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Molecular Imaging Techniques in the Diagnosis and Monitoring of Infectious Diseases

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Abstract

Purpose of Review

Combined positron emission tomography and computer tomography with 2-deoxy-[fluorine-18]-flouro-D-glucose ([18F]FDG-PET/CT) is increasingly used in suspected infection and inflammation. Evidence is mounting within several areas. We believe [18F]FDG-PET/CT is a key modality in infection and inflammation and this overview outlines the diagnostic values in most common uses within this domain.

Recent Findings

[18F]FDG-PET/CT is considered helpful in establishing the underlying disease in 50–60% of FUO patients. In patients with complex blood stream infections, [18F]FDG-PET/CT changes treatment and reduces relapse rates and mortality—if scans are negative prognosis is favorable and it may be safe to withhold or de-escalate treatment strategy. In infectious endocarditis, [18F]FDG-PET/CT has an impact in prosthetic valve endocarditis and cardiovascular implantable electronic devices whereas its diagnostic use in NVE is limited. In spondylodiscitis, [18F]FDG-PET/CT and MRI have overall equally and complementary diagnostic performance with combined sensitivity and specificity of ~ 100%. In vascular graft infections, [18F]F DG-PET/CT is highly sensitive (> 90%) with a high negative predictive value, whereas false positive findings are challenging, especially early post-operative. Leucocyte scintigraphy combined with bone marrow scintigraphy has a better overall accuracy compared to [18F]FDG-PET/CT in suspected hip and knee prosthetic joint infections, but several practical issues favor [18F]FDG-PET/CT. Future developments of more specific tracers and novel scanner technology holds potential.

Summary

Evidence for [18F]FDG-PET/CT in infectious and inflammatory disease supports the use in fever of unknown origin, bloodstream infections, spondylodiscitis, infective endocarditis, vascular graft infections, and prosthetic joint infections. However, the literature is generally heterogeneous and several issues remain unclarified, e.g., patient selection and interpretation criteria. [18F]FDG-PET/CT has a definite role in infectious and inflammatory imaging, but firm evidence is still lacking on its precise place in the diagnostic pathways.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Maria Ekelund Thorsen MD, Kate Rewers MD & Søren Hess MD

  2. Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

    Shashi B. Singh MD

  3. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Thomas J. Werner MSc & Abass Alavi MD, PhD (hon), MD (hon)

  4. Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

    Søren Hess MD

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All authors contributed to conceptualizing this work and contributed individual sections of the main text. K.R. prepared figures 1 & 2. All authors reviewed the manuscript and approved the final version.

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Correspondence to Søren Hess MD.

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Thorsen, M.E., Singh, S.B., Rewers, K. et al. Molecular Imaging Techniques in the Diagnosis and Monitoring of Infectious Diseases. Curr Treat Options Infect Dis (2024). https://doi.org/10.1007/s40506-024-00274-1

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