Imaging of Invasive Fungal Infections- The Role of PET/CT

Ankrah, Alfred O.; Lawal, Ismaheel; Dierckx, Rudi; Sathekge, Mike; Glaudemans, Andor W.J.M.

doi:10.1053/j.semnuclmed.2022.07.003

Cited by 11 publications

(10 citation statements)

References 129 publications

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“…Thoracic MRI has been found to have similar performance characteristics as high-resolution CT for detecting pneumonia or lung infiltrates in neutropenic patients with acute myeloid leukemia [ 38 , 39 ], and can be used to assess treatment response of malignancy-associated infiltrates or masses with similar sensitivity as 18F-fluorodeoxyglucose (FDG)-PET/CT (FDG-PET/CT) [ 38 ]. Pulmonary angiography can also be performed by MRI using T1-shortening contrast agents like gadolinium to produce high-resolution images of the pulmonary arteries and veins [ 40 ]. Images can be quickly assessed for perfusion defects and their location caused by angioinvasive fungi, and more detailed postprocessing can provide quantitative assessment of contrast passage kinetics.…”

Section: Mrimentioning

confidence: 99%

“…Images can be quickly assessed for perfusion defects and their location caused by angioinvasive fungi, and more detailed postprocessing can provide quantitative assessment of contrast passage kinetics. This allows for the quantification of pulmonary blood flow, volume, and mean transit time, and the generation of parametric maps [ 40 ]. Hence, MRI could be a radiation-free alternative to CT and CTPA with lower risk for CIN.…”

Section: Mrimentioning

confidence: 99%

“…Although standard CT and CTPA are effective in identifying the location and invasive nature of IMI in the lungs, they have limited sensitivity for detecting extrathoracic IFD and accurate assessments of disease response to antifungal therapy [ 39 , 40 ]. FDG-PET/CT, a whole-body functional imaging technique, has been explored as a tool to assess the metabolic activity of fungal lesions and guide decisions regarding treatment duration or progression to additional chemotherapy cycles.…”

Section: F-fluorodeoxyglucose-pet/ctmentioning

confidence: 99%

See 2 more Smart Citations

Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: are we making progress?

Lewis

Stanzani

Morana

et al. 2023

Current Opinion in Infectious Diseases

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Purpose of review In patients with hematological malignancies, high-resolution computed tomography (CT) is the recommended imaging approach for diagnosis, staging and monitoring of invasive fungal disease (IFD) but lacks specificity. We examined the status of current imaging modalities for IFD and possibilities for more effective applications of current technology for improving the specificity of IFD diagnosis. Recent findings Although CT imaging recommendations for IFD are largely unchanged in the last 20 years, improvements in CT scanner technology and image processing algorithms now allow for technically adequate examinations at much lower radiation doses. CT pulmonary angiography can improve both the sensitivity and specificity of CT imaging for angioinvasive molds in both neutropenic and nonneutropenic patients, through detection of the vessel occlusion sign (VOS). MRI-based approaches also show promise not only for early detection of small nodules and alveolar hemorrhage but can also be used to detect pulmonary vascular occlusion without radiation and iodinated contrast media. 18F-fluorodeoxyglucose (FDG) PET/computed tomography (FDG-PET/CT) is increasingly used to monitor long-term treatment response for IFD, but could become a more powerful diagnostic tool with the development of fungal-specific antibody imaging tracers. Summary High-risk hematology patients have a considerable medical need for more sensitive and specific imaging approaches for IFD. This need may be addressable, in part, by better exploiting recent progress in CT/MRI imaging technology and algorithms to improve the specificity of radiological diagnosis for IFD.

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Section: Mrimentioning

confidence: 99%

Section: Mrimentioning

confidence: 99%

Section: F-fluorodeoxyglucose-pet/ctmentioning

confidence: 99%

See 1 more Smart Citation

Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: are we making progress?

