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Joosten L, Boss M, Jansen T, Brom M, Buitinga M, Aarntzen E, Eriksson O, Johansson L, de Galan B, Gotthardt M. Molecular Imaging of Diabetes. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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152
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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153
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Ordoñez AA, Jain SK. Imaging of Bacterial Infections. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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154
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Longhitano A, Alipour R, Khot A, Bajel A, Antippa P, Slavin M, Thursky K. The role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in assessment of complex invasive fungal disease and opportunistic co-infections in patients with acute leukemia prior to allogeneic hematopoietic cell transplant. Transpl Infect Dis 2020; 23:e13547. [PMID: 33338319 DOI: 10.1111/tid.13547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Individuals diagnosed with acute lymphoid and myeloid malignancies are at significant risk of invasive fungal and bacterial infections secondary to their marked immunocompromised states with a significant high risk of mortality. The role of metabolic imaging with 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography (PET/CT) has been increasingly recognized in optimizing the diagnosis of invasive infection, monitoring the response to therapy and guiding the duration of antimicrobial therapy or need to escalate to surgical intervention. METHODS Two distinct cases of pulmonary co-infection of rare fungal and bacterial pathogens are explored in severely immunocompromised individuals where FDG PET/CT aided both patients to make a full recovery and transition to HCT. The first case explores mixed Scedosporium apiospermum and Rhizomucor pulmonary infection on a background of T cell/myeloid mixed phenotype acute leukemia ultimately warranting long-term antifungal therapy and lobectomy prior to HCT. The second case explores Fusarium and Nocardia pulmonary infection on a background of relapsed AML also warranting surgical resection with lobectomy and long-term antimicrobials prior to transition to HCT. DISCUSSION The cases highlight the utility of FDG PET/CT to support the diagnosis of infections, including the presence or absence of disseminated infection, and to provide highly sensitive monitoring of the infection over time. FDG PET/CT played a key role in directing therapy duration decisions and prompted the necessity for surgical intervention. Ultimately, the use of FDG PET/CT allowed for a successful transition to HCT highlighting its value in this clinical setting. CONCLUSION FDG PET/CT has an emerging role in the diagnostic and monitoring pathway for complex infections in high-risk immunocompromised patients.
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Affiliation(s)
- Anthony Longhitano
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Ramin Alipour
- Sir Peter MacCallum Department of Oncology, University of Melbourne Parkville, Melbourne, Vic., Australia.,Department of Molecular Imaging and Therapeutic Nuclear Medicine, Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Ashish Bajel
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Vic., Australia.,Lung Cancer Service, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne Parkville, Melbourne, Vic., Australia.,National Centre for Infection in Cancer, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Karin Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,National Centre for Antimicrobial Stewardship (NCAS), The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Parkville, Vic., Australia
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155
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Kawakami M, Hirata K, Furuya S, Kobayashi K, Sugimori H, Magota K, Katoh C. Development of Combination Methods for Detecting Malignant Uptakes Based on Physiological Uptake Detection Using Object Detection With PET-CT MIP Images. Front Med (Lausanne) 2020; 7:616746. [PMID: 33425962 PMCID: PMC7785870 DOI: 10.3389/fmed.2020.616746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/04/2020] [Indexed: 12/02/2022] Open
Abstract
Deep learning technology is now used for medical imaging. YOLOv2 is an object detection model using deep learning. Here, we applied YOLOv2 to FDG-PET images to detect the physiological uptake on the images. We also investigated the detection precision of abnormal uptake by a combined technique with YOLOv2. Using 3,500 maximum intensity projection (MIP) images of 500 cases of whole-body FDG-PET examinations, we manually drew rectangular regions of interest with the size of each physiological uptake to create a dataset. Using YOLOv2, we performed image training as transfer learning by initial weight. We evaluated YOLOv2's physiological uptake detection by determining the intersection over union (IoU), average precision (AP), mean average precision (mAP), and frames per second (FPS). We also developed a combination method for detecting abnormal uptake by subtracting the YOLOv2-detected physiological uptake. We calculated the coverage rate, false-positive rate, and false-negative rate by comparing the combination method-generated color map with the abnormal findings identified by experienced radiologists. The APs for physiological uptakes were: brain, 0.993; liver, 0.913; and bladder, 0.879. The mAP was 0.831 for all classes with the IoU threshold value 0.5. Each subset's average FPS was 31.60 ± 4.66. The combination method's coverage rate, false-positive rate, and false-negative rate for detecting abnormal uptake were 0.9205 ± 0.0312, 0.3704 ± 0.0213, and 0.1000 ± 0.0774, respectively. The physiological uptake of FDG-PET on MIP images was quickly and precisely detected using YOLOv2. The combination method, which can be utilized the characteristics of the detector by YOLOv2, detected the radiologist-identified abnormalities with a high coverage rate. The detectability and fast response would thus be useful as a diagnostic tool.
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Affiliation(s)
- Masashi Kawakami
- Graduate School of Biomedical Science and Engineering, Hokkaido University, Sapporo, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sho Furuya
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kentaro Kobayashi
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Keiichi Magota
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Chietsugu Katoh
- Graduate School of Biomedical Science and Engineering, Hokkaido University, Sapporo, Japan.,Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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156
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Diagnostic Value of Structural and Functional Neuroimaging in Autoimmune Epilepsy. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:8894213. [PMID: 33380947 PMCID: PMC7752299 DOI: 10.1155/2020/8894213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/14/2020] [Accepted: 12/02/2020] [Indexed: 01/15/2023]
Abstract
Epilepsy is a common nervous system disease, which affects about 70 million people all over the world. In 2017, the International League Against Epilepsy (ILAE) considered immune factors as its independent cause, and the concept of autoimmune epilepsy (AE) was widely accepted. Early diagnosis and timely treatment can effectively improve the prognosis of the disease. However, due to the diversity of clinical manifestations, the expensive cost of autoantibody detection, and the increased prevalence in Western China, the difficulty for clinicians in early diagnosis and treatment has increased. Fortunately, convenient and fast imaging examinations are expected to help even more. The imaging manifestations of AE patients were characteristic, especially the combined application of structural and functional neuroimaging, which improved the diagnostic value of imaging. In this paper, several common autoantibodies associated with AE and their structure and function changes in neuroimaging were reviewed to provide help for neurologists to achieve the goal of precision medicine.
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157
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Patient Preparation and Patient-related Challenges with FDG-PET/CT in Infectious and Inflammatory Disease. PET Clin 2020; 15:125-134. [PMID: 32145883 DOI: 10.1016/j.cpet.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several factors that influence physiologic 18F-fluorodeoxyglucose (FDG) uptake and general FDG distribution may affect PET/CT imaging in infection and inflammation. The general impact of hyperglycemia on the diagnostic performance of FDG-PET/CT is probably less in infection/inflammation than in malignancy. Patient preparation may reduce physiologic FDG uptake, but recommendations are less established than in malignancy. Local implementation of various patient preparatory measures should reflect the specific patient population and indications. This article outlines some of the challenges with physiologic FDG distribution, focusing on infectious and inflammatory diseases, and potential countermeasures and patient preparation to limit physiologic uptake before scan.
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158
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Tavakoli S. Promises and Challenges of Metabolic Imaging: Where Does 18F-FDG Stand in the Immunometabolism Era? J Nucl Med 2020; 61:130S-131S. [PMID: 33293434 DOI: 10.2967/jnumed.120.251744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Sina Tavakoli
- Department of Radiology, University of Pittsburgh, and Heart, Lung, Blood, and Vascular Medicine Institute, UPMC Department of Medicine, Pittsburgh, Pennsylvania
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159
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Peripheral Photopenia on Whole-Body PET/CT Imaging With 18F-FDG in Patients With Compartment Syndrome and Mesenteric Venous Thrombosis. Clin Nucl Med 2020; 45:1007-1009. [PMID: 33031238 DOI: 10.1097/rlu.0000000000003315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We present 2 cases that demonstrate photopenia in peripheral areas on whole-body PET/CT imaging with F-FDG as a sign of absent perfusion with severe short-term complications. The scan of the first patient shows photopenia in the right ankle and foot, resulting from compartment syndrome, caused by hemolytic group A streptococcus bacteremia with endocarditis and septic emboli, necessitating lower leg amputation. The scan of the second patient shows photopenia in the transverse colon, resulting from mesenteric venous thrombosis caused by polycythemia vera, leading to necrosis and perforation of the transverse colon, necessitating transverse and right hemicolectomy.
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160
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Emamifar A, Hess S, Ellingsen T, Due Kay S, Christian Bang J, Gerke O, Syrak Hansen P, Ahangarani Farahani Z, Petersen H, Marcussen N, Jensen Hansen IM, Thye Rønn P. Prevalence of Newly Diagnosed Malignancies in Patients with Polymyalgia Rheumatica and Giant Cell Arteritis, Comparison of 18F-FDG PET/CT Scan with Chest X-ray and Abdominal Ultrasound: Data from a 40 Week Prospective, Exploratory, Single Centre Study. J Clin Med 2020; 9:E3940. [PMID: 33291857 PMCID: PMC7762038 DOI: 10.3390/jcm9123940] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of the study was to identify the prevalence of newly diagnosed malignancies in patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), with the aid of 18F-FDG PET/CT scan compared to conventional imaging techniques: Chest X-ray (CXR) and abdominal ultrasound (US). Secondarily, to examine the relative diagnostic accuracy of these two imaging modalities for the detection of cancer. Eighty consecutive patients with newly diagnosed PMR, GCA, or concomitant PMR and GCA, were included and followed up for 40 weeks. All patients underwent an 18F-FDG PET/CT scan, CXR, and abdominal US at diagnosis. Imaging findings were dichotomously categorized into malignant or benign. Among 80 patients, three patients were diagnosed with seronegative rheumatoid arthritis and were excluded from the analysis. Of the remaining 77, 64 (83.1%) patients were diagnosed with pure PMR, 3 (3.9%) with pure GCA, and 10 (13.0%) with concomitant PMR and GCA. Five types of cancer that were more prevalent than the one-year prevalence of 1.2% among the background population were found in four (5.2%; 95%CI: 1.4-12.8%) patients. CXR/abdominal US could detect the solid cancer in one patient, whereas 18F-FDG PET/CT could identify all four solid cancers. Furthermore, four (5.2%; 95%CI: 1.4-12.8%) cases of monoclonal gammopathy of undetermined significance (MGUS) were found. An increase in C reactive protein (CRP) implicated an increased risk for cancer of 2.4% (OR: 1.024, 95%CI: 1.001-1.047; p = 0.041). 18F-FDG PET/CT can reveal occult cancers at an early stage with a high negative predictive value, and it is specifically beneficial in PMR/GCA patients with nonspecific symptoms.
