Chih-Hsing Wan1, Jing-Ren Tseng2,3, Ming-Hsun Lee4, Lan-Yan Yang5, Tzu-Chen Yen6,7. 1. Department of Nuclear Medicine, Mackay Memorial Hospital at Taipei, No. 92, Section 2, Zhong-shan North road, Zhong-shan District, Taipei, Taiwan, Republic of China. 2. Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China. 3. Department of Medical Imaging and Radiological Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. 4. Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, Republic of China. 5. Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, Republic of China. 6. Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China. yen1110@adm.cgmh.org.tw. 7. Department of Medical Imaging and Radiological Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China. yen1110@adm.cgmh.org.tw.
Abstract
BACKGROUND: Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP. METHODS: Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results. RESULTS: Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%). CONCLUSIONS: FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.
BACKGROUND: Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP. METHODS: Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results. RESULTS: Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%). CONCLUSIONS: FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.
Authors: Kalpana Gupta; Thomas M Hooton; Kurt G Naber; Björn Wullt; Richard Colgan; Loren G Miller; Gregory J Moran; Lindsay E Nicolle; Raul Raz; Anthony J Schaeffer; David E Soper Journal: Clin Infect Dis Date: 2011-03-01 Impact factor: 9.079
Authors: Francois Jamar; John Buscombe; Arturo Chiti; Paul E Christian; Dominique Delbeke; Kevin J Donohoe; Ora Israel; Josep Martin-Comin; Alberto Signore Journal: J Nucl Med Date: 2013-01-28 Impact factor: 10.057