Top

European Journal of Nuclear Medicine and Molecular Imaging

Published in:

Open Access 01-03-2017 | Original Article

The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection

Authors: Neval E. Wareham, J. D. Lundgren, C. Da Cunha-Bang, F. Gustafsson, M. Iversen, H. H. Johannesen, A. Kjær, A. Rasmussen, H. Sengeløv, S. S. Sørensen, B. M. Fischer

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 3/2017

Abstract

Purpose

Solid organ transplant (SOT) recipients are at high risk of developing infections and malignancies. ¹⁸F-FDG PET/CT may enable timely detection of these diseases and help to ensure early intervention. We aimed to describe the clinical utility of FDG PET/CT in consecutive, diagnostic unresolved SOT recipients transplanted from January 2004 to May 2015.

Methods

Recipients with a post-transplant FDG PET/CT performed as part of diagnostic work-up were included. Detailed chart reviews were done to extract relevant clinical information and determine the final diagnosis related to the FDG PET/CT. Based on á priori defined criteria and the final diagnosis, results from each scan were classified as true or false, and diagnostic values determined.

Results

Among the 1,814 recipients in the cohort, 145 had an FDG PET/CT performed; 122 under the indication of diagnostically unresolved symptoms with a suspicion of malignancy or infection. The remaining (N = 23) had an FDG PET/CT to follow-up on a known disease or to stage a known malignancy. The 122 recipients underwent a total of 133 FDG PET/CT scans performed for a suspected malignancy (66 %) or an infection (34 %). Sensitivity, specificity, and positive and negative predictive values of the FDG PET/CT in diagnosing these conditions were 97, 84, 87, and 96 %, respectively.

Conclusion

FDG PET/CT is an accurate diagnostic tool for the work-up of diagnostic unresolved SOT recipients suspected of malignancy or infection. The high sensitivity and NPV underlines the potential usefulness of PET/CT for excluding malignancy or focal infections in this often complex clinical situation.

Available only for authorised users

Denton MD, Magee CC, Sayegh MH. Immunosuppressive strategies in transplantation. Lancet. 1999;353(9158):1083–91.CrossRefPubMed

Guba M, Graeb C, Jauch KW, Geissler EK. Pro- and anti-cancer effects of immunosuppressive agents used in organ transplantation. Transplantation. 2004;77(12):1777–82.CrossRefPubMed

Hojo M, Morimoto T, Maluccio M, Asano T, Morimoto K, Lagman M, et al. Cyclosporine induces cancer progression by a cell-autonomous mechanism. Nature. 1999;397(6719):530–4.CrossRefPubMed

Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601–14.CrossRefPubMed

Apel H, Walschburger-Zorn K, Haberle L, Wach S, Engehausen DG, Wullich B. De novo malignancies in renal transplant recipients: experience at a single center with 1882 transplant patients over 39 yr. Clin Transplant. 2013;27(1):E30–6.CrossRefPubMed

Campistol JM, Cuervas-Mons V, Manito N, Almenar L, Arias M, Casafont F, et al. New concepts and best practices for management of pre- and post-transplantation cancer. Transplant Rev (Orlando). 2012;26(4):261–79.CrossRef

Dugue PA, Rebolj M, Garred P, Lynge E. Immunosuppression and risk of cervical cancer. Expert Rev Anticancer Ther. 2013;13(1):29–42.CrossRefPubMed

Engels EA, Pfeiffer RM, Fraumeni Jr JF, Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA. 2011;306(17):1891–901.CrossRefPubMedPubMedCentral

Schwartz RS. Immunodeficiency, immunosuppression, and susceptibility to neoplasms. J Natl Cancer Inst Monogr. 2001;28:5–9.

10.

Acuna SA, Fernandes KA, Daly C, Hicks LK, Sutradhar R, Kim SJ, et al. Cancer Mortality Among Recipients of Solid-Organ Transplantation in Ontario, Canada. JAMA Oncol. 2016;2(4):463–9.CrossRefPubMed

11.

Sengelov H, Gerds TA, Braendstrup P, Kornblit B, Mortensen BK, Petersen SL, et al. Long-term survival after allogeneic haematopoietic cell transplantation for AML in remission: single-centre results after TBI-based myeloablative and non-myeloablative conditioning. Bone Marrow Transplant. 2013;48(9):1185–91.CrossRefPubMed

12.

Wang XL, Li H, Wang QS, Zhang XL. Clinical value of pre-and postoperative 18F-FDG PET/CT in patients undergoing liver transplantation for hepatocellular carcinoma. Nan Fang Yi Ke Da Xue Xue Bao. 2006;26(8):1087–91. 1095.PubMed

13.

Ng SH, Joseph CT, Chan SC, Ko SF, Wang HM, Liao CT, et al. Clinical usefulness of 18F-FDG PET in nasopharyngeal carcinoma patients with questionable MRI findings for recurrence. J Nucl Med. 2004;45(10):1669–76.PubMed

14.

