Clinical utility of FDG PET/CT in acute complicated pyelonephritis—results from an observational study
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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.
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.
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%).
FDG PET/CT may be clinically useful in the assessment of patients with ACP who have a progressive disease course.
KeywordsFDG PET/CT Acute complicated pyelonephritis Coinfection Progressive disease course
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).
Compliance with ethical standard
Institutional Review Board of the Chang Gung Memorial Hospital (CGMH) at Linkou.
Conflict of interest
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 was waived for all patients included in this retrospective study.
- 1.Grabe M, Bartoletti R, Bjerklund Johansen TE, et al. EAU guidelines on urological infections. European Association of Urology. 2015. Available online: http://uroweb.org/guideline/urological-infections.
- 5.Gupta K, Trautner BW. Urinary tract infections, pyelonephritis, and prostatitis. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J, editors. Harrison’s principles of internal medicine, 19e. New York, NY: McGraw-Hill; 2015.Google Scholar
- 6.Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, et al. Infectious Diseases Society of America.; European Society for Microbiology and Infectious Diseases.. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–20.CrossRefPubMedGoogle Scholar
- 7.National Guideline Clearinghouse (NGC). Guideline summary: ACR Appropriateness Criteria® acute pyelonephritis. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). 2012. [cited 2017 Jan 03]. Available: https://www.guideline.gov.
- 17.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39 (2 suppl 1):S1–S266.Google Scholar
- 24.Guler S, Cimen S, Hurton S, Molinari M. Diagnosis and treatment modalities of symptomatic polycystic kidney disease. In: Li X, editor. Polycystic kidney disease [Internet]. Brisbane (AU): Codon Publications; 2015. Chapter 4.Google Scholar