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Affiliation(s)
- Amir Emamifar
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark; (H.P.); (P.T.R.)
- Diagnostic Center, Svendborg Hospital, OUH, 5700 Svendborg, Denmark;
- Department of Rheumatology, Svendborg Hospital, OUH, 5700 Svendborg, Denmark; (S.D.K.); (I.M.J.H.)
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, 6700 Esbjerg, Denmark;
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark;
| | - Susan Due Kay
- Department of Rheumatology, Svendborg Hospital, OUH, 5700 Svendborg, Denmark; (S.D.K.); (I.M.J.H.)
| | | | - Oke Gerke
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Per Syrak Hansen
- Diagnostic Center, Svendborg Hospital, OUH, 5700 Svendborg, Denmark;
| | | | - Henrik Petersen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark; (H.P.); (P.T.R.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark;
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, 5000 Odense, Denmark;
| | | | - Peter Thye Rønn
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5000 Odense, Denmark; (H.P.); (P.T.R.)
- Diagnostic Center, Svendborg Hospital, OUH, 5700 Svendborg, Denmark;
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161
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Paez D, Sathekge MM, Douis H, Giammarile F, Fatima S, Dhal A, Puri SK, Erba PA, Lazzeri E, Ferrando R, Filho PA, Magboo VP, Morozova O, Núñez R, Pellet O, Mariani G. Comparison of MRI, [ 18F]FDG PET/CT, and 99mTc-UBI 29-41 scintigraphy for postoperative spondylodiscitis-a prospective multicenter study. Eur J Nucl Med Mol Imaging 2020; 48:1864-1875. [PMID: 33210240 PMCID: PMC8113215 DOI: 10.1007/s00259-020-05109-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
Purpose Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [18F]FDG PET/CT, and SPECT/CT with 99mTc-UBI 29-41. Methods Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%). Results Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P < 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [18F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64–0.92) and 0.80 (95% CI: 0.64–0.98), respectively. SPECT/CT with 99mTc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [18F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80–1.00). Conclusion [18F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [18F]FDG PET/CT. The diagnostic performance of SPECT/CT with 99mTc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05109-x.
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Affiliation(s)
- Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Mike M Sathekge
- Nuclear Medicine Department, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - Hassan Douis
- University Hospital Birmigham, NHS Foundation Trust, Birmingham, UK
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria.
| | - Shazia Fatima
- Department of Nuclear Medicine, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Anil Dhal
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Sunil K Puri
- Department of Radiology, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Paola A Erba
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Elena Lazzeri
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Ferrando
- Ferrari Ferrando-Paez Nuclear Medicine Clinic and Uruguayan Center of Molecular Imaging (CUDIM), Montevideo, Uruguay
| | | | | | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Rodolfo Núñez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
- Excel Diagnostics and Nuclear Oncology Center, Houston, TX, USA
| | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Giuliano Mariani
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Vasculitis changes in COVID-19 survivors with persistent symptoms: an [ 18F]FDG-PET/CT study. Eur J Nucl Med Mol Imaging 2020; 48:1460-1466. [PMID: 33123760 PMCID: PMC7595761 DOI: 10.1007/s00259-020-05084-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/19/2020] [Indexed: 12/20/2022]
Abstract
Purpose Several patients experience unexplained persistent symptoms after SARS-CoV-2 recovering. We aimed at evaluating if 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) was able to demonstrate a persistent inflammatory process. Methods Recovered adult COVID-19 patients, who complained unexplained persisting symptoms for more than 30 days during the follow-up visits, were invited to participate in the study. Patients fulfilling inclusion criteria were imaged by [18F]FDG positron emission tomography/computed tomography ([18F]FDG-PET/CT). Whole-body [18F]FDG-PET/CT, performed according to good clinical practice, was qualitatively (comparison with background/liver) and semi-quantitatively (target-to-blood pool ratio calculated as average SUVmax artery/average SUVmean inferior vena cava) analyzed. Negative follow-up [18F]FDG-PET/CT images of oncologic patients matched for age/sex served as controls. Mann-Whitney test was used to test differences between groups. SPSS version 26 was used for analyses. Results Ten recovered SARS-CoV-2 patients (seven male and three females, median age 52 years, range 46–80) with persisting symptoms were enrolled in the study. Common findings at visual analysis were increased [18F]FDG uptake in bone marrow and blood vessels (8/10 and 6/10 cases, respectively). [18F]FDG uptake in bone marrow did not differ between cases and controls (p = 0.16). The total vascular score was similar in the two groups (p = 0.95). The target-to-blood pool ratio resulted higher in recovered SARS-CoV-2 patients than in controls. Conclusion Although the total vascular score was similar in the two groups, the target-to-blood pool ratio was significantly higher in three vascular regions (thoracic aorta, right iliac artery, and femoral arteries) in the recovered COVID-19 cohort than in controls, suggesting that SARS-CoV-2 induces vascular inflammation, which may be responsible for persisting symptoms.
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Slart RHJA, Glaudemans AWJM, Gheysens O, Lubberink M, Kero T, Dweck MR, Habib G, Gaemperli O, Saraste A, Gimelli A, Georgoulias P, Verberne HJ, Bucerius J, Rischpler C, Hyafil F, Erba PA. Procedural recommendations of cardiac PET/CT imaging: standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM. Eur J Nucl Med Mol Imaging 2020; 48:1016-1039. [PMID: 33106926 PMCID: PMC8041672 DOI: 10.1007/s00259-020-05066-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 01/18/2023]
Abstract
With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [18F]FDG, but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicenter trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Finally, PET/MR applications in 4Is cardiovascular diseases are also briefly described. Diagnosis and management of 4Is-related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/MR, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.
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Affiliation(s)
- Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Medical Imaging Centre, Department of Nuclear medicine & Molecular Imaging (EB50), University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
- Faculty of Science and Technology Biomedical, Photonic Imaging, University of Twente, Enschede, The Netherlands.
| | - Andor W J M Glaudemans
- Medical Imaging Centre, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mark Lubberink
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - Tanja Kero
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
- Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
- Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Oliver Gaemperli
- HeartClinic, Hirslanden Hospital Zurich, Hirslanden, Switzerland
| | - Antti Saraste
- Turku PET Centre, Turku University Hospital, University of Turku, Turku, Finland
- Heart Center, Turku University Hospital, Turku, Finland
| | | | - Panagiotis Georgoulias
- Department of Nuclear Medicine, Faculty of Medicine, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Bucerius
- Department of Nuclear Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabien Hyafil
- Department of Nuclear Medicine, DMU IMAGINA, Georges-Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, University of Paris, F75015 Paris, France
- PARCC, INSERM, University of Paris, F-75006 Paris, France
| | - Paola A Erba
- Medical Imaging Centre, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Nuclear Medicine, University of Pisa, Pisa, Italy
- Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy
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Pijl JP, Kwee TC, Slart RHJA, Yakar D, Wouthuyzen-Bakker M, Glaudemans AWJM. Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia. Eur J Nucl Med Mol Imaging 2020; 48:1467-1477. [PMID: 33106925 PMCID: PMC8113205 DOI: 10.1007/s00259-020-05071-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate which clinical factors and laboratory values are associated with high FDG uptake in the bone marrow and spleen on 2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with bacteremia. METHODS One hundred forty-five consecutive retrospective patients with bacteremia who underwent FDG-PET/CT between 2010 and 2017 were included. Mean standard uptake values (SUVmean) of FDG in bone marrow, liver, and spleen were measured. Bone marrow-to-liver SUV ratios (BLR) and spleen-to-liver SUV ratios (SLR) were calculated. Linear regression analyses were performed to examine the association of BLR and SLR with age, gender, hemoglobin, leukocyte count, platelets, glucose level, C-reactive protein (CRP), microorganism, days of antibiotic treatment before FDG-PET/CT, infection focus, use of immunosuppressive drugs, duration of hospital stay (after FDG-PET/CT), ICU admission, and mortality. RESULTS C-reactive protein (p = 0.006), a cardiovascular or musculoskeletal focus of infection (p = 0.000 for both), and bacteremia caused by Gram-negative bacteria (p = 0.002) were independently and positively associated with BLR, while age (p = 0.000) and glucose level before FDG-PET/CT (p = 0.004) were independently and negatively associated with BLR. For SLR, CRP (p = 0.001) and a cardiovascular focus of infection (p = 0.020) were independently and positively associated with SLR, while age (p = 0.002) and glucose level before FDG-PET/CT (p = 0.016) were independently and negatively associated with SLR. CONCLUSION High FDG uptake in the bone marrow is associated with a higher inflammatory response and younger age in patients with bacteremia. In patients with high FDG uptake in the bone marrow, a cardiovascular or musculoskeletal focus of infection is more likely than other foci, and the infection is more often caused by Gram-negative species. High splenic FDG uptake is associated with a higher inflammatory response as well, and a cardiovascular focus of infection is also more likely in case of high splenic FDG uptake.
