Potential Usefulness of FDG PET/CT in Patients with Sepsis of Unknown Origin

Abstract

PurposeThe role of FDG PET in the evaluation of patients with sepsis of unknown origin remains unclear. We sought to assess the value of FDG PET/CT in patients with sepsis of unknown cause and to define its priority in this group of subjects.MethodsA total of 53 patients with sepsis of unknown origin underwent FDG PET/CT within two weeks of diagnosis. All of the patients were followed up for at least 3 months after discharge to determine the clinical outcomes. The impact of FDG PET/CT was assessed according to the number of cases who had their treatment modified on the basis of the imaging results. Logistic regression analysis was used to identify the independent predictors of positive FDG PET/CT findings.ResultsOf the 53 study patients, 35 (66%) had positive FDG PET/CT findings, and 13 (25%) had their treatment modified on the basis of the imaging results. Logistic regression analysis identified normal serum aspartate aminotransferase (odds ratio [OR] = 6.134; 95% confidence interval [CI] = 1.443–26.076, P = 0.014) and increased serum alkaline phosphatase levels (OR = 5.813; 95% CI = 1.386–24.376, P = 0.016) at diagnosis as independent predictors of positive FDG PET/CT findings. A scoring system using these two covariates was developed, which defined three distinct priority groups for FDG PET/CT imaging.ConclusionOur findings suggest that FDG PET/CT may be clinically useful for the detection of occult foci of infection in patients with sepsis of unknown origin.

Clinical Usefulness of 18F-FDG PET/CT for the Detection of Infections of Unknown Origin in Patients Undergoing Maintenance Hemodialysis

“…Another important finding from this study is that chronic liver disease was identified as a significant predictor of negative 18 F-FDG PET/CT findings, which is consistent with our previous results obtained in septic patients without overt kidney disease (6). It should be noted that Taiwan has a unique background, with the highest prevalence of uremia and endemic hepatitis B virus and hepatitis C virus infections (22).…”

“…Several previous studies have shown the clinical utility of 18 F-FDG PET/CT in the detection of unknown sites of infection and metastatic foci (6,13,30). In the current study, 18 (24.6%) of the 73 patients with positive 18 F-FDG PET/CT findings had more than one site of infection identified during a single image acquisition.…”

“…Current guidelines suggest that the major indications for 18 F-FDG PET/ CT in the setting of infectious diseases include osteomyelitis, spinal infections, fever of unknown origin, and metastatic infections (5). Moreover, we have previously demonstrated the clinical utility of 18 F-FDG PET/CT imaging in the detection of occult infection foci in patients with sepsis, ultimately inducing major management changes (6). Although loss of renal function is related to impaired functioning of immune defenses and increased susceptibility to infections, the potential clinical usefulness of 18 F-FDG PET/CT for the detection of infection foci of unknown origin in ESRD patients undergoing MHD remains unclear (7,8).…”

Different FDG‐PET metabolic patterns of anti‐AMPAR and anti‐NMDAR encephalitis: Case report and literature review

“…Except for mesial temporal hyperintensity or whole‐brain atrophy, structural brain images are usually nonspecific in autoimmune encephalitis (Wei et al, ). 18 F‐fluorodeoxyglucose positron emission tomography and computed tomography (FDG‐PET/CT) evaluates the glucose metabolism of the brain and has been used to assess inflammatory and infectious diseases (Jamar et al, ; Tseng et al, ), but its application in evaluating immune‐mediated encephalitis is emerging too. The diagnostic criteria reported by Graus et al indicated the role of FDG‐PET in the detection of definite autoimmune limbic encephalitis by bilateral mesial temporal signal abnormalities in FDG‐PET (Graus et al, ).…”

Intra-abdominal sepsis: new definitions and current clinical standards

“…In hospital non-survivors, the values are significantly lower than that in survivors [26]. Alternatively, positron emission tomography (PET)-CT scan could play an important role in further diagnosis of intra-abdominal sepsis, but is mainly restricted to septic foci of unknown origin [27] or spreading multifocal bacteremia (e.g., Staphylococcus aureus) [28].…”