Analysis of the Role of [18F] Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) Imaging in Early Diagnosis and Management of Invasive Mold Infections (IMIs)

G. ChamiLos, H.A. MacapinLac, D.R Kontoyiannis*.

Author address: 

The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

Abstract: 

Analysis of the Role of [18F] Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) Imaging in Early Diagnosis and Management of Invasive Mold Infections (IMIs) G. ChamiLos, H.A. MacapinLac, D.R Kontoyiannis*. The University oJ: Texas M.D. Anderson Cancer Center, Houston, TX, USA compromised patients. EarLy diagnosis of IMIs by conventional methods is chaLLenging, and there is need for innovation in this area. Emerging evidence suggests that [18F] fluorodeoxygLucose (FDG) positron emission tomography (PET) imaging could be a useful tool in diagnosis and management of a range of opportunistic infections in immunocompromised patients. Methods: We retrospectively evaluated the medical records of patients with probable or proven IMI (n= 13) who underwent FDG PET imaging around the time of their infection, at The University of Texas M.D. Anderson Cancer Center over a 5-year period (12/1999 to 4/2004). We additionaLLy reviewed the avaiLabLe Literature on FDG PET imaging in diagnosis and/or foLLow up of patients with IMIs (n=9). Results: We identified 22 patients with IMIs (15 definite, 7 probable). FDG PET imaging was performed for cancer staging in the majority (14/22 or 64%) of cases. Most patients had an underling malignancy (16/22 or 73%), primarily of haematotogicat origin (12/16 or 75%), and typical risk factors for IMIs, including receipt of a significant dose of corticosteroids (14/22 or 46%), and severe neutropenia (4/22 or 18%). In 7 recipients of attogeneic HSCT most had developed active GVHD (6/7 or 86%). ALL IMIs were caused by either Asper~illus (16/22 or 73%) or Zy~omycetes (6/22 or 27%) species. Pneumonia was the predominant manifestation of IMIs (17/22), whereas there were 4 cases of disseminated infection and 1 case of sinusitis. The median day of FDG PET study in respect to IMI diagnosis was day 15 (range: day 26 to day 60). The median standardized uptake value SUV of Lesions caused by IMIs was 3.7 (range: 0.9-11.8). In 16 eLigibLe patients, FDG PET revealed an occult site of infection in 3 (19%) cases of disseminated IMIs (incLuding 2 cases with CNS involvement) and was heLpfuL in guiding antifungat treatment in 9 (56%) patients with IMI. Conclusion: FDG PET imaging has the potential to become a useful toot for diagnosis of occult foci of disseminated IMIs and monitoring of antifungat treatment. However, prospective validation and analysis of cost effectiveness of FDG PET imaging in patients with IMIs is needed.
2006

abstract No: 

S98

Full conference title: 

14th International Symposium of Infections in the Immunocompromised Host
    • ISIIH, 14th