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Dondi F, Pisani AR, Lucarelli NM, Gazzilli M, Talin A, Albano D, Rubini D, Maggialetti N, Rubini G, Bertagna F. Correlation between Kidney Uptake at [18F]FDG PET/CT and Renal Function. J Pers Med 2023; 14:40. [PMID: 38248741 PMCID: PMC10817585 DOI: 10.3390/jpm14010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Different insights into the connection between kidney [18F]fluorodesoxyglucose ([18F]FDG) uptake at positron emission tomography/computed tomography (PET/CT) and renal function have been proposed in the past. The aim of this study was therefore to assess the presence of a correlation between these two parameters. Kidney uptakes were assessed and compared to the creatinine (Cr) values and estimated glomerular filtration rate (EGFR) among different classes of renal functional impairment or kidney status. A total of 339 patients and 385 different PET/CT scans were included in this study. Significant correlations between kidney uptakes and renal function parameters were reported in most of the groups studied, with the exception of patients with Cr < 1.2 mg/dL and subjects with a kidney transplantation. Strong concordance in the assessment of renal parenchymal uptakes between the different readers was reported. To conclude, strong correlations for renal [18F]FDG uptake with Cr levels and the EGFR were reported, with the exception of the group of patients with a Cr value < 1.2 mg/dL and for the group with a kidney transplantation.
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Affiliation(s)
- Francesco Dondi
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| | - Antonio Rosario Pisani
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Nicola Maria Lucarelli
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Maria Gazzilli
- Nuclear Medicine, ASL Bari—P.O. Di Venere, 70012 Bari, Italy
| | - Anna Talin
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| | - Domenico Albano
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
| | - Dino Rubini
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy;
| | - Nicola Maggialetti
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Giuseppe Rubini
- Section of Nuclear Medicine, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.R.P.); (N.M.); (G.R.)
| | - Francesco Bertagna
- Nuclear Medicine, Università Degli Studi di Brescia and ASST Spedali Civili Brescia, 25123 Brescia, Italy; (F.D.); (A.T.); (D.A.); (F.B.)
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Rachid A, Chen B, Zhu G. A preliminary study on the effect of renal function on the metabolism of 18F-FDG in the human cerebellum. Quant Imaging Med Surg 2023; 13:5034-5042. [PMID: 37581043 PMCID: PMC10423388 DOI: 10.21037/qims-22-917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/12/2023] [Indexed: 08/16/2023]
Abstract
Background The cerebellum is less affected by normal aging or neurodegenerative diseases, the aim of this paper is to investigate the effect of renal function status on uptake of 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) in human cerebellum based on independent creatinine (CRE) or blood urea nitrogen (BUN) levels. Methods A total of 253 patients who underwent 18F-FDG PET/CT scans were included. The patients were divided into groups according to renal function status: 201 patients with normal renal function, 16 patients with increase CRE, 36 patients with decrease CRE, and 31 patients with abnormal BUN. The maximum standardized uptake values were obtained in regions of interest (ROIs) for multiple tissue types (right cerebellum, right lobe of liver, right lung, bone marrow and psoas muscle at the level of the fourth lumbar vertebra). Moreover, the selected normal CRE groups were pair-matched with CRE decrease group with respect to age, sex, body mass index and glucose, respectively. Results Among 253 patients who met the inclusion/exclusion criteria, the final analysis included 967 ROIs (244 cerebellum, 191 lungs, 230 muscles, 145 bone marrow, and 157 liver) from 18F-FDG PET/CT scans. Among patients grouped by CRE or BUN levels, the uptake of 18F-FDG by cerebellum was significantly decreased in patients with CRE decrease level (P=0.001). There were no statistically significant differences between the other groups. Matched-pair analysis indicated there were no significant changes in outcomes between the CRE decrease group and the age-, sex-, BMI-, and glucose-matched controls compared to pre-matching. Conclusions In patients with normal renal function and reduced CRE concentration, decrease cerebellar glucose metabolism was observed; however, no abnormal uptake of 18F-FDG was found in the cerebellum and other normal tissues of patients with impaired renal function. Consequently, in the study of cerebellar 18F-FDG metabolism, it may be necessary to consider the influence of blood CRE level.
