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01-03-2017 | Original Article

¹⁸F-FDG PET/CT for the Diagnosis of Malignant and Infectious Complications After Solid Organ Transplantation

Authors: Nastassja Muller, Romain Kessler, Sophie Caillard, Eric Epailly, Fabrice Hubelé, Céline Heimburger, Izzie-Jacques Namer, Raoul Herbrecht, Cyrille Blondet, Alessio Imperiale

Published in: Nuclear Medicine and Molecular Imaging | Issue 1/2017

Abstract

Purpose

Infection and malignancy represent two common complications after solid organ transplantation, which are often characterized by poorly specific clinical symptomatology. Herein, we have evaluated the role of ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in this clinical setting.

Methods

Fifty-eight consecutive patients who underwent FDG PET/CT after kidney, lung or heart transplantation were included in this retrospective analysis. Twelve patients underwent FDG PET/CT to strengthen or confirm a diagnostic suspicion of malignancies. The remaining 46 patients presented with unexplained inflammatory syndrome, fever of unknown origin (FUO), CMV or EBV seroconversion during post-transplant follow-up without conclusive conventional imaging. FDG PET/CT results were compared to histology or to the finding obtained during a clinical/imaging follow-up period of at least 6 months after PET/CT study.

Results

Positive FDG PET/CT results were obtained in 18 (31 %) patients. In the remaining 40 (69 %) cases, FDG PET/CT was negative, showing exclusively a physiological radiotracer distribution. On the basis of a patient-based analysis, FDG PET/CT’s sensitivity, specificity, PPV and NPV were respectively 78 %, 90 %, 78 % and 90 %, with a global accuracy of 86 %. FDG PET/CT was true positive in 14 patients with bacterial pneumonias (n = 4), pulmonary fungal infection (n = 1), histoplasmosis (n = 1), cutaneous abscess (n = 1), inflammatory disorder (sacroiliitis) (n = 1), lymphoma (n = 3) and NSCLC (n = 3). On the other hand, FDG PET/CT failed to detect lung bronchoalveolar adenocarcinoma, septicemia, endocarditis and graft-versus-host disease (GVHD), respectively, in four patients. FDG PET/CT contributed to adjusting the patient therapeutic strategy in 40 % of cases.

Conclusions

FDG PET/CT emerges as a valuable technique to manage complications in the post-transplantation period. FDG PET/CT should be considered in patients with severe unexplained inflammatory syndrome or FUO and inconclusive conventional imaging or to discriminate active from silent lesions previously detected by conventional imaging particularly when malignancy is suspected.

Mahillo B, Carmona M, Álvarez M, White S, Noel L, Matesanz R. 2009 global data in organ donation and transplantation: activities, laws, and organization. Transplantation. 2011;92:1069–74.CrossRefPubMed

Parker A, Bowles K, Bradley JA, Emery V, Featherstone C, Gupte G, et al. Diagnosis of post-transplant lymphoproliferative disorder in solid organ transplant recipients—BCSH and BTS Guidelines: Guideline. Br J Haematol. 2010;149:675–92.CrossRefPubMed

Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol. 2005;56:155–67.CrossRefPubMed

Richardson CM, Pointon KS, Manhire AR, Macfarlane JT. Percutaneous lung biopsies: a survey of UK practice based on 5444 biopsies. Br J Radiol. 2002;75:731–5.CrossRefPubMed

Cohen MB, A-Kader HH, Lambers D, Heubi JE. Complications of percutaneous liver biopsy in children. Gastroenterology. 1992;102:629–32.CrossRefPubMed

Eiro M, Katoh T, Watanabe T. Risk factors for bleeding complications in percutaneous renal biopsy. Clin Exp Nephrol. 2005;9:40–5.CrossRefPubMed

Wiener RS, Schwartz LM, Woloshin S, Welch HG. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann Intern Med. 2011;155:137–44.CrossRefPubMedPubMedCentral

Anastasiadis A, Zapała L, Cordeiro E, Antoniewicz A, Dimitriadis G, De Reijke T. Complications of prostate biopsy. Expert Rev Anticancer Ther. 2013;13:829–37.CrossRefPubMed

Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G. PET/CT for the staging and follow-up of patients with malignancies. Eur J Radiol. 2009;70:382–92.CrossRefPubMed

10.

Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol. 2009;19:731–44.CrossRefPubMed

11.

Townsend DW, Carney JPJ, Yap JT, Hall NC. PET/CT today and tomorrow. J Nucl Med Off Publ Soc Nucl Med. 2004;45(1):4S–14S.

12.

Braun JJ, Kessler R, Constantinesco A, Imperiale A. 18F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging. 2008;35:1537–43.CrossRefPubMed

13.

