Diffuse increased splenic F-18 fluorodeoxyglucose uptake may be an indirect sign of acute pyogenic cause rather than tuberculous in patients with infectious spondylitis

Kim, Keunyoung; Kim, Seong-Jang; Kim, In Joo; Kim, Bum Soo; Pak, Kyoungjune; Kim, Heeyoung

doi:10.1097/mnm.0b013e32834bbdf1

Cited by 15 publications

(7 citation statements)

References 21 publications

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“…As a specialized immune organ, the spleen has various functions, such as clearance of microorganisms, the site of development for lymphocytes (both T and B), release of immunoglobulins, and production of immune mediators 31 . Generally, 18 F-FDG uptake is related to tissue metabolism, which may explain why an increased 18 F-FDG uptake in the spleen may reflect increased glucose consumption in the spleen in the event of an infection 21 . A recent study demonstrated that current inflammation could result in diffuse splenic 18 F-FDG uptake 32 .…”

Section: Discussionmentioning

confidence: 99%

Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity

Seong

Jeong

Lee

et al. 2021

Sci Rep

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Kikuchi-Fujimoto disease (KFD) is usually self-limiting, but prolonged systemic symptoms often result in frequent hospital visits, long admission durations, or missed workdays. We investigated the role of fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing KFD severity. We reviewed the records of 31 adult patients with pathologically confirmed KFD who underwent 18F-FDG PET/CT between November 2007 and April 2018 at a tertiary-care referral hospital. Disease severity was assessed using criteria based on clinical manifestations of advanced KFD. Systemic activated lymph nodes and severity of splenic activation were determined using semi-quantitative and volumetric PET/CT parameters. The median of the mean splenic standardized uptake value (SUVmean) was higher in patients with severe KFD than those with mild KFD (2.38 ± 1.18 vs. 1.79 ± 0.99, p = 0.058). Patients with severe KFD had more systemically activated volume and glycolytic activity than those with mild KFD (total lesion glycolysis: 473.5 ± 504.4 vs. 201.6 ± 363.5, p = 0.024). Multivariate logistic regression showed that myalgia (odds ratio [OR] 0.035; 95% confidence interval [CI] 0.001–0.792; p = 0.035), total lymph node SUVmax (cutoff 9.27; OR 24.734; 95% CI 1.323–462.407; p = 0.032), and spleen SUVmean (cutoff 1.79; OR 37.770; 95% CI 1.769–806.583; p = 0.020) were significantly associated with severe KFD. 18F-FDG PET/CT could be useful in assessing KFD severity.

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Section: Discussionmentioning

confidence: 99%

Splenic uptake on FDG PET/CT correlates with Kikuchi-Fujimoto disease severity

Seong

Jeong

Lee

et al. 2021

Sci Rep

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“…Diffuse splenic uptake is a visual observation on PET/CT corresponding to a global capture of 18 FDG by the organ, relative to liver uptake. This phenomenon, described and used as a potential severity criterion in oncology (11)(12)(13)(14), hardly referred in pyogenic infections (15), has never been reported in IE. In this prospective study, this phenomenon was observed in 24 patients, among them 23 IE (resulting in a specificity of 96%).…”

Section: -Global Splenic Uptakementioning

confidence: 99%

Comparison Between ESC and Duke Criteria for the Diagnosis of Prosthetic Valve Infective Endocarditis

Philip

Tessonier

Mancini

et al. 2020

JACC: Cardiovascular Imaging

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Background:18 F-FDG PET/CT has been added as a major criterion in the ESC 2015 infective endocarditis guidelines, but the benefit of the ESC criteria has not been prospectively compared with the conventional Duke criteria Objectives:1. Primary objective: To assess the value of the ESC criteria including 18 F-FDG-PET/CT in prosthetic valve infective endocarditis (PVE). 2. Secondary objectives i: to assess the reproducibility of 18 F-FDG-PET/CT, ii: to compare its diagnostic value with that of echocardiography, and iii: to assess the diagnostic value of the presence of a diffuse splenic uptake Methods :Between 2014 and 2017, 175 patients with suspected PVE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable 18 F-FDG PET/CT, 115 patients were evaluated, including 91 definite and 24 rejected IE, as defined by an expert Consensus. Results :Cardiac uptake by 18 F-FDG PET/CT was observed in 67/91 patients with definite PVE and 6 with rejected IE (sensitivity 73.6% 95%CI: 63.3 to 82.3%, specificity 75% 53.3% to 90.2%). The ESC 2015 classification increased the sensitivity of Duke criteria from 57.1% 46.3 to 67.5% to 83.5% 74.3% to 90.5%, (p< 0.001) but decreased its specificity from 95.8%  78.9% to 99.9% to 70.8% 48.9% to 87.4%. Intraobserver reproducibility of 18 F-FDG PET/CT was good (kappa= 0.84) but inter observer reproducibility was less satisfactory (kappa= 0.63). A diffuse splenic uptake was observed in 24 (20.3%) patients, including 23 (25.3%) of definite PVE, and only 1 (4.2%) rejected PVE (p=0.024). Conclusion :18 F-FDG PET/CT is a useful diagnostic tool in suspected PVE, and explains the greater sensitivity of ESC criteria compared to Duke criteria. However, 18 F-FDG PET/CT also presents important limitations concerning its feasibility, specificity and reproducibility. Our study describes for the first time a new endocarditis criterion, i.e. the presence of a diffuse splenic uptake on 18 F-FDG PET/CT.

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“…Dans une étude récente, Kim et al indiquent qu'un SUV max splénique supérieur à un cut-off de 1,49 peut être considéré comme un signe indirect d'infection à pyogène [11]. Nos résultats montrent également que des augmentations d'activité au niveau de la moelle osseuse ou de la rate peuvent être considérées comme des signes indirects de sepsis.…”

Section: Discussionunclassified

“…Au cours d'un processus infectieux, certains organes, en particulier la rate et la moelle osseuse, présentent une augmentation de la captation du 18 F-FDG, ce qui peut constituer des signes indirects d'infection [10,11]. Différentes cytokines sont sécrétées par l'organisme durant un sepsis et vont être à l'origine de modifications endocriniennes, endothéliales, cardiovasculaires.…”

Section: Introductionunclassified