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Affiliation(s)
- Abdoul Rachid
- Department of Nuclear Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
- College of International Education, Dalian Medical University, Dalian, China
| | - Bo Chen
- Department of Nuclear Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Guangwen Zhu
- Department of Nuclear Medicine, First Affiliated Hospital, Dalian Medical University, Dalian, China
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Bodard S, Kharroubi-Lakouas D, Guinebert S, Dariane C, Gillard P, Sakhi H, Ferriere E, Delaye M, Timsit MO, Correas JM, Hélénon O, Boudhabhay I. [Cancer imaging and prevention of renal failure]. Bull Cancer 2022:S0007-4551(22)00392-7. [PMID: 36371283 DOI: 10.1016/j.bulcan.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/11/2022]
Abstract
The risk of acute renal failure (ARF) following iodinated contrast media injection has long been overestimated because of the previous use of more toxic ICPs and uncontrolled studies. Nowadays, this concept is being questioned. Patients with severe renal failure and/or ARF are the only group still considered at risk. In these patients, it is necessary to discuss an alternative without an iodinated contrast agent. Contrast-enhanced ultrasound, MRI, spectral CT or PET-CT scan can be used instead of contrast-enhanced CT. Preventive measures should be applied when appropriate substitute to CT is not available or not diagnosed (minimum necessary dose of ICP, interruption of some treatments and prior hydration). These recommendations formalized by the European Society of Urogenital Radiology (ESUR) in 2018 address most situations faced by clinicians. In complex situations, an opinion from a nephrologist remains necessary after asking the radiologist about the availability of acceptable substitutes.
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Affiliation(s)
- Sylvain Bodard
- AP-HP, Hôpital Necker Enfants malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris Cité, 75006 Paris, France; Sorbonne université, CNRS, Inserm, laboratoire d'imagerie biomédicale, Paris, France.
| | | | - Sylvain Guinebert
- AP-HP, Hôpital Necker Enfants malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris Cité, 75006 Paris, France
| | - Charles Dariane
- Université de Paris Cité, 75006 Paris, France; AP-HP, hôpital européen Georges Pompidou, service d'urologie, 75015 Paris, France
| | - Paul Gillard
- AP-HP, Hôpital Necker Enfants malades, service d'imagerie adulte, 75015 Paris, France
| | - Hamza Sakhi
- Université de Paris Cité, 75006 Paris, France; AP-HP, hôpital Necker Enfants malades, service de néphrologie et transplantation rénale adulte, 75015 Paris, France
| | - Elsa Ferriere
- Université de Paris Cité, 75006 Paris, France; AP-HP, hôpital Necker Enfants malades, service de néphrologie et transplantation rénale adulte, 75015 Paris, France
| | - Matthieu Delaye
- Institut curie, université Versailles Saint-Quentin, département d'oncologie médicale, Saint-Cloud, France; Groupe de Recherche Interdisciplinaire Francophone en Onco-Néphrologie (GRIFON), Paris, France
| | - Marc-Olivier Timsit
- Université de Paris Cité, 75006 Paris, France; AP-HP, hôpital européen Georges Pompidou, service d'urologie, 75015 Paris, France
| | - Jean-Michel Correas
- AP-HP, Hôpital Necker Enfants malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris Cité, 75006 Paris, France
| | - Olivier Hélénon
- AP-HP, Hôpital Necker Enfants malades, service d'imagerie adulte, 75015 Paris, France; Université de Paris Cité, 75006 Paris, France
| | - Idris Boudhabhay
- Université de Paris Cité, 75006 Paris, France; AP-HP, hôpital Necker Enfants malades, service de néphrologie et transplantation rénale adulte, 75015 Paris, France
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Amoabeng KA, Laurila S, Juárez-orozco LE, Marthinsen ABL, Moczulski D, Rebelos E, Dadson P. The utilization of positron emission tomography in the evaluation of renal health and disease. Clin Transl Imaging. [DOI: 10.1007/s40336-021-00469-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abstract
Purpose
Positron emission tomography (PET) is a nuclear imaging technique that uses radiotracers to visualize metabolic processes of interest across different organs, to diagnose and manage diseases, and monitor therapeutic response. This systematic review aimed to characterize the value of PET for the assessment of renal metabolism and function in subjects with non-oncological metabolic disorders.
