DOI: 10.1007/s00259-017-3835-9Pages: 1-9

Clinical utility of FDG PET/CT in acute complicated pyelonephritis—results from an observational study

1. Mackay Memorial Hospital at Taipei, Department of Nuclear Medicine

2. Chang Gung Memorial Hospital at Linkou, Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation

3. Chang Gung University, Department of Medical Imaging and Radiological Science, College of Medicine

4. Chang Gung Memorial Hospital at Linkou, Division of Infectious Diseases, Department of Internal Medicine

5. Chang Gung Memorial Hospital at Linkou, Biostatistics Unit, Clinical Trial Center

Correspondence to:
Tzu-Chen Yen
Tel: 886-3328 1200
Email: yen1110@adm.cgmh.org.tw

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Abstract

Background

Acute complicated pyelonephritis (ACP) is an upper urinary tract infection associated with coexisting urinary tract abnormalities or medical conditions that could predispose to serious outcomes or treatment failures. Although CT and magnetic resonance imaging (MRI) are frequently used in patients with ACP, the clinical value of 18F–fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) has not been systematically investigated. This single-center retrospective study was designed to evaluate the potential usefulness of FDG PET/CT in patients with ACP.

Methods

Thirty-one adult patients with ACP who underwent FDG PET/CT were examined. FDG PET/CT imaging characteristics, including tracer uptake patterns, kidney volumes, and extrarenal imaging findings, were reviewed in combination with clinical data and conventional imaging results.

Results

Of the 31 patients, 19 (61%) showed focal FDG uptake. The remaining 12 study participants showed a diffuse FDG uptake pattern. After volumetric approximation, the affected kidneys were found to be significantly enlarged. Patients who showed a focal uptake pattern had a higher frequency of abscess formation requiring drainage. ACP patients showing diffuse tracer uptake patterns had a more benign clinical course. Seven patients had suspected extrarenal coinfections, and FDG PET/CT successfully confirmed the clinical suspicion in five cases. FDG PET/CT was as sensitive as CT in identifying the six patients (19%) who developed abscesses. Notably, FDG PET/CT findings caused a modification to the initial antibiotic regimen in nine patients (29%).

Conclusions

FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.

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  • Accepted: Sep 14, 2017
  • Online: Sep 26, 2017

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