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Becker KK, Søholm J, Hess S. The Diagnostic Yield of [ 18F]FDG-PET/CT in a Heterogeneous In-Patient Population with Suspected Infection or Inflammation Is Comparable to Findings in Patients with Classic Fever of Unknown Origin. Diagnostics (Basel) 2024; 14:1420. [PMID: 39001310 PMCID: PMC11241151 DOI: 10.3390/diagnostics14131420] [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] [Received: 05/10/2024] [Revised: 06/11/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Suspected infection or inflammation of unknown origin in in-patients remains challenging. Literature on [18F]FDG-PET/CT is abundant in classic fever of unknown origin (FUO), but evidence is complex and may not always reflect clinical reality. This study explores the application of [18F]FDG-PET/CT in a diverse clinical population of in-patients with suspected infection not defined by stringent FUO-criteria. METHODS Retrospective chart review of consecutive in-patients who underwent [18F]FDG-PET/CT in the workup of suspected infection or inflammation from 1 July 2022 to 31 December 2022 was conducted. We evaluated indications, diagnostic yield, and clinical impact of [18F]FDG-PET/CT, and compared the findings of [18F]FDG-PET/CT and stand-alone CT. Univariate logistic regression assessed associations between [18F]FDG-PET/CT outcome and clinical parameters. Receiver operating characteristic curve (ROC) analysis evaluated diagnostic performance. RESULTS 77 patients met the inclusion criteria. [18F]FDG-PET/CT established a diagnosis in 35% of cases, ruled out focal infection in 26%, and thus was helpful in 61% of patients. It prompted 72 additional examinations resulting in seven incidental diagnoses, including two cancers. Antibiotic treatment was changed in 26% of cases. Regression analysis found white blood cell counts (WBC) associated with true positive outcomes. [18F]FDG-PET/CT was compared to stand-alone CT findings, and was concordant in 69% of cases. CONCLUSIONS Results were comparable to findings in more classic FUO. [18F]FDG-PET/CT was clinically helpful in 61% of cases but also prompted many additional examinations with relatively few clinically important findings. WBC count was a predictor of true positive outcome. CT and [18F]FDG-PET/CT were discordant in 31%, of cases, especially in cases of endocarditis and spondylodiscitis.
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Affiliation(s)
- Kristian Kimer Becker
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
- IRIS-Imaging Research Initiative Southwest, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
| | - Jacob Søholm
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
| | - Søren Hess
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
- IRIS-Imaging Research Initiative Southwest, University Hospital of Southern Denmark, 6700 Esbjerg, Denmark
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark
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Sluijter TE, Yakar D, Roest C, Tsoumpas C, Kwee TC. Does FDG-PET/CT for incidentally found pulmonary lesions lead to a cascade of more incidental findings? Clin Imaging 2024; 108:110116. [PMID: 38460254 DOI: 10.1016/j.clinimag.2024.110116] [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: 12/13/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To determine the frequency, nature, and downstream healthcare costs of new incidental findings that are found on whole-body FDG-PET/CT in patients with a non-FDG-avid pulmonary lesion ≥10 mm that was incidentally found on previous imaging. MATERIALS AND METHODS This retrospective study included a consecutive series of patients who underwent whole-body FDG-PET/CT because of an incidentally found pulmonary lesion ≥10 mm. RESULTS Seventy patients were included, of whom 23 (32.9 %) had an incidentally found pulmonary lesion that proved to be non-FDG-avid. In 12 of these 23 cases (52.2 %) at least one new incidental finding was discovered on FDG-PET/CT. The total number of new incidental findings was 21, of which 7 turned out to be benign, 1 proved to be malignant (incurable metastasized cancer), and 13 whose nature remained unclear. One patient sustained permanent neurologic impairment of the left leg due to iatrogenic nerve damage during laparotomy for an incidental finding which turned out to be benign. The total costs of all additional investigations due to the detection of new incidental findings amounted to €9903.17, translating to an average of €141.47 per whole-body FDG-PET/CT scan performed for the evaluation of an incidentally found pulmonary lesion. CONCLUSION In many patients in whom whole-body FDG-PET/CT was performed to evaluate an incidentally found pulmonary lesion that turned out to be non-FDG-avid and therefore very likely benign, FDG-PET/CT detected new incidental findings in our preliminary study. Whether the detection of these new incidental findings is cost-effective or not, requires further research with larger sample sizes.
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Affiliation(s)
- Tim E Sluijter
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Netherlands Cancer Institute, Amsterdam, Department of Radiology, the Netherlands
| | - Christian Roest
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Charalampos Tsoumpas
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Mestres C, Van Hemelrijck M, Quintana E, Smit FE. Significance and current approaches to vascular graft infection. Indian J Thorac Cardiovasc Surg 2023; 39:333-340. [PMID: 38093914 PMCID: PMC10713901 DOI: 10.1007/s12055-023-01638-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023] Open
Abstract
Vascular graft/endograft infection (VGEI) is a constant in cardiovascular surgery with published rates between 1 and 5%. Every graft type and anatomical location is a potential target for infectious complications. These patients are sick patients with high frailty burden. Management of VGEI entails a multidisciplinary and multimodality approach. Here we review some aspects of the problem of VGEI including prevention, diagnosis, and surgical therapy with focus on recent developments in the field.