Methods
This review was conducted and reported in accordance with the PRISMA statement. Research articles reporting “kidney” or “renal” metabolism evaluated with PET imaging between 1980 and 2021 were systematically searched in Medline/PubMed, Science Direct, and the Cochrane Library. Search results were exported and stored in RefWorks, the duplicates were removed, and eligible studies were identified, evaluated, and summarized.
Results
Thirty reports met the inclusion criteria. The majority of the studies were prospective (73.33%, n = 22) in nature. The most utilized PET radiotracers were 15O-labeled radio water (H215O, n = 14) and 18F-fluorodeoxyglucose (18F-FDG, n = 8). Other radiotracers used in at least one study were 14(R,S)-(18)F-fluoro-6-thia-heptadecanoic acid (18F-FTHA), 18F-Sodium Fluoride (18F-NaF), 11C-acetate, 68-Gallium (68Ga), 13N-ammonia (13N-NH3), Rubidium-82 (82Rb), radiolabeled cationic ferritin (RadioCF), 11C‐para-aminobenzoic acid (11C-PABA), Gallium-68 pentixafor (68Ga-Pentixafor), 2-deoxy-2-F-fluoro-d-sorbitol (F-FDS) and 55Co-ethylene diamine tetra acetic acid (55Co-EDTA).
Conclusion
PET imaging provides an effective modality for evaluating a range of metabolic functions including glucose and fatty acid uptake, oxygen consumption and renal perfusion. Multiple positron emitting radiolabeled racers can be used for renal imaging in clinical settings. PET imaging thus holds the potential to improve the diagnosis of renal disorders, and to monitor disease progression and treatment response.
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Schreuder N, de Romijn I, Jager PL, Kosterink JGW, van Puijenbroek EP. Safe use of radiopharmaceuticals in patients with chronic kidney disease: a systematic review. EJNMMI Radiopharm Chem 2021; 6:27. [PMID: 34417933 PMCID: PMC8380202 DOI: 10.1186/s41181-021-00145-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) may need to have their radiopharmaceutical dosage adjusted to prevent adverse effects and poor outcomes, but there are few recommendations on radiopharmaceutical dosing for this group of patients. The aim of this study is to provide an overview of the available information on radiopharmaceutical dose recommendations for patients with CKD. METHODS We performed a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a literature search in the MEDLINE (PubMed) and Embase databases and screened potentially relevant studies using inclusion and exclusion criteria. We independently assessed the included observational studies' methodologies and extracted relevant data. RESULTS Of the 5795 studies first identified, 34 were included in this systematic review. These studies described three radiopharmaceuticals: [131I]sodium iodine, [18F]fludeoxyglucose, and [131I]iobenguane. Twenty-nine studies (85.3%) reported data on patients with CKD stage 5, while only three studies mentioned CKD patients in other stages (8.8%). CONCLUSION We found no consistent recommendations for radiopharmaceutical dosing in patients with CKD. Although some studies do mention dosing difficulties in patients with CKD, information is available for only a few radiopharmaceuticals, and recommendations are sometimes contradictory. Further research on radiopharmaceutical dosing in patients with CKD is needed to determine whether these patients require specific dosing, especially for therapeutic radiopharmaceuticals where a non-optimised dose may lead to an increased risk of toxicity for non-targeted organs. Including patients with CKD in studies and providing specific information about dosing in these patients should be a priority for the radiopharmaceutical community.
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Affiliation(s)
- Nanno Schreuder
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands.