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Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.,TechMed Centre, Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Nuclear Medicine in the diagnosis of pathologies of the spine: role of hybrid imaging. Rev Esp Med Nucl Imagen Mol 2020; 40:37-49. [PMID: 33041242 DOI: 10.1016/j.remn.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Clinical problems in the human spine are still common in our society, often causing pain and can also limit movement. Back pain is a very common clinical entity, although difficult to diagnose due to its multifactorial nature. There are multiple processes that can alter the structure of the spine, injure vertebrae and/or the surrounding tissue. For the study of the spine, image diagnosis is essential, and within this, molecular hybrid techniques play an important role by providing us with an image of functional and morphological fusion. Among these, SPECT/CT is key in the diagnosis of traumatic and stress pathology, allowing us to locate hidden vertebral fractures, and is also very useful in degenerative and post-surgical pathology. On the other hand, PET/CT with 18F-FDG also plays an important role in the management and monitoring of infectious and oncological processes. This review describes the application of these hybrid techniques in the different pathologies of the spine and the findings of their images, being very useful for the diagnostic assessment and therapeutic management of the patient.
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Skovsbo Clausen A, Ørbæk M, Renee Pedersen R, Oestrup Jensen P, Lebech AM, Kjaer A. 64Cu-DOTATATE Positron Emission Tomography (PET) of Borrelia Burgdorferi Infection: In Vivo Imaging of Macrophages in Experimental Model of Lyme Arthritis. Diagnostics (Basel) 2020; 10:diagnostics10100790. [PMID: 33036200 PMCID: PMC7601205 DOI: 10.3390/diagnostics10100790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Macrophages play a key role in the inflammatory response in Lyme arthritis (LA) and could be a target for diagnosing and monitoring active Borrelia burgdorferi sensu lato (Bb) infection. Therefore, we evaluated the potential of macrophage imaging using 64Cu-DOTATATE PET/CT for detection of Bb activity in a murine model of LA. LA was established in C3H/HeNRj mice infected with Bb B31 strain ML23 pBBE22luc. Bioluminescence imaging was performed to detect migration of spirochetes and inflammatory phagocytes to the joints. Three weeks post-infection 64Cu-DOTATATE PET/CT imaging was performed at an early (3 h) and late (48 h) time point. Plasma levels of a systemic macrophage marker in plasma CD163 were measured. 64Cu-DOTATATE uptake in infected joints was increased at the early (p < 0.0001) and late time points (p = 0.0005) compared with uptake in non-infected controls. No significant difference in plasma levels of CD163 was measured. 64Cu-DOTATATE PET allows for in vivo detection and quantification of LA locally in the joints through non-invasive visualization of macrophages. In contrast, measurement of a systemic macrophage marker in plasma, CD163, did not allow to detect disease. We suggest that 64Cu-DOTATATE PET could become a valuable diagnostic tool for in situ detection of Bb infection-related inflammation.
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Affiliation(s)
- Anne Skovsbo Clausen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, DK-2100 Copenhagen, Denmark;
- Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Mathilde Ørbæk
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; (M.Ø.); (A.-M.L.)
| | - Regitze Renee Pedersen
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, DK-2200 Copenhagen, Denmark; (R.R.P.); (P.O.J.)
| | - Peter Oestrup Jensen
- Costerton Biofilm Center, Department of Immunology and Microbiology, University of Copenhagen, DK-2200 Copenhagen, Denmark; (R.R.P.); (P.O.J.)
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark
- Center for Rheumatology and Spine Diseases, Institute for Inflammation Research, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100 Copenhagen, Denmark; (M.Ø.); (A.-M.L.)
- Institute of Clinical Medicine, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, DK-2100 Copenhagen, Denmark;
- Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-35327504
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167
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Risk assessment of osteoradionecrosis associated with periodontitis using 18F-FDG PET/CT. Eur J Radiol 2020; 132:109259. [PMID: 33012550 DOI: 10.1016/j.ejrad.2020.109259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/28/2020] [Accepted: 08/26/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Osteoradionecrosis (ORN) is a serious complication after radiotherapy (RT), even in the era of intensity modulated radiation therapy (IMRT). The purpose of this study was to evaluate whether 18F-FDG PET/CT can predict ORN associated with periodontal disease in patients with oropharyngeal or oral cavity squamous cell carcinoma (OP/OC SCC) undergoing RT. METHODS One hundred and five OP/OC SCC patients treated with RT who underwent pretreatment 18F-FDG PET/CT between October 2007 and June 2016 were retrospectively reviewed. A post-treatment diagnosis of ORN was made clinically based on presence of exposed irradiated mandibular bone that failed to heal after a period of three months without persistent or recurrent tumor. The maximum standardized uptake value (SUVmax) of periodontal regions identified on PET/CT was measured for all patients. Image-based staging of periodontitis was also performed using American Academy of Periodontology staging system on CT. RESULTS Among 105 patients, 14 (13.3 %) developed ORN. The SUVmax of the periodontal region in patients with ORN (3.35 ± 1.23) was significantly higher than patients without ORN (1.92 ± 0.66) (P < .01). The corresponding CT stage of periodontitis in patients with ORN was significantly higher (2.71±0.47) than patients without ORN (1.80±0.73) (P < .01). ROC analysis revealed the cut-off values of developing ORN were 2.1 in SUVmax, and II in CT stage of periodontitis. The corresponding AUC was 0.86 and 0.82, respectively. CONCLUSIONS Pretreatment 18F-FDG PET/CT identification of periodontitis may be helpful to predict the future development of ORN in patients with OP/OC SCC undergoing RT.
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Signore A, Glaudemans AWJM. Reply to comment by J.P. Suarez Fernandez on “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 2020; 47:2503-2504. [DOI: 10.1007/s00259-020-04909-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cimini A, Ricci M, Chiaravalloti A, Crocco A, Russo F, Schillaci O. A Rare Case of Pulmonary Schistosomiasis: 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings. Indian J Nucl Med 2020; 35:336-338. [PMID: 33642761 PMCID: PMC7905290 DOI: 10.4103/ijnm.ijnm_79_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 11/04/2022] Open
Abstract
Schistosomiasis is a helminthic infection acquired through direct contact with contaminated fresh water. To the best of our knowledge, this is the first case pulmonary of schistosomias is evaluated with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) reported in the literature. Functional imaging with 18F-FDG PET/CT may help in the diagnosis of schistosomiasis, leading to a correct definition of the disease extension.
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Affiliation(s)
- Andrea Cimini
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Maria Ricci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Department of Nuclear Medicine IRCSS, Neuromed, Pozzilli, Italy
| | - Antonio Crocco
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Francesca Russo
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
- Department of Nuclear Medicine IRCSS, Neuromed, Pozzilli, Italy
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170
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Suarez Fernandez JP. Comments on “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 2020; 47:2501-2502. [DOI: 10.1007/s00259-020-04889-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
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Moussaddaq AS, Brochard C, Palard-Novello X, Garin E, Wallenhorst T, Le Balc’h E, Merlini L’heritier A, Grainville T, Siproudhis L, Lièvre A. Incidental anal 18fluorodeoxyglucose uptake: Should we further examine the patient? World J Clin Cases 2020; 8:3679-3690. [PMID: 32953844 PMCID: PMC7479548 DOI: 10.12998/wjcc.v8.i17.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/15/2020] [Accepted: 08/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There are no studies on incidental anal 18F-fluorodeoxyglucose (18FDG) uptake.
AIM To assess the rate and aetiologies of incidental anal 18FDG uptake and to evaluate the correlation between 18FDG positron-emission tomography/computed tomography (PET/CT) parameters and the diagnosis of an anorectal disease.
METHODS The data from patients with incidental anal 18FDG uptake were retrospectively analysed. Patients who underwent anorectal examinations were identified and compared to those who did not undergo examinations. Patients who were offered treatment were then identified and compared to those who did not receive treatment.
RESULTS Among the 43020 18FDG PET/CT scans performed, 197 18FDG PET/CT scans of 146 patients (0.45%) reported incidental anal uptake. Among the 134 patients included, 48 (35.8%) patients underwent anorectal examinations, and anorectal diseases were diagnosed in 33 (69.0%) of these patients and treated in 18/48 (37.5%) patients. Among the examined patients, those with a pathology requiring treatment had significantly smaller metabolic volumes (MV) 30 and MV41 values and higher maximal and mean standardized uptake value measurements than those who did not require treatment.
CONCLUSION Incidental anal 18FDG uptake is rare, but a reliable anorectal diagnosis is commonly obtained when an anorectal examination is performed. The diagnosis of an anorectal disease induces treatment in more than one-third of the patients. These data should encourage practitioners to explore incidental anal 18FDG uptake systematically.
