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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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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Acknowledgements

The authors acknowledge the statistical assistance of the Clinical Trial Center, Linkou, Taiwan (founded by the Ministry of Health and Welfare of Taiwan; grant MOHW106-TDU-B-212-113005).

Funding

No funding was received for this study.

Author information

Author notes

  1. Chih-Hsing Wan and Jing-Ren Tseng contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Mackay Memorial Hospital at Taipei, No. 92, Section 2, Zhong-shan North road, Zhong-shan District, Taipei, Taiwan, Republic of China

    Chih-Hsing Wan

  2. Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital at Linkou, No. 5, Fu-Hsing ST., Kwei-Shan, Taoyuan, Taiwan, Republic of China

    Jing-Ren Tseng & Tzu-Chen Yen

  3. Department of Medical Imaging and Radiological Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China

    Jing-Ren Tseng & Tzu-Chen Yen

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

    Ming-Hsun Lee

  5. Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, Republic of China

    Lan-Yan Yang

Authors
  1. Chih-Hsing Wan
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  2. Jing-Ren Tseng
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Corresponding author

Correspondence to Tzu-Chen Yen.

Ethics declarations

Institutional Review Board of the Chang Gung Memorial Hospital (CGMH) at Linkou.

Conflict of interest

None.

Ethical approval

This retrospective study was performed in accordance with the 1964 Declaration of Helsinki and was approved by the Institutional Review Board of the Chang Gung Memorial Hospital (CGMH) at Linkou (Number: 104-7091C).

Informed consent

Informed consent was waived for all patients included in this retrospective study.

Additional information

Chi-Hsing Wan and Jing-Ren Tseng are the first authors.

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Wan, CH., Tseng, JR., Lee, MH. et al. Clinical utility of FDG PET/CT in acute complicated pyelonephritis—results from an observational study. Eur J Nucl Med Mol Imaging 45, 462–470 (2018). https://doi.org/10.1007/s00259-017-3835-9

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  • DOI: https://doi.org/10.1007/s00259-017-3835-9

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