Ilse J E Kouijzer1,2,3, Linda M Kampschreur4, Peter C Wever5, Corneline Hoekstra6, Marjo E E van Kasteren7, Monique G L de Jager-Leclercq8, Marrigje H Nabuurs-Franssen9, Marjolijn C A Wegdam-Blans10, Heidi S M Ammerlaan11, Jacqueline Buijs12, Lioe-Fee de Geus-Oei3,13, Wim J G Oyen14, Chantal P Bleeker-Rovers15,2. 1. Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands ilsekouijzer@gmail.com. 2. Radboud Expert Centre for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands. 3. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands. 4. Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. 5. Department of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 6. Department of Nuclear Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 7. Department of Internal Medicine, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands. 8. Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands. 9. Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. 10. Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, The Netherlands. 11. Department of Internal Medicine, Catharina Hospital, Eindhoven, The Netherlands. 12. Department of Internal Medicine, Zuyderland Medical Center, Heerlen, The Netherlands. 13. Department of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands; and. 14. Institute of Cancer Research/Royal Marsden Hospital, London, U.K., and Department of Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. 15. Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
In 1%-5% of all acute Q fever infections, chronic Q fever develops, mostly manifesting as endocarditis, infected aneurysms, or infected vascular prostheses. In this study, we investigated the diagnostic value of 18F-FDG PET/CT in chronic Q fever at diagnosis and during follow-up. Methods: All adult Dutch patients suspected of chronic Q fever who were diagnosed since 2007 were retrospectively included until March 2015, when at least one 18F-FDG PET/CT scan was obtained. Clinical data and results from 18F-FDG PET/CT at diagnosis and during follow-up were collected. 18F-FDG PET/CT scans were prospectively reevaluated by 3 nuclear medicine physicians using a structured scoring system. Results: In total, 273 patients with possible, probable, or proven chronic Q fever were included. Of all 18F-FDG PET/CT scans performed at diagnosis, 13.5% led to a change in diagnosis. Q fever-related mortality rate in patients with and without vascular infection based on 18F-FDG PET/CT was 23.8% and 2.1%, respectively (P = 0.001). When 18F-FDG PET/CT was added as a major criterion to the modified Duke criteria, 17 patients (1.9-fold increase) had definite endocarditis. At diagnosis, 19.6% of 18F-FDG PET/CT scans led to treatment modification. During follow-up, 57.3% of 18F-FDG PET/CT scans resulted in treatment modification. Conclusion: 18F-FDG PET/CT is a valuable technique in diagnosis of chronic Q fever and during follow-up, often leading to a change in diagnosis or treatment modification and providing important prognostic information on patient survival.
In 1%-5% of all acute Q fever infections, chronic Q fever develops, mostly manifesting as endocarditis, infected aneurysms, or infected vascular prostheses. In this study, we investigated the diagnostic value of 18F-FDG PET/CT in chronic Q fever at diagnosis and during follow-up. Methods: All adult Dutch patients suspected of chronic Q fever who were diagnosed since 2007 were retrospectively included until March 2015, when at least one 18F-FDG PET/CT scan was obtained. Clinical data and results from 18F-FDG PET/CT at diagnosis and during follow-up were collected. 18F-FDG PET/CT scans were prospectively reevaluated by 3 nuclear medicine physicians using a structured scoring system. Results: In total, 273 patients with possible, probable, or proven chronic Q fever were included. Of all 18F-FDG PET/CT scans performed at diagnosis, 13.5% led to a change in diagnosis. Q fever-related mortality rate in patients with and without vascular infection based on 18F-FDG PET/CT was 23.8% and 2.1%, respectively (P = 0.001). When 18F-FDG PET/CT was added as a major criterion to the modified Duke criteria, 17 patients (1.9-fold increase) had definite endocarditis. At diagnosis, 19.6% of 18F-FDG PET/CT scans led to treatment modification. During follow-up, 57.3% of 18F-FDG PET/CT scans resulted in treatment modification. Conclusion: 18F-FDG PET/CT is a valuable technique in diagnosis of chronic Q fever and during follow-up, often leading to a change in diagnosis or treatment modification and providing important prognostic information on patient survival.
Authors: René van den Brom; Aarieke de Jong; Erik van Engelen; Annet Heuvelink; Piet Vellema Journal: Small Rumin Res Date: 2020-05-15 Impact factor: 1.611