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Khan D, Phulia A, Kumar S, Sarswat S, Kv S, Sagar S. Role of 18 F-FDG PET/CT for providing a targeted approach for etiology of PUO. Nucl Med Commun 2024; 45:702-709. [PMID: 38832445 DOI: 10.1097/mnm.0000000000001855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
AIM This study aimed to evaluate the potential role of 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) in providing a targeted approach for diagnosing the etiology of Pyrexia of Unknown Origin (PUO). METHODS A total of 573 PUO patients were included in this ambispective study, with a mean age of 39.40 ± 4.6 years. Patients underwent FDG PET/CT scans using dedicated hybrid scanners. PET/CT data were interpreted by experienced nuclear medicine physicians. The study analyzed the guidance provided by FDG PET/CT for appropriate biopsy sites and assessed concordance between PET/CT findings and histopathological examination. RESULTS Out of the 573 patients, a final diagnosis was reached for 219 patients, including malignancy, infectious causes, noninfectious inflammatory causes (NIID), and precancerous conditions. FDG PET/CT played a crucial role in guiding clinicians to appropriate biopsy sites, contributing to a higher diagnostic yield. Concordance between PET/CT findings and histopathological examination emphasized the noninvasive diagnostic potential of PET/CT in identifying underlying causes of PUO. Overall, FDG PET/CT contributed to guiding the appropriate site of biopsy or concordance of the first differential diagnosis with the final diagnosis in 50.05% of cases. CONCLUSION This study highlights the valuable role of FDG PET/CT in providing a targeted approach for diagnosing PUO, showcasing its potential in guiding clinicians towards appropriate biopsy sites and improving the diagnostic yield. The findings underscore the importance of integrating FDG PET/CT into the diagnostic pathway for PUO, ultimately enhancing patient management and outcomes. Further prospective studies are necessary to validate these results and refine the integration of FDG PET/CT in the diagnosis of PUO.
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Affiliation(s)
- Dikhra Khan
- Department of Nuclear Medicine, All India Institute of Medical Sciences,
| | | | - Suraj Kumar
- Department of Nuclear Medicine, PGI Chandigarh, Chandigarh and
| | | | - Sivasankar Kv
- Department of Nuclear Medicine, All India Institute of Medical Sciences,
| | - Sambit Sagar
- Department of Nuclear Medicine, All India Institute of Medical Sciences,
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2
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Hess S, Noriega-Álvarez E, Leccisotti L, Treglia G, Albano D, Roivainen A, Glaudemans AWJM, Gheysens O. EANM consensus document on the use of [ 18F]FDG PET/CT in fever and inflammation of unknown origin. Eur J Nucl Med Mol Imaging 2024; 51:2597-2613. [PMID: 38676736 PMCID: PMC11224117 DOI: 10.1007/s00259-024-06732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE Patients with fever and inflammation of unknown origin (FUO/IUO) are clinically challenging due to variable clinical presentations with nonspecific symptoms and many differential diagnoses. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is increasingly used in FUO and IUO, but the optimal diagnostic strategy remains controversial. This consensus document aims to assist clinicians and nuclear medicine specialists in the appropriate use of [18F]FDG-PET/CT in FUO and IUO based on current evidence. METHODS A working group created by the EANM infection and inflammation committee performed a systematic literature search based on PICOs with "patients with FUO/IUO" as population, "[18F]FDG-PET/CT" as intervention, and several outcomes including pre-scan characteristics, scan protocol, diagnostic yield, impact on management, prognosis, and cost-effectiveness. RESULTS We included 68 articles published from 2001 to 2023: 9 systematic reviews, 49 original papers on general adult populations, and 10 original papers on specific populations. All papers were analysed and included in the evidence-based recommendations. CONCLUSION FUO and IUO remains a clinical challenge and [18F]FDG PET/CT has a definite role in the diagnostic pathway with an overall diagnostic yield or helpfulness in 50-60% of patients. A positive scan is often contributory by directly guiding treatment or subsequent diagnostic procedure. However, a negative scan may be equally important by excluding focal disease and predicting a favorable prognosis. Similar results are obtained in specific populations such as ICU-patients, children and HIV-patients.
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Affiliation(s)
- Søren Hess
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Edel Noriega-Álvarez
- Department of Nuclear Medicine, University Hospital of Guadalajara, Guadalajara, Spain
| | - Lucia Leccisotti
- Section of Nuclear Medicine, Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Nuclear Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Domenico Albano
- Nuclear Medicine, University of Brescia, ASST Spedali Civili Brescia, Brescia, Italy
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Turku, Finland
- Turku PET Centre, Turku University Hospital, Turku, Finland
- InFLAMES Research Flagship, University of Turku, Turku, Finland
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands.
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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3
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Besson FL, Nocturne G, Noël N, Gheysens O, Slart RHJA, Glaudemans AWJM. PET/CT in Inflammatory and Auto-immune Disorders: Focus on Several Key Molecular Concepts, FDG, and Radiolabeled Probe Perspectives. Semin Nucl Med 2024; 54:379-393. [PMID: 37973447 DOI: 10.1053/j.semnuclmed.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
Chronic immune diseases mainly include autoimmune and inflammatory diseases. Managing chronic inflammatory and autoimmune diseases has become a significant public health concern, and therapeutic advancements over the past 50 years have been substantial. As therapeutic tools continue to multiply, the challenge now lies in providing each patient with personalized care tailored to the specifics of their condition, ushering in the era of personalized medicine. Precise and holistic imaging is essential in this context to comprehensively map the inflammatory processes in each patient, identify prognostic factors, and monitor treatment responses and complications. Imaging of patients with inflammatory and autoimmune diseases must provide a comprehensive view of the body, enabling the whole-body mapping of systemic involvement. It should identify key cellular players in the pathology, involving both innate immunity (dendritic cells, macrophages), adaptive immunity (lymphocytes), and microenvironmental cells (stromal cells, tissue cells). As a highly sensitive imaging tool with vectorized molecular probe capabilities, PET/CT can be of high relevance in the management of numerous inflammatory and autoimmune diseases. Relying on key molecular concepts of immunity, the clinical usefulness of FDG-PET/CT in several relevant inflammatory and immune-inflammatory conditions, validated or emerging, will be discussed in this review, together with radiolabeled probe perspectives.
