18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET): An Important Tool in the Management of Infection in Patients with Hematological Cancer.

Abstract Background: FDG-PET is useful for detecting cancer (ca) sites and preliminary data suggest a role in bone and joint infection, mostly in non-immunosuppressed hosts. Purpose: To determine the role of FDG-PET in the management of infection in patients (pts) with hematological ca. Patients and Methods: Between 10/01/2001 and 5/31/2004, FDG-PET scans performed for ca staging and /or for the diagnosis of suspected infection that were reported as showing increased radiotracer uptake at extramedullary sites were reviewed. Results of FDG-PET were correlated with clinical and laboratory findings to identify episodes of infection. Results: 184 infections were documented by FDG-PET in 164 pts (90% multiple myeloma). Median age was 58 years (range 25–79) and 108 pts were males. 59 pts were neutropenic (<1000 neutrophils/ml) and 32 had severe immunosuppression (neutrophils, lymphocytes and / or CD4 counts <100 cells/ml).FDG-PET identified respiratory tract infections (118; including pneumonia/empyema, 112 and sinusitis, 6), vascular infections (27; septic thrombophlebitis (STP), 16 and infection of implantable catheter, 11), discitis / osteomyelitis (19), gastrointestinal tract infections (10; colitis, 5; diverticulitis and abdominal abscess (2 each) and esophagitis, 1), periodontal abscesses (10), cellulitis (2) and mastoiditis (1). 59 infections were microbiologically documented including bacterial (42), fungal (13), viral and mycobacterial (2 each). FDG-PET detected infectious foci despite severe immunosuppression (32 episodes). FDG-PET contributed to pt management including identification of the presence and site of infection (77), determination of its extent (81), modification of the diagnostic work-up and /or therapy (71) and evaluation of response (79). 58 clinically silent infections were detected among pts undergoing FDG-PET for ca staging. Conclusion: In pts with hematological ca, FDG-PET is a useful tool for establishing the presence, site (s), and extent of infection with various pathogens and in various organs, even in the setting of severe immunosuppression. FDG-PET can identify clinically silent infections and infections not detectable by other methods (such as STP) and can result in significant changes in pt management.

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Long-Term Follow-Up of Thyroid Incidentalomas Visualized with 18F-Fluorodeoxyglucose Positron Emission Tomography—Impact of Thyroid Scintigraphy in the Diagnostic Work-Up

Diagnostics ◽

10.3390/diagnostics11030557 ◽

2021 ◽

Vol 11 (3) ◽

pp. 557

Author(s):

Kirsten Korsholm ◽

Michala Reichkendler ◽

Louise Alslev ◽

Åse Krogh Rasmussen ◽

Peter Oturai

Keyword(s):

Emission Tomography ◽

Thyroid Scintigraphy ◽

Fdg Uptake ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Diagnostic Work ◽

Fdg Pet Ct ◽

Work Up ◽

Diagnostic Work Up

Our objective was to evaluate the frequency of malignancy in incidental thyroidal uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in a cohort of Danish patients, and furthermore to evaluate the impact of thyroid scinti-graphy in the diagnostic work-up. All whole-body PET/CT reports from 1 January 2010 to 31 December 2013 were retrospectively reviewed and further analyzed if visually increased thyroidal FDG uptake was reported. Patient electronic files were searched for further thyroid evaluation. Of 13,195 18F-FDG-PET/CT scans in 9114 patients, 312 PET/CT reports mentioned incidental thyroid FDG-uptake, and 279 patients were included in the study (3.1%). The thyroid was further investigated in 137 patients (49%), and 75 patients underwent thyroid scintigraphy. A total of 57 patients had a thyroid biopsy and 21 proceeded to surgery. Surgical specimens displayed malignancy in 10 cases, and one thyroid malignancy was found by autopsy. Hence, 11 patients were diagnosed with thyroid malignancies among 279 patients with incidental thyroid 18F-FDG uptake (3.9%). In 34 patients, a biopsy was avoided due to the results of the thyroid scintigraphy. We conclude that patients with thyroid incidentalomas can benefit from further diagnostic work-up including a thyroid scintigraphy.

