Fluorodeoxyglucose imaging in healthy subjects with HIV infection: impact of disease stage and therapy on pattern of nodal activation

Brust, Douglas G.; Polis, Michael A.; Davey, Richard T.; Hahn, Barbara; Bacharach, Stephen L.; Whatley, Millie; Fauci, Anthony S.; Carrasquillo, Jorge A.

doi:10.1097/01.aids.0000222070.52996.76

Cited by 53 publications

(28 citation statements)

References 33 publications

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“…Our data concur with the findings of previous studies showing that the degree of FDG uptake is related to viral load in reactive adenopathy [3, 28], and we demonstrated a significant correlation between viral load and SUL uptake in HIV-infected patients with reactive adenopathy. This differs from the findings of Brust et al [25], which may have been due to differences in the patient populations, levels of viremia and SUL-Max threshold. We also found lower metabolic uptake in aviremic HIV-infected patients with reactive adenopathy [25].…”

Section: Discussioncontrasting

confidence: 99%

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Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Mhlanga

Durand

Tsai

et al. 2014

Eur J Nucl Med Mol Imaging

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Purpose To determine the diagnostic accuracy of a semiautomated 18F-FDG PET/CT measurement of total lesion glycolysis (TLG), maximum and peak standardized uptake value at lean body mass (SUL-Max and SUL-Peak), qualitative estimates of left/right nodal symmetry and FDG uptake for differentiating lymphoma from reactive adenopathy in HIV-infected patients. Methods We retrospectively analyzed 41 whole-body 18F-FDG PET/CT studies performed in HIV-infected patients for clinical reasons. The study received institutional review board approval. Of the 41 patients, 19 had biopsy-proven untreated lymphoma, and 22 with reactive adenopathy without malignancy on follow-up were used as controls. Nodal and extranodal visual qualitative metabolic scores, SUL-Max, SUL-Peak, CT nodal size, and PERCIST 1.0 threshold-based TLG and metabolic tumor volume (MTV) were determined. The qualitative intensity of nodal involvement and symmetry of uptake were compared using receiver operator curve (ROC) analysis. HIV plasma viral RNA measurements were also obtained. Results All of the quantitative PET metrics performed well in differentiating lymphoma from reactive adenopathy and performed better than qualitative visual intensity scores. The areas under the ROC curves (AUC) were significantly higher for TLG=0.96, single SUL-Peak=0.96, single SUL-Max=0.97, and MTV=0.96, compared to 0.67 for CT nodal size (p<0.001). These PET metrics performed best in separating the two populations in aviremic patients, with AUCs of 1 (AUC 0.91 for CT nodal size). TLG, MTV, SUL-Peak and SUL-Max were more reliable markers among viremic individuals, with AUCs between 0.84 and 0.93, compared to other metrics. PET metrics were significantly correlated with plasma viral load in HIV-reactive adenopathy controls. Asymmetrical FDG uptake had an accuracy of 90.4 % for differentiating lymphoma from reactive adenopathy in HIV-infected patients. Conclusion Quantitative PET metabolic metrics as well as the qualitative assessment of symmetry of nodal uptake appear to be valuable tools for differentiating lymphoma from reactive adenopathy in HIV-infected patients using FDG PET. These parameters appear more robust in aviremic patients.

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Section: Discussioncontrasting

confidence: 99%

“…Studies have shown a positive linear relationship between viral load and SUV of the whole-body lymphoid tissue in HIV-infected patients. A more variable relationship is seen between viral loads when regions of interest are manually drawn to obtain total lymph node SUV [25]. …”

Section: Discussionmentioning

confidence: 99%

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Mhlanga

Durand

Tsai

et al. 2014

Eur J Nucl Med Mol Imaging

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“…In a study reported by Castaigne et al [23] FDG-PET was able to detect disseminated tuberculosis in HIV-positive patients who showed atypical signs and were difficult to diagnose. In our HIV-positive patients, Castleman disease and Kaposi's sarcoma were identified as true-positive results and systemic aspergillosis was identified as a false-negative result, in addition to three true-positive results in HIV patients with systemic nodal activation [24].…”

Section: Discussionmentioning

confidence: 61%

FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study

et al. 2011

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FDG-PET for the diagnosis of FUO provided additional diagnostic information and had a high clinical impact, especially among patients with infectious diseases. It was also helpful in cases with unknown or other miscellaneous diseases by allowing the exclusion of focally active diseases. The prevalence of diseases in hospitals significantly affected the effectiveness of FDG-PET for the diagnosis of FUO. FDG-PET is a useful examination providing various degrees of clinical impact for the management of FUO, depending on the characteristics of the patient and the hospital.

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“…In patients with active sarcoidosis, significant uptake is seen at the disease sites and can be mistaken for lymphoma or other lymphoproliferative disorders. (24). In AIDS patients, toxoplasmosis is the most common opportunistic infection, and the CNS is the most common site for this infection (128).…”

Section: Soft Tissue Infectionmentioning

confidence: 99%

Role of Modern Imaging Techniques for Diagnosis of Infection in the Era of¹⁸F-Fluorodeoxyglucose Positron Emission Tomography

et al. 2008

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During the past several years, it has become quite evident that positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) imaging can play a major role in the management of patients with suspected infection. Particularly, several groups have demonstrated that this powerful imaging methodology is very effective in the evaluation of osteomyelitis, infected prostheses, fever of unknown origin, and AIDS. In view of its extraordinary sensitivity in detecting disease activity and the ability to quantitate the degree of FDG uptake, PET might prove to be an appropriate modality for monitoring disease activity and evaluating response to therapy. FDG-PET has many advantages over existing imaging techniques for the diagnosis of infectious diseases. These include feasibility of securing diagnostic results within 1.5 to 2 h, excellent spatial resolution, and accurate anatomical localization of sites of abnormality. The availability of PET/computed tomography as a practical tool has further enhanced the role of metabolic imaging in many settings. In the future, this modality is very likely to be employed on a routine basis for detecting, characterizing, and monitoring patients with suspected and proven infection.

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Fluorodeoxyglucose imaging in healthy subjects with HIV infection: impact of disease stage and therapy on pattern of nodal activation

Abstract: Abnormal fluorodeoxyglucose accumulation occurs in the nodes of individuals with detectable viral loads. Interruption of effective HAART results in the activation of previously quiescent nodal areas.

Cited by 53 publications

References 33 publications

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study

Role of Modern Imaging Techniques for Diagnosis of Infection in the Era of¹⁸F-Fluorodeoxyglucose Positron Emission Tomography

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Fluorodeoxyglucose imaging in healthy subjects with HIV infection: impact of disease stage and therapy on pattern of nodal activation

Abstract: Abnormal fluorodeoxyglucose accumulation occurs in the nodes of individuals with detectable viral loads. Interruption of effective HAART results in the activation of previously quiescent nodal areas.

Cited by 53 publications

References 33 publications

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

Differentiation of HIV-associated lymphoma from HIV-associated reactive adenopathy using quantitative FDG PET and symmetry

FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study

Role of Modern Imaging Techniques for Diagnosis of Infection in the Era of18F-Fluorodeoxyglucose Positron Emission Tomography

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Role of Modern Imaging Techniques for Diagnosis of Infection in the Era of¹⁸F-Fluorodeoxyglucose Positron Emission Tomography