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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 3/2018

01-03-2018 | Original Article

Clinical utility of FDG PET/CT in acute complicated pyelonephritis—results from an observational study

Authors: Chih-Hsing Wan, Jing-Ren Tseng, Ming-Hsun Lee, Lan-Yan Yang, Tzu-Chen Yen

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2018

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Abstract

Background

Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of 18F–fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP.

Methods

Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results.

Results

Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%).

Conclusions

FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.
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Metadata
Title
Clinical utility of FDG PET/CT in acute complicated pyelonephritis—results from an observational study
Authors
Chih-Hsing Wan
Jing-Ren Tseng
Ming-Hsun Lee
Lan-Yan Yang
Tzu-Chen Yen
Publication date
01-03-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-017-3835-9

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