Fluorodeoxyglucose F18 Positron Emission Tomography Coupled With Computed Tomography in Suspected Acute Renal Allograft Rejection

Lovinfosse, Pierre; Weekers, Laurent; Bonvoisin, Catherine; Bovy, Christophe; Grosch, Stéphanie; Krzesinski, Jean-Marie; Hustinx, Roland; Jouret, François

doi:10.1111/ajt.13429

Cited by 33 publications

(38 citation statements)

References 28 publications

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“…Limitations of 18 F-FDG-PET/CT imaging include its cost and availability, as well as the exposure to radiation originating from both PET and CT procedures. Still, a cumulative exposure dose of ∼5 mSv remains low compared with other classical radiological exams, like thorax CT (7 mSv) or abdomen CT (8 mSv) or coronary angiography (16 mSv) [15, 74]. The uptake of 18 F-FDG is not specific for inflammation and may be increased in other conditions, like tumours or infections [71, 75].…”

Section: Positron Emission Tomographymentioning

confidence: 99%

“…One rodent model of allogeneic KTx suggested that 18 F-FDG PET/CT non-invasively detects renal cellular-mediated AR [19, 51]. Recently, we have prospectively shown the usefulness of 18 F-FDG PET/CT in KTRs presenting with suspected AR prompting a transplant biopsy (Figure 2) [15]. On the basis of 32 18 FDG-PET/CTs in 31 adult KTRs, we found a positive correlation between 18 F-FDG transplant uptake (i.e.…”

Section: Positron Emission Tomographymentioning

confidence: 99%

“…Moreover, repeated biopsies to evaluate the renal graft's status pose challenges, including practicability and cost. Therefore, alternative, less invasive but highly sensitive modalities are currently under investigation to reinforce our armamentarium in the diagnosis of AR [1, 9–15]. Likewise, it would be useful to non-invasively predict non-rejection in KTRs with acute renal dysfunction and suspected AR in order to avoid needless transplant biopsy.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, activated leukocytes are characterized by an increased avidity for glucose and its radiolabelled analogue, 18F-fluoro-deoxy-glucose ( 18 F-FDG). Such an accumulation of 18 F-FDG is detectable by positron emission tomography (PET), as demonstrated in both rat and man [15, 19]. …”

Section: Introductionmentioning

confidence: 99%

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Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I.In vivoimaging methods

et al. 2016

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Kidney transplantation (KTx) represents the best available treatment for patients with end-stage renal disease. Still, full benefits of KTx are undermined by acute rejection (AR). The diagnosis of AR ultimately relies on transplant needle biopsy. However, such an invasive procedure is associated with a significant risk of complications and is limited by sampling error and interobserver variability. In the present review, we summarize the current literature about non-invasive approaches for the diagnosis of AR in kidney transplant recipients (KTRs), including in vivo imaging, gene expression profiling and omics analyses of blood and urine samples. Most imaging techniques, like contrast-enhanced ultrasound and magnetic resonance, exploit the fact that blood flow is significantly lowered in case of AR-induced inflammation. In addition, AR-associated recruitment of activated leukocytes may be detectable by 18F-fluoro-deoxy-glucose positron emission tomography. In parallel, urine biomarkers, including CXCL9/CXCL10 or a three-gene signature of CD3ε, IP-10 and 18S RNA levels, have been identified. None of these approaches has been adopted yet in the clinical follow-up of KTRs, but standardization of procedures may help assess reproducibility and compare diagnostic yields in large prospective multicentric trials.

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Section: Positron Emission Tomographymentioning

confidence: 99%

Section: Positron Emission Tomographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I.In vivoimaging methods

et al. 2016

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“…Citation rates show a similar trend, with a surge for all included publications, but a lower rate for publications combining imaging and KTX. Studies focusing on PET/CT for the diagnosis of acute allograft rejection showed significant associations in both acute rat renal allograft models and a clinical study, while the sensitivity remained too low for clinical applications [11][12][13][14].…”

Section: Lessons Learntmentioning

confidence: 99%

Have we forgotten imaging prior to and after kidney transplantation?

et al. 2018

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[18F]FDG PET/CT imaging disproves renal allograft acute rejection in kidney transplant recipients with acute kidney dysfunction: a validation cohort

Lovinfosse

Weekers

Pottel

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose. [ 18 F]FDG-PET/CT may predict the absence of acute allograft rejection (AR) in kidney transplant recipients (KTRs) with acute kidney injury (AKI). Still, the proposed threshold of 1.6 of the mean of mean standardized uptake values (mSUVmean) in the renal parenchyma needs validation.Methods. We prospectively performed 86 [ 18 F]FDG-PET/CT in 79 adult KTRs who underwent per cause transplant biopsy for suspected AR. Biopsy-proven polyoma-BK nephropathies (n=7) were excluded.PET/CT was performed 192 ± 18 minutes after administration of 254.4 ± 30.4 MBq of [ 18 F]FDG. The SUV mean was measured in both upper and lower poles of the renal allograft. One-way analysis of variance (ANOVA) and Tukey's studentized range test were sequentially performed. The receiver operating characteristic (ROC) curve was drawn to discriminate "AR" from non-pathological ("normal" + "borderline") conditions.Results. The median age of the cohort was 55 [43; 63] years, with M/F gender ratio of 47/39. The mean eGFR was 31.9 ± 14.6 ml/min/1.73m². Biopsies were categorized in 4 groups: "normal" (n=54), "borderline" (n=9), "AR" (n=14) or "others" (n=2). The median [min; max] mSUV mean reached 1.72 [1.02; 2.07], 1.97 [1.55; 2.11], 2.13 [1.65, 3.12] and 1.84 [1.57; 2.12] in "normal", "borderline", "AR" and "others" groups, respectively. ANOVA demonstrated a signi cant difference of mSUV mean among groups (F=13.25, p<0.0001). The ROC area under the curve was 0.86. Test sensitivity and speci city corresponding to the threshold value of 1.6 were 100% and 30%, respectively. Conclusion.[ 18 F]FDG -PET/CT may help noninvasively prevent inessential transplant biopsies in KTR with AKI.

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Fluorodeoxyglucose F18 Positron Emission Tomography Coupled With Computed Tomography in Suspected Acute Renal Allograft Rejection

Cited by 33 publications

References 28 publications

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I.In vivoimaging methods

Non-invasive approaches in the diagnosis of acute rejection in kidney transplant recipients. Part I.In vivoimaging methods

Have we forgotten imaging prior to and after kidney transplantation?

[18F]FDG PET/CT imaging disproves renal allograft acute rejection in kidney transplant recipients with acute kidney dysfunction: a validation cohort

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