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Affiliation(s)
- Florent L Besson
- Department of Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris-Saclay, AP-HP, DMU SMART IMAGING, CHU Bicêtre, Paris, France; Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; Université Paris-Saclay, Commissariat à l'énergie Atomique et aux Énergies Alternatives (CEA), Centre National de la Recherche Scientifique (CNRS), INSERM, BioMaps, Le Kremlin-Bicêtre, France.
| | - Gaetane Nocturne
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; Department of Rheumatology, Hôpital Bicêtre Assistance Publique -Hôpitaux de Paris, Le Kremlin-Bicêtre, France; Center for Immunology of Viral Infections and Auto-Immune Diseases (IMVA), Université Paris-Saclay, Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Le Kremlin Bicêtre, Paris, France
| | - Nicolas Noël
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France; Center for Immunology of Viral Infections and Auto-Immune Diseases (IMVA), Université Paris-Saclay, Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Le Kremlin Bicêtre, Paris, France; Department of Internal Medicine, Hôpital Bicêtre Assistance Publique -Hôpitaux de Paris, Le Kremlin-Bicêtre, Paris, France
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires St-Luc and Institute for Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands; Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands
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4
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Martinez-Lorca A, Ajuria-Illarramendi O, Orduña-Diez MDP. Osteomyelitis detected by 18F-FDG PET-CT. An Pediatr (Barc) 2024; 100:390-391. [PMID: 38637203 DOI: 10.1016/j.anpede.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/29/2024] [Indexed: 04/20/2024] Open
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5
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Singh SB, Shrestha N, Bhandari S, Shrestha S, Shrestha B, Shrestha N, Rijal S, Singh R, Hess S, Werner TJ, Alavi A, Revheim ME. [ 18F]FDG PET/CT for identifying the causes of fever of unknown origin (FUO). AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2024; 14:87-96. [PMID: 38737639 PMCID: PMC11087293 DOI: 10.62347/oqqc6007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/20/2024] [Indexed: 05/14/2024]
Abstract
Fever of unknown origin (FUO) continues to be a challenging diagnosis in clinical medicine. It has more than 200 known causes, including infections, autoimmune diseases, neoplasia, and other miscellaneous disorders. Despite the development of a wide range of diagnostic tools, a specific diagnostic algorithm for FUO is not yet available. However, [18F]FDG PET/CT, which yields information on cellular metabolism, in addition to details of organ anatomy, has been shown to be successful in the FUO investigation. This study highlights the uses of [18F]FDG PET/CT in diagnosing various causes of FUO. [18F]FDG PET/CT has been increasingly used to detect septic infections, sterile inflammatory processes, and malignancies, occupying a significant portion of the known causes of FUO. It has led to a more definitive identification of the etiology of FUO and accurate clinical management. However, more in-depth studies are crucial to understanding if [18F]FDG PET/CT can be used in the work-up of FUO.
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Affiliation(s)
- Shashi B Singh
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA 19104, USA
- Current affiliation: Department of Radiology, Stanford University School of MedicineStanford, CA 94305, USA
| | | | - Sadikshya Bhandari
- Dhulikhel Hospital, Kathmandu University School of Medical SciencesDhulikhel, Kavre 11008, Nepal
| | - Suprita Shrestha
- Nepal Medical College Teaching HospitalAttarkhel, Kathmandu 13344, Nepal
| | | | | | - Swarnima Rijal
- Kathmandu Medical CollegeSinamangal, Kathmandu 21266, Nepal
| | | | - Soren Hess
- Department of Nuclear Medicine, Odense University HospitalOdense 5000, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern DenmarkOdense 5230, Denmark
| | - Thomas J Werner
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- The Intervention Center, Rikshospitalet, Division for Technology and Innovation, Oslo University HospitalOslo 0424, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloOslo 0313, Norway
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6
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Olianti C, Trapani S, Secinaro A, Holm Reichkendler M. Fever of unknown origin in pediatrics: role of nuclear medicine. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:48-57. [PMID: 38454877 DOI: 10.23736/s1824-4785.24.03546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Fever of unknown origin (FUO) is a debated issue in numerous scientific studies in adult patients with a not jet-defined workflow in a clinical and diagnostic setting. Few works are published about pediatric patients even if FUO represents a challenging, not infrequent scenario in hospital and outpatient recovery. The fever might be the onset symptom of a transient mild infection or the beginning of a more difficult-to-diagnose and serious pathological condition. In the adult workflow 18FDG PET-CT is nowadays playing a relevant role, considering the limited spread of conventional 99mTc-HMPAO-White Blood Cells scintigraphy. It represents a robust tool for diagnosing the eventual site of infection, but it is limited by procedural complexity and long duration, up to 24 hours. The WBC-scintigraphy is also not suitable for children, only for young adults or adolescents, considering the relevant blood sample entity and the procedural risk for sensitive subjects. The most assessed clinical and diagnostic know-how on Pediatric FUO are summarized and a synthetic flow-chard is presented to support the clinical management and to choose the best diagnostic pathway.
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Affiliation(s)
- Catia Olianti
- Unit of Nuclear Medicine, Department of Image Diagnostics, Careggi University Hospital, Florence, Italy -
| | - Sandra Trapani
- Department of Medical Pediatric, Meyer Children's University Hospital IRCCS, Florence, Italy
| | - Aurelio Secinaro
- Department of Radiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michala Holm Reichkendler
- Unit of Nuclear Medicine, Department of Image Diagnostic, Rigshospitalet University Hospital, Copenhagen, Denmark
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7
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Ugan Atik S, Arslan P, Bilgiç S, Sonmezoglu K, Cilsal E, Gokalp S, Guzeltas A. 18F-fluorodeoxyglucose positron emission tomography/CT in the diagnosis of right-sided endocarditis in children and adults with infective endocarditis. Cardiol Young 2024:1-6. [PMID: 38164792 DOI: 10.1017/s104795112300392x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Infectious endocarditis poses a diagnostic challenge due to its highly variable clinical presentation. To establish a definitive diagnosis, different imaging modalities are essential. In recent years, positron emission tomography/CT has gained increasing significance in diagnosing infective endocarditis; however, its application in the pediatric age group remains limited. This study encompasses patients definitively or potentially diagnosed with infectious endocarditis at our institution from 2018 to 2023. METHODS A total of 29 patients underwent 18F-fluorodeoxyglucose positron emission tomography/CT examinations, with 19 of them presenting with right-sided infective endocarditis. RESULTS Evidence consistent with infective endocarditis was observed in 18 (94.7%) of the patients. Pulmonary septic embolism was identified in 15 (78.9%) cases, and splenic involvement was noted in 12 (57.8%) cases. Transthoracic/transesophageal echocardiography failed to reveal vegetation or provided uncertain results in six patients, whereas fluorodeoxyglucose-positron emission tomography-CT exhibited involvement. Subsequently, the diagnosis of infective endocarditis was confirmed post-surgery based on the fluorodeoxyglucose-positron emission tomography-CT findings. CONCLUSION Our results, along with our clinical experience, demonstrate that fluorodeoxyglucose-positron emission tomography-CT is a safe and viable method for diagnosing right-sided endocarditis, which is often challenging to visualize using echocardiography.
