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Treglia G, Albano D, Rizzo A, Bellasi A, Glaudemans AWJM, Gheysens O. Performance of [ 18F]FDG PET/CT in Diagnosing Cyst Infections in Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and a Bivariate Meta-Analysis. Diagnostics (Basel) 2024; 14:1603. [PMID: 39125479 PMCID: PMC11312050 DOI: 10.3390/diagnostics14151603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has been suggested as a useful imaging method for diagnosing cyst infections in patients with autosomal dominant polycystic kidney disease (ADPKD). The aim of this article is to provide evidence-based data in this setting. METHODS A systematic literature review (exploring several bibliographic databases) and a bivariate meta-analysis were carried out to calculate the pooled diagnostic performance of [18F]FDG PET/CT in diagnosing probable cyst infection in ADPKD. RESULTS Ten studies (282 PET/CT scans and 249 patients) were included in the analysis. The pooled sensitivity and specificity of [18F]FDG PET/CT in this setting were 84.6% (95% confidence interval: 75.4-90.7) and 94.9% (95% confidence interval: 72.6-99.2), respectively, without statistical heterogeneity or significant publication bias. [18F]FDG PET/CT significantly changed patient management in more than half of ADPKD patients with suspected cyst infection. CONCLUSIONS [18F]FDG PET/CT has high performance in diagnosing probable cyst infections in ADPKD patients with an impact on management in the majority of patients. Although more studies are warranted, the provided evidence-based data are an important step towards the integration of [18F]FDG PET/CT in clinical and diagnostic guidelines on probable cyst infection in ADPKD patients.
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Affiliation(s)
- Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Faculty of Biology and Medicine, University of Lausanne, 1011 Lausanne, Switzerland
| | - Domenico Albano
- Division of Nuclear Medicine, ASST Spedali Civili Brescia, 25123 Brescia, Italy;
- Nuclear Medicine Department, University of Brescia, 25121 Brescia, Italy
| | - Alessio Rizzo
- Division of Nuclear Medicine, Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy;
| | - Antonio Bellasi
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Service of Nephrology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Andor W. J. M. Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700-RB Groningen, The Netherlands;
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc and Institute of Clinical and Experimental Research (IREC), Université Catholique de Louvain, 1200 Brussels, Belgium;
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Otto W, Psomiadis JS, Kirshner B. Management of a Suspected Renal Cyst Infection With Intracystic Hemorrhage in a Patient With Autosomal Dominant Polycystic Kidney Disease. Cureus 2023; 15:e39319. [PMID: 37351251 PMCID: PMC10282502 DOI: 10.7759/cureus.39319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 06/24/2023] Open
Abstract
Renal cyst infections are a serious complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infections are challenging to treat and have a high incidence of complications such as sepsis and death. No guideline or evidence-based strategy for diagnosis or treatment of cyst infection currently exists. This lack of standardized guidance leads to individualized medical decision-making for each individual case, despite the high risk of morbidity and mortality associated with the infection. This case describes a 33-year-old female with a past medical history of ADPKD that presented with hematuria, increased urinary frequency, and left flank pain. On computed tomography (CT) imaging, she was found to have a large intracystic hemorrhage with an associated hematoma formation. Laboratory evaluation was remarkable for leukocytosis with left shift but normal renal function. Urinalysis displayed hematuria and the presence of protein, but the culture resulted in no growth. In the presence of clinical signs of infection, she was suspected to have an infected renal cyst that did not have glomerular communication, given the bland urinalysis and negative urine culture. Her hemoglobin stabilized, and she did not require embolization or percutaneous drainage of the cyst. Intravenous levofloxacin was initiated, and the patient clinically improved with the normalization of leukocytosis. Blood cultures remained negative, and she was discharged to home with a course of oral levofloxacin with a resolution of symptoms.