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Affiliation(s)
- Carlos–Alberto Mestres
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
| | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences and The Robert WM Frater Cardiovascular Research Centre, The University of the Free State, PO Box 339 (Internal Box G32), Bloemfontein, 9300 South Africa
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Hernández-Meneses M, Perissinotti A, Páez-Martínez S, Llopis J, Dahl A, Sandoval E, Falces C, Ambrosioni J, Vidal B, Marco F, Cuervo G, Moreno A, Bosch J, Tolosana JM, Fuster D, Miró JM. Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:970-979. [PMID: 37028797 DOI: 10.1016/j.rec.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/17/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES The role of [18F]FDG-PET/CT in cardiac implantable electronic device (CIED) infections requires better evaluation, especially in the diagnosis of systemic infections. We aimed to determine the following: a) the diagnostic accuracy of [18F]FDG-PET/CT in each CIED topographical region, b) the added value of [18F]FDG-PET/CT over transesophageal echocardiography (TEE) in diagnosing systemic infections, c) spleen and bone marrow uptake in differentiating isolated local infections from systemic infections, and d) the potential application of [18F]FDG-PET/CT in follow-up. METHODS Retrospective single-center study including 54 cases and 54 controls from 2014 to 2021. The Primary endpoint was the diagnostic yield of [18F]FDG-PET/CT in each topographical CIED region. Secondary analyses described the performance of [18F]FDG-PET/CT compared with that of TEE in systemic infections, bone marrow and spleen uptake in systemic and isolated local infections, and the potential application of [18F]FDG-PET/CT in guiding cessation of chronic antibiotic suppression when completed device removal is not performed. RESULTS We analyzed 13 (24%) isolated local infections and 41 (76%) systemic infections. Overall, the specificity of [18F]FDG-PET/CT was 100% and sensitivity 85% (79% pocket, 57% subcutaneous lead, 22% endovascular lead, 10% intracardiac lead). When combined with TEE, [18F]FDG-PET/CT increased definite diagnosis o fsystemic infections from 34% to 56% (P=.04). Systemic infections with bacteremia showed higher spleen (P=.05) and bone marrow metabolism (P=.04) than local infections. Thirteen patients without complete device removal underwent a follow-up [18F]FDG-PET/CT, with no relapses after discontinuation of chronic antibiotic suppression in 6 cases with negative follow-up [18F]FDG-PET/CT. CONCLUSIONS The sensitivity of [18F]FDG-PET/CT for evaluating CIED infections was high in local infections but much lower in systemic infections. However, accuracy increased when [18F]FDG-PET/CT was combined with TEE in endovascular lead bacteremic infection. Spleen and bone marrow hypermetabolism could differentiate bacteremic systemic infection from local infection. Although further prospective studies are needed, follow-up [18F]FDG-PET/CT could play a potential role in the management of chronic antibiotic suppression therapy when complete device removal is unachievable.
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Affiliation(s)
- Marta Hernández-Meneses
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Servicio de Medicina Nuclear, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain
| | - Silvia Páez-Martínez
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Departamento de Genética, microbiología y estadística, Universidad de Barcelona, Barcelona, Spain
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte University Hospital Copenhagen, Hellerup, Denmark
| | - Elena Sandoval
- Servicio de Cirugía Cardiovascular, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Carlos Falces
- Servicio de Cardiología, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain
| | - Bárbara Vidal
- Servicio de Cardiología, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Francesc Marco
- Servicio de Microbiología, Hospital Clinic-ISGlobal, Universidad de Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Servicio de Microbiología, Hospital Clinic-ISGlobal, Universidad de Barcelona, Barcelona, Spain
| | - José M Tolosana
- Servicio de Cardiología, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - David Fuster
- Servicio de Medicina Nuclear, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain.
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Infection of Vascular Prostheses: A Comprehensive Review. PROSTHESIS 2023. [DOI: 10.3390/prosthesis5010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Vascular graft or endograft infection (VGEI) is a complex disease that complicates vascular-surgery and endovascular-surgery procedures and determines high morbidity and mortality. This review article provides the most updated general evidence on the pathogenesis, prevention, diagnosis, and treatment of VGEI. Several microorganisms are involved in VGEI development, but the most frequent one, responsible for over 75% of infections, is Staphylococcus aureus. Specific clinical, surgical, radiologic, and laboratory criteria are pivotal for the diagnosis of VGEI. Surgery and antimicrobial therapy are cornerstones in treatment for most patients with VGEI. For patients unfit for surgery, alternative treatment is available to improve the clinical course of VGEI.
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