- GE Healthcare Radiopharmacy Zwolle, Zwolle, The Netherlands.
| | - Iris de Romijn
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Jos G W Kosterink
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eugène P van Puijenbroek
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
- Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
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Campochiaro C, Misra DP. PET in Takayasu arteritis: onwards and upwards towards a future of robust multimodality disease activity assessment? Rheumatology (Oxford) 2021; 61:SI4-SI5. [PMID: 34373894 DOI: 10.1093/rheumatology/keab644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow-226014, India
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Abstract
White blood cells activated by either a pathogen or as part of a systemic inflammatory disease are characterized by high energy consumption and are therefore taking up the glucose analogue PET tracer FDG avidly. It is therefore not surprising that a steadily growing body of research and clinical reports now supports the use of FDG PET/CT to diagnose a wide range of patients with non-oncological diseases. However, using FDG PET/CT in patients with infectious or inflammatory diseases has some limitations and potential pitfalls that are not necessarily as pronounced in oncology FDG PET/CT. Some of these limitations are of a general nature and related to the laborious acquisition of PET images in patients that are often acutely ill, whereas others are more disease-specific and related to the particular metabolism in some of the organs most commonly affected by infections or inflammatory disease. Both inflammatory and infectious diseases are characterized by a more diffuse and less pathognomonic pattern of FDG uptake than oncology FDG PET/CT and the affected organs also typically have some physiological FDG uptake. In addition, patients referred to PET/CT with suspected infection or inflammation are rarely treatment naïve and may have received varying doses of antibiotics, corticosteroids or other immune-modulating drugs at the time of their examination. Combined, this results in a higher rate of false positive FDG findings and also in some cases a lower sensitivity to detect active disease. In this review, we therefore discuss the limitations and pitfalls of FDG PET/CT to diagnose infections and inflammation taking these issues into consideration. Our review encompasses the most commonly encountered inflammatory and infectious diseases in head and neck, in the cardiovascular system, in the abdominal organs and in the musculoskeletal system. Finally, new developments in the field of PET/CT that may help overcome some of these limitations are briefly highlighted.
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Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Pieter H Nienhuis
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Andor W J M Glaudemans
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen; Faculty of Science and Technology, Department of Biomedical Photonic Imaging, University of Twente, Enschede
| | - Lars C Gormsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus N.
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Otomi Y, Otsuka H, Shono N, Onishi H, Mitsuhashi R, Matsuzaki S, Takaoka Y, Enomoto H, Sakamoto Y, Sasahara M, Abe T, Shinya T, Harada M. A reduced physiological 18F-fluorodeoxyglucose uptake in the brain and liver caused by malignant lymphoma being deprived of the tracer. J Med Invest 2021; 68:181-185. [PMID: 33994467 DOI: 10.2152/jmi.68.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose : To investigate whether or not the physiological brain and liver FDG uptake are decreased in patients with highly accelerated glycolysis lesions. Methods : We retrospectively analyzed 51 patients with malignant lymphoma. We compared the FDG uptake in the brain and liver of the patients with that in a control group. In 24 patients with a complete response (CR) or partial response (PR) to treatment, we compared the brain and liver uptake before and after treatment. Results : The maximum standardized uptake value (SUVmax) and total glycolytic volume (TGV) of the brain as well as the SUVmax and mean standardized uptake value (SUVmean) of the liver in malignant lymphoma patients were 13.1 ± 2.3, 7386.3 ± 1918.4, 3.2 ± 0.5, and 2.3 ± 0.4, respectively ; in the control group, these values were 14.9 ± 2.4, 8566.2 ± 1659.5, 3.4 ± 0.4, and 2.5 ± 0.3, respectively. The SUVmax and TGV of the brain and the SUVmean of the liver in malignant lymphoma patients were significantly lower than the control group. The SUVmax and TGV of the brain after treatment were significantly higher than before treatment. Both the SUVmax and SUVmean of liver after treatment were higher than before treatment, but not significant. Conclusion : A decreased physiological brain and liver FDG uptake is caused by highly accelerated lesion glycolysis. J. Med. Invest. 68 : 181-185, February, 2021.