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Affiliation(s)
- Whitnee Otto
- Internal Medicine, Piedmont Macon Medical Center, Macon, USA
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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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Liu Y, Tang S. Artificial Intelligence Algorithm-Based Computed Tomography Image of Both Kidneys in Diagnosis of Renal Dysplasia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5823720. [PMID: 35126629 PMCID: PMC8813217 DOI: 10.1155/2022/5823720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/11/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022]
Abstract
The objective of this study was to explore the accuracy of low-dosage computed tomography (CT) images based on the expectation maximization algorithm denoising algorithm (EM algorithm) in the detection and diagnosis of renal dysplasia, so as to provide reasonable research basis for accuracy improvement of clinical diagnosis of renal dysplasia. 120 patients with renal dysplasia in hospital were randomly selected as the research objects, and they were divided into two groups by random number method, with 60 patients in each group. The low-dosage CT images of patients in the control group were not processed (nonalgorithm group), and the low-dosage CT images of patients in the observation group were denoised using the EM algorithm (algorithm group). In addition, it was compared with the results of the comprehensive diagnosis (gold standard) to analyze the accuracy of the diagnosis of the two groups of patients and the consistency with the results of the pathological diagnosis. The results were compared with those of the comprehensive diagnosis (gold standard) to analyze the accuracy of the diagnosis of the two groups of patients. The results showed that the peak signal-to-noise ratio (PSNR) (15.9 dB) of the EM algorithm was higher than the regularized adaptive matching pursuit (RAMP) algorithm (1.69 dB) and the mean filter (4.3 dB) (P < 0.05). The time consumption of EM algorithm (21 s) was shorter than that of PWLS algorithm (34 s) and MS-PWLS algorithm (39 s) (P < 0.05). The diagnosis accuracy of dysplasia of single kidney, absence of single kidney, horseshoe kidney, and duplex kidney was obviously higher in the algorithm group than the control group (P < 0.05), which were 66.67% vs. 90%, 60% vs. 88.89%, 71.42% vs. 100%, and 60% vs. 88.89%, respectively. The incidence of hypertension in patients with autosomal dominant polycystic kidney disease (ADPKD) (56.77%) was much higher than that of the other diseases (P < 0.05). After denoising by the EM algorithm, low-dosage CT image could improve the diagnostic accuracy of several types of renal dysplasia except ADPKD, showing certain clinical application value. In addition, ADPKD was easy to cause hypertension.
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Affiliation(s)
- Yonghui Liu
- Department of Urology Surgery, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001 Hunan, China
| | - Siai Tang
- Department of Endocrine Nephrology, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001 Hunan, China
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Klinkhammer BM, Lammers T, Mottaghy FM, Kiessling F, Floege J, Boor P. Non-invasive molecular imaging of kidney diseases. Nat Rev Nephrol 2021; 17:688-703. [PMID: 34188207 PMCID: PMC7612034 DOI: 10.1038/s41581-021-00440-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 02/05/2023]
Abstract
In nephrology, differential diagnosis or assessment of disease activity largely relies on the analysis of glomerular filtration rate, urinary sediment, proteinuria and tissue obtained through invasive kidney biopsies. However, currently available non-invasive functional parameters, and most serum and urine biomarkers, cannot capture intrarenal molecular disease processes specifically. Moreover, although histopathological analyses of kidney biopsy samples enable the visualization of pathological morphological and molecular alterations, they only provide information about a small part of the kidney and do not allow longitudinal monitoring. These limitations not only hinder understanding of the dynamics of specific disease processes in the kidney, but also limit the targeting of treatments to active phases of disease and the development of novel targeted therapies. Molecular imaging enables non-invasive and quantitative assessment of physiological or pathological processes by combining imaging technologies with specific molecular probes. Here, we discuss current preclinical and clinical molecular imaging approaches in nephrology. Non-invasive visualization of the kidneys through molecular imaging can be used to detect and longitudinally monitor disease activity and can therefore provide companion diagnostics to guide clinical trials, as well as the safe and effective use of drugs.
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Affiliation(s)
| | - Twan Lammers
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany
- Department of Pharmaceutics, Utrecht University, Utrecht, Netherlands
- Department of Targeted Therapeutics, University of Twente, Enschede, Netherlands
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, RWTH Aachen University Hospital, Aachen, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Jürgen Floege
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Boor
- Institute of Pathology, RWTH Aachen University Hospital, Aachen, Germany.
- Department of Nephrology and Immunology, RWTH Aachen University Hospital, Aachen, Germany.
- Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany.
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Sharma P. Fever of Unknown Origin: 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Showing Renal Cyst Infection in Autosomal Dominant Polycystic Kidney Disease. Indian J Nucl Med 2021; 36:43-45. [PMID: 34040295 PMCID: PMC8130681 DOI: 10.4103/ijnm.ijnm_139_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Fever of unknown origin (FUO) is a convoluted clinical dilemma. It can be caused by infective, inflammatory, malignant, and other pathologies. The identification of etiopathogenesis is essential for instituting definitive management. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) is now an integral part of FUO management. We present the case of a 60-year-old female with autosomal dominant polycystic kidney disease (ADPKD), where the infected renal cyst was detected as the cause of FUO on18F-FDG PET-CT.