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Affiliation(s)
- Anne-Sophie Moussaddaq
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Charlène Brochard
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
- Inphy CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes 35000, France
| | - Etienne Garin
- Department of Nuclear Medicine, Cancer Institute Eugène Marquis, Rennes 35000, France
- Laboratoire Traitement du Signal et de l'Image-UMR1099, University of Rennes, Inserm, Rennes 35000, France
| | - Timothée Wallenhorst
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Eric Le Balc’h
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | | | - Thomas Grainville
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Laurent Siproudhis
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
- Inphy CIC 1414 University Hospital of Rennes, Pontchaillou, Rennes 35000, France
| | - Astrid Lièvre
- Department of Gastroenterology, University Hospital of Rennes, Pontchaillou, Rennes 35000, France
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Liddy S, Mallia A, Collins CD, Killeen RP, Skehan S, Dodd JD, Subesinghe M, Murphy DJ. Vascular findings on FDG PET/CT. Br J Radiol 2020; 93:20200103. [PMID: 32356457 PMCID: PMC7465845 DOI: 10.1259/bjr.20200103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Since its introduction into clinical practice, 2-deoxy-2-[18F]flu-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has become firmly established in the field of oncological imaging, with a growing body of evidence demonstrating its use in infectious and inflammatory vascular pathologies. This pictorial review illustrates the utility of FDG PET/CT as a diagnostic tool in the investigation of vascular disease and highlights some of the more common incidental vascular findings that PET reporters may encounter on standard oncology FDG PET/CTs, including atherosclerosis, large vessel vasculitis, complications of vascular grafts, infectious aortitis and acute aortic syndromes.
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Affiliation(s)
| | - Andrew Mallia
- Division of Nuclear Medicine, Department of Medical Imaging, Mater Dei Hospital, Msida, Malta
| | | | | | | | - Jonathan D Dodd
- Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland
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Manika K, Kipourou M, Georga S, Faniadou E, Pilianidis G, Arsos G, Kioumis I. 18F-FDG PET/CT contribution to tuberculous vertebral osteomyelitis diagnosis: a case report. Oxf Med Case Reports 2020; 2020:omaa068. [PMID: 32995024 PMCID: PMC7507868 DOI: 10.1093/omcr/omaa068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/21/2020] [Indexed: 12/05/2022] Open
Abstract
Tuberculous vertebral osteomyelitis (TVO) is an extrapulmonary tuberculosis form characterized by difficulty and delay in diagnosis. PET/CT is a valuable, well-established tool in the diagnostic workup of cancer and fever of unknown origin, which is increasingly appreciated in the management of infectious diseases. We report a TVO case where PET/CT had a valuable contribution towards diagnosis and monitoring of treatment response, highlighting its advantages and future perspectives when dealing with infectious diseases.
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Affiliation(s)
- Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Thessaloniki, Greece
| | - Maria Kipourou
- Pulmonary Department, 424 General Military Hospital, Thessaloniki, Greece
| | - Stamata Georga
- Nuclear Medicine Department, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
| | - Eleni Faniadou
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Thessaloniki, Greece
| | - Georgios Pilianidis
- Department of Internal Medicine, “G. Papanikolaou” Hospital, Thessaloniki, Greece
| | - Georgios Arsos
- Nuclear Medicine Department, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
| | - Ioannis Kioumis
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, “G. Papanikolaou” Hospital, Thessaloniki, Greece
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174
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Examination of cross-calibration and concentration linearity with quantitative gallium-67 single-photon emission computed tomography: phantom experiment. Radiol Phys Technol 2020; 13:385-391. [PMID: 32857274 DOI: 10.1007/s12194-020-00582-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
We evaluated whether scattered radiation should be considered for cross-calibration and concentration linearity with quantitative gallium-67 (67Ga) single-photon emission computed tomography (SPECT). The scanned data from cylinder and spherical phantoms were used. They were reconstructed using ordered subset expectation maximization with resolution recovery, scatter, and computed tomography (CT)-based attenuation correction. The standardized uptake values (SUVs) of the cylinder phantom SPECT/CT images were calculated using system planar sensitivity with and without scatter correction, and the results were compared with the theoretical value. To determine concentration linearity, the relationship between the measured SUVs in three different spherical phantoms was evaluated. SUVs calculated by system planar sensitivity without scatter correction were closer to the theoretical values. Furthermore, the 37-mm sphere showed proper radioactive linearity. Our study suggests the utility of the SUV for 67Ga SEPCT/CT. Nevertheless, additional studies are required.
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175
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Dijkstra GW, Glaudemans AWJM, Erba PA, Wouthuyzen-Bakker M, Sinha B, Vállez García D, van der Sluis LWM, Slart RHJA. Relationship between 18F-FDG Uptake in the Oral Cavity, Recent Dental Treatments, and Oral Inflammation or Infection: A Retrospective Study of Patients with Suspected Endocarditis. Diagnostics (Basel) 2020; 10:E625. [PMID: 32846896 PMCID: PMC7555096 DOI: 10.3390/diagnostics10090625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
[18F]-fluorodeoxyglucose positron emission tomography ([18F]FDG PET/CT) has proven to be a useful diagnostic tool in patients with suspected infective endocarditis (IE), but is conflicting in relation to dental procedures. QUESTIONS Is there a correlation between [18F]FDG PET/CT findings, recent dental treatment, and an affected oral cavity? (2) Is there a correlation between infective endocarditis (IE), oral health status, and (extra)cardiac findings on [18F]FDG PET/CT? METHODS This retrospective study included 52 patients. All [18F]FDG PET/CT scans were examined visually by pattern recognition using a three-point scale and semi-quantified within the volume of interest (VOI) using SUVmax. RESULTS 19 patients were diagnosed with IE (group 1), 14 with possible IE (group 2), and 19 without IE based on the modified Duke criteria (group 3). No correlation was found between visual PET and SUVmax and sites of oral inflammation and infection. The visual PET scores and SUVmax were not significantly different between all groups. A significant difference in the SUVmax of the valve between all groups was observed. CONCLUSIONS This study suggests that no correlation exists between the PET findings in the oral cavity and dental treatments or inflammation/infection. No correlation between IE, actual oral health status, and extra-cardiac findings was demonstrated. Additional research is needed to conclude whether [18F]FDG PET/CT imaging is a reliable diagnostic modality for oral inflammation and infection sites.
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Affiliation(s)
- Geertruida W. Dijkstra
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (G.W.D.); (L.W.M.v.d.S.)
| | - Andor W. J. M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
| | - Paola A. Erba
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
- Department of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56128 Pisa, Italy
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (M.W.-B.); (B.S.)
| | - Bhanu Sinha
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (M.W.-B.); (B.S.)
| | - David Vállez García
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
| | - Luc W. M. van der Sluis
- Center for Dentistry and Oral Hygiene, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (G.W.D.); (L.W.M.v.d.S.)
| | - Riemer H. J. A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, PO 9700 RB Groningen, The Netherlands; (P.A.E.); (D.V.G.); (R.H.J.A.S.)
- Department of Biomedical Photonic Imaging, University of Twente, 7522 NB Enschede, The Netherlands
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176
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Vigil Díaz C, Salvat Dávila C, Fernández Llana B, Domínguez Grande ML, Suárez Fernández JP, Martín Fernández N, Rodríguez Fonseca OD, Lisei Coscia D, González García FM. PET/CT with 18F-Fluordesoxyglucose in patients with suspected endovascular prosthesis infection. Rev Esp Med Nucl Imagen Mol 2020; 40:12-18. [PMID: 32819884 DOI: 10.1016/j.remn.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Infection of large vessel prostheses is a rare but critical complication. The aim of this work is to assess the impact of PET/CT with 18F-Fluordesoxyglucose (PET-FDG) on the diagnosis of infection in our environment. MATERIAL AND METHODS Thirty-five patients (38 scans) were evaluated for suspected prosthetic infection. A qualitative analysis was performed taking into account the distribution of the radiopharmaceutical, categorizing the studies as positive or negative for infection. Those with focal or multifocal deposits along the vascular prosthesis were considered positive, and negative if a homogeneous and diffuse distribution over the whole prosthesis was observed, or a total absence of uptake. A semi-quantitative analysis was performed using SUVmax and average SUV values, and a metabolic index was calculated (SUVmax of the graft / average SUV of the normal vascular pool). RESULTS The PET-FDG study was positive in 20 patients, with a diagnostic accuracy of 84%. The 38 PET-FDG scans performed showed positive capture patterns (focal in 6, multifocal in 15, diffuse in 4) and negative pattern in the remaining 13. The sensitivity, specificity, positive and negative predictive values obtained for the PET-FDG were 95%, 89%, 90% and 94%, and for the AngioTC study 50%, 73%, 73% and 50%, respectively. The area values under the ROC curve were as follows: for the AngioTC 0.642 (not significant), and for the SUVmax values of 0.925 (p<0.005), average SUV of 0.922 (p<0.005) and for the metabolic index of 0.917 (p<0.005). CONCLUSIONS The PET-FDG proves to be a tool with high diagnostic accuracy in the infection of vascular prosthesis, both visual analysis according to patterns and semi-quantitative.