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Affiliation(s)
- Yoichi Otomi
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Hideki Otsuka
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Nahomi Shono
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Hajime Onishi
- Department of Radiology, Tsurugi Municipal Handa Hospital, Tokushima, Japan
| | - Ryota Mitsuhashi
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Saya Matsuzaki
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Yukiko Takaoka
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Hideaki Enomoto
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Yuko Sakamoto
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Mihoko Sasahara
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Takashi Abe
- Department of Radiology, Nagoya University Hospital, Aichi, Japan
| | - Takayoshi Shinya
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
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Pijl JP, Londema M, Kwee TC, Nijsten MWN, Slart RHJA, Dierckx RAJO, van der Voort PHJ, Glaudemans AWJM, Pillay J. FDG-PET/CT in intensive care patients with bloodstream infection. Crit Care 2021; 25:133. [PMID: 33827655 PMCID: PMC8028784 DOI: 10.1186/s13054-021-03557-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Background 2-Deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is an advanced imaging technique that can be used to examine the whole body for an infection focus in a single examination in patients with bloodstream infection (BSI) of unknown origin. However, literature on the use of this technique in intensive care patients is scarce. The purpose of this study was to evaluate the diagnostic yield of FDG-PET/CT in intensive care patients with BSI. Methods In this retrospective cohort study, all intensive care patients from our Dutch university medical center who had culture-proven BSI between 2010 and 2020 and underwent FDG-PET/CT to find the focus of infection were included. Diagnostic performance was calculated and logistic regression analysis was performed to evaluate the association between FDG-PET/CT outcome and C-reactive protein level (CRP), leukocyte count, duration of antibiotic treatment, duration of ICU stay, quality of FDG-PET/CT, and dependency on mechanical ventilation. In addition, the impact of FDG-PET/CT on clinical treatment was evaluated. Results 30 intensive care patients with BSI were included. In 21 patients, an infection focus was found on FDG-PET/CT which led to changes in clinical management in 14 patients. FDG-PET/CT achieved a sensitivity of 90.9% and specificity of 87.5% for identifying the focus of infection. Poor quality of the FDG-PET images significantly decreased the likelihood of finding an infection focus as compared to reasonable or good image quality (OR 0.16, P = 0.034). No other variables were significantly associated with FDG-PET/CT outcome. No adverse events during the FDG-PET/CT procedure were reported. Conclusion FDG-PET/CT has a high diagnostic yield for detecting the infection focus in patients with BSI admitted to intensive care. Poor PET image quality was significantly associated with a decreased likelihood of finding the infection focus in patients with BSI. This could be improved by adequate dietary preparation and cessation of intravenous glucose and glucose-regulating drugs. Recent advances in PET/CT technology enable higher image quality with shorter imaging time and may contribute to routinely performing FDG-PET/CT in intensive care patients with BSI of unknown origin.
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Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Mark Londema
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Maarten W N Nijsten
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.,Faculty of Science and Technology, Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands
| | - Rudi A J O Dierckx
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Peter H J van der Voort
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Janesh Pillay
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ahn SY, Park HK, Moon JH, Baek DW, Cho HJ, Sohn SK, Kang SR, Min JJ, Bom HS, Hong CM, Jeong SY, Song GY, Yang DH, Ahn JS, Kim HJ, Jung SH, Lee JJ. Prognostic impact of 18F-FDG PET/CT in patients with multiple myeloma presenting with renal impairment. Int J Hematol 2021; 113:668-674. [PMID: 33475961 DOI: 10.1007/s12185-021-03079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
Renal insufficiency (RI) is a frequent manifestation of multiple myeloma (MM) at time of diagnosis but there is no reliable prognostic factor for patients with MM presenting with RI. This study investigated the prognostic impact of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with MM with RI at diagnosis. The records of 209 patients with MM between June 2011 and November 2018 were retrospectively analyzed. PET/CT positivity was defined as the presence of more than three focal lesions or the presence of extramedullary disease. Of 209 patients, 90 (43.1%) had RI and showed similar survival outcomes to patients who had normal renal function. In total, 113 patients (54.0%) were PET/CT-positive, and 46.6% of patients with RI were PET/CT-positive at baseline. In patients with RI, those who were PET/CT-positive showed significantly inferior survival outcomes to those who were PET/CT-negative [progression-free survival (PFS), 12.7 vs. 34.0 months, P < 0.001; overall survival (OS), 42.2 months vs. not reached, P = 0.001]. On multivariate analysis, PET/CT positivity was significantly associated with PFS and OS in patients with RI. In conclusion, PET/CT is a reliable imaging technique for predicting survival outcomes in patients with MM with RI.
