Contribution of 18F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis

Besson, Florent L.; Chaumet-Riffaud, Philippe; Playe, Margot; Noël, Nicolas; Lambotte, Olivier; Goujard, Cécile; Prigent, Alain; Durand, Emmanuel

doi:10.1007/s00259-016-3377-6

Cited by 60 publications

(47 citation statements)

References 37 publications

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“…Currently, there is ample evidence that 18 F-FDG PET is a very useful diagnostic tool for many infectious indications, including fever of unknown origin, endocarditis, spondylodiscitis, and vascular graft infections 8, 11, 12 . This approach can help in defining the location and extent of infection, thereby providing guidance for biopsy and for therapy follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…A clinically applied alternative is positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose ( 18 F-FDG), which can serve as a diagnostic tool for localizing infections, inflammatory conditions and unknown origins of fever 7, 8 . In this case, it is generally believed that the infection-specific signal originates from increased glucose uptake by cells involved in the inflammatory process, such as leukocytes, monocytes, lymphocytes, giant cells and macrophages 9 .…”

Section: Introductionmentioning

confidence: 99%

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In vitro imaging of bacteria using 18F-fluorodeoxyglucose micro positron emission tomography

Heuker

Sijbesma

Suárez

et al. 2017

Sci Rep

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Positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (18F-FDG) can be applied to detect infection and inflammation. However, it was so far not known to what extent bacterial pathogens may contribute to the PET signal. Therefore, we investigated whether clinical isolates of frequently encountered bacterial pathogens take up 18F-FDG in vitro, and whether FDG inhibits bacterial growth as previously shown for 2-deoxy-glucose. 22 isolates of Gram-positive and Gram-negative bacterial pathogens implicated in fever and inflammation were incubated with 18F-FDG and uptake of 18F-FDG was assessed by gamma-counting and µPET imaging. Possible growth inhibition by FDG was assayed with Staphylococcus aureus and the Gram-positive model bacterium Bacillus subtilis. The results show that all tested isolates accumulated 18F-FDG actively. Further, 18F-FDG uptake was hampered in B. subtilis pts mutants impaired in glucose uptake. FDG inhibited growth of S. aureus and B. subtilis only to minor extents, and this effect was abrogated by pts mutations in B. subtilis. These observations imply that bacteria may contribute to the signals observed in FDG-PET infection imaging in vivo. Active bacterial FDG uptake is corroborated by the fact that the B. subtilis phosphotransferase system is needed for 18F-FDG uptake, while pts mutations protect against growth inhibition by FDG.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

In vitro imaging of bacteria using 18F-fluorodeoxyglucose micro positron emission tomography

Heuker

Sijbesma

Suárez

et al. 2017

Sci Rep

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“…This method may hold great potential to provide direct insights into the extent, distribution, and time course of inflammatory cell infiltrates in renal tissue. Other nuclear medicine techniques used for imaging of inflammation including radiolabeled autologous leukocytes and antigranulocyte antibodies for scintigraphic imaging or PET with 18 F-FDG have not been evaluated systematically for imaging of allograft infections (23). Limited data have suggested cortical 18 F-FDG uptake in pyelonephritis (24).…”

Section: Discussionmentioning

confidence: 99%

Integrating MRI and Chemokine Receptor CXCR4-Targeted PET for Detection of Leukocyte Infiltration in Complicated Urinary Tract Infections After Kidney Transplantation

et al. 2017

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Complicated urinary tract infections (UTIs) are frequent in immunosuppressed patients after kidney transplantation and may lead to allograft failure or urosepsis. Noninvasive detection of allograft involvement as well as localization of the primary site of infection are challenging. Therefore, we sought to determine whether molecularly targeted PET, combined with diffusion-weighted MRI, enables detection of leukocytes in renal allografts. Thirteen kidney transplant recipients with complicated UTIs underwent both PET with a specific CXCR4 ligand,Ga-pentixafor, and diffusion-weighted MRI. The spatial distribution and intensity of CXCR4 upregulation in renal allografts as determined by SUVs on PET and diffusion restriction as determined by apparent diffusion coefficients (ADCs) on MRI were analyzed and compared with urinalysis, clinical chemistry and bacteriology, and biopsy, if available. Combined PET/MRI detected acute allograft infection in 9 patients and lower UTI/nonurologic infections in the remaining 4 patients. Leukocyte infiltration was identified by areas of CXCR4 upregulation compared with unaffected parenchyma in PET (SUV, 4.6 vs. 3.7; < 0.01), corresponding to areas with increased cell density in MRI (ADC, 0.89 vs. 1.59 × 10 mm/s, < 0.01). Allograft CXCR4 signal was paralleled by CXCR4 upregulation in lymphoid organs. Histopathologic evaluation supported a correlation between CXCR4 signal and presence of leukocytes. Combined CXCR4-targeted PET/MRI withGa-pentixafor may enable the noninvasive detection of leukocytes in renal allografts. This novel methodology may refine the characterization of infectious and inflammatory kidney diseases and may serve as a platform for future clinical studies targeting allograft infection.

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“…Tuberculosis (TB) is the most common infection causing FUO in developing countries [14][15][16], and FDG-PET has been shown to be very sensitive for the early detection of TB [17], which indicates the suitability of PET in FUO. According to a recent Chinese multi-center study, abnormal PET findings leading to final diagnosis were observed in approximately two-thirds of the FUO cases, and infection appeared to be the most frequent diagnosis (42%) [18] (this editorial is drafted based on the data generated from this prospective research to emphasize the importance of FDG-PET in this disorder). In another study in patients with FUO and suspicion of infection or inflammation foci, FDG-PET demonstrated sensitivity, specificity, and positive and negative predictive values of 93, 90, 87, and 95%, respectively [19].…”

Section: Infectious Disordersmentioning

confidence: 99%

FDG-PET imaging to detect and characterize underlying causes of fever of unknown origin: an unavoidable path for the foreseeable future

Al-Zaghal

Raynor

Seraj

et al. 2018

Eur J Nucl Med Mol Imaging

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Contribution of 18F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis

Cited by 60 publications

References 37 publications

In vitro imaging of bacteria using 18F-fluorodeoxyglucose micro positron emission tomography

In vitro imaging of bacteria using 18F-fluorodeoxyglucose micro positron emission tomography

Integrating MRI and Chemokine Receptor CXCR4-Targeted PET for Detection of Leukocyte Infiltration in Complicated Urinary Tract Infections After Kidney Transplantation

FDG-PET imaging to detect and characterize underlying causes of fever of unknown origin: an unavoidable path for the foreseeable future

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