B Leroy-Freschini1, G Treglia2,3,4, X Argemi5,6, C Bund1,5,7, R Kessler8,9, R Herbrecht10,11, A Imperiale1,5,7. 1. From the Biophysics and Nuclear Medicine, Strasbourg University Hospitals, Strasbourg, France. 2. Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. 3. Health Technology Assessment, Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. 4. Department of Nuclear Medicine and Molecular Imaging, CHUV University Hospital, Lausanne, Switzerland. 5. Federation of Translational Medicine of Strasbourg (FMTS), Faculty of Medicine, Strasbourg University, Strasbourg, France. 6. Infectious Diseases and Tropical Medicine, Strasbourg University Hospitals, Strasbourg, France. 7. ICube, CNRS/UMR 7357, Strasbourg University, Strasbourg, France. 8. Pneumology, Strasbourg University Hospitals, Strasbourg, France. 9. Vascular and Tissular Stress in Transplantation, EA7293 Illkirch, France. 10. Oncology and Hematology, Strasbourg University Hospitals, Strasbourg, France. 11. University of Strasbourg and INSERM U1113, Strasbourg, France.
Abstract
BACKGROUND: Opportunistic invasive fungal infections (IFIs) comprise a heterogeneous spectrum of pathogens, whose early diagnosis remains challenging. Candida spp. and Aspergillus spp, the most frequent pathogens in immunocompromised patients, frequently affect lungs, liver, bone and skin. AIM: To evaluate the impact of 18F-FDG PET/CT in the management of immunocompromised patients with IFI. DESIGN: A single-center retrospective study included 51 immunocompromised patients with IFI diagnosis undergoing 83 18F-FDG PET/CTs. METHODS: Twenty-nine 18F-FDG PET/CTs were performed for primary work-up in 29 treatment-naïve patients. Fifty-four PET/CTs were performed during follow-up to confirm IFI suspicion in 22 patients who had anti-fungal drug therapy before PET/CT. When available, histological and/or microbiological criteria were used to assess IFI diagnosis. RESULTS: Aspergillus spp. and Candida spp. were the most frequent microorganisms responsible for IFI in our population. 18F-FDG PET/CT sensitivity, specificity, positive and negative predictive values, and global accuracy were 93%, 81%, 95%, 72% and 90%, respectively. 18F-FDG PET/CT influenced the diagnostic work-up at primary staging in 16/29 patients (55%) by assessing the extent of infection and targeting the diagnostic procedure. 18F-FDG PET/CT results during treatment induced anti-fungal drugs dosage increase and/or new drugs addition in 8/54 cases (15%) and contributed to the reduction of anti-fungal drugs dosage or treatment withdraws in 17 cases (31%). CONCLUSIONS: We recommend the utilization of 18F-FDG PET/CT to improve the primary staging work-up of immunocompromised patients with IFI and to assess treatment effectiveness or disease relapse. Both 18F-FDG PET/CT and conventional imaging should be integrated into a well-defined imaging diagnostic algorithm considering the clinical context and both strengths and limitations of each diagnostic modality.
BACKGROUND: Opportunistic invasive fungal infections (IFIs) comprise a heterogeneous spectrum of pathogens, whose early diagnosis remains challenging. Candida spp. and Aspergillus spp, the most frequent pathogens in immunocompromised patients, frequently affect lungs, liver, bone and skin. AIM: To evaluate the impact of 18F-FDG PET/CT in the management of immunocompromised patients with IFI. DESIGN: A single-center retrospective study included 51 immunocompromised patients with IFI diagnosis undergoing 83 18F-FDG PET/CTs. METHODS: Twenty-nine 18F-FDG PET/CTs were performed for primary work-up in 29 treatment-naïve patients. Fifty-four PET/CTs were performed during follow-up to confirm IFI suspicion in 22 patients who had anti-fungal drug therapy before PET/CT. When available, histological and/or microbiological criteria were used to assess IFI diagnosis. RESULTS: Aspergillus spp. and Candida spp. were the most frequent microorganisms responsible for IFI in our population. 18F-FDG PET/CT sensitivity, specificity, positive and negative predictive values, and global accuracy were 93%, 81%, 95%, 72% and 90%, respectively. 18F-FDG PET/CT influenced the diagnostic work-up at primary staging in 16/29 patients (55%) by assessing the extent of infection and targeting the diagnostic procedure. 18F-FDG PET/CT results during treatment induced anti-fungal drugs dosage increase and/or new drugs addition in 8/54 cases (15%) and contributed to the reduction of anti-fungal drugs dosage or treatment withdraws in 17 cases (31%). CONCLUSIONS: We recommend the utilization of 18F-FDG PET/CT to improve the primary staging work-up of immunocompromised patients with IFI and to assess treatment effectiveness or disease relapse. Both 18F-FDG PET/CT and conventional imaging should be integrated into a well-defined imaging diagnostic algorithm considering the clinical context and both strengths and limitations of each diagnostic modality.
Authors: Alfred O Ankrah; Dina Creemers-Schild; Bart de Keizer; Hans C Klein; Rudi A J O Dierckx; Thomas C Kwee; Lambert F R Span; Pim A de Jong; Mike M Sathekge; Andor W J M Glaudemans Journal: Diagnostics (Basel) Date: 2021-01-17
Authors: Alfred O Ankrah; Lambert F R Span; Hans C Klein; Pim A de Jong; Rudi A J O Dierckx; Thomas C Kwee; Mike M Sathekge; Andor W J M Glaudemans Journal: Eur J Nucl Med Mol Imaging Date: 2018-10-21 Impact factor: 9.236