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Affiliation(s)
- Seo-Yeon Ahn
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hwa Kyung Park
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Joon Ho Moon
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Won Baek
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hee-Jeong Cho
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Kyun Sohn
- Department of Hematology-Oncology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ga-Young Song
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Deok-Hwan Yang
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jae-Sook Ahn
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hyeoung-Joon Kim
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Sung-Hoon Jung
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea.
| | - Je-Jung Lee
- Departments of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
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11
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Abstract
There is a well-established yet unexplained high prevalence of cardiovascular morbidity and mortality in individuals with end-stage kidney disease receiving dialysis. Potential causes include changes in cardiac structure and function, with increased left ventricular mass index as the best established cardiac structural change associated with this increase in mortality. However, in recent years, new echocardiographic and cardiac magnetic resonance imaging techniques have emerged that may provide novel markers that may better explain the mechanisms underlying the cardiovascular morbidity and mortality observed in end-stage kidney disease. This review outlines advances in cardiac imaging and the current status of imaging modalities, including echocardiography, cardiac magnetic resonance imaging, and cardiac positron emission tomography, to identify dialysis patients at high risk for cardiovascular mortality.
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Affiliation(s)
- Jeff Kott
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Nathaniel Reichek
- Cardiac Imaging Program and Research Department, St. Francis Hospital-The Heart Center, Roslyn, NY
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY
- Department of Biomedical Engineering, School of Engineering and Applied Mathematics, Stony Brook University, Stony Brook, NY
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Leonard Arbeit
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Sandeep K. Mallipattu
- Division of Nephrology, Department of Medicine, Stony Brook University, Stony Brook, NY
- Renal Section, Northport VA Medical Center, Northport, NY
- Address for Correspondence: Sandeep K. Mallipattu, MD, Department of Medicine/Nephrology, Stony Brook University, 100 Nicolls Rd, HSCT16-080E, Stony Brook, NY 11794-8176.
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12
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Muzaffar R, Koester E, Frye S, Alenezi S, Sterkel BB, Osman MM. Development of Simple Methods to Reduce the Exposure of the Public to Radiation from Patients Who Have Undergone 18F-FDG PET/CT. J Nucl Med Technol 2019; 48:63-67. [PMID: 31604894 DOI: 10.2967/jnmt.119.233296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022] Open
Abstract
At a time when reducing the radiation dose to patients and the public has become a major focus, we assessed the radiation exposure rate from patients after an 18F-FDG PET/CT scan and evaluated different interventions to reduce it. Methods: We enrolled 100 patients, divided into 2 groups. For both groups, the radiation dose rate was measured with an ionization survey meter immediately after the scan. For group 1, the patients then voided and their dose rate was measured again. For group 2, the patients waited 30 min before voiding, and we measured the dose rate before (group 2A) and after (group 2B) they voided. Results: In total, 74 of the 100 patients exceeded the 20 μSv/h (2 mR/h) threshold immediately after the scan. In group 1, the mean dose rate decreased by 20.0% from the postscan measurement, with 12 of 36 remaining at or above 20 μSv/h. In group 2A, the mean dose rate decreased by 23% from the postscan measurement, with 9 of 38 remaining at or above 20 μSv/h. In group 2B, the mean dose rate decreased by 35% from the postscan measurement, with 1 of 38 remaining at 20 μSv/h. Conclusion: Nearly 75% of patients undergoing an 18F-FDG PET/CT scan exceed 20 μSv/h when leaving the imaging facility. The most effective method to reduce radiation exposure was to have the patient void 30 min after the examination.