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Affiliation(s)
- Sezen Ugan Atik
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Perver Arslan
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Seçkin Bilgiç
- Department of Nuclear Medicine, Istanbul University Cerrahpaþa Faculty of Medicine, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Department of Nuclear Medicine, Istanbul University Cerrahpaþa Faculty of Medicine, Istanbul, Turkey
| | - Erman Cilsal
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Selman Gokalp
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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8
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Trapani S, Fiordelisi A, Stinco M, Resti M. Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 11:20. [PMID: 38255334 PMCID: PMC10814770 DOI: 10.3390/children11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient's history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | - Adele Fiordelisi
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | | | - Massimo Resti
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
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Chin J, Vali R, Charron M, Shammas A. Update on Pediatric Nuclear Medicine in Acute Care. Semin Nucl Med 2023; 53:820-839. [PMID: 37211467 DOI: 10.1053/j.semnuclmed.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
Various radiopharmaceuticals are available for imaging pediatric patients in the acute care setting. This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal chest radiograph. 99mTc-pertechnetate scintigraphy (Meckel's scan) is the best noninvasive procedure to establish the diagnosis of ectopic gastric mucosa in Meckel's diverticulum. 99mTcred blood cell scintigraphy generally is useful for assessing lower GI bleeding in patients from any cause. Hepatobiliary scintigraphy is the most accurate diagnostic imaging modality for acute cholecystitis. 99mTc-dimercaptosuccinic acid scintigraphy is the simplest, and the most reliable and sensitive method for the early diagnosis of focal or diffuse functional cortical damage. 99mTcmercaptoacetyltriglycine scintigraphy is used to evaluate for early and late complications of renal transplantation. Bone scintigraphy is a sensitive and noninvasive technique for diagnosis of bone disorders such as osteomyelitis and fracture. 18F-fluorodeoxyglucose-positron emission tomography could be valuable in the evaluation of fever of unknown origin in pediatric patients, with better sensitivity and significantly less radiation exposure than a gallium scan. Moving forward, further refinement of pediatric radiopharmaceutical administered activities, including dose reduction, greater radiopharmaceutical applications, and updated consensus guidelines is warranted, with the use of radionuclide imaging likely to increase.
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Affiliation(s)
- Joshua Chin
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Reza Vali
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Martin Charron
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amer Shammas
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Giraudo C, Carraro S, Zucchetta P, Cecchin D. Pediatric Imaging Using PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:625-636. [PMID: 37741646 DOI: 10.1016/j.mric.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
PET/MR imaging is a one-stop shop technique for pediatric diseases allowing not only an accurate clinical assessment of tumors at staging and restaging but also the diagnosis of neurologic, inflammatory, and infectious diseases in complex cases. Moreover, applying PET kinetic analyses and sequences such as diffusion-weighted imaging as well as quantitative analysis investigating the relationship between disease metabolic activity and cellularity can be applied. Complex radiomics analysis can also be performed.
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Affiliation(s)
- Chiara Giraudo
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Silvia Carraro
- Unit of Pediatric Allergy and Respiratory Medicine, Women's and Children's Health Department, University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Pietro Zucchetta
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy
| | - Diego Cecchin
- Complex Unit of Nuclear Medicine, Department of Medicine (DIMED), University Hospital of Padova, Via Nicolo' Giustiniani 2, 35128, Padova, Italy.
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Palestro CJ, Brandon DC, Dibble EH, Keidar Z, Kwak JJ. FDG PET in Evaluation of Patients With Fever of Unknown Origin: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:151-162. [PMID: 36722759 DOI: 10.2214/ajr.22.28726] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fever of unknown origin (FUO) is a diagnostic challenge, with its cause remaining undiagnosed in approximately half of patients. Nuclear medicine tests typically are performed after a negative or inconclusive initial workup. Gallium-67 citrate and labeled leukocytes were previous mainstays of radionuclide imaging for FUO, although they had limited diagnostic performance. FDG PET/CT has subsequently emerged as the nuclear medicine imaging test of choice, supported by a growing volume of evidence. A positive FDG PET/CT result contributes useful information by identifying potential causes of fever, localizing sites for further evaluation, and guiding further management; a negative result contributes useful information by excluding focal disease as the cause of fever and predicts a favorable prognosis. In 2021, CMS rescinded a prior national noncoverage determination for FDG PET for infection and inflammation, leading to increasing national utilization of FDG PET/CT for FUO workup. This article reviews the current status of the role of FDG PET/CT in the evaluation of patients with FUO. The literature reporting the diagnostic performance and yield of FDG PET/CT in FUO workup is summarized, with comparison with historically used nuclear medicine tests included. Attention is also given to the test's clinical impact; protocol, cost, and radiation considerations; and application in children.
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Affiliation(s)
- Christopher J Palestro
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Division of Nuclear Medicine & Molecular Imaging, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040
| | - David C Brandon
- Department of Radiology, Division of Nuclear Medicine, Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Jennifer J Kwak
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado Anschutz Medical Campus, Aurora, CO
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Voss SD. SPECT/CT, PET/CT and PET/MRI: oncologic and infectious applications and protocol considerations. Pediatr Radiol 2023; 53:1443-1453. [PMID: 36899268 DOI: 10.1007/s00247-023-05597-7] [Citation(s) in RCA: 2] [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: 07/01/2022] [Revised: 11/07/2022] [Accepted: 01/11/2023] [Indexed: 03/12/2023]
Abstract
Functional imaging is playing an increasingly important role in pediatric radiology. Hybrid imaging techniques utilizing PET/CT (positron emission tomography/computed tomography), PET/MRI (positron emission tomography/magnetic resonance imaging), or SPECT/CT (single photon emission computed tomography/computed tomography) are now available in nearly every clinical practice. There are an increasing number of indications for the use of functional imaging, including oncologic and infectious indications, and it is essential to select and design the hybrid imaging protocol in order to optimize both the functional and anatomic components of the examination. Optimizing the protocol includes strategies for dose reduction, judicious use of contrast media and diagnostic quality imaging as appropriate, and for the greatest reduction in exposure to ionizing radiation, utilizing PET/MRI, whenever available. This review will provide an overview of hybrid imaging protocol considerations with a focus on oncologic and infectious indications.
