The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection

Abstract

PurposeSolid organ transplant (SOT) recipients are at high risk of developing infections and malignancies. 18F-FDG PET/CT may enable timely detection of these diseases and help to ensure early intervention. We aimed to describe the clinical utility of FDG PET/CT in consecutive, diagnostic unresolved SOT recipients transplanted from January 2004 to May 2015.MethodsRecipients with a post-transplant FDG PET/CT performed as part of diagnostic work-up were included. Detailed chart reviews were done to extract relevant clinical information and determine the final diagnosis related to the FDG PET/CT. Based on á priori defined criteria and the final diagnosis, results from each scan were classified as true or false, and diagnostic values determined.ResultsAmong the 1,814 recipients in the cohort, 145 had an FDG PET/CT performed; 122 under the indication of diagnostically unresolved symptoms with a suspicion of malignancy or infection. The remaining (N = 23) had an FDG PET/CT to follow-up on a known disease or to stage a known malignancy. The 122 recipients underwent a total of 133 FDG PET/CT scans performed for a suspected malignancy (66 %) or an infection (34 %). Sensitivity, specificity, and positive and negative predictive values of the FDG PET/CT in diagnosing these conditions were 97, 84, 87, and 96 %, respectively.ConclusionFDG PET/CT is an accurate diagnostic tool for the work-up of diagnostic unresolved SOT recipients suspected of malignancy or infection. The high sensitivity and NPV underlines the potential usefulness of PET/CT for excluding malignancy or focal infections in this often complex clinical situation.Electronic supplementary materialThe online version of this article (doi:10.1007/s00259-016-3564-5) contains supplementary material, which is available to authorized users.

SNMMI Procedure Standard/EANM Practice Guideline on Pediatric18F-FDG PET/CT for Oncology 1.0

“…Less common indications with some evidence for the usefulness of 18 F-FDG PET/CT include neuroblastoma (in 123 I-MIBG–negative cases, and preoperative or pretherapy prognostic information) ( 29 – 34 ). 18 F-FDG PET/CT may also be useful in the evaluation of central nervous system tumors (grading, evaluation of response to therapy, prognosis, and differentiation of viable tumor tissue versus postradiation changes) ( 35 – 37 ); head and neck cancer including nasopharyngeal cancer ( 38 ); Langerhans cell histiocytosis (LCH) ( 39 – 41 ); posttransplant lymphoproliferative disorder ( 42 , 43 ); germ cell tumors (staging and recurrence) ( 44 ); Wilms tumor ( 45 , 46 ); thyroid cancer (negative iodine scan with rising serum thyroglobulin level); neurofibromatosis type 1 (when suspecting malignant transformation of neurofibroma) ( 7 , 47 ); thymic neoplasia; and for guiding biopsies, surgical resection, and radiation treatment planning ( 4 ). 18 F-FDG PET/CT may be beneficial in other specific clinical scenarios in children, and the decision to perform this examination should be a multidisciplinary team decision.…”

Diagnostic Yield of 18F-FDG PET After Lung Transplantation: A Single-center, Retrospective Cohort Study

“…Earlier studies have investigated the diagnostic yield of 18 F-FDG PET for infectious or malignant complications in solid organ transplant recipients. 7,8 However, the number of LTx recipients in these studies was relatively small (n ≤ 31% and ≤25%) and to our knowledge no large cohort study has been undertaken to determine the accuracy and clinical performance of 18 F-FDG PET in LTx recipients.…”

Diagnostic Performance of 18F-FDG PET or PET/CT for Detection of Post-Transplant Lymphoproliferative Disorder: A Systematic Review and a Bivariate Meta-Analysis

“…Nevertheless, false positive findings of 18 F-FDG PET/CT, mainly due to inflammatory conditions, infections, or other malignancies, should be taken into account [12][13][14][15][16][17]. However, infectious diseases and tumors represent common complications in transplant recipients and their detection by 18 F-FDG PET/CT in patients with suspicious PTLD should be considered as clinically relevant findings and not only as false positive results [18,19].…”