Lewis

Stanzani

Morana

et al. 2023

Current Opinion in Infectious Diseases

View full text Add to dashboard Cite

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“…This has resulted in widely adopted guidelines and recommendations for infective endocarditis (2, 3), vasculitis and polymyalgia rheumatica (4), vascular graft infections (5,6), peripheral bone infection (7), prosthetic joint infection (8), and spondylodiscitis (9). Furthermore, [ 18 F]FDG-PET/CT can be considered as an invaluable imaging tool in, e.g., patients with fever of unknown origin, both in adults and in children (10, 11), patients with bacteremia at high-risk (12), fungal infections (13,14) and infected renal or liver cysts (15, 16).…”

Section: Evidencementioning

confidence: 99%

Expert opinions in nuclear medicine: Finding the “holy grail” in infection imaging

Glaudemans

Gheysens

2023

Front. Med.

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Nuclear medicine imaging techniques are now widely accepted and increasingly used for diagnosing and treatment monitoring of infectious and inflammatory diseases. The latter has been exemplified by numerous recent clinical guidelines in which PET imaging is now part of the diagnostic flowcharts. In this perspective paper we discuss the current available guidelines, the current limitations, and we provide the future aims of research to achieve the holy grail in nuclear medicine: the differentiation between infection, inflammation and malignancy.

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“…While small studies show a higher sensitivity in detecting IFD, partic-ularly disseminated disease when compared with HRCT, 106 its utility in screening prior to alloHCT has not been studied. Benefits of FDG-PET are its utility in monitoring response to treatment due to the functional element of FDG uptake, which is an advantage over HRCT, 106,107 as well as its already routine use in hematological disease staging, though further studies are required to demonstrate the efficacy and evaluate cost-effectiveness of FDG-PET as a screening tool.…”

Section: Aml Azacitidinementioning

confidence: 99%

Approach to diagnostic evaluation and prevention of invasive fungal disease in patients prior to allogeneic hematopoietic stem cell transplant

O'Keeffe,

Singh,

Slavin

2023

Transplant Infectious Dis

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In recent years, advancements in the treatment landscape for hematological malignancies, such as acute myeloid leukemia and acute lymphoblastic leukemia, have significantly improved disease prognosis and overall survival. However, the treatment landscape is changing and the emergence of targeted oral therapies and immune‐based treatments has brought forth new challenges in evaluating and preventing invasive fungal diseases (IFDs). IFD disproportionately affects immunocompromised hosts, particularly those undergoing therapy for acute leukemia and allogeneic hematopoietic stem cell transplant. This review aims to provide a comprehensive overview of the pretransplant workup, identification, and prevention of IFD in patients with hematological malignancy. The pretransplant period offers a critical window to assess each patient's risk factors and implement appropriate prophylactic measures. Risk assessment includes evaluation of disease, host, prior treatments, and environmental factors, allowing a dynamic evaluation that considers disease progression and treatment course. Diagnostic screening, involving various biomarkers and radiological modalities, plays a crucial role in early detection of IFD. Antifungal prophylaxis choice is based on available evidence as well as individual risk assessment, potential for drug–drug interactions, toxicity, and patient adherence. Therapeutic drug monitoring ensures effective antifungal stewardship and optimal treatment. Patient education and counselling are vital in minimizing environmental exposures to fungal pathogens and promoting medication adherence. A well‐structured and individualized approach, encompassing risk assessment, prophylaxis, surveillance, and patient education, is essential for effectively preventing IFD in hematological malignancies, ultimately leading to improved patient outcomes and overall survival.

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Imaging of Invasive Fungal Infections- The Role of PET/CT

Cited by 11 publications

References 129 publications

Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: are we making progress?

Radiology-based diagnosis of fungal pulmonary infections in high-risk hematology patients: are we making progress?

Expert opinions in nuclear medicine: Finding the “holy grail” in infection imaging

Approach to diagnostic evaluation and prevention of invasive fungal disease in patients prior to allogeneic hematopoietic stem cell transplant

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