18F-FDG PET/CT for diagnosing infectious complications in patients with severe neutropenia after intensive chemotherapy for haematological malignancy or stem cell transplantation.

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Title:	18F-FDG PET/CT for diagnosing infectious complications in patients with severe neutropenia after intensive chemotherapy for haematological malignancy or stem cell transplantation.
Author(s):	Vos, F.J. ; Donnelly, J.P. ; Oyen, W.J.G. ; Kullberg, B.J. ; Bleeker-Rovers, C.P. ; Blijlevens, N.M.A.
Publication year:	2012
Source:	European Journal of Nuclear Medicine and Molecular Imaging, vol. 39, iss. 1, (2012), pp. 120-128
ISSN:	1619-7070
DOI:	http://dx.doi.org/10.1007/s00259-011-1939-1
Annotation:	1 januari 2012
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : http://hdl.handle.net/2066/107814
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Subject:	N4i 2: Invasive mycoses and compromised host N4i 2: Invasive mycoses and compromised host NCMLS 1: Infection and autoimmunity N4i 2: Invasive mycoses and compromised host ONCOL 3: Translational research ONCOL 3: Translational research N4i 1: Pathogenesis and modulation of inflammation
Organization:	Internal Medicine Haematology Nuclear Medicine
Journal title:	European Journal of Nuclear Medicine and Molecular Imaging
Volume:	vol. 39
Issue:	iss. 1
Page start:	p. 120
Page end:	p. 128
Abstract:	PURPOSE: Between 30 and 50% of febrile neutropenic episodes are accounted for by infection. C-reactive protein (CRP) is a nonspecific parameter for infection and inflammation but might be employed as a trigger for diagnosis. The aim of the study was to evaluate whether (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT can be used to detect inflammatory foci in neutropenic patients with elevated CRP and whether it helps to direct treatment. METHODS: Twenty-eight consecutive patients with neutropenia as a result of intensive chemotherapy for haematological malignancies or myeloablative therapy for haematopoietic stem cell transplantation were prospectively included. (18)F-FDG PET/CT was added to the regular diagnostic workup once the CRP level rose above 50 mg/l. RESULTS: Pathological FDG uptake was found in 26 of 28 cases despite peripheral neutrophil counts less than 0.1 x 10(-9)/l in 26 patients: in the digestive tract in 18 cases, around the tract of the central venous catheter (CVC) in 9 and in the lungs in 7 cases. FDG uptake in the CVC tract was associated with coagulase-negative staphylococcal bacteraemia (p < 0.001) and deep venous thrombosis (p = 0.002). The number of patients having Streptococcus mitis bacteraemia appeared to be higher in patients with grade 3 oesophageal FDG uptake (p = 0.08). Pulmonary FDG uptake was associated with the presence of invasive fungal disease (p = 0.04). CONCLUSION: (18)F-FDG PET/CT scanning during chemotherapy-induced febrile neutropenia and increased CRP is able to detect localized foci of infection and inflammation despite the absence of circulating neutrophils. Besides its potential role in detecting CVC-related infection during febrile neutropenia, the high negative predictive value of (18)F-FDG PET/CT is important for avoiding unnecessary diagnostic tests and therapy.