Lars Husmann1, Urs J Muehlematter2, Felix Grimm3, Bruno Ledergerber4, Michael Messerli2, Ken Kudura2, Hannes Gruenig2, Beat Muellhaupt5, Barbara Hasse4, Martin W Huellner2. 1. Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Switzerland. Electronic address: lars.husmann@usz.ch. 2. Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Switzerland. 3. Institute of Parasitology, University of Zurich, Switzerland. 4. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland. 5. Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Switzerland.
Abstract
PURPOSE: The aim of the study was to determine the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) at the end of benzimidazole therapy in alveolar echinococcosis. METHODS: A total of 22 patients undergoing PET/CT at the end of benzimidazole therapy were retrospectively registered. Maximum standardized uptake values (SUVmax) were measured in remaining echinococcus manifestations and compared to normal liver tissue. Long-term clinical follow-up was performed, and recorded data included laboratory parameters, clinical information and imaging. RESULTS: All patients had no detectable levels of Em-18 antibodies and all echinococcus manifestations were negative on PET/CT, i.e. without focally increased FDG uptake or uptake higher than normal/non-infected liver tissue. All manifestations displayed significantly less FDG-uptake than normal liver tissue, i.e. SUVmax 1.8 (interquartile range (IQR) 1.5-3.5) vs. 3.0 (IQR 2.6-5.7), (p < 0.001). Patients were clinically followed for a median of 9.5 years (IQR 6.5-32.0 years) after their initial diagnosis and for 4.5 years (IQR 3.0-14.0 years) after discontinuation of benzimidazole therapy. No patient showed signs of recurrent infection at the last clinical visit. The 10-year and 20-year freedom from all-cause mortality was 95.0% (95% confidence interval 69.5% - 99.3%), for both. Two events occurred in 292 patient years of follow-up; i.e. two patients (9%) died, one because of pancreatic cancer, the other one because of unknown reasons with no detectable antibody levels. CONCLUSIONS: Negative FDG-PET/CT results combined with no detectable levels of Em-18 antibodies may allow for the safe discontinuation of benzimidazole therapy in patients with alveolar echinococcosis.
PURPOSE: The aim of the study was to determine the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) at the end of benzimidazole therapy in alveolar echinococcosis. METHODS: A total of 22 patients undergoing PET/CT at the end of benzimidazole therapy were retrospectively registered. Maximum standardized uptake values (SUVmax) were measured in remaining echinococcus manifestations and compared to normal liver tissue. Long-term clinical follow-up was performed, and recorded data included laboratory parameters, clinical information and imaging. RESULTS: All patients had no detectable levels of Em-18 antibodies and all echinococcus manifestations were negative on PET/CT, i.e. without focally increased FDG uptake or uptake higher than normal/non-infected liver tissue. All manifestations displayed significantly less FDG-uptake than normal liver tissue, i.e. SUVmax 1.8 (interquartile range (IQR) 1.5-3.5) vs. 3.0 (IQR 2.6-5.7), (p < 0.001). Patients were clinically followed for a median of 9.5 years (IQR 6.5-32.0 years) after their initial diagnosis and for 4.5 years (IQR 3.0-14.0 years) after discontinuation of benzimidazole therapy. No patient showed signs of recurrent infection at the last clinical visit. The 10-year and 20-year freedom from all-cause mortality was 95.0% (95% confidence interval 69.5% - 99.3%), for both. Two events occurred in 292 patient years of follow-up; i.e. two patients (9%) died, one because of pancreatic cancer, the other one because of unknown reasons with no detectable antibody levels. CONCLUSIONS: Negative FDG-PET/CT results combined with no detectable levels of Em-18 antibodies may allow for the safe discontinuation of benzimidazole therapy in patients with alveolar echinococcosis.
Authors: Lars Husmann; Hannes Gruenig; Caecilia S Reiner; Ansgar Deibel; Bruno Ledergerber; Virginia Liberini; Stephan Skawran; Urs J Muehlematter; Michael Messerli; Barbara Hasse; Beat Muellhaupt; Martin W Huellner Journal: Sci Rep Date: 2022-07-06 Impact factor: 4.996
Authors: Ansgar Deibel; Daniel Stocker; Cordula Meyer Zu Schwabedissen; Lars Husmann; Philipp Andreas Kronenberg; Felix Grimm; Peter Deplazes; Cäcilia S Reiner; Beat Müllhaupt Journal: PLoS Negl Trop Dis Date: 2022-01-28
Authors: Lars Husmann; Ansgar Deibel; Stephan Skawran; Bruno Ledergerber; Urs J Muehlematter; Barbara Hasse; Martin W Huellner; Caecilia S Reiner; Beat Muellhaupt Journal: PLoS One Date: 2022-06-29 Impact factor: 3.752