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Cerebrospinal fluid p-tau217 performs better than p-tau181 as a biomarker of Alzheimer’s disease

Nature Communications ◽

10.1038/s41467-020-15436-0 ◽

2020 ◽

Vol 11 (1) ◽

Cited By ~ 30

Author(s):

Shorena Janelidze ◽

Erik Stomrud ◽

Ruben Smith ◽

Sebastian Palmqvist ◽

Niklas Mattsson ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cerebrospinal Fluid ◽

Amyloid Β ◽

Pet Tracer ◽

Positron Emission ◽

Diagnostic Work ◽

Work Up ◽

The Brain ◽

Better Than

AbstractCerebrospinal fluid (CSF) p-tau181 (tau phosphorylated at threonine 181) is an established biomarker of Alzheimer’s disease (AD), reflecting abnormal tau metabolism in the brain. Here we investigate the performance of CSF p-tau217 as a biomarker of AD in comparison to p-tau181. In the Swedish BioFINDER cohort (n = 194), p-tau217 shows stronger correlations with the tau positron emission tomography (PET) tracer [18F]flortaucipir, and more accurately identifies individuals with abnormally increased [18F]flortaucipir retention. Furthermore, longitudinal increases in p-tau217 are higher compared to p-tau181 and better correlate with [18F]flortaucipir uptake. P-tau217 correlates better than p-tau181 with CSF and PET measures of neocortical amyloid-β burden and more accurately distinguishes AD dementia from non-AD neurodegenerative disorders. Higher correlations between p-tau217 and [18F]flortaucipir are corroborated in an independent EXPEDITION3 trial cohort (n = 32). The main results are validated using a different p-tau217 immunoassay. These findings suggest that p-tau217 might be more useful than p-tau181 in the diagnostic work up of AD.

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Added value of 18F-FDG PET/CT in diagnosing infected hip prosthesis

Acta Radiologica ◽

10.1177/0284185117726812 ◽

2017 ◽

Vol 59 (5) ◽

pp. 569-576 ◽

Cited By ~ 5

Author(s):

Robert M Kwee ◽

Wouter AM Broos ◽

Boudewijn Brans ◽

Geert HIM Walenkamp ◽

Jan Geurts ◽

...

Keyword(s):

Fdg Pet ◽

Hip Prosthesis ◽

Added Value ◽

Pet Ct ◽

Conventional Tests ◽

18F Fdg ◽

Diagnostic Work ◽

Wbc Count ◽

Fdg Pet Ct ◽

Work Up

Background The diagnosis of infected hip prosthesis is frequently not straightforward yet very important as it changes treatment. Purpose To retrospectively investigate the added value of 18F-FDG PET/CT to conventional tests including radiography, erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) testing, and joint aspiration, in diagnosing infected hip prosthesis. Material and Methods Seventy-eight hip prostheses of 78 patients (55% men; mean age = 66.5 years; age range = 30–85 years) with non-specific clinical presentation, i.e. no abscess or sinus tract communicating with the joint space at clinical examination, were analyzed. Cultures of intra-articular fluid and peri-implant tissues after revision surgery or clinical follow-up ≥6 months served as gold standard. Areas under the receiver operating characteristic curves (AUCs) of radiography, ESR/CRP testing, aspiration culture, and white blood cell (WBC) count without and with the addition of 18F-FDG PET/CT were compared. Results The addition of 18F-FDG PET/CT increased AUCs: for radiography with 0.212, P = 0.001; for ESR/CRP testing with 0.076, P = 0.072; for aspiration culture with 0.126, P = 0.032; and for aspiration WBC count with 0.191, P = 0.035. Conclusion This study shows that 18F-FDG PET/CT adds to individual conventional tests in diagnosing infected hip prosthesis. It may improve the preoperative planning and should therefore be considered in the diagnostic work-up. Future studies should define the exact place of 18F-FDG PET/CT in the diagnostic work-up of periprosthetic joint infection.

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Clinical and Imaging Findings in Five Dogs with Intracranial Blastomycosis (Blastomyces dermatiditis)

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-5573 ◽

2011 ◽

Vol 47 (4) ◽

pp. 241-249 ◽

Cited By ~ 10

Author(s):

Silke Hecht ◽

William H. Adams ◽

Joanne R. Smith ◽

William B. Thomas

Keyword(s):

Fungal Infections ◽

Nasal Discharge ◽

Imaging Findings ◽

Inclusion Criteria ◽

Laboratory Findings ◽

Computed Tomographic ◽

Axial Mass ◽

The Central Nervous System ◽

Diagnostic Work ◽

Work Up

Fungal infections affecting the central nervous system are rare. The purpose of this study was to describe clinical and imaging findings in dogs with intracranial blastomycosis (Blastomyces dermatiditis). The radiology database was searched retrospectively for patients with a diagnosis of intracranial blastomycosis which had computed tomography performed as part of their diagnostic work-up. Medical records and imaging studies were reviewed. Five dogs met the inclusion criteria. Major presenting complaints were stertor/nasal discharge (n=2), exophthalmos (n=1), and seizures (n=2). Clinical and laboratory findings were variable. Computed tomographic examination revealed a single contrast-enhancing intra-axial mass (n=1), a nasal mass disrupting the cribriform plate (n=3), and an intracranial mass extending into the orbit and nasal cavity (n=1). Findings in intracranial blastomycosis in dogs are variable, and the disease may mimic other inflammatory disorders or neoplasia.

