PET/CT Imaging for Personalized Management of Infectious Diseases

Abstract

Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which is increasingly being used in infectious diseases. Because infection foci often consume more glucose than surrounding tissue, most infections can be diagnosed with PET/CT using 2-deoxy-2-[18F]fluoro-D-glucose (FDG), an analogue of glucose labeled with Fluorine-18. In this review, we discuss common infectious diseases in which FDG-PET/CT is currently applied including bloodstream infection of unknown origin, infective endocarditis, vascular graft infection, spondylodiscitis, and cyst infections. Next, we highlight the latest developments within the field of PET/CT, including total body PET/CT, use of novel PET radiotracers, and potential future applications of PET/CT that will likely lead to increased capabilities for patient-tailored treatment of infectious diseases.

Long axial field of view PET scanners: a road map to implementation and new possibilities

“…The arrival of the LAFOV PET/CT systems will provide a further boost to this field. Using current SAFOV PET/CT scanners, false-negative scans can be expected in patients with low-grade chronic infections, bacterial growth on biofilms at the joint prosthesis or vascular graft site, in small infectious foci, or in infections with a small number of bacterial colonies [ 34 , 35 ]. The LAFOV PET/CT scanner may reduce this problem and may lead to an increase in diagnostic accuracy in patients with bacteraemia, endocarditis, vascular graft infections and fracture-related infections.…”

The Diagnostic Value of 99mTc-HMPAO-Labelled White Blood Cell Scintigraphy and 18F-FDG PET/CT in Cardiac Device-Related Infective Endocarditis—A Systematic Review

“…Thus, this technique is considered to be very sensitive among nuclear medicine experts and provides quantification opportunities [38]. In addition, it is cost-effective in patients with Gram positive bacteremia and risk factors for septic dissemination, including prosthetic valves [39]. The diagnostic performance of this modality is dependent on the proper suppression of background activity from physiological 18F-FDG myocardial uptake by means of a low-carbohydrate and high-fat diet, followed by an at least 4-h fast [6].…”

Antibiotic‐Derived Radiotracers for Positron Emission Tomography: Nuclear or “Unclear” Infection Imaging?

“…The superior parameters of PET (sensitivity/resolution), its advanced technology (real‐time, whole‐body imaging/quantification), and the global impact of a growing PET infrastructure offer opportunities to develop new strategies that could revolutionize the management of patients with infectious diseases [90] . There are 20 antibiotic‐derived PET radiotracers with a bacterial‐specific binding mechanism, or MoA, reported in the literature (Table 1).…”

“…Measuring an enzyme/receptor's binding potential affords insight into the status of the target protein's rates of expression and activity (not total expression) [97] . In conjunction with parallel imaging (two radiopharmaceuticals simultaneously, or paramagnetic tracers for dual‐modality PET/MRI), antibiotic radiotracers may offer yet more opportunities to advance our understanding of the mechanisms governing antibiotic performance and the emergence of resistance [90] . Antibiotic‐PET imaging may also provide valuable input to fine‐tune in silico modeling and drug‐design strategies, [81, 95] and aid in evaluating the performance of drug‐delivery systems [103] .…”