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FDG PET/CT imaging in detecting and guiding management of invasive fungal infections: a retrospective comparison to conventional CT imaging

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Invasive fungal infections (IFIs) are common in immunocompromised patients. While early diagnosis can reduce otherwise high morbidity and mortality, conventional CT has suboptimal sensitivity and specificity. Small studies have suggested that the use of FDG PET/CT may improve the ability to detect IFI. The objective of this study was to describe the proven and probable IFIs detected on FDG PET/CT at our centre and compare the performance with that of CT for localization of infection, dissemination and response to therapy.

Methods

FDG PET/CT reports for adults investigated at Peter MacCallum Cancer Centre were searched using keywords suggestive of fungal infection. Chart review was performed to describe the risk factors, type and location of IFIs, indication for FDG PET/CT, and comparison with CT for the detection of infection, and its dissemination and response to treatment.

Results

Between 2007 and 2017, 45 patients had 48 proven/probable IFIs diagnosed prior to or following FDG PET/CT. Overall 96% had a known malignancy with 78% being haematological. FDG PET/CT located clinically occult infection or dissemination to another organ in 40% and 38% of IFI patients, respectively. Of 40 patients who had both FDG PET/CT and CT, sites of IFI dissemination were detected in 35% and 5%, respectively (p < 0.001). Of 18 patents who had both FDG PET/CT and CT follow-up imaging, there were discordant findings between the two imaging modalities in 11 (61%), in whom normalization of FDG avidity of a lesion suggested resolution of active infection despite a residual lesion on CT.

Conclusion

FDG PET/CT was able to localize clinically occult infection and dissemination and was particularly helpful in demonstrating response to antifungal therapy.

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Authors and Affiliations

  1. Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, Melbourne, VIC, Australia

    A. P. Douglas, K. A. Thursky, L. J. Worth & M. A. Slavin

  2. University of Melbourne, Melbourne, Australia

    A. P. Douglas, K. A. Thursky, L. J. Worth, R. J. Hicks & M. A. Slavin

  3. The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia

    A. P. Douglas, K. A. Thursky, L. J. Worth & M. A. Slavin

  4. Victorian Infectious Diseases Service, The Peter Doherty Institute for Immunity and Infection, Royal Melbourne Hospital, Melbourne, Australia

    K. A. Thursky & M. A. Slavin

  5. The National Centre for Antimicrobial Stewardship, Melbourne, Australia

    K. A. Thursky & L. J. Worth

  6. Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia

    E. Drummond, A. Hogg & R. J. Hicks

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  1. A. P. Douglas
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  7. M. A. Slavin
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Correspondence to A. P. Douglas.

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Douglas, A.P., Thursky, K.A., Worth, L.J. et al. FDG PET/CT imaging in detecting and guiding management of invasive fungal infections: a retrospective comparison to conventional CT imaging. Eur J Nucl Med Mol Imaging 46, 166–173 (2019). https://doi.org/10.1007/s00259-018-4062-8

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  • DOI: https://doi.org/10.1007/s00259-018-4062-8

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