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Affiliation(s)
- Stephan D Voss
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
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Fisher IF, Shemer R, Dor Y. Epigenetic liquid biopsies: a novel putative biomarker in immunology and inflammation. Trends Immunol 2023; 44:356-364. [PMID: 37012121 DOI: 10.1016/j.it.2023.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
Immune and inflammatory processes occurring within tissues are often undetectable by blood cell counts, standard circulating biomarkers, or imaging, representing an unmet biomedical need. Here, we outline recent advances indicating that liquid biopsies can broadly inform human immune system dynamics. Nucleosome-size fragments of cell-free DNA (cfDNA) released from dying cells into blood contain rich epigenetic information such as methylation, fragmentation, and histone mark patterns. This information allows to infer the cfDNA cell of origin, as well as pre-cell death gene expression patterns. We propose that the analysis of epigenetic features of immune cell-derived cfDNA can shed light on immune cell turnover dynamics in healthy people, and inform the study and diagnosis of cancer, local inflammation, infectious or autoimmune diseases, as well as responses to vaccination.
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14
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Goodman AL, Packham A, Sharkey AR, Cook GJR. Advanced Imaging for Detection of Foci of Infection in Staphylococcus aureus Bacteremia- Can a Scan Save Lives? Semin Nucl Med 2023; 53:175-183. [PMID: 36690574 PMCID: PMC10016027 DOI: 10.1053/j.semnuclmed.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/23/2023]
Abstract
Bloodstream infection or sepsis is a common cause of mortality globally. Staphylococcus aureus (S. aureus) is of particular concern, through its ability to seed metastatic infections in almost any organ after entering the bloodstream (S. aureus bacteraemia), often without localising signs. A positive blood culture for S. aureus bacteria should lead to immediate and urgent identification of the cause. Failure to detect a precise focus of infection is associated with higher mortality, sometimes despite appropriate antibiotics. This is likely due to the limited ability to effectively target therapy in occult lesions. Early detection of foci of metastatic S. aureus infection is therefore key for optimal diagnosis and subsequent therapeutic management. 18F-FDG-PET/CT and MRI offer us invaluable tools in the localisation of foci of S. aureus infection. Crucially, they may identify unexpected foci at previously unsuspected locations in the body, for example vertebral osteomyelitis in the absence of back pain. S. aureus bloodstream infections are further complicated by their microbiological recurrence; 18F-FDG-PET/CT provide a means of localising, thus enabling source control. More evidence is emerging as to the utility of 18F-FDG-PET/CT in this setting, perhaps even to the point of reducing mortality. 18 F-FDG-PET/MRI may have a similar impact. The available evidence demonstrates a need to investigate the impact of 18F-FDG-PET/CT and MRI scanning in clinical management and outcomes of S. aureus infection further in a randomised prospective clinical trial.
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Affiliation(s)
- Anna L Goodman
- Medical Research Council Clinical Trials Unit at University College London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Alice Packham
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical Research Facility, University Hospitals Birmingham Foundation Trust, London, UK
| | - Amy R Sharkey
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gary J R Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College London and Guy's and St Thomas' PET Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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15
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Eynath Y, Halperin E, Buchrits S, Gafter-Gvili A, Bernstine H, Catalano O, Avni T. Predictors for spontaneous resolution of classical FUO in patients undergoing PET-CT. Intern Emerg Med 2023; 18:367-374. [PMID: 36512183 DOI: 10.1007/s11739-022-03171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
Spontaneous resolution is common in patients with classic fever of unknown origin (FUO). Identifying predictors of spontaneous resolution could reduce the usage of unnecessary, invasive tests or empirical therapy, and furthermore reduce patient anxiety. Identify predictors associated with spontaneous resolution of FUO. A single center, retrospective, cohort study. All hospitalized patients who underwent an [18F] FDG PET-CT scan for the investigation of classical FUO between 1/2012 and 1/2020 were included. We compared patients with spontaneous resolution of fever and clinical symptoms, to those who were diagnosed with a specific etiology of FUO (subdivided to infectious diseases, non-infectious inflammatory diseases (NIID), and malignancies). Epidemiologic characteristics as well as laboratory and PETCT study results were compared. Variables that were found to be associated with spontaneous resolution of FUO on univariate analysis (p < 0.1) were entered into a multivariable regression analysis. The results are reported as odds ratios (OR) and 95% confidence intervals (CI). A total of 303 patients were hospitalized for the investigation of classical FUO and underwent complete assessment. Fever resolved without a diagnosis in 84/303 patients (28%). Variables that were associated with spontaneous resolution of FUO on multivariable analysis included: no anemia, no hypoalbuminemia and no pathological FDG uptake on PET-CT. In 17.8% (15/84) of studies, PET-CT yielded false-positive results that led to additional unnecessary, invasive investigation. Patients without anemia or hypoalbuminemia, and those without uptake on PET-CT are more likely to have spontaneous resolution of classical FUO.