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Affiliation(s)
- C Vigil Díaz
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - C Salvat Dávila
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - B Fernández Llana
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - M L Domínguez Grande
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - J P Suárez Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - N Martín Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - O D Rodríguez Fonseca
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - D Lisei Coscia
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - F M González García
- Servicio de Medicina Nuclear, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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177
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Li Y, Daryaee F, Yoon GE, Noh D, Smith-Jones PM, Si Y, Walker SG, Turkman N, Meimetis L, Tonge PJ. Positron Emission Tomography Imaging of Staphylococcus aureus Infection Using a Nitro-Prodrug Analogue of 2-[ 18F]F- p-Aminobenzoic Acid. ACS Infect Dis 2020; 6:2249-2259. [PMID: 32672928 DOI: 10.1021/acsinfecdis.0c00374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Deep-seated bacterial infections caused by pathogens such as Staphylococcus aureus are difficult to diagnose and treat and are thus a major threat to human health. In previous work we demonstrated that positron emission tomography (PET) imaging with 2-[18F]F-p-aminobenzoic acid (2-[18F]F-PABA) could noninvasively identify, localize, and monitor S. aureus infection with excellent sensitivity and specificity in a rodent soft tissue infection model. However, 2-[18F]F-PABA is rapidly N-acetylated and eliminated, and in an attempt to improve radiotracer accumulation in bacteria we adopted a prodrug strategy in which the acid was protected by an ester and the amine was replaced with a nitro group. Metabolite analysis indicated that the nitro group of ethyl 2-[18F]fluoro-4-nitrobenzoate (2-[18F]F-ENB) is converted to the corresponding amine by bacteria-specific nitroreductases while the ester is hydrolyzed in vivo into the acid. PET/CT imaging of 2-[18F]F-ENB and the corresponding acid 2-[18F]F-NB in a rat soft tissue infection model demonstrated colocalization of the radiotracer with the bioluminescent signal arising from S. aureus Xen29, and demonstrated that the tracer could differentiate S. aureus infection from sterile inflammation. Significantly, the accumulation of both 2-[18F]F-ENB and 2-[18F]F-NB at the site of infection was 17-fold higher than at the site of sterile inflammation compared to 8-fold difference observed for 2-[18F]F-PABA, supporting the proposal that the active radiotracer in vivo is 2-[18F]F-NB. Collectively, these data suggest that 2-[18F]F-ENB and 2-[18F]F-NB have the potential for translation to humans as a rapid, noninvasive diagnostic tool to identify and localize S. aureus infections.
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Affiliation(s)
- Yong Li
- Chronus Pharmaceuticals, 25 Health Sciences Drive, Stony Brook, New York 11790, United States
| | - Fereidoon Daryaee
- Chronus Pharmaceuticals, 25 Health Sciences Drive, Stony Brook, New York 11790, United States
| | - Grace E. Yoon
- The Facility for Experimental Radiopharmaceutical Manufacturing, Department of Psychiatry, Stony Brook University, Stony Brook, New York 11794, United States
| | - Doyoung Noh
- The Facility for Experimental Radiopharmaceutical Manufacturing, Department of Psychiatry, Stony Brook University, Stony Brook, New York 11794, United States
| | - Peter M. Smith-Jones
- The Facility for Experimental Radiopharmaceutical Manufacturing, Department of Psychiatry, Stony Brook University, Stony Brook, New York 11794, United States
| | | | - Stephen G. Walker
- Department of Oral Biology and Pathology, Stony Brook University, Stony Brook, New York 11794, United States
| | | | - Labros Meimetis
- Chronus Pharmaceuticals, 25 Health Sciences Drive, Stony Brook, New York 11790, United States
| | - Peter J. Tonge
- Chronus Pharmaceuticals, 25 Health Sciences Drive, Stony Brook, New York 11790, United States
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178
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van Ginkel MS, Glaudemans AW, van der Vegt B, Mossel E, Kroese FG, Bootsma H, Vissink A. Imaging in Primary Sjögren's Syndrome. J Clin Med 2020; 9:E2492. [PMID: 32756395 PMCID: PMC7463854 DOI: 10.3390/jcm9082492] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease characterized by dysfunction and lymphocytic infiltration of the salivary and lacrimal glands. Besides the characteristic sicca complaints, pSS patients can present a spectrum of signs and symptoms, which challenges the diagnostic process. Various imaging techniques can be used to assist in the diagnostic work-up and follow-up of pSS patients. Developments in imaging techniques provide new opportunities and perspectives. In this descriptive review, we discuss imaging techniques that are used in pSS with a focus on the salivary glands. The emphasis is on the contribution of these techniques to the diagnosis of pSS, their potential in assessing disease activity and disease progression in pSS, and their contribution to diagnosing and staging of pSS-associated lymphomas. Imaging findings of the salivary glands will be linked to histopathological changes in the salivary glands of pSS patients.
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Affiliation(s)
- Martha S. van Ginkel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Esther Mossel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Frans G.M. Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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179
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Ha FJ, Agarwal S, Tweed K, Palmer SC, Adams HS, Thillai M, Williams L. Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge. Curr Cardiol Rev 2020; 16:90-97. [PMID: 31345153 PMCID: PMC7460708 DOI: 10.2174/1573403x15666190725121246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
Cardiac Sarcoidosis (CS) represents a unique diagnostic dilemma. Guidelines have been recently revised to reflect the established role of sophisticated imaging techniques. Trans-thoracic Echocardiography (TTE) is widely adopted for initial screening of CS. Contemporary TTE techniques could enhance detection of subclinical Left Ventricular (LV) dysfunction, particularly LV global longitudinal strain assessment which predicts event-free survival (meta-analysis of 5 studies, hazard ratio 1.28, 95% confidence interval 1.18-1.37, p < 0.0001). However, despite the wide availability of TTE, it has limited sensitivity and specificity for CS diagnosis. Cardiac Magnetic resonance Imaging (CMR) is a crucial diagnostic modality for suspected CS. Presence of late gadolinium enhancement signifies myocardial scar and enables risk stratification. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) coupled with myocardial perfusion imaging can identify active CS and guide immunosuppressant therapy. Gallium scintigraphy may be considered although FDG-PET is often preferred. While CMR and FDG-PET provide complementary information in CS evaluation, current guidelines do not recommend which imaging modalities are essential in suspected CS and if so, which modality should be performed first. The utility of hybrid imaging combining both advanced imaging modalities in a single scan is currently being explored, although not yet widely available. In view of recent, significant advances in cardiac imaging techniques, this review aims to discuss changes in guidelines for CS diagnosis, the role of various cardiac imaging modalities and the future direction in CS.
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Affiliation(s)
- Francis J Ha
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Sharad Agarwal
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| | - Katharine Tweed
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| | - Sonny C Palmer
- St Vincent's Hospital Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Heath S Adams
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Muhunthan Thillai
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom.,Department of Medicine University of Cambridge, Cambridge, CB2 0AY, United Kingdom
| | - Lynne Williams
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
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180
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Cerebral abscesses imaging: A practical approach. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e11-e24. [PMID: 32757543 DOI: 10.15586/jptcp.v27i3.688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Brain abscesses (BAs) are focal infections of the central nervous system (CNS) that start as a localised area of weakening of the brain parenchyma (cerebritis) and develops into a collection of pus surrounded by a capsule. Pyogenic (bacterial) BAs represent the majority of all BAs; in some cases, the diagnostic and therapeutic management can be challenging. Imaging has a primary role in differentiating BAs from other lesions. Conventional magnetic resonance imaging (cMRI) is essential for the identification of the lesion, its localisation and its morphological features. However, cMRI does not allow to reliably differentiate BAs from other intracranial mass lesions such as necrotic tumours. Advanced sequences, such as diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI) and proton MR spectroscopy (1H-MRS) are very useful in the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumours, and provide essential information on structural, vascular and metabolic characteristics allowing greater neuroradiological confidence. The aim of this pictorial review is to provide a practical approach showing the added value of more advanced MRI techniques in their diagnostic management.
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181
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Georga S, Exadaktylou P, Petrou I, Katsampoukas D, Mpalaris V, Moralidis EI, Arvaniti K, Papastergiou C, Arsos G. Diagnostic Value of 18F-FDG-PET/CT in Patients with FUO. J Clin Med 2020; 9:jcm9072112. [PMID: 32635566 PMCID: PMC7408628 DOI: 10.3390/jcm9072112] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
Conventional diagnostic imaging is often ineffective in revealing the underlying cause in a considerable proportion of patients with fever of unknown origin (FUO). The aim of this study was to assess the diagnostic value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with FUO. We retrospectively reviewed 18F-FDG-PET/CT scans performed on 50 consecutive adult patients referred to our department for further investigation of classic FUO. Final diagnosis was based on histopathological and microbiological findings, clinical criteria, or clinical follow-up. Final diagnosis was established in 39/50 (78%) of the patients. The cause of FUO was infection in 20/50 (40%), noninfectious inflammatory diseases in 11/50 (22%), and malignancy in 8/50 (16%) patients. Fever remained unexplained in 11/50 (22%) patients. 18F-FDG-PET/CT scan substantially contributed to the diagnosis in 70% of the patients, either by identifying the underlying cause of FUO or by directing to the most appropriate site for biopsy. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of 18F-FDG-PET/CT for active disease detection in patients with FUO were 94.7%, 50.0%, 84.0%, 85.7%, and 75.0%, respectively. In conclusion, whole-body 18F-FDG-PET/CT is a highly sensitive method for detection of the underlining cause of FUO or for correctly targeting suspicious lesions for further evaluation.
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Affiliation(s)
- Stamata Georga
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
- Correspondence: ; Tel.: +30-6944687881
| | - Paraskevi Exadaktylou
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
| | - Ioannis Petrou
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
| | - Dimitrios Katsampoukas
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
| | - Vasilios Mpalaris
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
| | - Efstratios-Iordanis Moralidis
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
| | - Kostoula Arvaniti
- ICU and Antimicrobial Stewardship Unit, Papageorgiou General Hospital, 56403 Thessaloniki, Greece;
| | | | - Georgios Arsos
- 3rd Department of Nuclear Medicine, Aristotle University of Thessaloniki Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (P.E.); (I.P.); (D.K.); (V.M.); (E.-I.M.); (G.A.)