Treglia G, Taralli S, Calcagni ML, Maggi F, Giordano A, Bonomo L. Is there a role for fluorine 18 fluorodeoxyglucose-positron emission tomography and positron emission tomography/computed tomography in evaluating patients with mycobacteriosis? A systematic review. J Comput Assist Tomogr. 2011;35:387–93.CrossRefPubMed

14.

Jamar F, Buscombe J, Chiti A, Christian PE, Delbeke D, Donohoe KJ, et al. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med. 2013;54:647–58.CrossRefPubMed

15.

Federici L, Blondet C, Imperiale A, Sibilia J, Pasquali J-L, Pflumio F, et al. Value of (18)F-FDG-PET/CT in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome: a single centre analysis experience. Int J Clin Pract. 2010;64:55–60.CrossRefPubMed

16.

Dong M, Zhao K, Liu Z, Wang G, Yang S, Zhou G. A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol. 2011;80:834–44.CrossRefPubMed

17.

Okumura W, Iwasaki T, Toyama T, Iso T, Arai M, Oriuchi N, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med. 2004;45:1989–98.PubMed

18.

Balink H, Collins J, Bruyn GA, Bruyn G, Gemmel F. F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med. 2009;34:862–8.CrossRefPubMed

19.

Guy SD, Tramontana AR, Worth LJ, Lau E, Hicks RJ, Seymour JF, et al. Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients. Eur J Nucl Med. 2012;39:1348–55.CrossRef

20.

Sturm E, Rings EHHM, Schölvinck EH, Gouw ASH, Porte RJ, Pruim J. Fluordeoxyglucose positron emission tomography contributes to management of pediatric liver transplantation candidates with fever of unknown origin. Liver Transplant. 2006;12:1698–704.CrossRef

21.

Kazama T, Faria SC, Varavithya V, Phongkitkarun S, Ito H, Macapinlac HA. FDG PET in the evaluation of treatment for lymphoma: clinical usefulness and pitfalls1. RadioGraphics. 2005;25:191–207.CrossRefPubMed

22.

Imperiale A, Riehm S, Braun JJ. Interest of [18F]FDG PET/CT for treatment efficacy assessment in aggressive phenotype of sarcoidosis with special emphasis on sinonasal involvement. Q J Nucl Med Mol Imaging Off Publ Ital Assoc Nucl Med AIMN Int Assoc Radiopharmacol IAR Sect Soc Radiopharm Chem Biol. 2013;57:177–86.

23.

Sathekge M, Maes A, Kgomo M, Stoltz A, Van de Wiele C. Use of 18F-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis. J Nucl Med. 2011;52:880–5.CrossRefPubMed

24.

von Falck C, Maecker B, Schirg E, Boerner AR, Knapp WH, Klein C, et al. Post transplant lymphoproliferative disease in pediatric solid organ transplant patients: a possible role for [18F]-FDG-PET(/CT) in initial staging and therapy monitoring. Eur J Radiol. 2007;63:427–35.CrossRef

25.

McCormack L, Hany TI, Hubner M, Petrowsky H, Mullhaupt B, Knuth A, et al. How useful is PET/CT imaging in the management of post-transplant lymphoproliferative disease after liver transplantation? In four patients with PTLD investigated with PET/CT, this method provided new information that changed medical management in three of the four patients. Am J Transplant. 2006;6:1731–6.CrossRefPubMed

26.

Graute V, Jansen N, Sohn H-Y, Becker A, Klein B, Schmid I, et al. Diagnostic role of whole-body [18F]-FDG positron emission tomography in patients with symptoms suspicious for malignancy after heart transplantation. J Heart Lung Transplant. 2012;31:958–66.CrossRefPubMed

27.

Jigang Yang HZ. The role of 18F-FDG PET/CT in the evaluation of pediatric transplant patients. Hell. J. Nucl. Med. 2015;18

28.

Helderman JH, Bennett WM, Cibrik DM, Kaufman DB, Klein A, Takemoto SK. Immunosuppression: practice and trends. Am J Transplant. 2003;3:41–52.CrossRefPubMed

29.

Vajdic CM, van Leeuwen MT. Cancer incidence and risk factors after solid organ transplantation. Int J Cancer. 2009;125:1747–54.CrossRefPubMed

30.

Penn I, Starzl TE. Malignant tumors arising de novo in immunosuppressed organ transplant recipients. Transplantation. 1972;14:407–17.CrossRefPubMedPubMedCentral

31.

Thomas JA, Crawford DH, Burke M. Clinicopathologic implications of Epstein-Barr virus related B cell lymphoma in immunocompromised patients. J Clin Pathol. 1995;48:287.CrossRefPubMedPubMedCentral

32.

Opelz G, Döhler B. Lymphomas after solid organ transplantation: a collaborative transplant study report: lymphomas after solid organ transplantation. Am J Transplant. 2004;4:222–30.CrossRefPubMed

33.

