The Role of PET in Monitoring Therapy in Fungal Infections

Ankrah, Alfred O.; Klein, Hans; Span, Lambert F.R.; Vries, E. F. J. de; Dierckx, Rudi; Sathekge, Mike; Glaudemans, Andor W.J.M.

doi:10.2174/1381612824666171213101648

Cited by 17 publications

(25 citation statements)

References 93 publications

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“…Again, antifungal agents frequently have side effects, and resistance by fungi may develop. 81 Furthermore, IFIs frequently occur in patients with hematologic malignancies, and solid tumors, and in patients who have undergone organ transplant who are being considered for treatment or are already on therapies that would depress their immune system. 82 If IFIs are not properly treated before institution of such therapy, the infection may disseminate, resulting in high morbidity or even mortality in these patients.…”

Section: Invasive Fungal Infectionsmentioning

confidence: 99%

Monitoring Response to Therapy

Sathekge

Ankrah

Lawal

et al. 2018

Seminars in Nuclear Medicine

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Monitoring response to treatment is a key element in the management of infectious diseases, yet controversies still persist on reliable biomarkers for noninvasive response evaluation. Considering the limitations of invasiveness of most diagnostic procedures and the issue of expression heterogeneity of pathology, molecular imaging is better able to assay in vivo biologic processes noninvasively and quantitatively. The usefulness of F-FDG-PET/CT in assessing treatment response in infectious diseases is more promising than for conventional imaging. However, there are currently no clinical criteria or recommended imaging modalities to objectively evaluate the effectiveness of antimicrobial treatment. Therapeutic effectiveness is currently gauged by the patient's subjective clinical response. In this review, we present the current studies for monitoring treatment response, with a focus on Mycobacterium tuberculosis, as it remains a major worldwide cause of morbidity and mortality. The role of molecular imaging in monitoring other infections including spondylodiscitis, infected prosthetic vascular grafts, invasive fungal infections, and a parasitic disease is highlighted. The role of functional imaging in monitoring lipodystrophy associated with highly active antiretroviral therapy for human immunodeficiency virus is considered. We also discuss the key challenges and emerging data in optimizing noninvasive response evaluation.

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Section: Invasive Fungal Infectionsmentioning

confidence: 99%

Monitoring Response to Therapy

Sathekge

Ankrah

Lawal

et al. 2018

Seminars in Nuclear Medicine

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“…If the treatment of the underlying condition of the IFI involves further depression of the immune system such as ASCT, there is the risk of dissemination of IFI during treatment. Monitoring is crucial to treat IFIs adequately, but also not to subject the patients to unnecessary treatment with toxic effects and to lower the expensive costs of the treatment [2]. In our study, the mean duration of treatment till the last FDG-PET/CT was 33.5 weeks (range, 5–242).…”

Section: Discussionmentioning

confidence: 77%

“…Anatomical imaging, particularly with (chest and abdominal) computed tomography (CT) but also with brain magnetic resonance imaging (MRI), is usually used for the management of IFIs [4, 6]. However, the anatomical changes associated with IFIs may persist for long periods, even after adequate treatment, thereby potentially delaying any further therapy that may be required for the underlying disease [2]. Functional imaging with 2-fluorodeoxyglucose positron emission tomography integrated with CT (FDG-PET/CT) has been found useful in the monitoring of IFIs in a relatively small numbers of studies and case reports available on this topic [2].…”

Section: Introductionmentioning

confidence: 99%

Role of FDG PET/CT in monitoring treatment response in patients with invasive fungal infections

