OtherClinical Investigations

18F-FDG PET in Detecting Metastatic Infectious Disease

Chantal P. Bleeker-Rovers, Fidel J. Vos, Geert J.A. Wanten, Jos W.M. van der Meer, Frans H.M. Corstens, Bart-Jan Kullberg and Wim J.G. Oyen
Journal of Nuclear Medicine December 2005, 46 (12) 2014-2019;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A) In 45-y-old woman with S. aureus septicemia and persistent fever during therapy, PET showed increased 18F-FDG uptake in multiple lesions in both lungs, mediastinum, and upper abdomen. Subsequently, chest CT also showed multiple lesions in both lungs and mediastinum. Cholangitis caused by gallstones was confirmed by abdominal ultrasound and endoscopic retrograde cholangiopancreatography (ERCP). Fever disappeared within 2 d after ERCP. (B) After 3 mo, 18F-FDG PET was normal and antibiotic therapy was discontinued.

Tables

  • TABLE 1

    Characteristics of 40 Patients with Suspected Metastatic Infectious Disease on Whom 18F-FDG PET Was Performed

    CharacteristicTotal (n = 40)Metastatic foci
    Yes (n = 30)No (n = 10)
    Male (%)23 (58)17 (57)6 (60)
    Female (%)17 (42)13 (43)4 (40)
    Age (y)*60 ± 1760 ± 1760 ± 18
    Community-acquired infection (%)30 (75)23 (77)7 (70)
    Duration of symptoms until presentation (d)*†1 ± 81 ± 71 ± 9
    Duration of symptoms until adequate therapy (d)*†2 ± 83 ± 82 ± 9
    CVC present (%)13 (33)10 (33)3 (30)
    Duration of CVC present (wk)*12 ± 6214 ± 691 ± 9
    Total parenteral nutrition (%)9 (23)7 (23)2 (20)
    Diabetes mellitus (%)4 (10)3 (10)1 (10)
    Peritoneal dialysis (%)2 (5)1 (3)1 (10)
    Hemodialysis (%)1 (3)01 (10)
    Pacemaker (%)3 (8)3 (10)0
    Congenital heart disease (%)3 (8)3 (10)0
    Mechanical heart valve (%)2 (5)2 (7)0
    Malignancy (%)1 (3)1 (3)0
    Immunosuppressive drugs (%)8 (20)7 (23)1 (10)
    Intravenous drug use000
    Positive blood cultures (no. per patient)*3 ± 34 ± 3‡2 ± 1‡
    Duration of positive blood cultures (d)*2 ± 83 ± 8‡1 ± 1‡

    • ↵* Median ± SD.

    • ↵† One patient was excluded from these calculations because she had lower back pain, periodic low-grade fever, and fatigue for almost 3 y before she was diagnosed with a S. aureus psoas abscess and before 18F-FDG PET was performed.

    • ↵‡ P < 0.05.

  • TABLE 2

    Culture Results

    CategoryTotal (n = 40)Metastatic foci
    Yes (n = 30)No (n = 10)
    Gram-positive bacteria
        Staphylococcus aureus1477
        Staphylococcus epidermidis110
        Streptococcus pneumoniae330
        Other Streptococcus spp.541
        Enterococcus spp.*211
    Gram-negative bacteria
        Escherichia coli330
        Proteus mirabilis110
        Enterobacter cloacae110
        Salmonella group D110
        Serratia marcescens110
    Yeasts
        Candida albicans660
        Candida parapsilosis211
        Candida tropicalis*101

    • ↵* In 1 patient, blood cultures were positive for Enterococcus faecium as well as Candida tropicalis.

  • TABLE 3

    Portal of Entry: Source of Bacteremia or Fungemia

    DiagnosisTotal (n = 40)Metastatic foci
    Yes (n = 30)No (n = 10)
    CVC-related bloodstream infection1293
    Soft-tissue or skin infection514
    Pneumonia110
    Urinary tract infection440
    CAPD-peritonitis211
    Wound infection101
    Cholangitis211
    Meningitis110
    Unknown12120

    • CAPD = continuous ambulatory peritoneal dialysis.

  • TABLE 4

    Localization of Metastatic Infectious Foci in 30 Patients Eventually Diagnosed with Metastatic Disease

    Organ systemPatients (n = 30)
    Endocarditis5
    Endovascular10
    Lungs7
    Liver or biliary tract2
    Spleen2
    Arthritis4
    Nonvertebral osteomyelitis1
    Vertebral osteomyelitis3
    Psoas abscess1
    Skin or soft tissue5
    Brain2
    Eye1

    • In 11 patients, metastatic infectious foci were found in >1 organ system.

  • TABLE 5

    18F-FDG PET Results on 40 Patients with Suspected Metastatic Infectious Disease

    18F-FDG PET resultsPatients (n = 40)Confirmation
    TotalPartialNot
    Negative
        True-negative6
        False-negative0
    Positive
        True-positive31*2731
            Clinically relevant181521
            Clinically irrelevant1010
            Already known12*1200
        False-positive3003

    • ↵* In 1 patient with S. aureus bacteremia without metastatic infection, 18F-FDG uptake was seen in an abscess of his right arm, which was the source of his bacteremia. 18F-FDG PET was otherwise normal.

  • TABLE 6

    Outcome of 40 Patients with Suspected Metastatic Infectious Disease

    CharacteristicTotal (n = 40)Metastatic foci
    Yes (n = 30)No (n = 10)
    Duration of fever (d)*18 ± 2725 ± 307 ± 14
    Duration of hospitalization (d)*45 ± 2547 ± 25†23 ± 18†
    Duration of antibiotic therapy (d)*50 ± 26675 ± 299†35 ± 16†
    Admission to ICU (%)7 (18)6 (20)1 (10)
    Duration of ICU stay (d)*2 ± 62 ± 62
    Cure (%)30 (75)20 (67)†10 (100)†
    Persistent infection (%)4 (10)4 (13)0
    Relapse (%)1 (3)1 (3)0
    Death (%)5 (13)5 (17)0

    • ↵* Median ± SD.

    • ↵† P < 0.05.

    • ICU = intensive care unit.

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