Kato H, Miyazaki T, Nakajima M, Takita J, Kimura H, Faried A, et al. The incremental effect of positron emission tomography on diagnostic accuracy in the initial staging of esophageal carcinoma. Cancer. 2005;103(1):148–56.CrossRefPubMed

15.

Goerres GW, Stupp R, Barghouth G, Hany TF, Pestalozzi B, Dizendorf E, et al. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging. 2005;32(2):153–62.CrossRefPubMed

16.

Yen RF, Chen TH, Ting LL, Tzen KY, Pan MH, Hong RL. Early restaging whole-body (18)F-FDG PET during induction chemotherapy predicts clinical outcome in patients with locoregionally advanced nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging. 2005;32(10):1152–9.CrossRefPubMed

17.

Bakker NA, van Imhoff GW, Verschuuren EA, van Son WJ. Presentation and early detection of post-transplant lymphoproliferative disorder after solid organ transplantation. Transpl Int. 2007;20(3):207–18.CrossRefPubMed

18.

Blaes AH, Cioc AM, Froelich JW, Peterson BA, Dunitz JM. Positron emission tomography scanning in the setting of post-transplant lymphoproliferative disorders. Clin Transplant. 2009;23(6):794–9.CrossRefPubMed

19.

Dierickx D, Tousseyn T, Requile’ A, Verscuren R, Sagaert X, Morscio J, et al. The accuracy of PET in the detection of Posttransplant Lymphoproliferative Disorder (PTLD). Haematologica 2012 Oct 12.

20.

Munster S, Zustin J, Derlin T. Atypical mycobacteriosis caused by Mycobacterium haemophilum in an immunocompromised patient: diagnosis by (18)F-FDG PET/CT. Clin Nucl Med. 2013;38(4):e194–5.CrossRefPubMed

21.

Revest M, Patrat-Delon S, Devillers A, Tattevin P, Michelet C. Contribution of 18fluoro-deoxyglucose PET/CT for the diagnosis of infectious diseases. Med Mal Infect. 2014;44(6):251–60.CrossRefPubMed

22.

Sah BR, Husmann L, Mayer D, Scherrer A, Rancic Z, Puippe G, et al. Diagnostic performance of 18F-FDG-PET/CT in vascular graft infections. Eur J Vasc Endovasc Surg. 2015;49(4):455–64.CrossRefPubMed

23.

Saleem BR, Berger P, Vaartjes I, de Keizer B, Vonken EJ, Slart RH, et al. Modest utility of quantitative measures in (18)F-fluorodeoxyglucose positron emission tomography scanning for the diagnosis of aortic prosthetic graft infection. J Vasc Surg. 2015;61(4):965–71.CrossRefPubMed

24.

Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET/CT in infection and inflammation--current and emerging clinical applications. Clin Radiol. 2015;70(7):787–800.CrossRefPubMed

25.

Vos FJ, Bleeker-Rovers CP, Sturm PD, Krabbe PF, van Dijk AP, Cuijpers ML, et al. 18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia. J Nucl Med. 2010;51(8):1234–40.CrossRefPubMed

26.

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(4):647–58.CrossRefPubMed

27.

Cunha-Bang C, Kirkby N, Sonderholm M, Sorensen SS, Sengelov H, Iversen M, et al. The time course of development and impact from viral resistance against ganciclovir in cytomegalovirus infection. Am J Transplant. 2013;13(2):458–66.CrossRefPubMed

28.

Levine JM, Weiner M, Kelly KM. Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate. J Pediatr Hematol Oncol. 2006;28(11):711–4.CrossRefPubMed

29.

Kuritzkes B, Parikh M, Melamed J, Hindman N, Pachter HL. False-positive rate of positron emission tomography/computed tomography for presumed solitary metastatic adrenal disease in patients with known malignancy. Ann Surg Oncol. 2015;22(2):437–40.CrossRefPubMed

30.

Kim MP, Correa AM, Hofstetter W, Mehran R, Rice DC, Roth JA, et al. Limitations of 18F-2-deoxy-D-glucose positron emission tomography in N1 detection in patients with pathologic stage II-N1 and implications for management. Ann Thorac Surg. 2015;99(2):414–20.CrossRefPubMed

31.

El-Galaly TC, Mylam KJ, Brown P, Specht L, Christiansen I, Munksgaard L, et al. Positron emission tomography/computed tomography surveillance in patients with Hodgkin lymphoma in first remission has a low positive predictive value and high costs. Haematologica. 2012;97(6):931–6.CrossRefPubMedPubMedCentral

32.

Carr R, Fanti S, Paez D, Cerci J, Gyorke T, Redondo F, et al. Prospective international cohort study demonstrates inability of interim PET to predict treatment failure in diffuse large B-cell lymphoma. J Nucl Med. 2014;55(12):1936–44.CrossRefPubMed

33.

Bleeker-Rovers CP, van der Meer JW, Oyen WJ. Fever of unknown origin. Semin Nucl Med. 2009;39(2):81–7.CrossRefPubMed

34.