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Affiliation(s)
- Razi Muzaffar
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, Saint Louis, Missouri
| | - Elyse Koester
- Division of Nuclear Medicine, St. Louis University Hospital, SSM Health, St. Louis, Missouri
| | - Sarah Frye
- Medical Imaging and Radiation Therapeutics, Saint Louis University, St. Louis, Missouri; and
| | - Saud Alenezi
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, Saint Louis, Missouri
| | - Barbara B Sterkel
- Diagnostic Imaging Service VA, St. Louis Health Care System, Saint Louis, Missouri
| | - Medhat M Osman
- Division of Nuclear Medicine, Department of Radiology, Saint Louis University, Saint Louis, Missouri
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13
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Huang CK, Huang JY, Ruan SY, Chien KL. Diagnostic performance of FDG PET/CT in critically ill patients with suspected infection: A systematic review and meta-analysis. J Formos Med Assoc 2019; 119:941-949. [PMID: 31604648 DOI: 10.1016/j.jfma.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/PURPOSE Nuclear imaging, including gallium scintigraphy and fluorodeoxyglucose (FDG) positron emission tomography (PET), has been widely used to identify focus of infection in fever of unknown origin. However, little is known about its role in critically ill patients, who are usually with multiple inflammatory foci and unable to tolerate long image acquisition time. This systematic review aimed to evaluate the diagnostic performance of FDG PET for suspected infection in critically ill patients. METHODS PubMed and Embase were searched up to July 24th, 2019 to identify studies evaluating the diagnostic performance of FDG PET for finding infection focus in critically ill patients following the PRISMA guidelines. The bivariate mixed-effects model was used to pool the measure for diagnostic performance. Publication bias was evaluated by Deeks' method. RESULTS A total of 4 studies with 87 patients were included. All the four studies evaluated FDG PET. Majority of the patients were either mechanically ventilated (76%) or shocked requiring vasopressors (61%). Test and transportation related adverse events were rare (2%). The summary sensitivity and specificity were 0.94 (95% CI, 0.79-0.99) and 0.66 (95% CI, 0.45-0.83), respectively. The AUC for summary ROC curve was 0.83. CONCLUSION FDG PET was a very sensitive tool with acceptable specificity for detecting the origin of infection in critically ill patients. However, current available studies have limitation in evaluating safety issue. Further research should investigate both benefit and risk of doing this test for this group of vulnerable patients.
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Affiliation(s)
- Chun-Kai Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Jei-Yie Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sheng-Yuan Ruan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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14
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Hanssen O, Lovinfosse P, Weekers L, Hustinx R, Jouret F. [ 18F-FDG positron emission tomography in non-oncological renal pathology: Current indications and perspectives]. Nephrol Ther 2019; 15:430-438. [PMID: 30982747 DOI: 10.1016/j.nephro.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 12/26/2022]
Abstract
Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which provides anatomical and functional information. PET/CT is increasingly used in non-oncological nephrology since conventional radiological approaches after injection of contrast agents are relatively contra-indicated in patients with chronic kidney disease (CKD). PET/CT after i.v. injection of 18F-fluoro-deoxy-glucose (FDG) is not toxic and is characterized by a high sensitivity. The level of irradiation (∼5mSv) is acceptable. CKD does not significantly influence tissue uptake of 18F-FDG. The purpose of the present review aims at detailing the non-oncological indications of 18F-FDG PET/CT in general nephrology and after kidney transplantation. Particularly, 18F-FDG PET/CT appears useful in the diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease, as well as in the characterization of retroperitoneal fibrosis. In kidney transplant recipients, 18F-FDG PET/CT may help in the diagnostic work-up of suspected acute rejection, thereby eventually avoiding unnecessary kidney transplant biopsy. Perspectives in 18F-FDG PET/CT imaging are discussed, including innovative approaches of image analysis.
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Affiliation(s)
- Oriane Hanssen
- Service de néphrologie, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Pierre Lovinfosse
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Laurent Weekers
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - Roland Hustinx
- Service de médecine nucléaire et imagerie oncologique, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique
| | - François Jouret
- Service de néphrologie, centre hospitalier universitaire de Liège, avenue Hippocrate 13, 4000 Liège, Belgique; Groupe interdisciplinaire de géno-protéomique appliquée (GIGA), sciences cardiovasculaires, université de Liège, Liège, Belgique.
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15
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Lovinfosse P, Hustinx R, Weekers L, Jouret F, Detry O. Re: The role of FDG PET in detecting rejection after liver transplantation. Surgery 2019; 165:853-8. [PMID: 30054015 DOI: 10.1016/j.surg.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/06/2018] [Indexed: 11/20/2022]
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