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Affiliation(s)
- Punit Sharma
- Department of Nuclear Medicine and PET-CT, Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
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The use of a visual 4-point scoring scale improves the yield of 18F-FDG PET-CT imaging in the diagnosis of renal and hepatic cyst infection in patients with autosomal dominant polycystic kidney disease. Eur J Nucl Med Mol Imaging 2020; 48:254-259. [DOI: 10.1007/s00259-020-04903-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/02/2020] [Indexed: 12/31/2022]
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Prabhu M, Damle NA, Ray A, Kandasamy D. 18F-FDG PET/CT in cyst infection in autosomal dominant polycystic kidney disease. Indian J Radiol Imaging 2020; 30:102-104. [PMID: 32476761 PMCID: PMC7240894 DOI: 10.4103/ijri.ijri_469_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/26/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022] Open
Abstract
Infection of a cyst within an autosomal dominant polycystic kidney disease (ADPKD) is a serious complication. Diagnosis with conventional imaging techniques such as ultrasonography, computed tomography (CT), and magnetic resonance imaging can be sometimes challenging. The definite diagnosis is analysis of the cyst fluid, but cyst punctures can cause bleeding, rupture, and contamination of adjacent cysts. Recently, FDG PET/CT has been reported as a sensitive tool for detection of cyst infection. We describe a case of 63-year-old woman with infected cysts in the left kidney, in whom accurate diagnosis was made on FDG PET/CT. FDG PET/CT is an important investigation in patients with fever of uncertain etiology, where renal cyst infection is a possible cause, but other etiologies also need to be ruled out.
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Affiliation(s)
- Meghana Prabhu
- Department of Nuclear Medicine, A.I.I.M.S, New Delhi, India
| | | | - Animesh Ray
- Department of Medicine, A.I.I.M.S, New Delhi, India
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Pijl JP, Glaudemans AWJM, Slart RHJA, Kwee TC. 18F-FDG PET/CT in Autosomal Dominant Polycystic Kidney Disease Patients with Suspected Cyst Infection. J Nucl Med 2018; 59:1734-1741. [PMID: 29653972 DOI: 10.2967/jnumed.117.199448] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/28/2018] [Indexed: 12/28/2022] Open
Abstract
The objective of this study was to determine the value of 18F-FDG PET/CT for diagnosing renal or hepatic cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD). Methods: This retrospective, single-center study included all patients who had ADPKD and underwent 18F-FDG PET/CT because of suspected cyst infection between 2010 and 2017. Results: Thirty 18F-FDG PET/CT scans of 30 individual patients were included; 19 of them had positive results for cyst infection. According to a previously established clinical and biochemical reference standard, 18F-FDG PET/CT achieved a sensitivity of 88.9%, a specificity of 75.0%, a positive predictive value of 84.2%, and a negative predictive value of 81.8% for the diagnosis of cyst infection. In 5 cases, 18F-FDG PET/CT suggested that the symptoms could be explained by a different pathologic process, including pneumonia (n = 1), generalized peritonitis (n = 1), pancreatitis (n = 1), colitis (n = 1), and cholangitis (n = 1). The total duration of the hospital stay and the duration between the 18F-FDG PET/CT scan and hospital discharge for patients with 18F-FDG PET/CT scan results that were positive for cyst infection were significantly longer than those for patients with negative scan results (P = 0.005 and P = 0.009, respectively). Creatinine levels were significantly higher in patients with 18F-FDG PET/CT scan results that were positive for cyst infection than in patients with negative scan results (P = 0.015). Other comparisons of clinical parameters (age, sex, presence of fever [>38.5°C] for more than 3 d, abdominal pain, history of solid-organ transplantation and nephrectomy, and immune status), laboratory values (C-reactive protein level, leukocyte count, and estimated glomerular filtration rate), and microbiologic test results (blood and urine cultures) were not significantly different (P = 0.13-1.00) in patients with positive and negative 18F-FDG PET/CT scan results. Conclusion: 18F-FDG PET/CT is a useful imaging modality for the evaluation of patients with ADPKD and suspected cyst infection.
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Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Riemer H J A Slart
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and.,Department of Biomedical Photonic Imaging (BMPI), University of Twente, Enschede, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
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