Positron Emission Tomography as a Diagnostic Tool in Infection: Present Role and Future Possibilities

Basu, Sandip; Chryssikos, Timothy; Moghadam-Kia, Siamak; Zhuang, Hongming; Torigian, Drew A.; Alavi, Abass

doi:10.1053/j.semnuclmed.2008.08.004

Cited by 231 publications

(154 citation statements)

References 115 publications

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“…One of the main causes is certainly the nonspecificity of FDG uptake in tumor; it is well known that false-positive results could be because of inflammation, infection, or other unknown benign tumors, 77,78 and so, it is really difficult to distinguish malignant from benign lesions in such clinical situations.…”

Section: Discussionmentioning

confidence: 99%

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Schillaci

2012

Seminars in Nuclear Medicine

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Positron emission tomography (PET) and positron emission tomography/computed tomography imaging with fluorodeoxyglucose (FDG) are widely used as a powerful evaluation modality in oncological nuclear medicine not only for detecting tumors but also for staging and for therapy monitoring. Nevertheless, there are numerous causes of FDG uptake in benign processes seen on PET images. In fact, the degree of FDG uptake is related to the cellular metabolic rate and the number of glucose transporters. FDG accumulation in tumors is due, in part, to an increased number of glucose transporters in malignant cells. However, FDG is not specific for neoplasms: a similar situation exists in inflammation; activated inflammatory cells demonstrate increased expression of glucose transporters. Therefore, there is growing interest in improving the specificity of FDG-PET in patients with cancer. Preliminary studies showed that in several neoplasms, the uptake of FDG continues to increase for hours after radiopharmaceutical injection, and this difference in the time course of FDG uptake could be useful to improve the accuracy of PET to distinguish benign lesions from malignant ones. Also in experimental cultures, dual-point acquisition (early at 40-60 minutes postinjection and delayed at 90-270 minutes) demonstrated that it is able to differentiate inflammatory from neoplastic tissue. In general, inflammatory tissue is expected to reduce FDG uptake as the time goes by, whereas the uptake in the neoplastic lesions is supposed to be increasing. There is evidence in the recent literature of the clinical usefulness of dual-time-point FDG-PET imaging in a wide variety of malignancies, including those of head and neck, lung, breast, gallbladder, cervix, liver, and in brain tumors. A lesion is likely to be malignant if the standard uptake value increases over time, whereas it is likely to be benign if the standard uptake value is stable or decreases. It is worth noting that in many of these studies, dual-time-point PET improved not only the specificity but also the sensitivity in assessing breast, pulmonary, liver, and other tumors because of increased lesion-to-background ratio, as a consequence of FDG washout from the surrounding normal tissues and increasing neoplastic uptake. Semin Nucl Med 42:267-280

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Section: Discussionmentioning

confidence: 99%

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Schillaci

2012

Seminars in Nuclear Medicine

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“…tional imaging modality for a variety of oncologic and nononcologic (e.g., inflammatory and infectious) applications (1)(2)(3). The contribution of 18 F-FDG PET to medicine has been unmatched by any other functional imaging modality (4).…”

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confidence: 99%

Complementary Roles of Whole-Body Diffusion-Weighted MRI and¹⁸F-FDG PET: The State of the Art and Potential Applications