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Affiliation(s)
- Yair Eynath
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
| | - Erez Halperin
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Shira Buchrits
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Gafter-Gvili
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Onofrio Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tomer Avni
- Internal Medicine Department A, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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16
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Şahin Ö, Ataş B, Metin Akcan Ö, Şen AE. 18F-FDG PET/CT Findings Overlapping Lymphoma in a Patient with Systemic Juvenile Idiopathic Arthritis. Mol Imaging Radionucl Ther 2023; 32:90-93. [PMID: 36820811 PMCID: PMC9950687 DOI: 10.4274/mirt.galenos.2021.30922] [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] [Indexed: 02/24/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is an important autoinflammatory disease whose first symptom is usually fever, and life-threatening conditions such as macrophage activation syndrome can develop when diagnosis and treatment is delayed. sJIA is an exclusion diagnosis, and there is no specific test that distinguishes it from other febrile diseases. We report the positron emission tomography/computed tomography (PET/CT) findings of sJIA in a 12-year-old girl who presented with fever, rash, and arthralgia. 18F-fluorodeoxyglucose (FDG) uptake was observed in the spleen, bone marrow, and lymph nodes in 18F-FDG PET/CT performed to investigate the etiology of fever of unknown origin. The result of excisional biopsy performed with the suspicion of lymphoma from the left cervical lymph node with intense 18F-FDG uptake was reported as reactive hyperplasia. PET/CT is an alternative diagnostic method for patients with fever of unknown origin. In this case report, we emphasize that in patients with sJIA, there may be intense fluorodeoxyglucose-avid lymph nodes that may lead to the consideration of lymphoproliferative disease, and PET/CT findings along with spleen and bone marrow involvement may overlap with lymphoma.
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Affiliation(s)
- Özlem Şahin
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Nuclear Medicine, Konya, Turkey,* Address for Correspondence: Necmettin Erbakan University, Meram Faculty of Medicine, Department of Nuclear Medicine, Konya, Turkey Phone: +90 505 240 12 92 E-mail:
| | - Bülent Ataş
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Pediatric Nephrology, Konya, Turkey
| | - Özge Metin Akcan
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Pediatric Infectious Diseases, Konya, Turkey
| | - Ahmet Eren Şen
- Necmettin Erbakan University, Meram Faculty of Medicine, Department of Nuclear Medicine, Konya, Turkey
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17
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van Rijsewijk ND, IJpma FFA, Wouthuyzen-Bakker M, Glaudemans AWJM. Molecular Imaging of Fever of Unknown Origin: An Update. Semin Nucl Med 2023; 53:4-17. [PMID: 35902280 DOI: 10.1053/j.semnuclmed.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
18F-FDG PET/CT, 67Ga-citrate and white blood cell (WBC) scintigraphy are molecular imaging techniques currently used in the diagnostic workup of fever of unknown origin. However, it is unknown which technique fits which patient group best. A systematic literature search has been performed for original articles regarding the use of molecular imaging in fever of unknown origin. A total of 820 eligible studies were screened of which 63 articles evaluating 5094 patients met the inclusion criteria. 18F-FDG PET/CT provided good diagnostic accuracy (with a weighted mean sensitivity, specificity, positive predicting value, negative predictive value, accuracy and helpfulness of 84.4%, 61.8%, 80.7%, 67.8%, 76.3%, and 61.1%, respectively). Even within specific patient groups such as children, elderly, patients with connective tissue diseases, patients on renal replacement therapy, and HIV-infected patients, 18F-FDG PET/CT provided good diagnostic values. For 67Ga-citrate scintigraphy, the weighted mean sensitivity, specificity, positive predictive value, negative predictive value, and helpfulness were 42.2%, 80.3%, 82.4%, 41.9%, and 42.2%, respectively. WBC scintigraphy shows a weighted mean sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 73.5%, 86.3%, 79.1%, 82.4%, and 79.5%, respectively. However, compared to 67Ga-citrate and WBC scintigraphy, significantly more research has been performed using 18F-FDG PET/CT and 18F-FDG PET/CT has the advantage of relatively short procedural duration; it is therefore the preferred molecular diagnostic imaging technique. 67Ga-citrate and WBC scintigraphy can only be considered if 18F-FDG PET/CT is not available.
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Affiliation(s)
- Nick D van Rijsewijk
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Glaudemans AWJM, Gheysens O. Expert opinions in nuclear medicine: Finding the "holy grail" in infection imaging. Front Med (Lausanne) 2023; 10:1149925. [PMID: 36923013 PMCID: PMC10008957 DOI: 10.3389/fmed.2023.1149925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 03/03/2023] Open
Abstract
Nuclear medicine imaging techniques are now widely accepted and increasingly used for diagnosing and treatment monitoring of infectious and inflammatory diseases. The latter has been exemplified by numerous recent clinical guidelines in which PET imaging is now part of the diagnostic flowcharts. In this perspective paper we discuss the current available guidelines, the current limitations, and we provide the future aims of research to achieve the holy grail in nuclear medicine: the differentiation between infection, inflammation and malignancy.
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Affiliation(s)
- Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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19
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Khalatbari H, Shulkin BL, Parisi MT. Emerging Trends in Radionuclide Imaging of Infection and Inflammation in Pediatrics: Focus on FDG PET/CT and Immune Reactivity. Semin Nucl Med 2023; 53:18-36. [PMID: 36307254 DOI: 10.1053/j.semnuclmed.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
The most common indication for 18F-FDG PET/CT is tumor imaging, which may be performed for initial diagnosis, staging, therapeutic response monitoring, surveillance, or suspected recurrence. In the routine practice of pediatric nuclear medicine, most infectious, inflammatory, and autoimmune processes that are detected on 18F-FDG PET/CT imaging - except for imaging in fever or inflammation of unknown origin - are coincidental and not the main indication for image acquisition. However, interpreting these "coincidental" findings is of utmost importance to avoid erroneously attributing these findings to a neoplastic process. We review the recent literature on fever of unknown origin as well as inflammation of unknown origin in pediatrics and then focus on the 18F FDG PET/CT imaging findings seen in two specific entities with increased immune reactivity: hemophagocytic lymphohistiocytosis syndrome and the immune-related adverse events associated with checkpoint inhibitors. We will subsequently close with two sections highlighting related topics and relevant references for further reading.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Radiology, St. Jude Children's Research Hospital, Memphis, TN.
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
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20
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Li Q, Yao M, Tian R, Sun X. Evaluating diagnostic tests when a gold standard is not available: reply to Lo and Lo. Pediatr Radiol 2022; 52:2653-2654. [PMID: 36169669 DOI: 10.1007/s00247-022-05506-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Qianrui Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Sichuan, Chengdu, China.,Chinese Evidence-Based Medicine Center, Cochrane China Center, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China.,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Minghong Yao
- Chinese Evidence-Based Medicine Center, Cochrane China Center, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China.,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Sichuan, Chengdu, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, Cochrane China Center, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China. .,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China. .,Sichuan Center of Technology Innovation for Real World Data, Chengdu, China.
