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Assessment of Suspected Malignancy or Infection in Immunocompromised Patients After Solid Organ Transplantation by [18F]FDG PET/CT and [18F]FDG PET/MRI

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Abstract

Purpose

To study the value of 2-deoxy-2-[18F]fluoro-D-glucose([18F]FDG) positron emission tomography/computed tomography (PET/CT) and [18F]FDG positron emission tomography/magnetic resonance imaging (PET/MRI) in assessing immunocompromised patients with suspected malignancy or infection.

Methods

[18F]FDG-PET/CT and [18F]FDG-PET/MRI examinations of patients who were immunocompromised after receiving lung, heart, pancreas, kidney, liver, or combined kidney-liver transplants were analyzed in this retrospective study. Patients underwent whole-body hybrid-imaging because of clinical signs of malignancy and/or infection. Findings were assessed by molecular features ([18F]FDG-uptake) and morphological changes. The final diagnosis, which was arrived at after review of clinical, laboratory, and histopathologic analyses and follow-up imaging studies, served as the reference standard.

Results

Altogether, (i) 28 contrast-enhanced [18F]FDG-PET/CT scans (CE-PET/CT), (ii) 33 non-contrast [18F]FDG-PET/CT scans (NC-PET/CT), and (iii) 18 [18F]FDG-PET/MRI scans were included. Additionally, 12/62 patients underwent follow-up PET imaging to rule out vital tumor or metabolic active inflammatory processes. CE-PET/CT exhibited 94.4% sensitivity, 80.0% specificity, 89.5% positive predictive value (PPV), 88.9% negative predictive value (NPV), and 89.3% accuracy with regard to the reference standard. NC-PET/CT exhibited 91.3% sensitivity, 80.0% specificity, 91.3% PPV, 80.0% NPV, and 87.9% accuracy. PET/MRI exhibited 88.6% sensitivity, 99.2% specificity, 99.6% PPV, 81.3% NPV, and 94.4% accuracy. Exact McNemar statistical test (one-sided) showed significant difference between the CT-/MR-component alone and the integrated PET/CT and PET/MRI for diagnosis of malignancy or infection (p value < 0.001). Radiation exposure was 4- to 7-fold higher with PET/CT than with PET/MRI.

Conclusion

For immunocompromised patients with clinically unresolved symptoms, to rule out vital tumor manifestations or metabolic active inflammation, [18F]FDG-PET/MRI, CE-[18F]FDG-PET/CT, and NC-[18F]FDG-PET/CT exhibit excellent performance in diagnosing malignancy or infection. The main strength of PET/MRI is its considerably lower level of radiation exposure than that associated with PET/CT.

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References

  1. Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342:605–12.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  3. Pizzo PA. Fever in immunocompromised patients. N Engl J Med. 1999;341:893–900.

    Article  CAS  Google Scholar 

  4. Fishman JA. Infection in organ transplantation. Am J Transplant. 2017;17:856–79.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  6. 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.

    Article  Google Scholar 

  7. Wareham NE, Lundgren JD, Da Cunha-Bang C, Gustafsson F, Iversen M, Johannesen HH, et al. The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection. Eur J Nucl Med Mol Imaging. 2017;44:421–31.

    Article  Google Scholar 

  8. Muller N, Kessler R, Caillard S, et al. 18F-FDG PET/CT for the diagnosis of malignant and infectious complications after solid organ transplantation. Nucl Med Mol Imaging. 2017;51:58–68.

    Article  CAS  Google Scholar 

  9. Sugawara Y, Braun DK, Kison PV, Russo JE, Zasadny KR, Wahl RL. Rapid detection of human infections with fluorine-18 fluorodeoxyglucose and positron emission tomography: preliminary results. Eur J Nucl Med. 1998;25:1238–43.

    Article  CAS  Google Scholar 

  10. De Winter F, Vogelaers D, Gemmel D, Dierckx RA. Promising role of 18-F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis. 2002;21:247–57.

    Article  Google Scholar 

  11. Ehman EC, Johnson GB, Villanueva-Meyer JE, Cha S, Leynes AP, Larson PEZ, et al. PET/MRI: where might it replace PET/CT? J Magn Reson Imaging. 2017;46:1247–62.

    Article  Google Scholar 

  12. Bailey DL, Pichler BJ, Gückel B, Barthel H, Beer AJ, Botnar R, et al. Combined PET/MRI: from status quo to status go. Summary Report of the Fifth International Workshop on PET/MR Imaging; February 15-19, 2016; Tübingen, Germany. Mol Imaging Biol. 2016;18:637–50.

    Article  CAS  Google Scholar 

  13. Guberina N, Forsting M, Suntharalingam S, Nassenstein K, Theysohn J, Ringelstein A, et al. Radiation dose monitoring in the clinical routine. Rofo. 2017;189:356–60.

    PubMed  Google Scholar 

  14. Guberina N, Suntharalingam S, Naßenstein K, Forsting M, Theysohn J, Wetter A, et al. Verification of organ doses calculated by a dose monitoring software tool based on Monte Carlo simulation in thoracic CT protocols. Acta Radiol. 2018;59:322–6.

    Article  Google Scholar 

  15. ICRP. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP. 2007;37:2–4.

    Google Scholar 

  16. ICRP. Radiation dose to patients from radiopharmaceuticals: addendum 3 to ICRP publication 53. ICRP Publication 106. Ann ICRP. 2008;38:1–2.

    Article  CAS  Google Scholar 

  17. Snyder JJ, Israni AK, Peng Y, Zhang L, Simon TA, Kasiske BL. Rates of first infection following kidney transplant in the United States. Kidney Int. 2009;75:317–26.

    Article  Google Scholar 

  18. Fishman JA, Rubin RH. Infection in organ transplant recipients. N Engl J Med. 1998;338:1741–51.

    Article  CAS  Google Scholar 

  19. Kauffman HM, Cherikh WS, McBride MA, Cheng Y, Hanto DW. Post-transplant de novo malignancies in renal transplant recipients: the past and the present. Transpl Int. 2006;19:607–20.

    Article  Google Scholar 

  20. Wong G, Chapman JR. Cancers after renal transplantation. Transplant Rev (Orlando). 2008;22:141–9.

    Article  Google Scholar 

  21. Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF. To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med. 2004;45:56S–65S.

    CAS  PubMed  Google Scholar 

  22. ACR Committee on Drugs and Contrast Media. ACR Manual on Contrast Media, Version 10.3. Reston: American College of Radiology; 2018. Available via https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Accessed 14 Nov 2019.

  23. 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;40:779–87.

    Article  CAS  Google Scholar 

  24. 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;43:1824–36.

    Article  CAS  Google Scholar 

  25. 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;6:53.

    Article  Google Scholar 

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Acknowledgments

Acknowledgments to Prof. Bockisch.

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Authors and Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Nika Guberina and Hana Rohn. The first draft of the manuscript was written by Nika Guberina and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nika Guberina.

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Conflict of Interest

Nika Guberina, Anja Gäckler, Johannes Grueneisen, Axel Wetter, Oliver Witzke, Ken Herrmann, Christoph Rischpler, Wolfgang Fendler, Lale Umutlu, Lino Morris Sawicki, Michael Forsting and Hana Rohn declare that they have no conflict of interest. There is no source of funding.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Guberina, N., Gäckler, A., Grueneisen, J. et al. Assessment of Suspected Malignancy or Infection in Immunocompromised Patients After Solid Organ Transplantation by [18F]FDG PET/CT and [18F]FDG PET/MRI. Nucl Med Mol Imaging 54, 183–191 (2020). https://doi.org/10.1007/s13139-020-00648-5

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