Comparison of FDG and FDG-labeled leukocytes PET/CT in diagnosis of infection

 

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Summary

The aim of this study is to compare FDG and FDG-labeled leukocyte (WBC) PET/CT in the diagnosis of infection using different SUV and visual thresholds for interpretation. Patients, material, method: 49 consecutive patients (27 men, 22 women, mean age: 55.7 years, range: 16-89 years) with suspected musculoskeletal infection (n = 34), vascular graft infection (n = 5), aortitis (n =1 ), endo - carditis (n = 1), mass lesion which is suspicious for infection or malignity (n = 6), and fever of unknown origin (n = 2) underwent both FDG and WBC-PET/CT. Images were evaluated by both visual analysis (grade 1-3) according to uptake intensity and quantitative grading (grade 1-3) based on lesion to background SUVmax values. Final diagnosis was made by histopathological, microbiological analysis or clinical-radiological work-up. Results: The diagnosis of infection was made in total 24 patients, of whom 14 were diagnosed by histopathological and the rest by clinical-radiological work-up. WBC-PET/CT imaging with the visual threshold of 1b as infection positivity (for truncal lesions uptake equivalent to liver or lumbar vertebrae uptake; for extremity lesions uptake significantly higher than neighbouring soft tissue uptake or higher than neighbouring bone marrow uptake) was found to have the highest diagnostic accuracy (AUC: 0.874, CI: 0.771-0.997, p < 0.001). The optimal SUV threshold was found to be 8.8 (p = 0.006; sensitivity: 72.7%, specificity: 82.8) and 5.3 (p < 0.001; sensitivity: 81.8%, specificity: 79.3%) for FDG and WBC-PET/CT, respectively by ROC curve analysis. Conclusion: WBC-PET/CT is more valuable than FDG PET/CT in the imaging of infection. Visual threshold of >1b seems to be more suitable for detection of infection.

Zusammenfassung

Das Ziel dieser Studie ist FDG-PET/CT und PETCT mit FDG-markierten Leukozyten in der Diagnose von Infektionen mit verschiedenen visuellen und SUV-Schwellen für die Interpretation zu vergleichen. Patienten, Material, Methoden: 49 Patienten (27 Männer, 22 Frauen, durchschnittliches Alter: 55,7 Jahre, Altersspanne: 16–89 Jahre) mit der Verdachtsdiagnose muskuloskelettale Infektion (n = 34), Infektion eines Gefäßtransplantats (n = 5), Aortitis (n = 1), Endokarditis (n =1 ), Raumforderungen verursacht durch Infektion oder malignen Prozess (n = 6) und von Fieber unklarer Genese (n = 2) wurden sowohl eine FDG-PET/ CT als auch eine FDG-markierte Leukozyten- PET/CT-Untersuchung unterzogen. Die Bilder wurden sowohl durch visuelle Analyse (Grad 1–3) nach Aufnahme Intansität als auch quantitative Analyse (Grad 1–3) basierend auf Läsion-zu-Hintergrund-SUVmax-Werten bewertet. Die endgültige Diagnose wurde durch histologische und mikrobiologische Analyse oder klinisch-radiologische Verlaufsbeobachtung gestellt. Ergebnisse: Die Diagnose einer Infektion wurde insgesamt 24 Patienten gestellt. In 14 Patienten geschah dies rein histopathologisch. In den restlichen Patienten wurde die Diagnose durch die klinisch- radiologische Verlaufsbeobachtung gestellt. Die Genauigkeit der FDG-markierte Leukozyten-PET/CT war dann am höchsten, wenn visuell Score >1b (für trunkal Läsionen FDG-Aufnahme entspricht Leber- oder Lendenwirbel- Aufnahme, für Extremitäten-Läsionen FDG-Aufnahme ist höher als die benachbarten Weichgewebe-Aufnahme oder höher als die benachbarten Knochenmark-Aufnahme) als Infektion Positivität ausgewählt wurde (AUC: 0,874, CI: 0,771–0,997, p < 0,001). Die Sensitivität, Spezifität, positiver und negativer Vorhersagewert und Treffsicherheit waren jeweils 100%, 14,3%, 44,4%, 100% und 49,2% für FDG PET/CT und 83,3%, 91,4%, 87%, 88,9% und 88,1% für FDGmarkierte Leukozyten-PET/CT, insofern man für die Diagnose einer Infektion einen visuellen Score >1b gewählt hatte. Wurde ein quantitativer Score >1b für eine positive Diagnose einer Infektion gewählt, so ergaben sich Werte von 100%, 20,6%, 47,1%, 100% und 53,4% für FDG-PET/CT und 95,7%, 76,5%, 73,3%, 96,3% und 84,2% für FDGmarkierte Leukozyten-PET/CT. Die optimale SUV-Schwelle war 8,8 (p = 0,006; die Sensitivität: 72,7%, Spezifität: 82,8%) und 5,3 (p < 0,001; die Sensitivität: 81,8%, Spezifität: 79,3%) für FDG und WBC-PET/CT, jeweils durch die ROC-Kurve-Analyse. Schlussfolgerung: FDG-markierte Leukozyten-PET/CT ist höherwertiger als FDG-PET/CT in der Bildgebung von Infektionen. Dabei scheint ein Grad >1b geeigneter zu sein, um eine Infektion zu erkennen.

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