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182
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Assessment of Suspected Malignancy or Infection in Immunocompromised Patients After Solid Organ Transplantation by [ 18F]FDG PET/CT and [ 18F]FDG PET/MRI. Nucl Med Mol Imaging 2020; 54:183-191. [PMID: 32831964 DOI: 10.1007/s13139-020-00648-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/24/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To study the value of 2-deoxy-2-[18F]fluoro-D-glucose([18F]FDG) positron emission tomography/computed tomography (PET/CT) and [18F]FDG positron emission tomography/magnetic resonance imaging (PET/MRI) in assessing immunocompromised patients with suspected malignancy or infection. Methods [18F]FDG-PET/CT and [18F]FDG-PET/MRI examinations of patients who were immunocompromised after receiving lung, heart, pancreas, kidney, liver, or combined kidney-liver transplants were analyzed in this retrospective study. Patients underwent whole-body hybrid-imaging because of clinical signs of malignancy and/or infection. Findings were assessed by molecular features ([18F]FDG-uptake) and morphological changes. The final diagnosis, which was arrived at after review of clinical, laboratory, and histopathologic analyses and follow-up imaging studies, served as the reference standard. Results Altogether, (i) 28 contrast-enhanced [18F]FDG-PET/CT scans (CE-PET/CT), (ii) 33 non-contrast [18F]FDG-PET/CT scans (NC-PET/CT), and (iii) 18 [18F]FDG-PET/MRI scans were included. Additionally, 12/62 patients underwent follow-up PET imaging to rule out vital tumor or metabolic active inflammatory processes. CE-PET/CT exhibited 94.4% sensitivity, 80.0% specificity, 89.5% positive predictive value (PPV), 88.9% negative predictive value (NPV), and 89.3% accuracy with regard to the reference standard. NC-PET/CT exhibited 91.3% sensitivity, 80.0% specificity, 91.3% PPV, 80.0% NPV, and 87.9% accuracy. PET/MRI exhibited 88.6% sensitivity, 99.2% specificity, 99.6% PPV, 81.3% NPV, and 94.4% accuracy. Exact McNemar statistical test (one-sided) showed significant difference between the CT-/MR-component alone and the integrated PET/CT and PET/MRI for diagnosis of malignancy or infection (p value < 0.001). Radiation exposure was 4- to 7-fold higher with PET/CT than with PET/MRI. Conclusion For immunocompromised patients with clinically unresolved symptoms, to rule out vital tumor manifestations or metabolic active inflammation, [18F]FDG-PET/MRI, CE-[18F]FDG-PET/CT, and NC-[18F]FDG-PET/CT exhibit excellent performance in diagnosing malignancy or infection. The main strength of PET/MRI is its considerably lower level of radiation exposure than that associated with PET/CT.
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183
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Mahmood M, Abu Saleh O. The Role of 18-F FDG PET/CT in Imaging of Endocarditis and Cardiac Device Infections. Semin Nucl Med 2020; 50:319-330. [DOI: 10.1053/j.semnuclmed.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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184
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Signore A, Lauri C. RE:
99m
Tc‐HMPAO‐leucocyte scintigraphy and [
18
F]FDG‐PET/CT in infection. Clin Otolaryngol 2020; 45:652-653. [DOI: 10.1111/coa.13553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/30/2020] [Accepted: 04/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit Department of Medical‐Surgical Sciences and of Translational Medicine “Sapienza” University of Rome Rome Italy
| | - Chiara Lauri
- Nuclear Medicine Unit Department of Medical‐Surgical Sciences and of Translational Medicine “Sapienza” University of Rome Rome Italy
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Ten Hove D, Treglia G, Slart RHJA, Damman K, Wouthuyzen-Bakker M, Postma DF, Gheysens O, Borra RJH, Mecozzi G, van Geel PP, Sinha B, Glaudemans AWJM. The value of 18F-FDG PET/CT for the diagnosis of device-related infections in patients with a left ventricular assist device: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2020; 48:241-253. [PMID: 32594196 PMCID: PMC7835315 DOI: 10.1007/s00259-020-04930-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/14/2020] [Indexed: 12/18/2022]
Abstract
Background Left ventricular assist devices (LVADs) are increasingly used for the treatment of advanced heart failure. LVADs improve quality of life and decrease mortality, but the driveline carries substantial risk for major infections. These device-related LVAD and driveline infections are difficult to diagnose with conventional imaging. We reviewed and analysed the current literature on the additive value of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) imaging for the diagnosis of LVAD-related infections.” Materials/methods We performed a systematic literature review using several databases from their inception until the 31st of December, 2019. Studies investigating the diagnostic performance of FDG-PET/CT in patients with suspected LVAD infection were retrieved. After a bias risk assessment using QUADAS-2, a study-aggregate meta-analysis was performed on a per examination-based analysis. Results A total of 10 studies were included in the systematic review, eight of which were also eligible for study-aggregate meta-analysis. For the meta-analysis, a total of 256 FDG-PET/CT scans, examining pump/pocket and/or driveline infection, were acquired in 230 patients. Pooled sensitivity of FDG-PET/CT was 0.95 (95% confidence interval (CI) 0.89–0.97) and pooled specificity was 0.91 (95% CI 0.54–0.99) for the diagnosis of device-related infection. For pump/pocket infection, sensitivity and specificity of FDG-PET/CT were 0.97 (95%CI 0.69–1.00) and 0.93 (95%CI 0.64–0.99), respectively. For driveline infection, sensitivity and specificity were 0.96 (95%CI 0.88–0.99) and 0.99 (95%CI 0.13–1.00) respectively. Significant heterogeneity existed across studies for specificity, mostly caused by differences in scan procedures. Predefined criteria for suspicion of LVAD and/or driveline infection were lacking in all included studies. Conclusions FDG-PET/CT is a valuable tool for assessment of device-related infection in LVAD patients, with high sensitivity and high, albeit variable, specificity. Standardization of FDG-PET/CT procedures and criteria for suspected device-related LVAD infections are needed for consistent reporting of FDG-PET/CT scans. Electronic supplementary material The online version of this article (10.1007/s00259-020-04930-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- D Ten Hove
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. .,Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - G Treglia
- Clinic of Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano, Switzerland.,Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Via Lugano 4F, CH-6500, Bellinzona, Switzerland
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - K Damman
- University of Groningen, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D F Postma
- Department of Internal Medicine and infectious diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - O Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - R J H Borra
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands.,Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Mecozzi
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P P van Geel
- University of Groningen, Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
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186
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Rodent Leukocyte Isolation and Radiolabeling for Inflammation Imaging Study. Nucl Med Mol Imaging 2020; 54:147-155. [PMID: 32582398 DOI: 10.1007/s13139-020-00645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022] Open
Abstract
Purpose The objective of this study was to describe to develop methods of rodent leukocyte isolation and radiolabeling for in vivo inflammation imaging. Methods Thigh muscle inflammation was induced by injection of collagenase. Blood was collected from the jugular vein and separated by Histopaque. The collected cells were incubated in a 37 °C CO2 incubator for 1~2 h. After incubation, 99mTc-HMPAO and 18F-FDG were used to treat leukocytes followed by incubation for 30 min. 99mTc-HMPAO and 18F-FDG labeled autologous leukocytes were injected into the tail veins of rats. The images were then acquired at various time points. Image-based lesion to normal muscle ratio was compared. Results After Histopaque separation, the proportion of lymphocytes was higher than that of other cell types. After CO2 incubation, the collected leukocytes were viable, while room temperature exposed leukocytes without CO2 incubation were non-viable. Granulocytes, especially, were more quickly influenced by various conditions than the mononuclear cells. Labeling efficiencies of 99mTc-HMPAO and 18F-FDG were 4.00 ± 2.06 and 1.8%, respectively. 99mTc-HMPAO- and 18F-FDG-labeled leukocytes targeted well the inflamed lesion. 99mTc-HMPAO-labeled leukocytes, but not 18F-FDG-labeled leukocytes, were found in the abdomen activity. Conclusion Inflamed lesions of rats were well visualized using autologous radiolabeled leukocytes. This method might provide good information for understanding inflammatory diseases.
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187
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Diabetic Foot Infections: The Diagnostic Challenges. J Clin Med 2020; 9:jcm9061779. [PMID: 32521695 PMCID: PMC7355769 DOI: 10.3390/jcm9061779] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to plan the most appropriate treatment for the patient. The isolation of the pathogen from bone or soft tissues is still the gold standard for diagnosis; however, it would be desirable to have a non-invasive test that is able to detect, localize, and evaluate the extent of the infection with high accuracy. A multidisciplinary approach is the key for the correct management of diabetic patients dealing with infective complications, but at the moment, no definite diagnostic flow charts still exist. This review aims at providing an overview on multimodality imaging for the diagnosis of DFI and to address evidence-based answers to the clinicians when they appeal to radiologists or nuclear medicine (NM) physicians for studying their patients.
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188
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Pijl JP, Kwee TC, Legger GE, Peters HJH, Armbrust W, Schölvinck EH, Glaudemans AWJM. Role of FDG-PET/CT in children with fever of unknown origin. Eur J Nucl Med Mol Imaging 2020; 47:1596-1604. [PMID: 32030452 PMCID: PMC7188721 DOI: 10.1007/s00259-020-04707-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in children with fever of unknown origin (FUO). METHODS This retrospective single-center study included 110 children (0-18 years) with FUO who underwent FDG-PET/CT between 2010 and 2019. The diagnostic value of FDG-PET/CT for identifying cause of fever was calculated, treatment modifications after FDG-PET/CT were assessed, and logistic regression analyses were performed to identify clinical and biochemical factors associated with FDG-PET/CT outcome. RESULTS In 53 out of 110 patients (48%), FDG-PET/CT identified a (true positive) cause of fever. Endocarditis (11%), systemic juvenile idiopathic arthritis (5%), and inflammatory bowel disorder (5%) were the most common causes of FUO. In 42 patients (38%), no cause of fever was found on FDG-PET/CT. In 58 out of 110 patients (53%), treatment modifications were made after FDG-PET/CT. FDG-PET/CT achieved a sensitivity of 85.5%, specificity of 79.2%, positive predictive value of 84.1%, and negative predictive value of 80.9%. On multivariate logistic regression, C-reactive protein was positively associated with finding a true positive focus of fever on FDG-PET/CT (OR = 1.01 (95% CI 1.00-1.02) per mg/L increase in CRP), while leukocyte count was negatively associated with finding a true positive focus of fever (OR = 0.91 (95% CI 0.85-0.97) per 109 leukocytes/L increase). CONCLUSION FDG-PET/CT is a valuable diagnostic tool in the evaluation of children with FUO, since it may detect a true underlying cause in almost half (48%) of all cases where none was found otherwise. It allows full-body evaluation in patients without disease-specific symptoms on one examination. CRP and leukocyte count were significantly associated with FDG-PET/CT results, which may contribute to a priori assessment on the outcome of FDG-PET/CT. Future research could be aimed at evaluating more patient-specific factors to prospectively estimate the added value of FDG-PET/CT in children with FUO.