Balink H, Collins J, Bruyn GA, Gemmel F. F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med. 2009;34(12):862–8.CrossRefPubMed

35.

Keidar Z, Gurman-Balbir A, Gaitini D, Israel O. Fever of unknown origin: the role of 18F-FDG PET/CT. J Nucl Med. 2008;49(12):1980–5.CrossRefPubMed

36.

Garcia-Velloso MJ, Jurado M, Ceamanos C, Aramendia JM, Garrastachu MP, Lopez-Garcia G, et al. Diagnostic accuracy of FDG PET in the follow-up of platinum-sensitive epithelial ovarian carcinoma. Eur J Nucl Med Mol Imaging. 2007;34(9):1396–405.CrossRefPubMed

37.

Ahmad SS. Physiological uptake in FDG PET simulating disease. Biomed Imaging Interv J. 2006;2(4), e59.

38.

Li S, Zheng Q, Ma Y, Wang Y, Feng Y, Zhao B, et al. Implications of false negative and false positive diagnosis in lymph node staging of NSCLC by means of (1)(8)F-FDG PET/CT. PLoS One. 2013;8(10), e78552.CrossRefPubMedPubMedCentral

39.

Reuter S, Schnockel U, Edemir B, Schroter R, Kentrup D, Pavenstadt H, et al. Potential of noninvasive serial assessment of acute renal allograft rejection by 18F-FDG PET to monitor treatment efficiency. J Nucl Med. 2010;51(10):1644–52.CrossRefPubMed

40.

Pawelski H, Schnockel U, Kentrup D, Grabner A, Schafers M, Reuter S. SPECT- and PET-based approaches for noninvasive diagnosis of acute renal allograft rejection. Biomed Res Int. 2014;2014:874785.CrossRefPubMedPubMedCentral

41.

Daly KP, Dearling JL, Seto T, Dunning P, Fahey F, Packard AB, et al. Use of [18F]FDG Positron Emission Tomography to Monitor the Development of Cardiac Allograft Rejection. Transplantation. 2015;99(9):e132–9.CrossRefPubMedPubMedCentral

42.

Chen DL, Wang X, Yamamoto S, Carpenter D, Engle JT, Li W, et al. Increased T cell glucose uptake reflects acute rejection in lung grafts. Am J Transplant. 2013;13(10):2540–9.CrossRefPubMedPubMedCentral

43.

Vos FJ, Bleeker-Rovers CP, Kullberg BJ, Adang EM, Oyen WJ. Cost-effectiveness of routine (18)F-FDG PET/CT in high-risk patients with gram-positive bacteremia. J Nucl Med. 2011;52(11):1673–8.CrossRefPubMed

44.

Cheng G, Torigian DA, Zhuang H, Alavi A. When should we recommend use of dual time-point and delayed time-point imaging techniques in FDG PET? Eur J Nucl Med Mol Imaging. 2013;40(5):779–87.CrossRefPubMed

45.

Christlieb SB, Strandholdt CN, Olsen BB, Mylam KJ, Larsen TS, Nielsen AL, et al. Dual time-point FDG PET/CT and FDG uptake and related enzymes in lymphadenopathies: preliminary results. Eur J Nucl Med Mol Imaging. 2016;43(10):1824–36.CrossRefPubMed

46.

Hofheinz F, Hoff J, Steffen IG, Lougovski A, Ego K, Amthauer H, et al. Comparative evaluation of SUV, tumor-to-blood standard uptake ratio (SUR), and dual time point measurements for assessment of the metabolic uptake rate in FDG PET. EJNMMI Res. 2016;6(1):53.CrossRefPubMedPubMedCentral

47.

Shen G, Deng H, Hu S, Jia Z. Potential performance of dual-time-point 18F-FDG PET/CT compared with single-time-point imaging for differential diagnosis of metastatic lymph nodes: a meta-analysis. Nucl Med Commun. 2014;35(10):1003–10.CrossRefPubMed

48.

Wu C, Li F, Niu G, Chen X. PET imaging of inflammation biomarkers. Theranostics. 2013;3(7):448–66.CrossRefPubMedPubMedCentral

Title: The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection
Authors: Neval E. Wareham
J. D. Lundgren
C. Da Cunha-Bang
F. Gustafsson
M. Iversen
H. H. Johannesen
A. Kjær
A. Rasmussen
H. Sengeløv
S. S. Sørensen
B. M. Fischer
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 3/2017
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-016-3564-5

At a glance: The STEP trials

Springer Medicine

The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2017

Lymphoma: current status of clinical and preclinical imaging with radiolabeled antibodies

William C. Klingesmith III: The Mathematics and Biology of the Biodistribution of Radiopharmaceuticals: A Clinical Perspective

Erratum to: Role of PET/CT in malignant pediatric lymphoma

The prognostic and predictive value of sstr2-immunohistochemistry and sstr2-targeted imaging in neuroendocrine tumors

“la synoviorthèse” can more than synovitis!

FDG-PET imaging to detect and characterize infectious disorders; an unavoidable path for the foreseeable future