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21
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22
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Minamimoto R. Optimal use of the FDG-PET/CT in the diagnostic process of fever of unknown origin (FUO): a comprehensive review. Jpn J Radiol 2022; 40:1121-1137. [PMID: 35781177 PMCID: PMC9616755 DOI: 10.1007/s11604-022-01306-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
Numerous studies have clarified the usefulness of 18F-fluorodeoxyglucose (FDG)-PET/CT (positron emission tomography) for diagnosing the cause of fever of unknown origin (FUO). Various types of disease can cause FUO, but the cause remains unknown in a certain proportion of FUO, even when the advanced diagnostic methodologies are used. FDG-PET/CT is regarded as a second-line modality in the diagnostic process of FUO, and its potential to identify the cause of FUO will be maximized when the appropriate clinical considerations are understood. Accordingly, this review presents basic knowledge regarding FUO, and reports the current status of FDG-PET/CT applied to diagnosing the cause of FUO, including diagnostic performance, test protocols, possible factors influencing the diagnostic result, outcomes, and cost-effectiveness. This knowledge will enable effective future use of FDG-PET/CT to improve outcomes in patients with FUO.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-ku, Tokyo, 162-8655, Japan.
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23
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Li Q, Tian R, Wang H, Li L, Wu T, Ren Y, Su M, Zou K, Sun X. Quantifying the contribution of 18F-FDG PET to the diagnostic assessment of pediatric patients with fever of unknown origin: a systematic review and meta-analysis. Pediatr Radiol 2022; 52:1500-1511. [PMID: 35348809 DOI: 10.1007/s00247-022-05333-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 10/18/2021] [Accepted: 02/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in the diagnostic assessment of pediatric fever of unknown origin is not known, and evidence from adults is not applicable. OBJECTIVE To quantify the contribution of 18F-FDG PET to pediatric fever of unknown origin, considering its diagnostic limitations. MATERIALS AND METHODS We searched PubMed, EMBASE and Cochrane Central Register of Controlled Trials up to Feb. 18, 2021. We included studies on patients with pediatric fever of unknown origin presenting sufficient data to calculate the likelihood of achieving definite diagnosis (based on pathology or clinical follow-up) between those with abnormal PET findings versus those with normal PET findings. We assessed the risk of bias using a modified Newcastle-Ottawa quality assessment scale and quantified the value of PET by pooling the likelihood of achieving definite diagnosis using a random-effects model. RESULTS We included 6 studies and found that pediatric patients with abnormal PET findings were about 17 times more likely to achieve definite diagnoses than those with normal PET findings (odds ratio [OR]: 16.75, 95% confidence interval [CI] 8.0-35, P < 0.00001). Sensitivity analyses using a fixed-effect model (OR 16.91, 95% CI 8.1-35, P < 0.0001) or removing one study at a time (OR 12-20, 95% CI lower bound 3.8-8.6, 95% CI upper bound 33-45, P < 0.0001) did not significantly alter the results. Sample size (interaction P = 0.75), imaging modality (interaction P = 0.29), length of follow-up (interaction P = 0.37), fever of unknown origin subclasses (interaction P = 0.89) and geographical areas (interaction P = 0.74) of studies showed no statistically significant influence on the results. CONCLUSION 18F-FDG PET is a promising approach in the diagnostic work-up of pediatric fever of unknown origin. Further studies are warranted to support routine use in clinical care.
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Affiliation(s)
- Qianrui Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.,Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Hongxi Wang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Li
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Tian Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yan Ren
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Minggang Su
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kang Zou
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China.,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Centre, Cochrane China Centre, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, China. .,National Medical Products Administration (NMPA) Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, Sichuan, China.
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24
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Abbati G, Abu Rumeileh S, Perrone A, Galli L, Resti M, Trapani S. Pelvic Pyomyositis in Childhood: Clinical and Radiological Findings in a Tertiary Pediatric Center. CHILDREN 2022; 9:children9050685. [PMID: 35626862 PMCID: PMC9139856 DOI: 10.3390/children9050685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Pyomyositis (PM) is an infrequent but increasing bacterial infection of the skeletal muscle, with muscles of the pelvis and thigh frequently involved. The diagnosis is often challenging, especially when a deep muscle is affected. We present a single-center pediatric cohort affected by pelvic PM. A retrospective analysis was performed, including children admitted to Meyer Children’s Hospital between 2010 and 2020. Demographic, anamnestic, clinical, laboratory, radiological and management data were collected. Forty-seven patients (range 8 days–16.5 years, 66% males) were selected. Pain (64%), functional limitations (40%) and fever (38%) were the most common presenting symptoms; 11% developed sepsis. The median time to reach the diagnosis was 5 days (IQR 3–9). Staphylococcus aureus was the most common organism (30%), Methicillin-Resistant S aureus (MRSA) in 14%. PM was associated with osteomyelitis (17%), arthritis (19%) or both (45%). The infection was multifocal in 87% of children and determined abscesses in 44% (40% multiple). Pelvic MRI scan, including diffusion-weighted imaging (DWI), always showed abnormalities when performed. Clinical and laboratory findings in pelvic PM are unspecific, especially in infancy. Nevertheless, the infection may be severe, and the suspicion should be higher. MRI is the most useful radiological technique, and DWI sequence could reveal insidious infections.
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Affiliation(s)
- Giulia Abbati
- Paediatric Residency, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
- Correspondence: ; Tel.: +39-3389919979
| | - Sarah Abu Rumeileh
- Paediatric Residency, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
| | - Anna Perrone
- Radiology Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
- Infectious Disease Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy
| | - Massimo Resti
- Paediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
| | - Sandra Trapani
- Department of Health Sciences, University of Florence, Viale Pieraccini 24, 50139 Florence, Italy; (L.G.); (S.T.)
- Paediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Florence, Italy;
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25
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Mulders-Manders CM, Kouijzer IJ, de Geus-Oei LF. 18F-FDG-PET/CT imaging in fever and inflammation of unknown origin. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00035-1] [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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26
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Li Q, Tian R, Sun X. More Evidence Is Warranted to Establish the Role of 18FDG-PET/CT in Fever of Unknown Origin (FUO) Investigations Among Children. Clin Infect Dis 2021; 73:e2842-e2844. [PMID: 33064795 DOI: 10.1093/cid/ciaa1574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Qianrui Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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27
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Kawanami H, Yasutomi M, Hayashi T, Takeuchi M, Ohshima Y. Utility of positron emission tomography for diagnosis of systemic juvenile idiopathic arthritis with lung involvement. Pediatr Int 2021; 63:1381-1382. [PMID: 34327769 DOI: 10.1111/ped.14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/11/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Haruna Kawanami
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Motoko Yasutomi
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Taihei Hayashi
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | | | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Eleyan L, Khan AA, Musollari G, Chandiramani AS, Shaikh S, Salha A, Tarmahomed A, Harky A. Infective endocarditis in paediatric population. Eur J Pediatr 2021; 180:3089-3100. [PMID: 33852085 DOI: 10.1007/s00431-021-04062-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture-negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort. What is Known: • The current diagnostic techniques including 'Duke's criteria' for paediatric infective endocarditis diagnosis • The current management guidelines utilised for paediatric infective endocarditis What is New: • The long-term outcomes of patients that underwent medical and surgical intervention • The quality of life of paediatric patients that underwent medical and surgical intervention.
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Affiliation(s)
- Loay Eleyan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Ameer Ahmed Khan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Gledisa Musollari
- Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK
| | | | - Simran Shaikh
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Ahmad Salha
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Abdulla Tarmahomed
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Amer Harky
- Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK. .,Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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29
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Rudolph H, Gress K, Weiss C, Schroten H, Adams O, Tenenbaum T. General Characteristics of Children with Single- and Co-Infections and Febrile Seizures with a Main Focus on Respiratory Pathogens: Preliminary Results. Pathogens 2021; 10:pathogens10081061. [PMID: 34451525 PMCID: PMC8399297 DOI: 10.3390/pathogens10081061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 01/15/2023] Open
Abstract
Febrile seizures (FS) affect up to 5% of children. The pathogen etiology in regard of viral loads has never been investigated. In a prospective cohort study we investigated the correlation between virus type and quantity in nasopharyngeal aspirates (NPAs) and the clinical characteristics in pediatric patients with a FS. From January 2014 to April 2016, 184 children with a FS were prospectively enrolled. The mean age of all included children was 26.7 ± 18.3 months with a male to female ratio of 1.4:1. Males with an acute disease and a short duration or absence of prior symptoms had a higher risk for complex FS. The majority of patients with FS presented with a generalized convulsion (180; 98%) and was admitted to hospital (178; 97%). Overall, 79 (43%) single and in 59 (32%) co-infections were detected. Human herpes virus 6 (HHV6), influenza, adenovirus (AV) and rhinovirus (RV) were the dominant pathogens, all detected with clinically significant high viral loads. HHV6 positive cases were significantly younger and less likely to have a positive family/personal history for FS. Influenza positives showed a higher rate of complex seizures, lower leukocyte and higher monocyte counts. AV positive cases were more likely to have a positive family history for FS and showed higher C-reactive protein values. In conclusion, a high viral load may contribute to the development of a FS in respiratory tract infections.
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Affiliation(s)
- Henriette Rudolph
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
| | - Katharina Gress
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
| | - Christel Weiss
- Institute of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
| | - Horst Schroten
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
| | - Ortwin Adams
- Institute of Virology, University Children’s Hospital, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
| | - Tobias Tenenbaum
- Paediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; (H.R.); (K.G.); (H.S.)
- Correspondence: or ; Tel.: +49-30-5518-5060
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30
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Tian Y, Zhang Y, Wen B, Li C, He Y. Hepatosplenic tuberculosis on 18F-FDG PET/CT imaging in a patient with pyrexia of unknown origin. Rev Esp Med Nucl Imagen Mol 2021. [PMID: 33903087 DOI: 10.1016/j.remn.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Y Tian
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Y Zhang
- Department of Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - B Wen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - C Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Y He
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China.
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31
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PET/Computed Tomography in the Evaluation of Fever of Unknown Origin and Infectious/Inflammatory Disease in Pediatric Patients. PET Clin 2021; 15:361-369. [PMID: 32498991 DOI: 10.1016/j.cpet.2020.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fever in children is common. If it persists and its cause cannot be identified in a reasonable time, along with laboratory and conventional imaging investigations, it is defined as fever of unknown origin (FUO). 18F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) is well established in the evaluation of malignancy, which is a possible cause of FUO. FDG often locates inflammatory and infectious lesions considered nonspecific or false-positive for oncology; however, these findings are beneficial in FUO evaluation because infectious and inflammatory diseases are important FUO causes. FDG-PET/CT is being increasingly used for investigation of FUO as well as infectious/inflammatory disease.
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Pijl JP, Kwee TC, Slart RHJA, Glaudemans AWJM. PET/CT Imaging for Personalized Management of Infectious Diseases. J Pers Med 2021; 11:133. [PMID: 33669375 PMCID: PMC7920259 DOI: 10.3390/jpm11020133] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/28/2022] Open
Abstract
Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which is increasingly being used in infectious diseases. Because infection foci often consume more glucose than surrounding tissue, most infections can be diagnosed with PET/CT using 2-deoxy-2-[18F]fluoro-D-glucose (FDG), an analogue of glucose labeled with Fluorine-18. In this review, we discuss common infectious diseases in which FDG-PET/CT is currently applied including bloodstream infection of unknown origin, infective endocarditis, vascular graft infection, spondylodiscitis, and cyst infections. Next, we highlight the latest developments within the field of PET/CT, including total body PET/CT, use of novel PET radiotracers, and potential future applications of PET/CT that will likely lead to increased capabilities for patient-tailored treatment of infectious diseases.
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Affiliation(s)
- Jordy P. Pijl
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
| | - Thomas C. Kwee
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
| | - Riemer H. J. A. Slart
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7500 AE Enschede, The Netherlands
| | - Andor W. J. M. Glaudemans
- Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB Groningen, The Netherlands; (T.C.K.); (R.H.J.A.S.); (A.W.J.M.G.)
