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

  • Chih-Hsing Wan
  • Jing-Ren Tseng
  • Ming-Hsun Lee
  • Lan-Yan Yang
  • Tzu-Chen YenEmail author
Original Article



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.


FDG 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).


No funding was received for this study.

Compliance with ethical standard

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

Conflict of interest


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.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Nuclear MedicineMackay Memorial Hospital at TaipeiTaipeiRepublic of China
  2. 2.Department of Nuclear Medicine and Center for Advanced Molecular Imaging and TranslationChang Gung Memorial Hospital at LinkouTaoyuanRepublic of China
  3. 3.Department of Medical Imaging and Radiological Science, College of MedicineChang Gung UniversityTaoyuanRepublic of China
  4. 4.Division of Infectious Diseases, Department of Internal MedicineChang Gung Memorial Hospital at LinkouTaoyuanRepublic of China
  5. 5.Biostatistics Unit, Clinical Trial CenterChang Gung Memorial Hospital at LinkouTaoyuanRepublic of China

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