F-18-fluorodeoxyglucose positron emission tomography combined with CT in critically ill patients with suspected infection

• Published in: Intensive care medicine Vol. 36; no. 3; pp. 504 - 511
• Main Authors: Simons, Koen S., Pickkers, Peter, Bleeker-Rovers, Chantal P., Oyen, Wim J. G., van der Hoeven, Johannes G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2010; Springer; Springer Nature B.V
• Subjects: Accuracy; Adolescent; Adult; Aged; Analysis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Child; Child, Preschool; Clinical death. Palliative care. Organ gift and preservation; Critical Care Medicine; Critical Illness; CT imaging; Diagnosis; Diagnostic tests; Drug dosages; Emergency Medicine; Endocarditis; Female; Fever of Unknown Origin - etiology; Fluorodeoxyglucose F18; Glucose; Heart surgery; Hospital patients; Humans; Infant; Infant, Newborn; Infection; Infection - diagnosis; Infections; Intensive; Intensive care; Intensive care medicine; Male; Medical imaging; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Netherlands; Nuclear medicine; Original; Pain Medicine; Patients; Pediatrics; PET imaging; Pneumology/Respiratory System; Positron-Emission Tomography - methods; Radiopharmaceuticals; Retrospective Studies; Scanners; Tomography; Tomography, X-Ray Computed; Young Adult; Netherlands; Infection; Critical illness; Intensive care; Diagnosis; Positron emission tomography; Human; 2-deoxy-2-fluoroglucose; Critically ill; Computerized axial tomography; Resuscitation; Emission tomography
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-009-1697-8

Purpose To assess the value of F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) combined with CT in critically ill patients suspected of having an infection. Methods FDG-PET CT scans requested for evaluation of a suspected infection or inflammatory process in critically ill, mechanically ventilated patients were analyzed (blinded for the final clinical diagnosis) and compared with clinical follow-up. Results Thirty-five FDG-PET/CT scans performed in 33 ICU patients (28 adults and 5 children), median age 58 years (range 1 month–72 years), were analyzed. Twenty-one FDG-PET/CT scans were true positive. Three FDG-PET/CT scans were considered false positive, in one case leading to additional diagnostic procedures (specificity 79%). Additionally, 11 true negatives were found (sensitivity 100%), leading to an overall accuracy of 91%. Conclusions FDG-PET/CT scanning is of additional value in the evaluation of suspected infection in critically ill patients in whom conventional diagnostics did not lead to a diagnosis. Apart from the high accuracy, in this study it appeared that, in addition to conventional diagnostic techniques that were routinely performed, a normal FDG-PET/CT ruled out important infections requiring prolonged antibiotic therapy or drainage. Since sensitivity is lower in highly metabolic active tissues (e.g., endocarditis, meningitis), the FDG-PET/CT scan is not suited to detect infections in these tissues.