Infection

, Volume 35, Issue 1, pp 11–18 | Cite as

F-18-Fluorodeoxyglucose (FDG) Positron-Emission Tomography of Echinococcus multilocularis Liver Lesions: Prospective Evaluation of its Value for Diagnosis and Follow-up during Benzimidazole Therapy

  • K. D. M. Stumpe
  • E. C. Renner-Schneiter
  • A. K. Kuenzle
  • F. Grimm
  • Z. Kadry
  • P.-A. Clavien
  • P. Deplazes
  • G. K. von Schulthess
  • B. Muellhaupt
  • R. W. Ammann
  • E. L. Renner
Clinical and Epidemiological Study

Abstract

Background:

Long-term benzimidazole therapy benefits patients with non-resectable alveolar echinococcosis (AE). Methods to assess early therapeutic efficacy are lacking. Recently, AE liver lesions were reported to exhibit increased F-18-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET). To assess the value of FDG-PET for diagnosis and follow-up of AE patients.

Patients/Methods:

Twenty-six consecutive patients with newly diagnosed AE were enrolled. Baseline evaluation included CT and FDG-PET. Thirteen patients (11 women; median age 50 years, range 40-76) were resected, the remaining 13 (8 women; median age 60 years, range 39–72) had non-resectable disease, were started on benzimidazoles, and CT and FDG-PET were repeated at 6, 12 and 24 months of therapy. Twelve consecutive patients with newly diagnosed cystic echinococcosis (CE) of the liver were also subjected to baseline FDG-PET.

Results:

In 21/26 AE patients, baseline PET scans showed multifocally increased FDG uptake in the hepatic lesions' periphery, while liver lesions were FDG negative in 11/12 CE patients. Thus, sensitivity and specificity of FDG-PET for AE vs. CE were 81% and 92%, respectively. In 5 of 10 non-resectable patients with increased baseline FDG uptake, the intensity of uptake decreased (or disappeared) during benzimidazole therapy, in 3 by ≥2 grades within the initial 6 months.

Conclusions:

FDG-PET is a sensitive and specific adjunct in the diagnosis of suspected AE and can help in differentiating AE from CE. The rapid improvement of positive PET scans with benzimidazole therapy in some patients indicates that absent FDG uptake does not necessarily reflect parasite viability.

Abbreviations

E. multilocularis

Echinococcus multilocularis

E. granulosus

Echinococcus granulosus

AE

alveolar echinococcosis

CE

cystic echinococcosis

PET

positron emission tomography

FDG

fluorodeoxyglucose

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Copyright information

© Urban & Vogel München 2007

Authors and Affiliations

  • K. D. M. Stumpe
    • 1
  • E. C. Renner-Schneiter
    • 2
    • 6
  • A. K. Kuenzle
    • 1
  • F. Grimm
    • 3
  • Z. Kadry
    • 4
    • 5
  • P.-A. Clavien
    • 4
  • P. Deplazes
    • 3
  • G. K. von Schulthess
    • 1
  • B. Muellhaupt
    • 2
  • R. W. Ammann
    • 2
  • E. L. Renner
    • 2
    • 6
  1. 1.Clinic of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland
  2. 2.Clinic of Gastroenterology and HepatologyUniversity Hospital ZurichZurichSwitzerland
  3. 3.Institute of ParasitologyUniversity of ZurichZurichSwitzerland
  4. 4.Dept. of Visceral and Transplantation SurgeryUniversity Hospital ZurichZurichSwitzerland
  5. 5.Division of Transplantation, Department of SurgeryThe Milton S., Hershey Medical CenterHershey, PAUSA
  6. 6.Dept. of Medicine/Section of HepatologyUniversity of Manitoba, John Buhler Research Centre, Room 809Winnipeg, MB R3A 1R9Canada

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