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33
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Wareham NE, Nielsen SD, Sørensen SS, Fischer BM. FDG PET/CT for Detection of Infectious Complications Following Solid Organ Transplantation. Semin Nucl Med 2021; 51:321-334. [PMID: 33397588 DOI: 10.1053/j.semnuclmed.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infectious complications after solid organ transplantation (SOT) are often more severe and remain a diagnostic challenge due to vague and atypical clinical presentations. Diagnostic performance of conventional diagnostic tools is frequently inadequate which may lead to delayed diagnosis with the risk of poorer outcomes. This literature review aimed to investigate the current evidence on the use of 18F-fluoro-deoxy-glucose (FDG) Positron Emission Tomography (PET)/computer tomography (CT) in infectious complications after SOT. Based on search in PubMed, Medline, and Cochrane databases, 13 articles and 46 case reports were included. For inclusion, articles were to include data on patients with infectious complications after SOT, and where FDG PET/CT was part of the work-up. Final searches were conducted on 02 September 2020. Overall, in the absence of initial diagnostic clues, FDG PET/CT should be considered as the imaging technique of choice as it may guide further investigations and eventually reveal the diagnosis in most of the patients. However, the available literature of the role of FDG PET/CT in SOT recipients with infectious complications is scarce and well-designed prospective studies including control groups are warranted to establish the role of FDG PET/C/ in SOT recipients. The main drawback of FDG PET/CT is the lack of ability to differentiate between cancer and infectious diseases which are both highly prevalent in this patient group. Accordingly, the main reasons for "false" results of FDG PET/CT is the misdiagnosis of cancer in benign inflammatory or infectious processes, information which nonetheless can be useful.
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Affiliation(s)
- Neval E Wareham
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Søren Schwartz Sørensen
- Department of Nephrology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Barbara Malene Fischer
- The PET Centre, Guy's & St Thomas Hospital, School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London
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34
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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: 69] [Impact Index Per Article: 23.0] [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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Abstract
The aim of the study was to assess the feasibility of 18FDG PET in cardiac inflammation with a particular focus on the delayed scan. Thirty-five consecutive 18FDG PET scans of patients with suspected or confirmed cardiac inflammation were retrospectively reviewed. The patients were referred for PET because of endocarditis (n = 16) or sarcoidosis (n = 19). Among them four patients had two consecutive for follow up and treatment control (two patients with sarcoidosis, two with endocarditis). In all of the cases a standard head to mid-thigh scan was performed 45–60 min after 18FDG injection as well as a delayed heart scan 1 h after the standard imaging was performed. 18FDG PET confirmed active inflammation in 10 out of 35 scans. Delayed scans in positive cases showed SUVmax value increase, but did not have an impact on the result, neither they did in negative cases—no significant differences between standard and delayed scan were found. Interestingly in 5 out of 14 cases with suspected endocarditis PET revealed the extracardiac inflammation focus, thus changing initial diagnosis. 18FDG PET also indicated which prosthesis caused inflammation if there were many. In the sarcoidosis group the aim was to confirm or exclude heart involvement (13 scans) or to assess the response to the steroid therapy (6 scans) in patients with previously confirmed sarcoidosis. PET revealed active heart disease in 3 initial scans, and 1 follow up scan. 18FDG PET is a valuable imaging method for the cardiac inflammation assessment. It adequately localises the active inflammation site. Also, since it is a whole-body scan it may detect the extracardiac inflammation foci, which in some cases may change the initial diagnosis. In our study the delayed scans showed no added value.
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Evaluation of FDG-PET/CT Use in Children with Suspected Infection or Inflammation. Diagnostics (Basel) 2020; 10:diagnostics10090715. [PMID: 32961994 PMCID: PMC7554864 DOI: 10.3390/diagnostics10090715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
[18F]-FDG-PET/CT ([18F]-fluoro-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT)) is increasingly used as a diagnostic tool in suspected infectious or inflammatory conditions. Studies on the value of FDG-PET/CT in children are scarce. This study assesses the role of FDG-PET/CT in suspected infection or inflammation in children. In this multicenter cohort study, 64 scans in 59 children with suspected infection or inflammation were selected from 452 pediatric FDG-PET/CT scans, performed in five hospitals between January 2016 and August 2017. Main outcomes were diagnostic information provided by FDG-PET/CT for diagnostic scans and impact on clinical management for follow-up scans. Of these 64 scans, 50 were performed for primary diagnosis and 14 to monitor disease activity. Of the positive diagnostic scans, 23/27 (85%) contributed to establishing a diagnosis. Of the negative diagnostic scans, 8/21 (38%) contributed to the final diagnosis by narrowing the differential or by providing information on the disease manifestation. In all follow-up scans, FDG-PET/CT results guided management decisions. CRP was significantly higher in positive scans than in negative scans (p = 0.004). In 6% of diagnostic scans, relevant incidental findings were identified. In conclusion, FDG-PET/CT performed in children with suspected infection or inflammation resulted in information that contributed to the final diagnosis or helped to guide management decisions in the majority of cases. Prospective studies assessing the impact of FDG-PET/CT results on diagnosis and patient management using a structured diagnostic protocol are feasible and necessary.
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37
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Tian Y, Zhang Y, Wen B, Li C, He Y. Hepatosplenic tuberculosis on 18F-FDG PET/CT imaging in a patient with Pyrexia of Unknown Origin. Rev Esp Med Nucl Imagen Mol 2020; 40:267-269. [PMID: 34218896 DOI: 10.1016/j.remnie.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Yueli Tian
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
| | - Yuepeng Zhang
- Department of Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
| | - Bin Wen
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
| | - Chongjiao Li
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
| | - Yong He
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China.
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38
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Franceschi AM, Clifton M, Ahmed O, Matthews R, Franceschi D. Incidental PET/CT Findings of Suspected COVID-19 in a Region of High Prevalence. Cureus 2020; 12:e9716. [PMID: 32944437 PMCID: PMC7489331 DOI: 10.7759/cureus.9716] [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: 06/04/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022] Open
Abstract
We describe a case of suspected COVID-19 pneumonia in a 61-year-old male with known primary central nervous system diffuse large B-cell lymphoma (DLBCL) who underwent restaging PET/CT during the initial peak of infection of COVID-19 pneumonia within the New York region. At the time of his routine PET-CT to assess for disease progression, typical CT imaging features of COVID-19 pneumonia were identified. Upon further investigation, the patient was asymptomatic, and his infection status remained unknown. He was subsequently lost to follow-up with his COVID-19 status pending.
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Affiliation(s)
- Ana M Franceschi
- Radiology, Donald and Barbara Zucker School of Medicine at Hofstra - Northwell Health, New York, USA
| | - Michael Clifton
- Radiology, Stony Brook University Hospital, Stony Brook, USA
| | - Osama Ahmed
- Radiology, Stony Brook University Hospital, Stony Brook, USA
| | - Robert Matthews
- Radiology, Stony Brook University Hospital, Stony Brook, USA
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