Diagnostic Performance of  18 F-FDG PET/CT in Infectious and Inflammatory Diseases according to Published Meta-Analyses

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Abstract

Purpose

To date, several meta-analyses have reported data about the diagnostic performance of ¹⁸F-FDG PET/CT in infectious and inflammatory diseases. This article aims to summarize the published evidence-based data about the diagnostic performance of ¹⁸F-FDG PET/CT in this setting.

Methods

A comprehensive computer literature search of meta-analyses published in PubMed/MEDLINE and Cochrane library database from January 2009 through December 2018 and regarding the diagnostic performance of ¹⁸F-FDG PET/CT in infectious and inflammatory diseases was carried out. This combination of key words was used: (i) “PET” OR “positron emission tomography” OR “FDG” OR “fluorodeoxyglucose” AND (ii) meta-analysis. Only records on inflammatory or infectious diseases were selected.

Results

The diagnostic performance of ¹⁸F-FDG PET/CT in detecting inflammatory and infectious diseases has been summarized taking into account 36 meta-analyses published in the literature. Evidence-based data demonstrated good diagnostic performance of ¹⁸F-FDG PET/CT for several inflammatory and infectious diseases, in particular cardiovascular infectious and inflammatory diseases and some musculoskeletal infections.

Conclusions

Evidence-based data about the diagnostic performance of ¹⁸F-FDG PET/CT in infectious and inflammatory diseases are increasing, with good diagnostic performance of this imaging method for some indications. More prospective multicenter studies and cost-effective analyses are warranted.

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Most cited references 71

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FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC

Riemer Slart, Andor W. J. M. Glaudemans, Panithaya Chareonthaitawee … (2018)

Large vessel vasculitis (LVV) is defined as a disease mainly affecting the large arteries, with two major variants, Takayasu arteritis (TA) and giant cell arteritis (GCA). GCA often coexists with polymyalgia rheumatica (PMR) in the same patient, since both belong to the same disease spectrum. FDG-PET/CT is a functional imaging technique which is an established tool in oncology, and has also demonstrated a role in the field of inflammatory diseases. Functional FDG-PET combined with anatomical CT angiography, FDG-PET/CT(A), may be of synergistic value for optimal diagnosis, monitoring of disease activity, and evaluating damage progression in LVV. There are currently no guidelines regarding PET imaging acquisition for LVV and PMR, even though standardization is of the utmost importance in order to facilitate clinical studies and for daily clinical practice. This work constitutes a joint procedural recommendation on FDG-PET/CT(A) imaging in large vessel vasculitis (LVV) and PMR from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine (EANM), the Cardiovascular Council of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and the PET Interest Group (PIG), and endorsed by the American Society of Nuclear Cardiology (ASNC). The aim of this joint paper is to provide recommendations and statements, based on the available evidence in the literature and consensus of experts in the field, for patient preparation, and FDG-PET/CT(A) acquisition and interpretation for the diagnosis and follow-up of patients with suspected or diagnosed LVV and/or PMR. This position paper aims to set an internationally accepted standard for FDG-PET/CT(A) imaging and reporting of LVV and PMR. Electronic supplementary material The online version of this article (10.1007/s00259-018-3973-8) contains supplementary material, which is available to authorized users.

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The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience.

Rob Beanlands, Ilias Mylonas, Jean DaSilva … (2012)

Cardiac sarcoidosis is a potentially fatal complication of sarcoidosis. The 1993 guidelines of the Ministry of Health, Labour, and Welfare (MHLW) of Japan have been used as the diagnostic gold standard and for comparison with imaging modalities. (18)F-FDG PET is not currently included in the guidelines. However, studies have shown promising data using (18)F-FDG PET. We conducted a systematic review of studies that evaluated the accuracy of (18)F-FDG PET for the diagnosis of cardiac sarcoidosis compared with MHLW guidelines. Data from a prospective Ontario provincial registry are also reported and included in the metaanalysis. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies that satisfied predetermined criteria. Quality evaluation using the Quality Assessment for Diagnostic Accuracy Studies was performed by 2 independent masked observers. Data were extracted and analyzed to measure study-specific and pooled accuracy for (18)F-FDG PET compared with the MHLW as the reference. A total of 519 titles was identified; 7 studies, including the Ontario registry, were selected for inclusion. Metaanalysis of these 7 studies was conducted, with a total of 164 patients, most of whom had been diagnosed with systemic sarcoidosis. The prevalence of cardiac sarcoidosis was 50% in the whole population. Pooled estimates for (18)F-FDG PET yielded 89% sensitivity (95% confidence interval [CI], 79%-96%), 78% specificity (95% CI, 68%-86%), a 4.1 positive likelihood ratio (95% CI, 1.7-10), and a 0.19 negative likelihood ratio (95% CI, 0.1-0.4). The overall diagnostic odds ratio was 25.6 (95% CI, 7.3-89.5), and the area under the summary receiver operator characteristic curve was 93% ± 3.5. The Ontario study yielded sensitivity and specificity of 79% and 70%, respectively. The high diagnostic accuracy determined for (18)F-FDG PET in this metaanalysis suggests potential value for diagnosis of cardiac sarcoidosis compared with the MHLW guidelines. These results may affect patient care by providing supportive evidence for more effective use of (18)F-FDG PET in the diagnosis of cardiac sarcoidosis. Large-scale multicenter studies are required to further evaluate this role.

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The Use of 18F-FDG-PET/CT for Diagnosis and Treatment Monitoring of Inflammatory and Infectious Diseases

Andor W. J. M. Glaudemans, Erik F. J. de Vries, Filippo Galli … (2013)

FDG-PET, combined with CT, is nowadays getting more and more relevant for the diagnosis of several infectious and inflammatory diseases and particularly for therapy monitoring. Thus, this paper gives special attention to the role of FDG-PET/CT in the diagnosis and therapy monitoring of infectious and inflammatory diseases. Enough evidence in the literature already exists about the usefulness of FDG-PET/CT in the diagnosis, management, and followup of patients with sarcoidosis, spondylodiscitis, and vasculitis. For other diseases, such as inflammatory bowel diseases, rheumatoid arthritis, autoimmune pancreatitis, and fungal infections, hard evidence is lacking, but studies also point out that FDG-PET/CT could be useful. It is of invaluable importance to have large prospective multicenter studies in this field to provide clear answers, not only for the status of nuclear medicine in general but also to reduce high costs of treatment.

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Author and article information

Contributors

Giorgio Treglia:

ORCID: https://orcid.org/0000-0001-9808-780X

Journal

Journal ID (nlm-ta): Contrast Media Mol Imaging

Journal ID (iso-abbrev): Contrast Media Mol Imaging

Journal ID (publisher-id): CMMI

Title: Contrast Media & Molecular Imaging

Publisher: Hindawi

ISSN (Print): 1555-4309

ISSN (Electronic): 1555-4317

Publication date Collection: 2019

Publication date (Electronic): 25 July 2019

Volume: 2019

Electronic Location Identifier: 3018349

Affiliations

¹Clinic of Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona and Lugano, Switzerland

²Health Technology Assessment Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

³Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

Author notes

Guest Editor: Sarah Ohrndorf

Author information

Giorgio Treglia https://orcid.org/0000-0001-9808-780X

Article

DOI: 10.1155/2019/3018349

PMC ID: 6683817

PubMed ID: 31427907

SO-VID: 427adf28-c7a9-41ed-ae03-0bef2f19c932

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 20 January 2019

Date revision received : 4 April 2019

Date accepted : 14 July 2019

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