CAP for definite diagnosis of PUO with markedly higher localisation (92.2 vs. 51.5 %; p = 0.003). In a comparative multicentre prospective study FDG PET\u002FCT demonstrated significantly superior diagnostic orientation (28.2% vs. 7.8%, p \\\u003C 0.001) and diagnostic contribution (19.4% vs. 5.8%, p \\\u003C 0.001) compared with CECT-CAP, and was associated with a markedly shorter time to definitive diagnosis (3.8 vs. 17.6 months, p = 0.02). However in these studies same patient underwent both FDG-PET\u002FCT and CECT-CAP. In a systematic review, meta-analysis FDG PET\u002FCT had pooled diagnostic yield of 56% and diagnostic yield beyond conventional CT at 32%. However another systematic review\u002Fmeta-analysis similarly reported a higher contributory effect of FDG-PET\u002FCT compared to Total Body CT (75.4% vs 68%,P = .39) for final diagnosis of PUO although it was not statistically significant. However both studies included data from retrospective studies.\n\nCurrent clinical practice varies with respect to the timing and sequencing of FDG PET\u002FCT and Conventional CECT in PUO evaluation. FDG PET\u002FCT is often used as a second-line investigation after CECT-CAP or when CECT-CAP is inconclusive; however, growing evidence suggests that early use of FDG PET\u002FCT may offer superior diagnostic yield and reduce diagnostic delay. However clear evidence from randomized controlled trials comparing FDG PET\u002FCT and CECT-CAP as upfront investigations is lacking. This uncertainty forms the basis of clinical equipoise and provides the rationale for the present study. In this study investigators will evaluate and compare the diagnostic localization and diagnostic yield of FDG PET\u002FCT over CECT-CAP for etiological diagnosis of PUO.",[27],"Pyrexia",[29,30,31],"Pyrexia of unknown origin (PUO)","contrast-enhanced computed tomography (CECT)","18F-fluorodeoxyglucose positron emission tomography (FDG-PET)","RECRUITING","2026-09-30",{"date":35,"type":36},"2026-10-05","ACTUAL",{"date":38,"type":36},"2026-04-09",{"date":40,"type":21},"2027-06-30",{"name":42,"class":43},"Post Graduate Institute of Medical Education and Research, Chandigarh","OTHER"]