Ankrah

Span

Klein

et al. 2018

Eur J Nucl Med Mol Imaging

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IntroductionInvasive fungal infections (IFIs) occur mostly in immunosuppressed patients and can be life-threatening. Inadequate treatment is associated with high morbidity and mortality. We examined the role of 2-fluorodeoxyglucose positron emission tomography integrated with CT (FDG-PET/CT) in monitoring IFIs and therapy decision-making, and evaluated the role of baseline metabolic parameters in predicting the metabolic response.MethodsAll patients between October 2009 and March 2018, diagnosed with IFIs, treated with antifungal drugs, and who underwent FDG-PET/CT at baseline and at one or more timepoints during treatment were retrospectively included. The electronic patient files were reviewed for pathology, microbiology, and laboratory findings. All FDG-PET/CT scans were performed according to standardized European Association of Nuclear Medicine/EANM Research Limited (EANM/EARL) protocols. For each scan, the global total lesion glycolysis (TLG) and metabolic volume (MV), highest maximum standardized uptake value (SUVmax), and peak standardized uptake value (SUVpeak) were determined. The role of FDG-PET/CT on monitoring antifungal therapy was assessed by looking at the clinical decision made as result of the scan. Furthermore, the added value of the baseline metabolic parameters in predicting metabolic response to the antifungal treatment was evaluated.ResultsTwenty-eight patients with in total 98 FDG-PET/CT scans were included with a mean age of 43 ± 22 years. FDG-PET/CT altered management in 14 out of the 28 patients (50%). At the final FDG-PET/CT scan, 19 (68%) had a complete metabolic response (CMR), seven a partial response and two patients were defined as having progressive disease. Using receiver operative analysis, the cut-off value, sensitivity, specificity, and significance for the baseline TLG and MV to discriminate patients with CMR were 160, 94%, 100%, p < 0.001 and 60, 84%, 75%, p = 0.001 respectively.ConclusionFDG-PET/CT is useful in the monitoring of IFIs resulting in management therapy change in half of the patients. Baseline TLG and MV were found to be able to predict the metabolic response to antifungal treatment.Electronic supplementary materialThe online version of this article (10.1007/s00259-018-4192-z) contains supplementary material, which is available to authorized users.

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“…There is an absolute need for an imaging test that is able to tell the clinician: (1) there is no active infection anymore, you can stop the treatment, (2) there is progression of infection, you have to modify the treatment, or (3) therapy is adequate, but the infection is not solved yet, you should continue the treatment. Till now, mainly case reports exist in literature, but all agree that 18 F-FDG-PET has added value: it can serve as a valuable tool for monitoring treatment response (Figure 2), leads to change in therapy in cases of poor response, may help to determine when antifungal agents do not effectively reach the site and surgery should be recommended, is helpful to stop therapy in cases with inactive disease at a time point when lesions on other imaging modalities have not completely resolved, and helped in deciding the best time point (no active infection anymore) for autologous stem cell transplantation in patients with leukaemia/lymphoma [43].…”

Section: (18f)-fluorodeoxyglucose Positron Emission Tomography/commentioning

confidence: 99%

Immuno-Imaging to Predict Treatment Response in Infection, Inflammation and Oncology

Lauri

Auletta

Anzola

et al. 2019

JCM

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Background: Molecular nuclear medicine plays a pivotal role for diagnosis in a preclinical phase, in genetically susceptible patients, for radio-guided surgery, for disease relapse evaluation, and for therapy decision-making and follow-up. This is possible thanks to the development of new radiopharmaceuticals to target specific biomarkers of infection, inflammation and tumour immunology. Methods: In this review, we describe the use of specific radiopharmaceuticals for infectious and inflammatory diseases with the aim of fast and accurate diagnosis and treatment follow-up. Furthermore, we focus on specific oncological indications with an emphasis on tumour immunology and visualizing the tumour environment. Results: Molecular nuclear medicine imaging techniques get a foothold in the diagnosis of a variety of infectious and inflammatory diseases, such as bacterial and fungal infections, rheumatoid arthritis, and large vessel vasculitis, but also for treatment response in cancer immunotherapy. Conclusion: Several specific radiopharmaceuticals can be used to improve diagnosis and staging, but also for therapy decision-making and follow-up in infectious, inflammatory and oncological diseases where immune cells are involved. The identification of these cell subpopulations by nuclear medicine techniques would provide personalized medicine for these patients, avoiding side effects and improving therapeutic approaches.

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The Role of PET in Monitoring Therapy in Fungal Infections

Cited by 17 publications

References 93 publications

Monitoring Response to Therapy

Monitoring Response to Therapy

Role of FDG PET/CT in monitoring treatment response in patients with invasive fungal infections

Immuno-Imaging to Predict Treatment Response in Infection, Inflammation and Oncology

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