Bakker NA, van Imhoff GW, Verschuuren EAM, van Son WJ. Presentation and early detection of post-transplant lymphoproliferative disorder after solid organ transplantation. Transpl Int. 2007;20:207–18.CrossRefPubMed

34.

Tsao L, Hsi ED. The clinicopathologic spectrum of posttransplantation lymphoproliferative disorders. Arch Pathol Lab Med. 2007;131:1209–18.PubMed

35.

Caillard S, Porcher R, Provot F, Dantal J, Choquet S, Durrbach A, et al. Post-transplantation lymphoproliferative disorder after kidney transplantation: report of a nationwide French registry and the development of a new prognostic score. J Clin Oncol. 2013;31:1302–9.CrossRefPubMed

36.

Watt KDS, Pedersen RA, Kremers WK, Heimbach JK, Sanchez W, Gores GJ. Long-term probability of and mortality from de novo malignancy after liver transplantation. Gastroenterology. 2009;137:2010–7.CrossRefPubMedPubMedCentral

37.

Dickson RP, Davis RD, Rea JB, Palmer SM. High frequency of bronchogenic carcinoma after single-lung transplantation. J Heart Lung Transplant. 2006;25:1297–301.CrossRefPubMedPubMedCentral

38.

Humar A, Michaels M. AST ID working group on infectious disease monitoring. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am J Transplant. 2006;6:262–74.CrossRefPubMed

39.

Yap CS, Seltzer MA, Schiepers C, Gambhir SS, Rao J, Phelps ME, et al. Impact of whole-body 18F-FDG PET on staging and managing patients with breast cancer: the referring physician’s perspective. J Nucl Med. 2001;42:1334–7.PubMed

40.

Seltzer MA, Yap CS, Silverman DH, Meta J, Schiepers C, Phelps ME, et al. The impact of PET on the management of lung cancer: the referring physician’s perspective. J Nucl Med. 2002;43:752–6.PubMed

41.

Meta J, Seltzer M, Schiepers C, Silverman DH, Ariannejad M, Gambhir SS, et al. Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician’s perspective. J Nucl Med. 2001;42:586–90.PubMed

42.

Kubota K, Matsuno S, Morioka N, Adachi S, Koizumi M, Seto H, et al. Impact of FDG-PET findings on decisions regarding patient management strategies: a multicenter trial in patients with lung cancer and other types of cancer. Ann Nucl Med. 2015;29:431–41.CrossRefPubMedPubMedCentral

43.

Panagiotidis E, Quigley A-M, Pencharz D, Ardeshna K, Syed R, Sajjan R, et al. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in diagnosis of post-transplant lymphoproliferative disorder. Leuk Lymphoma. 2013;55:515–9.CrossRefPubMed

44.

Dierickx D, Tousseyn T, Requilé A, Verscuren R, Sagaert X, Morscio J, et al. The accuracy of positron emission tomography in the detection of posttransplant lymphoproliferative disorder. Haematologica. 2013;98:771–5.CrossRefPubMedPubMedCentral

45.

Mamede M, Higashi T, Kitaichi M, Ishizu K, Ishimori T, Nakamoto Y, et al. [18F]FDG uptake and PCNA, Glut-1, and hexokinase-II expressions in cancers and inflammatory lesions of the lung. Neoplasia. 2005;7:369–79.CrossRefPubMedPubMedCentral

46.

Shyn PB. Interventional positron emission tomography/computed tomography: state-of-the-art. Tech Vasc Interv Radiol. 2013;16:182–90.CrossRefPubMed

47.

Imperiale A, Garnon J, Bachellier P, Gangi A, Namer IJ. Simultaneous 18F-FDOPA PET/CT-guided biopsy and radiofrequency ablation of recurrent neuroendocrine hepatic metastasis: further step toward a theranostic approach. Clin. Nucl. Med. 2015

48.

Cornelis F, Silk M, Schoder H, Takaki H, Durack JC, Erinjeri JP, et al. Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities. Eur J Nucl Med Mol Imaging. 2014;41:2265–72.CrossRefPubMed

Title: 18F-FDG PET/CT for the Diagnosis of Malignant and Infectious Complications After Solid Organ Transplantation
Authors: Nastassja Muller
Romain Kessler
Sophie Caillard
Eric Epailly
Fabrice Hubelé
Céline Heimburger
Izzie-Jacques Namer
Raoul Herbrecht
Cyrille Blondet
Alessio Imperiale
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Nuclear Medicine and Molecular Imaging / Issue 1/2017
Print ISSN: 1869-3474
Electronic ISSN: 1869-3482
DOI: https://doi.org/10.1007/s13139-016-0461-6

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Springer Medicine

¹⁸F-FDG PET/CT for the Diagnosis of Malignant and Infectious Complications After Solid Organ Transplantation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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