PET bei Infektionen und Inflammationen

Erstellt am 09 Sep 2015 13:33
Zuletzt geändert: 18 Oct 2022 17:47

Empfehlungen des britischen Royal College of Physicians and Royal College of Radiologists1:

Infection imaging:

  • Detection of site of focal infection in immuno-compromised patients or problematic cases of infection.
  • Evaluation of vascular graft infection in selected cases provided sufficient time has elapsed since surgery.

Pyrexia of unknown origin (PUO) / Fever of unknown origin (FUO):

  • To identify the cause of a PUO where conventional investigations have not revealed a source.

Übersichtsartikel der Universität Amsterdam, Department of Nuclear Medicine, University of Amsterdam Academic Medical Center und dem Medical Center Leeuwarden:
A Rationale for the Use of F18-FDG PET/CT in Fever and Inflammation of Unknown Origin2:

  • Inflammation of Unknown Origin (IUO) / unexplained inflammatory syndromes without persisting fever:
    • inflammatory syndrome that remained without diagnosis during hospital admission (for a median of 20 days)
    • threshold for C-reactive protein (CRP) values 15 mg/L

<=> no relationship between body temperature values and the severity of the underlying diseases:

  • multi-centre retrospective study that included 304 patients with clinical suspicion for large vessel vasculitis (LVV) and not fulfilling the temperature criteria for classic FUO:
  • A CRP cut-off point of 10 mg/L resulted in a sensitivity of 100%.
  • In patients with a normal CRP, 18-FDG PET/(CT) was not helpful.
  • For the ESR, when a cut-off point of 20 mm/h was chosen, a sensitivity of 94% and a specificity of 16% were found.

Although there is still insufficient literature for this to be described as an evidence-based indication, we can conclude, on the basis of a cumulated reported accuracy (.85%) and expert opinion that major indications for 18F-FDG PET/CT in infection and inflammation are as follows:
• Sarcoidosis
• Peripheral bone osteomyelitis (nonpostoperative, non–diabetic foot)
• Suspected spinal infection (spondylodiskitis or vertebral osteomyelitis, nonpostoperative)
• Evaluation of fever of unknown origin (FUO), including true FUO (defined according to the criteria of Durack and Street), postoperative fever and recurrent sepsis, immunodeficiency (both induced and acquired)-related FUO, neutropenic fever, and isolated acute-phase inflammation markers (persistently raised C-reactive Protein and/or erythrocyte sedimentation rate).
• Evaluation of metastatic infection and of high-risk patients with bacteremia.
• Primary evaluation of vasculitides (e.g., giant cell arteritis).
Other well-described applications, but without sufficient evidence-based indication, include the following:
• Evaluation of potentially infected liver and kidney cysts in polycystic disease.
• Suspected infection of intravascular devices, pacemakers, and catheters.
• AIDS-associated opportunistic infections, associated tumors, and Castleman disease.
• Assessment of metabolic activity in tuberculosis lesions.
Considering the available published data, it is unclear if 18F-FDG imaging offers any significant advantage over radiolabeled white blood cells or antigranulocyte monoclonal antibodies in the following situations:
• Diabetic foot infections.
• Joint prosthetic infections.
• Vascular prosthetic infections.
• Inflammatory bowel diseases.
• Endocarditis.

Eine gesundheitsökonomische Analyse aus Holland:

Balink und Koautoren3 untersuchten die Kosteneffizienz des PET-Einsatzes bei Fieber oder Entzündungszeichen unbekannter Ursache und kamen zu dem Schluss, dass der Einsatz der PET in dieser Indikation für das Niederländische Gesundheitssystem wahrscheinlich ökonomischer ist als die Beschränkung auf die konventionellen Untersuchungstechniken im Krankenhaus.

Siehe auch:

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