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Accuracy of FDG-PET–CT in the Diagnostic Work-up of Vascular Prosthetic Graft Infection

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2010.05.016 ◽

2010 ◽

Vol 40 (3) ◽

pp. 348-354 ◽

Cited By ~ 96

Author(s):

J.L.M. Bruggink ◽

A.W.J.M. Glaudemans ◽

B.R. Saleem ◽

R. Meerwaldt ◽

H. Alkefaji ◽

...

Keyword(s):

Fdg Pet ◽

Graft Infection ◽

Prosthetic Graft ◽

Prosthetic Graft Infection ◽

Pet Ct ◽

Diagnostic Work ◽

Fdg Pet Ct ◽

Work Up ◽

Diagnostic Work Up

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Optimizing the diagnostic work-up of acute uncomplicated urinary tract infections

BMC Family Practice ◽

10.1186/1471-2296-9-64 ◽

2008 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Bart J Knottnerus ◽

Patrick JE Bindels ◽

Suzanne E Geerlings ◽

Eric P Moll van Charante ◽

Gerben ter Riet

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Diagnostic Work ◽

Tract Infections ◽

Work Up ◽

Diagnostic Work Up

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Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study

BMC Family Practice ◽

10.1186/s12875-020-01305-8 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Michelle Spek ◽

Jochen W. L. Cals ◽

Guy J. Oudhuis ◽

Paul H. M. Savelkoul ◽

Eefje G. P. M. de Bont

Keyword(s):

Primary Care ◽

Cohort Study ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Electronic Patient Records ◽

Out Of Hours ◽

Diagnostic Work ◽

Tract Infections ◽

Work Up ◽

Diagnostic Work Up

Abstract Background Urinary tract infections (UTIs) are one of the most common infections in primary care. Previous research showed that GPs find it challenging to diagnose UTIs and frequently divert from guidelines leading to unwarranted antibiotic prescriptions and inefficient use of diagnostics such as urinary cultures. We hypothesise that management of UTIs during out-of-hours care may be extra challenging due to a higher workload and logistical issues regarding diagnostic work-up and obtaining results. We therefore aimed to study the workload, diagnostic work-up and treatment of UTIs during out-of-hours primary care. Methods We performed a retrospective observational cohort study in which we analysed a full year (2018) of electronic patient records of two large Dutch GP out-of-hours centres. All adult patients with UTI symptoms were included in this study. Descriptive statistics and multivariate regression were used to analyse diagnostics and subsequent management. Results A total of 5657 patients were included (78.9% female, mean age of 54 years), with an average of eight patients per day that contact a GP out-of-hours centre because of UTI symptoms. Urinary dipsticks were used in 87.5% of all patients visiting the out-of-hours centres with UTI symptoms. Strikingly, urinary cultures were only requested in 10.3% of patients in which urinary culture was indicated. Seventy-four percent of the patients received antibiotics. Seventy-nine percent of the patients with a negative nitrite test still received antibiotics. Remarkably, patients at risk of complications because of a UTI, such as men, received fewer antibiotic prescriptions. Conclusions In total, 74% of the patients received antibiotics. 8 out of 10 patients still received an antibiotic prescription in case of a negative nitrite test, and 9 out of 10 patients with an indication did not receive a urine culture. In conclusion, we found that correctly diagnosing UTIs and prescribing antibiotics for UTIs is a challenge that needs major improvement, especially during out-of-hours GP care.

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18F-FDG PET/CT Findings in Cytomegalovirus Colitis

Diagnostics ◽

10.3390/diagnostics9010003 ◽

2018 ◽

Vol 9 (1) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

Anna Kjaer ◽

Iben Ribberholt ◽

Kim Thomsen ◽

Per Ibsen ◽

Elena Markova ◽

...

