scholarly journals Diagnosis of an intestinal mucormycosis ‘fungus ball’ located with PET/CT with [18F] FDG-PET/CT

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Franklin Gallo ◽  
Lavinia Vija ◽  
Sophie Le Grand ◽  
Nada Moukarbel ◽  
Koen Mortele ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Fungal Infections ◽  
Abdominal Mass ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Fungus Ball ◽  
Pet Ct ◽  
Life Threatening ◽  
Primary Location ◽  
Fdg Pet Ct

AbstractMucormycosis is a life-threatening infection with most commonly rhino-orbital-cerebral and pulmonary syndromes that mostly occurs in immunocompromised patients. FDG-PET/CT emerged as a sensitive non-invasive tool to identify systemic mucormycosis. We present a 59-year-old woman for whom a PET/CT with 18F-FDG was performed in search of a primary location of mucormycosis with non-contributive conventional workup. A large left abdominal mass was seen, compatible with a fungus ball, with intense parietal uptake and without any central uptake. The localization of the infection provided a target for surgery and permitted to adapt the therapeutic strategy. After resection, the final diagnosis was consistent with mucormycosis. To our knowledge, this is the first report of a PET/CT image with FDG showing an intestinal fungus ball. PET/CT with 18F-FDG may contribute to the management of patients with fungal infections of unknown origin.

18F-FDG-PET/CT in unexplained elevated inflammatory markers

2016 ◽  
Vol 55 (06) ◽  
pp. 242-249 ◽  
Author(s):  
Isabell Braune ◽  
Birgit Meller ◽  
Carsten Sahlmann ◽  
Carsten Ritter ◽  
Johannes Meller ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Pet Ct ◽  
Significant Difference ◽  
18F Fdg ◽  
Fdg Pet Ct

SummaryThe diagnostic strategy in patients with fever or inflammation of unknown origin remains a major clinical challenge. The aim of this study was to evaluate the role of 18F-FDG-PET/CT in patients with unexplained elevated C-reactive protein with or without fever. Contribution of 18F-FDG-PET/CT to the final diagnosis was evaluated. In addition we determined whether a differentiation between patients with or without fever is clinically reasonable. Patients, methods: We retrospectively analysed 72 consecutive patients with unexplained elevated C-reactive protein levels (above 8mg/l) that underwent 18F-FDG-PET/ CT in our facility between 10/2009 and 11/2012. 18F-FDG-PET/CT was considered a so-called diagnostic scan when results decisively led to a final diagnosis and adequate therapy with a response of symptoms was initiated due to the PET/CT result. Results: In 60/72 patients (83%) a final diagnosis was established. Diagnoses included infections (58%), non-infectious inflammatory diseases (29%) and malignancies (8%). 18F-FDG-PET/CT was true positive in 47 cases (65%) and the diagnostic scan in 29 patients (40%). Sensitivity of 18F-FDG-PET/CT was 81% and specificity was 86%. Diagnostics, final diagnoses, 18F-FDG-PET/CT results, SUVmax, C-reactive protein levels and the diagnostic scan did not differ significantly between patients with fever and patients without fever. Conclusion: 18F-FDG-PET/CT is a useful method in the diagnostic workup of patients with inflammation of unknown origin. In our series there was no significant difference between patients with or without fever. Regarding 18F-FDG-PET/CT-imaging inflammation of unknown origin and unexplained fever can be joined to one entity.

The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study

2017 ◽  
Vol 77 (1) ◽  
pp. 70-77 ◽  
Author(s):  
Verena Schönau ◽  
Kristin Vogel ◽  
Matthias Englbrecht ◽  
Jochen Wacker ◽  
Daniela Schmidt ◽  
...  
Keyword(s):  
Prospective Study ◽  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Correct Diagnosis ◽  
Unknown Origin ◽  
Ct Scanning ◽  
Final Diagnosis ◽  
Intermittent Fever ◽  
Pet Ct ◽  
Fdg Pet Ct