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Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G E Legger
- Beatrix Children's Hospital, Department of Pediatric Rheumatology and Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helja J H Peters
- Beatrix Children's Hospital, Department of Pediatric Rheumatology and Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wineke Armbrust
- Beatrix Children's Hospital, Department of Pediatric Rheumatology and Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E H Schölvinck
- Beatrix Children's Hospital, Department of Pediatric Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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189
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Lauri C, Glaudemans AW, Campagna G, Keidar Z, Muchnik Kurash M, Georga S, Arsos G, Noriega-Álvarez E, Argento G, Kwee TC, Slart RH, Signore A. Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study. J Clin Med 2020; 9:jcm9061645. [PMID: 32486304 PMCID: PMC7356770 DOI: 10.3390/jcm9061645] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.
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Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (C.L.); (G.C.)
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
| | - Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (C.L.); (G.C.)
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, 3109601 Haifa, Israel; (Z.K.); (M.M.K.)
| | - Marina Muchnik Kurash
- Department of Nuclear Medicine, Rambam Health Care Campus, 3109601 Haifa, Israel; (Z.K.); (M.M.K.)
| | - Stamata Georga
- 3rd Department of Nuclear Medicine, Aristotle University Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (S.G.); (G.A.)
| | - Georgios Arsos
- 3rd Department of Nuclear Medicine, Aristotle University Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (S.G.); (G.A.)
| | - Edel Noriega-Álvarez
- Department of Nuclear Medicine, University Hospital of Ciudad Real, 13005 Ciudad Real, Spain;
| | - Giuseppe Argento
- Radiology Unit, Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Thomas C. Kwee
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
| | - Riemer H.J.A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7500 Enschede, The Netherlands
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (C.L.); (G.C.)
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
- Correspondence: ; Tel.: +39-06-3377-6191
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190
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Real-world experience of the role of 18F FDG PET-computed tomography in chronic spinal implant infection. Nucl Med Commun 2020; 41:715-720. [PMID: 32427702 DOI: 10.1097/mnm.0000000000001211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The presence of postinstrumentation back pain in patients after undergoing spinal surgery is a well established phenomenon. So too is the presence of infection, both overt and subclinical which can be a source of pain. The accurate assessment of infection in patients with spinal implants in situ and no overt radiological or biochemical abnormalities frequently presents a diagnostic challenge. We present our experience spanning 5 years of using 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (18F FDG PET)-computed tomography (CT) scans to aid the diagnostic process in treating presumed low-grade chronic implant infection. METHODS We undertook a retrospective analysis of all patients with spinal implants in place who were referred for 18F FDG PET-CT imaging over a 5-year period. All available images, case notes and laboratory results were reviewed. RESULTS Data pertaining to 49 patients were analysed, with infection diagnosed on 18F FDG PET-CT in 24 (45%) of those sent for scanning. Fifteen patients in the cohort underwent revision surgery, and 11 of whom had been diagnosed as infected on PET-CT. Confirmation of infection with positive microbiological sampling occurred in 8/11 giving a positive predictive value of 0.72 in our series. CONCLUSION We present a real-world experience of using 18F FDG PET-CT as a diagnostic tool in the evaluation of patients with chronic pain after undergoing spinal implantation. We have found PET-CT to be a promising modality and would recommend multicentre collaboration to ensure reproducibility across more centres.
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191
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Lauri C, Iezzi R, Rossi M, Tinelli G, Sica S, Signore A, Posa A, Tanzilli A, Panzera C, Taurino M, Erba PA, Tshomba Y. Imaging Modalities for the Diagnosis of Vascular Graft Infections: A Consensus Paper amongst Different Specialists. J Clin Med 2020; 9:jcm9051510. [PMID: 32429584 PMCID: PMC7290746 DOI: 10.3390/jcm9051510] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
Vascular graft infection (VGI) is a rare but severe complication of vascular surgery that is associated with a bad prognosis and high mortality rate. An accurate and prompt identification of the infection and its extent is crucial for the correct management of the patient. However, standardized diagnostic algorithms and a univocal consensus on the best strategy to reach a diagnosis still do not exist. This review aims to summarize different radiological and Nuclear Medicine (NM) modalities commonly adopted for the imaging of VGI. Moreover, we attempt to provide evidence-based answers to several practical questions raised by clinicians and surgeons when they approach imaging in order to plan the most appropriate radiological or NM examination for their patients.
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Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
- Correspondence: ; Tel.: +39-06-3377-6191
| | - Roberto Iezzi
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Michele Rossi
- Radiology Unit, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
| | - Alessandro Posa
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Alessandro Tanzilli
- Radiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.I.); (A.P.); (A.T.)
| | - Chiara Panzera
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy; (C.P.); (M.T.)
| | - Maurizio Taurino
- Vascular Surgery Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, “Sapienza” University of Rome, 00161 Rome, Italy; (C.P.); (M.T.)
| | - Paola Anna Erba
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands;
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, 56123 Pisa, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma-Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.T.); (S.S.); (Y.T.)
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Tian D, Huang H, Wen HY. Noninvasive methods for detection of chronic lung allograft dysfunction in lung transplantation. Transplant Rev (Orlando) 2020; 34:100547. [PMID: 32498976 DOI: 10.1016/j.trre.2020.100547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/15/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023]
Abstract
Lung transplantation (LTx) is the only therapeutic option for end-stage lung diseases. Chronic lung allograft dysfunction (CLAD), which manifests as airflow restriction and/or obstruction, is the primary factor limiting the long-term survival of patients after surgery. According to histopathological and radiographic findings, CLAD comprises two phenotypes, bronchiolitis obliterans syndrome and restrictive allograft syndrome. Half of all lung recipients will develop CLAD in 5 years, and this rate may increase up to 75% 10 years after surgery owing to the paucity in accurate and effective early detection and treatment methods. Recently, many studies have presented noninvasive methods for detecting CLAD and improving diagnosis and intervention. However, the significance of accurately detecting CLAD remains controversial. We reviewed published studies that have presented noninvasive methods for detecting CLAD to highlight the current knowledge on clinical symptoms, spirometry, imaging examinations, and other methods to detect the disease.
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Affiliation(s)
- Dong Tian
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu, China.
| | - Heng Huang
- Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Hong-Ying Wen
- Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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193
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Molecular imaging of inflammation - Current and emerging technologies for diagnosis and treatment. Pharmacol Ther 2020; 211:107550. [PMID: 32325067 DOI: 10.1016/j.pharmthera.2020.107550] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022]
Abstract
Inflammation is a key factor in multiple diseases including primary immune-mediated inflammatory diseases e.g. rheumatoid arthritis but also, less obviously, in many other common conditions, e.g. cardiovascular disease and diabetes. Together, chronic inflammatory diseases contribute to the majority of global morbidity and mortality. However, our understanding of the underlying processes by which the immune response is activated and sustained is limited by a lack of cellular and molecular information obtained in situ. Molecular imaging is the visualization, detection and quantification of molecules in the body. The ability to reveal information on inflammatory biomarkers, pathways and cells can improve disease diagnosis, guide and monitor therapeutic intervention and identify new targets for research. The optimum molecular imaging modality will possess high sensitivity and high resolution and be capable of non-invasive quantitative imaging of multiple disease biomarkers while maintaining an acceptable safety profile. The mainstays of current clinical imaging are computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) and nuclear imaging such as positron emission tomography (PET). However, none of these have yet progressed to routine clinical use in the molecular imaging of inflammation, therefore new approaches are required to meet this goal. This review sets out the respective merits and limitations of both established and emerging imaging modalities as clinically useful molecular imaging tools in addition to potential theranostic applications.