Keyword(s):

Fdg Pet ◽

Cytomegalovirus Colitis ◽

Positron Emission ◽

Azathioprine Treatment ◽

Pet Ct ◽

Inflammatory Bowel ◽

18F Fdg ◽

Diagnostic Work ◽

Fdg Pet Ct ◽

Cmv Colitis

We present a case demonstrating the diagnostic work-up of a patient undergoing azathioprine treatment for inflammatory bowel disease (IBD), diagnosed with an acute cytomegalovirus (CMV) infection and CMV colitis. An 18F-FDG positron emission tomography/computed tomography (PET/CT) performed 2 weeks after debut of symptoms revealed pathological 18F-FDG uptake in the left side of the colon mucosa, mimicked activity of IBD. However, a diagnosis of CMV colitis was based on the presence of CMV IgM antibodies, a seroconversion of CMV IgG antibodies, presence of CMV DNA in plasma and the finding af CMV DNA in biopsies from the intestinal mucosa. The patient responded to treatment with ganciclovir. This case highlights that a positive 18F-FDG PET/CT scan of the colon can be due to CMV colitis.

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Seronegative Neuromyelitis Optica Spectrum - The challenges on disease definition and pathogenesis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140032 ◽

2014 ◽

Vol 72 (6) ◽

pp. 445-450 ◽

Cited By ~ 16

Author(s):

Douglas Kazutoshi Sato ◽

Dagoberto Callegaro ◽

Marco Aurélio Lana-Peixoto ◽

Ichiro Nakashima ◽

Kazuo Fujihara

Keyword(s):

Optic Neuritis ◽

Neuromyelitis Optica ◽

Transverse Myelitis ◽

Laboratory Findings ◽

Disease Definition ◽

Highly Sensitive ◽

Diagnostic Work ◽

Work Up ◽

Extensive Transverse Myelitis ◽

Aqp4 Antibody

Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or longitudinally extensive transverse myelitis, and some brain lesions are also unique to NMOSD. Serum autoantibodies against aquaporin-4 (AQP4) are detected in most cases of NMOSD. However, some patients with NMOSD remain seronegative despite repetitive testing during attacks with highly sensitive cell-based assays. The differential diagnosis of NMOSD is not restricted to multiple sclerosis and it includes many diseases that can produce longitudinally extensive myelitis and/or optic neuritis. We review the clinical features, imaging, and laboratory findings that can be helpful on the diagnostic work-up, discuss the differences between AQP4 antibody positive and negative patients with NMOSD, including features of NMOSD with antibodies against myelin oligodendrocyte glycoprotein.

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Smell—Adding a New Dimension to Urinalysis

Biosensors ◽

10.3390/bios10050048 ◽

2020 ◽

Vol 10 (5) ◽

pp. 48

Author(s):

Eva H. Visser ◽

Daan J. C. Berkhout ◽

Jiwanjot Singh ◽

Annemieke Vermeulen ◽

Niloufar Ashtiani ◽

...

Keyword(s):

High Risk ◽

Bacterial Growth ◽

Pediatric Population ◽

Potential Biomarker ◽

Volatile Organic ◽

Dipstick Urinalysis ◽

Set Up ◽

Diagnostic Work ◽

Tract Infections ◽

Work Up

Background: Urinary tract infections (UTI) are among the most common infections in children. The primary tool to detect UTI is dipstick urinalysis; however, this has limited sensitivity and specificity. Therefore, urine culture has to be performed to confirm a UTI. Urinary volatile organic compounds (VOC) may serve as potential biomarker for diagnosing UTI. Previous studies on urinary VOCs focused on detection of UTI in a general population; therefore, this proof-of-principle study was set up in a clinical high-risk pediatric population. Methods: This study was performed at a tertiary nephro-urological clinic. Patients included were 0–18 years, clinically suspected of a UTI, and had abnormal urinalysis. Urine samples were divided into four groups, i.e., urine without bacterial growth, contamination, colonization, and UTI. VOC analysis was performed using an electronic nose (eNose) (Cyranose 320®) and VOC profiles of subgroups were compared. Results: Urinary VOC analysis discriminated between UTI and non-UTI samples (AUC 0.70; p = 0.048; sensitivity 0.67, specificity 0.70). The diagnostic accuracy of VOCs improved when comparing urine without bacterial growth versus with UTI (AUC 0.80; p = 0.009, sensitivity 0.79, specificity 0.75). Conclusions: In an intention-to-diagnose high-risk pediatric population, UTI could be discriminated from non-UTI by VOC profiling, using an eNose. Since eNose can be used as bed-side test, these results suggest that urinary VOC analysis may serve as an adjuvant in the diagnostic work-up of UTI in children.

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