FDG-PET/CT for Systemic Infections

Hess, Søren; Jakobsen, Nick Møldrup; Brøndserud, Mette Bordinggaard; Segtnan, Eivind Antonsen; Schifter, Søren

doi:10.2174/2211555204666150619154421

Cited by 3 publications

(3 citation statements)

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“…In a recent review, Carrera et al suggested 4 subclassifications of diaschisis (3) that may be more appropriate for mechanistic imaging. PET/CT with 18 F-FDG has shown promising results of visual image assessment of diaschisis (4)(5)(6)(7)(8)(9). Gliomas invade brain parenchyma and destroy healthy brain tissue, and lesions in turn damage other elements of the connectome as manifested by diaschisis.…”

Section: Diaschisis Denotes Brain Dysfunction Remote From a Focal Bramentioning

confidence: 99%

Prognostic Implications of Total Hemispheric Glucose Metabolism Ratio in Cerebrocerebellar Diaschisis

et al. 2016

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Diaschisis denotes brain dysfunction remote from a focal brain lesion. We have quantified diaschisis and investigated its prognostic value in glioma. We compared 50F-FDG PET/CT studies collected prospectively from 14 patients with supratentorial glioma (5 men and 9 women; age range, 35-77 y) with 10 single scans from healthy controls (age range, 43-75 y). Dedicated 3-dimensional segmentation software was used to obtain total hemispheric glucose metabolic ratios (THGr) by dividing total hemispheric F-FDG uptake in each diaschitic hemisphere-that is, the ipsilateral cerebral hemisphere (THGr(Ce)) and the contralateral cerebellar hemisphere (THGr(Cb))-by its respective contralateral side. Receiver-operating-characteristic (ROC) analysis was performed to determine optimal cut-offs for combinations of THGr(Ce) and THGr(Cb). Two independent observers obtained data for reproducibility analysis, and THGr values were compared with qualitative assessment of diaschisis performed by a PET neuroimaging specialist. Qualitative analysis confirmed cerebrocerebellar diaschisis in all glioblastoma PET studies performed within 1 y of death. Healthy subjects had significantly higher THGr(Ce) values ( = 0.0007) and THGr(Cb) values ( = 0.02) than glioblastoma patients. ROC analysis yielded diaschisis thresholds of 0.62 for THGr(Ce) and 0.84 for THGr (Cb). Qualitative assessment demonstrated cerebral diaschisis in 16 of 17 (94%) cases with THGr(Ce) below the determined threshold and cerebellar diaschisis in 25 of 26 (96%) cases with THGr(Cb) below the determined threshold. When both THGr(Ce) and THGr(Cb) were below the ROC threshold, the combined diaschisis measures had a positive predictive value for survival below 1 y of 100%. When one parameter was below the threshold, it had a positive predictive value of 75%, and when both parameters exceeded thresholds, the negative predictive value for survival above 1 y was 79%. Median interrater variability was 3.3% and 5.9% for THGr(Ce) and THGr(Cb), respectively. The THGr measures demonstrated diaschisis in the cerebrum and cerebellum of patients with glioma. Combined cerebrocerebellar diaschisis ratios with ROC thresholds for both forebrain and hindbrain had high negative and positive predictive values for survival for less than a year. The THGr method allows comparison of data obtained at different institutions and is now open for further validation in gliomas and other cerebral diseases.

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Section: Diaschisis Denotes Brain Dysfunction Remote From a Focal Bramentioning

confidence: 99%

Prognostic Implications of Total Hemispheric Glucose Metabolism Ratio in Cerebrocerebellar Diaschisis

et al. 2016

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“…Only few studies have investigated bacteremia of unknown origin (BUO) [8] despite its frequent occurrence at an estimated 8-22% of bacteremia cases [9][10][11]. Studies have pointed towards increased mortality when the origin of bacteremia is unknown/undetermined [12][13][14], underlining the importance of locating the primary site of infection in BUO.…”

Section: Introductionmentioning

confidence: 99%

“…Despite increased application in infectious/inflammatory diseases and an obvious potential in BUO [15], no larger studies have investigated the use of FDG-PET/CT in BUO [8].…”

Section: Introductionmentioning

confidence: 99%

Clinical value of FDG-PET/CT in bacteremia of unknown origin with catalase-negative gram-positive cocci or Staphylococcus aureus

Brøndserud

Pedersen

Rosenvinge

et al. 2019

Eur J Nucl Med Mol Imaging

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Bacteremia is associated with high mortality, especially when the site of infection is unknown. While conventional imaging usually focuses on specific body parts, FDG-PET/CT visualizes hypermetabolic foci throughout the body. Purpose: To investigate the ability of FDG/PET-CT to detect site of infection and its clinical impact in bacteremia of unknown origin with catalase-negative Gram-positive cocci (excluding pneumococci and enterococci) or Staphylococcus aureus (BUOCSA). Methods: We retrospectively identified 157 patients with 165 episodes of BUOCSA, who subsequently underwent FDG-PET/CT. Data were collected from medical records. Decision regarding important sites of infection in patients with bacteremia was based on the entire patient course and served as reference diagnosis for comparison with FDG-PET/CT findings. FDG-PET/CT was considered to have high clinical impact if it correctly revealed site(s) of infection in areas not assessed by other imaging modalities or if other imaging modalities were negative/equivocal in these areas, or if it established a new clinically relevant diagnosis, and/or led to change in antimicrobial treatment. Results: FDG-PET/CT detected sites of infection in 56.4% of cases and had high clinical impact in 47.3%. It was the first imaging modality to identify sites of infection in 41.1% bacteremia cases, led to change of antimicrobial therapy in 14.7%, and established a new diagnosis unrelated to bacteremia in 9.8%. Detection rate and clinical impact weren't significantly influenced by duration of antimicrobial treatment preceding FDG-PET/CT, days from suspicion of bacteremia to FDG-PET/CT-scan, type of bacteremia, or cancer. Conclusion: FDG-PET/CT appears clinically useful in BUOCSA. Prospective studies are warranted for confirmation.

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