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Assessment of lung glucose uptake in patients with systemic lupus erythematosus pulmonary arterial hypertension: a quantitative FDG-PET imaging study. Ann Nucl Med 2020; 34:407-414. [PMID: 32314147 DOI: 10.1007/s12149-020-01461-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Pulmonary arterial hypertension (PAH) is a recognized complication of systemic lupus erythematosus (SLE-PAH) patients and its lung pathology shares similarity to idiopathic PAH (IPAH) with distinctive inflammatory feature. FDG-PET reports glucose metabolism from both hyperproliferative and inflammatory cellular elements of vascular pathology in PAH. We explored the application of FDG-PET in reporting SLE-PAH pulmonary vascular pathology. METHODS Sixty-minute dynamic FDG-PET imaging was applied in 14 SLE-PAH patients, 20 IPAH patients and 10 healthy volunteers. Patlak analysis was used to quantify lung FDG uptake (influx rate Ki). RESULTS Mean lung FDG uptake in SLE-PAH (Ki 0.00714 ± 0.000602 mL/g/min) was significantly higher than that of the healthy volunteers (Ki 0.000262 ± 0.000168 mL/g/min) (p < 0.05). SLE-PAH patients with SLE disease activity score SLEDAI ≥ 5 demonstrated significantly increased lung FDG uptake (Ki 0.001075 ± 0.00055 mL/g/min) than those with SLEDAI < 5 (Ki 0.000233 ± 0.00017 mL/g/min) (p = 0.0038) and IPAH (Ki 0.000524 ± 0.000314 mL/g/min) (p = 0.0025). Lung FDG uptake in SLE-PAH correlated with SLEDAI score and plasma complement C3 and C4 levels (Ki vs SLEDAI, r = 0.607, p = 0.021; Ki vs C3, r = - 0.568, p = 0.034; Ki vs C4, r = - 0.661, p = 0.010). There were no significantly correlations between lung FDG uptake and pulmonary vascular haemodynamics and 6 min walking distance in both IPAH and SLE-PAH patients. CONCLUSIONS Our data indicated that increased lung FDG uptake in SLE-PAH patients correlates with SLE disease activity (SLEDAI) and immune/inflammatory status (C3 and C4). FDG-PET imaging may be developed as a potential intrapulmonary disease activity marker in SLE-PAH patients.
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195
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Challenging but Clinically Useful: Fluorodeoxyglucose PET/Computed Tomography in Inflammatory and Infectious Diseases. PET Clin 2020; 15:xi-xii. [DOI: 10.1016/j.cpet.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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196
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Carbone RG, Murdaca G, Negrini S, Penna D, Puppo F. Diagnosis of an unusual case of idiopathic mediastinal fibrosis by 18F-FDG PET/CT. Radiol Case Rep 2020; 15:435-436. [PMID: 32099588 PMCID: PMC7029048 DOI: 10.1016/j.radcr.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 11/01/2022] Open
Abstract
Diagnosis of idiopathic mediastinal fibrosis was done by exclusion in a 54-year-old woman with dyspnoea, chest pain, cough and fatigue showing positivity of 2-deoxy-2-[18F]fluoro-D-glucose positron-emission tomography/computed tomography total body imaging which turned out to normal after six and eighteen months of prednisone and pirfernidone treatment.
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197
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Gomes A, van Geel PP, Santing M, Prakken NHJ, Ruis ML, van Assen S, Slart RHJA, Sinha B, Glaudemans AWJM. Imaging infective endocarditis: Adherence to a diagnostic flowchart and direct comparison of imaging techniques. J Nucl Cardiol 2020; 27:592-608. [PMID: 30066279 PMCID: PMC7174257 DOI: 10.1007/s12350-018-1383-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Multimodality imaging is recommended to diagnose infective endocarditis. Value of additional imaging to echocardiography in patients selected by a previously proposed flowchart has not been evaluated. METHODS An observational single-center study was performed. Adult patients suspected of endocarditis/device infection were prospectively and consecutively enrolled from March 2016 to August 2017. Adherence to a diagnostic imaging-in-endocarditis-flowchart was evaluated in 176 patients. Imaging techniques were compared head-to-head in 46 patients receiving echocardiography (transthoracic plus transesophageal), multi-detector computed tomography angiography (MDCTA), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET/CT). RESULTS 69% of patients (121/176) adhered to the flowchart. Sensitivity of echocardiography, MDCTA, FDG-PET/CT in patients without prosthesis was 71%, 57%, 29% (86% when combined), while specificity was 100%, 75%, 100%, respectively. Sensitivity in patients with prosthesis was 75%, 75%, 83%, respectively (100% when combined), while specificity was 86% for all three modalities. Echocardiography performed best in the assessment of vegetations, morphological valve abnormalities/dehiscence, septum defects, and fistula formation. MDCTA performed best in the assessment of abscesses and ventricular assist device infection. FDG-PET/CT performed best in the assessment of cardiac device infection, extracardiac infectious foci, and alternative diagnoses. CONCLUSIONS This study demonstrates that the evaluated imaging-in-endocarditis-flowchart is applicable in daily clinical practice. Echocardiography, MDCTA, and FDG-PET/CT provide relevant complementary diagnostic information, particularly in patients with intracardiac prosthetic material.
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Affiliation(s)
- Anna Gomes
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands.
| | - Peter Paul van Geel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Santing
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niek H J Prakken
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathilde L Ruis
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands
- Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sander van Assen
- Department of Internal Medicine, Infectious Diseases, Treant Care Group, Hoogeveen, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1 (HPC:EB80), 9713GZ, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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198
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Bertolini V, Palmieri A, Bassi MC, Bertolini M, Trojani V, Piccagli V, Fioroni F, Cavuto S, Guberti M, Versari A, Cola S. CT protocol optimisation in PET/CT: a systematic review. EJNMMI Phys 2020; 7:17. [PMID: 32180029 PMCID: PMC7076098 DOI: 10.1186/s40658-020-00287-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/10/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Currently, no consistent guidelines for CT scans used within PET/CT examinations are available. This systematic review provides an up-to-date overview of studies to answer the following questions: What are the specific CT protocols used in PET/CT? What are the possible purposes of requiring a CT study within a PET/CT scan? Is the CT protocol obtained from a dosimetric optimisation study? Materials and method PubMed/MEDLINE, Cochrane Library, Embase and Scopus were systematically searched for relevant studies in accordance with the PRISMA statement. The literature search was conducted from January 2007 until June 2019. Data derived from studies were standardized in order to reduce possible biases, and they were divided into clinically homogeneous subgroups (adult, child or phantom). Subsequently, we divided the CT protocol intents into 3 types (anatomic localization only, attenuation correction only and diagnostic purpose). A narrative approach was used to summarise datasets and to investigate their heterogeneity (due to medical prescription methodology) and their combination in multiseries CT protocols. When weighted computed tomography dose index (CTDIw) was available, we calculated the volumetric computed tomography dose index (CTDIvol) using the pitch value to make the results uniform. Eventually, the correlation between protocol intents and CTDIvol values was obtained using a Kruskal–Wallis one-way ANOVA statistical test. Result Starting from a total of 1440 retrieved records, twenty-four studies were eligible for inclusion in addition to two large multicentric works that we used to compare the results. We analyzed 87 CT protocols. There was a considerable range of variation in the acquisition parameters: tube current–time product revealed to have the most variable range, which was 10–300 mAs for adults and 10–80 mAs for paediatric patients. Seventy percent of datasets presented scans acquired with tube current modulation, 9% used fixed tube current and in 21% of them, this information was not available. Dependence between mean CTDIvol values and protocol intent was statistically significant (p = 0.002). As expected, in diagnostic protocols, there was a statistically significant difference between CTDIvol values of with and without contrast acquisitions (11.68 mGy vs 7.99 mGy, p = 0.009). In 13 out of 87 studies, the optimisation aim was not reported; in 2 papers, a clinical protocol was used; and in 11 works, a dose optimisation protocol was applied. Conclusions According to this review, the dose optimisation in PET/CT exams depends heavily on the correct implementation of the CT protocol. In addition to this, considering the latest technology advances (i.e. iterative algorithms development), we suggest a periodic quality control audit to stay updated on new clinical utility modalities and to achieve a shared standardisation of clinical protocols. In conclusion, this study pointed out the necessity to better identify the specific CT protocol use within PET/CT scans, taking into account the continuous development of new technologies.
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Affiliation(s)
- V Bertolini
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - A Palmieri
- Nuclear Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M C Bassi
- Medical Library, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M Bertolini
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.
| | - V Trojani
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.,Medical Physics Specialization School, Università degli Studi di Bologna, Bologna, Italy
| | - V Piccagli
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - F Fioroni
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - S Cavuto
- Research and Statistics Infrastructure, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M Guberti
- Health Care Professionals Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - A Versari
- Nuclear Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - S Cola
- Nuclear Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
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Abstract
Periprosthetic joint infection (PJI) is a severe complication, associated with substantial morbidity and high costs. PJI can occur in the early postoperative period but also many years after joint replacement. Timely and accurate diagnosis is important for treatment planning. Diagnosis of PJI can be a challenge, especially for chronic and low-grade infections. The diagnostic performance of fludeoxyglucose F 18 (18F-FDG) positron emission tomography (PET) in detecting PJI seems sufficiently high for routine clinical application and has additional value to conventional tests. Further research is needed to determine the exact place of 18F-FDG PET in the diagnostic work-up of suspected PJI.
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Affiliation(s)
- Robert M Kwee
- Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, Groningen 9700 RB, the Netherlands.
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Finessi M, Bisi G, Deandreis D. Hyperglycemia and 18F-FDG PET/CT, issues and problem solving: a literature review. Acta Diabetol 2020; 57:253-262. [PMID: 31304560 DOI: 10.1007/s00592-019-01385-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/24/2019] [Indexed: 12/26/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a standard procedure for imaging cancer commonly used in the clinical practice for several diseases, in particular for cancer staging, restaging, treatment monitoring and radiation therapy planning. Despite the availability of many radiotracers, 18F-fluoro-2-deoxy-2-D-glucose ([18F]FDG) is the most used. International PET/CT guidelines propose protocols for patients' correct preparation before [18F]FDG injection, in particular with the regard of diabetic patients and therapy management. Hyperglycemic conditions and oral or insulin medication showed advantages and disadvantages on PET/CT scan accuracy: A correct knowledge of effects of these conditions on glucose metabolism assumes a fundamental role on patients management before [18F]FDG PET/CT scan.
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Affiliation(s)
- Monica Finessi
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy.
| | - Gianni Bisi
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
| | - Désirée Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
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