Kwee¹,

Takahara²,

Ochiai³

et al. 2010

J Nucl Med

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18 F-FDG PET is an established functional imaging modality for the evaluation of human disease. Diffusion-weighted MRI (DWI) is another rapidly evolving functional imaging modality that can be used to evaluate oncologic and nononcologic lesions throughout the body. The information provided by 18 F-FDG PET and DWI can be complementary, because the 2 methods are based on completely different biophysical underpinnings. This article will describe the basic principles, clinical applications, and limitations of DWI. In addition, the available evidence that correlates and compares 18 F-FDG PET and DWI will be reviewed. PET,usi ng the radiotracer 18 F-FDG, is an established functional imaging modality for a variety of oncologic and nononcologic (e.g., inflammatory and infectious) applications (1-3). The contribution of 18 F-FDG PET to medicine has been unmatched by any other functional imaging modality (4). At present, there is also growing interest in the application of diffusion-weighted MRI (DWI) in the body (5-7). DWI allows visualization and quantification of the mobility of water molecules and has many potential clinical applications. Importantly, although 18 F-FDG PET and DWI are both functional imaging modalities and provide a high lesion-to-background contrast, they are based on completely different biophysical and biochemical underpinnings. Therefore, the information provided by the 2 imaging modalities may be regarded as complementary. Given the developing applications of DWI, the increasing use of multimodality imaging (8), and the expected advent of fully integrated PET/MRI systems (9), knowledge of the characteristics, possibilities, and limitations of DWI technique is becoming increasingly important. This is true for both the imaging specialists and the clinicians who use these modalities. This article will review the basic principles, clinical applications, and limitations of DWI. Furthermore, the available evidence that correlates and compares 18 F-FDG PET with DWI will be reviewed.

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“…There are conflicting results regarding radiolabeled ciprofloxacin against microorganisms responsible for infection [24,25]. Although positron emission tomography (PET)-computed tomography using 18 F-fluorodeoxyglucose (FDG) may be promising for imaging bone infections [26][27][28], the impact of elevated serum glucose levels, present mainly in diabetic patients, on PET sensitivity is a controversial issue [29]. In addition, its high charge and limited accessibility hinder its widespread use in the detection of osteomyelitis.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

Assadi

Vahdat²,

Nabipour³

et al. 2011

Nuclear Medicine Communications

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Objective The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of inflammation. Currently available techniques cannot decisively address this issue. In this respect, antimicrobial peptide 99m Tc-ubiquicidin (UBI) 29-41 scans have been showing interesting results. The aim of this study was to determine the accuracy of 99m Tc-UBI scan in the detection of osteomyelitis and to compare it with 99m Tc-methylene diphosphonate scan and magnetic resonance imaging (MRI).Methods Twenty patients (mean age = 48.90 years) with suspected osteomyelitis were included in this study. After evaluation of each patient through history taking, physical examination, appropriate laboratory tests, and other processes including bone probing, wound culture, and plain film radiography, MRIs, 99m Tc-UBI scans, and 99m Tc-methylene diphosphonate scans were performed. For quantitative analysis, the mean count of abnormal-tonormal (A/N) region was calculated for images acquired at 15, 30, 45, 60, 120, and 240 min to obtain the most favorable time for imaging. Results In total, osteomyelitis was detected in the 99mTc-UBI scans of 17 patients, indicating 100% accuracy, compared with an accuracy of 90% for osteomyelitis detected in three-phase bone scans. The maximum mean A/N was observed at 15 min after intravenous injection (median: 1.91; interquartile range: 1.54-2.94). MRI was performed in 12 cases only with 75% accuracy. In addition, the A/N ratios for the 99m Tc-UBI scans were not significantly different between patients with or without Staphylococcus aureus growth on wound cultures.Conclusion For fast imaging with high accuracy, 99m Tc-UBI 29-41 is a suitable choice for the detection of osteomyelitis.

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Positron Emission Tomography as a Diagnostic Tool in Infection: Present Role and Future Possibilities

Cited by 231 publications

References 115 publications

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Complementary Roles of Whole-Body Diffusion-Weighted MRI and¹⁸F-FDG PET: The State of the Art and Potential Applications

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

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Positron Emission Tomography as a Diagnostic Tool in Infection: Present Role and Future Possibilities

Cited by 231 publications

References 115 publications

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Complementary Roles of Whole-Body Diffusion-Weighted MRI and18F-FDG PET: The State of the Art and Potential Applications

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

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Complementary Roles of Whole-Body Diffusion-Weighted MRI and¹⁸F-FDG PET: The State of the Art and Potential Applications