BackgroundFever of unknown origin (FUO) and inflammation of unknown origin (IUO) are diagnostically challenging conditions. Diagnosis of underlying disease may be improved by 18F-fluorodesoxyglucose positron emission tomography (18F-FDG-PET).MethodsProspective study to test diagnostic utility of 18F-FDG-PET/CT in a large cohort of patients with FUO or IUO and to define parameters that increase the likelihood of diagnostic 18F-FDG-PET/CT. Patients with FUO or IUO received 18F-FDG-PET/CT scanning in addition to standard diagnostic work-up. 18F-FDG-PET/CT results were classified as helpful or non-helpful in establishing final diagnosis. Binary logistic regression was used to identify clinical parameters associated with a diagnostic 18F-FDG-PET/CT.Results240 patients were enrolled, 72 with FUO, 142 with IUO and 26 had FUO or IUO previously (exFUO/IUO). Diagnosis was established in 190 patients (79.2%). The leading diagnoses were adult-onset Still’s disease (15.3%) in the FUO group, large vessel vasculitis (21.1%) and polymyalgia rheumatica (18.3%) in the IUO group and IgG4-related disease (15.4%) in the exFUO/IUO group. In 136 patients (56.7% of all patients and 71.6% of patients with a diagnosis), 18F-FDG-PET/CT was positive and helpful in finding the diagnosis. Predictive markers for a diagnostic 18F-FDG-PET/CT were age over 50 years (p=0.019), C-reactive protein (CRP) level over 30 mg/L (p=0.002) and absence of fever (p=0.001).Conclusion18F-FDG-PET/CT scanning is helpful in ascertaining the correct diagnosis in more than 50% of the cases presenting with FUO and IUO. Absence of intermittent fever, higher age and elevated CRP level increase the likelihood for a diagnostic 18F-FDG-PET/CT.

scholarly journals Inflammation of Unknown Origin: Evaluation and Prognosis of 57 Cases

2021 ◽  
Vol 11 (1) ◽  
pp. 32
Author(s):  
Suzanne Béra ◽  
Yvan Jamilloux ◽  
Mathieu Gerfaud-Valentin ◽  
Stéphane Durupt ◽  
Raphaèle Nove-Josserand ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Hematological Malignancies ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Diagnostic Value ◽  
Empirical Treatment ◽  
Pet Ct ◽  
Fdg Pet Ct

(1) Background: there are few studies on the inflammation of unknown origin (IUO). We sought to determine the etiologies and prognosis of IUO, as well as the contribution of complementary examinations. (2) Methods: this retrospective study analyzed patients meeting the Vanderschueren’s criteria in the Hospices Civils de Lyon from 2005 to 2020. (3) Results: a total of 57 patients (mean age: 67 years; interquartile range: 55–79) were included. Final diagnoses were made for 26 (46%) patients. Non-infectious inflammatory diseases were the most common diagnoses (13/26, 50%), followed by neoplasms (10/26, 38%; 8/10 hematological malignancies), infections (2/26, 8%), and miscellaneous causes (1/26, 4%). Moreover, 18-FDG-PET/CT was contributory in 12/42 cases. Anti-neutrophil cytoplasmic antibodies, serology, temporal biopsies, and bone marrow aspirates were contributory in 3/41, 1/57, 5/23, and 3/19 cases, respectively. At last follow-up (mean follow-up duration: 48 months), 8/31 undiagnosed patients were cured (five received an empirical treatment), and 5/31 died (one death was related to the empirical treatment). (4) Conclusion: more than half of the IUO remained undiagnosed. Non-infectious inflammatory diseases and hematological malignancies were the most common etiologies. Moreover, 18-FDG-PET/CT had the highest diagnostic value. Most IUO without final diagnosis persisted. The role of empirical treatments remains to be explored.

scholarly journals Diagnostic Splenectomy: Characteristics, Pre-Operative Investigations, and Identified Pathologies for 20 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1519
Author(s):  
Jean Maillot ◽  
Jean-Valère Malfuson ◽  
Thierry Lazure ◽  
Stéphane Benoist ◽  
Anne Cremades ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
B Cell Lymphoma ◽  
Final Diagnosis ◽  
Abdominal Symptoms ◽  
Positron Emission ◽  
Pet Ct ◽  
Immunological Diseases ◽  
Fdg Pet Ct

Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. We studied the medical files of 142 patients who underwent a splenectomy for any reason over a 10-year period and identified 20 diagnostic splenectomies. Diagnostic splenectomies were mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin for 10. The other patients had surgery for other causes (cytopenia, abdominal symptoms, suspicion of relapsing malignant hemopathies). Splenectomy contributed to the final diagnosis in 19 of 20 cases, corresponding mostly to lymphoid hemopathies (14/20). The most frequent disease was diffuse large B-cell lymphoma (8/20). Splenectomy did not reveal any infectious disease. The most relevant pre-operative procedures to aid the diagnosis were 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations. Diagnostic splenectomy is useful and necessary in certain difficult diagnostic situations. Highlights: Diagnostic splenectomy is still useful in 2020 to diagnose unexplained splenomegaly or fever of unknown origin. Lymphoma was the most common final diagnosis. FDG PET/CT was the most useful tool to aid in the diagnosis.

scholarly journals FDG-PET/CT in intensive care patients with bloodstream infection

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Jordy P. Pijl ◽  
Mark Londema ◽  
Thomas C. Kwee ◽  
Maarten W. N. Nijsten ◽  
Riemer H. J. A. Slart ◽  
...  
Keyword(s):  
Intensive Care ◽  
Image Quality ◽  
Fdg Pet ◽  
Diagnostic Yield ◽  
Unknown Origin ◽  
Intensive Care Patients ◽  
Pet Ct ◽  
Infection Focus ◽  
Focus Of Infection ◽  
Fdg Pet Ct

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.

scholarly journals The Added Value of [18F]FDG PET/CT in the Management of Invasive Fungal Infections

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 137
Author(s):  
Alfred O. Ankrah ◽  
Dina Creemers-Schild ◽  
Bart de Keizer ◽  
Hans C. Klein ◽  
Rudi A. J. O. Dierckx ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Added Value ◽  
X Rays ◽  
Imaging Studies ◽  
Imaging Methods ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Anatomy-based imaging methods are the usual imaging methods used in assessing invasive fungal infections (IFIs). [18F]FDG PET/CT has also been used in the evaluation of IFIs. We assessed the added value of [18F]FDG PET/CT when added to the most frequently used anatomy-based studies in the evaluation of IFIs. The study was conducted in two University Medical Centers in the Netherlands. Reports of [18F]FDG PET/CT and anatomy-based imaging performed within two weeks of the [18F]FDG PET/CT scan were retrieved, and the presence and sites of IFI lesions were documented for each procedure. We included 155 [18F]FDG PET/CT scans performed in 73 patients. A total of 216 anatomy-based studies including 80 chest X-rays, 89 computed tomography studies, 14 magnetic resonance imaging studies, and 33 ultrasound imaging studies were studied. The anatomy-based studies were concordant with the [18F]FDG PET/CT for 94.4% of the scans performed. [18F]FDG PET/CT detected IFI lesions outside of the areas imaged by the anatomy-based studies in 48.6% of the scans. In 74% of the patients, [18F]FDG PET/CT added value in the management of the IFIs.

Diagnostic value of [18F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation

2009 ◽  
Vol 37 (1) ◽  
pp. 136-145 ◽  
Author(s):  
Niklas Jasper ◽  
Jan Däbritz ◽  
Michael Frosch ◽  
Markus Loeffler ◽  
Matthias Weckesser ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diagnostic Value ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

2-[18F]FDG PET/CT in Fever of Unknown Origin

2021 ◽  
pp. 209-216
Author(s):  
Ilse J. E. Kouijzer ◽  
Chantal P. Bleeker-Rovers ◽  
Lioe-Fee de Geus-Oei
Keyword(s):  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals Curious case of fever of unknown origin

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-227258
Author(s):  
Manasvini Bhatt ◽  
Manish Soneja ◽  
Madhavi Tripathi ◽  
Ashutosh Biswas
Keyword(s):  
Ct Scan ◽  
Fdg Pet ◽  
Unknown Origin ◽  
Bone Marrow Examination ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for Mycobacterium tuberculosis with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.

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