The use of a visual 4-point scoring scale improves the yield of 18F-FDG PET-CT imaging in the diagnosis of renal and hepatic cyst infection in patients with autosomal dominant polycystic kidney disease

Abstract

Purpose

[18F]FDG PET/CT (PET/CT) proved useful in the diagnosis of renal and hepatic cyst infection (CyI) in patients with autosomal dominant polycystic kidney disease (ADPKD). However, the definition of CyI by PET/CT is unclear. Here, we characterize the [18F]FDG uptake in CyI in order to infer a visual 4-point diagnostic scale.

Methods

All ADPKD patients hospitalized between 2007 and 2019 for suspected CyI and who underwent an [18F]FDG PET/CT scan were listed. CyI was defined by 5 concomitant criteria: fever ≥ 38 °C; abdominal pain; peak plasma CRP ≥ 70 mg/L; no other cause of inflammation; and favorable outcomes after antibiotics for ≥ 21 days. First, all PET/CT images were visually interpreted. Next, the [18F]FDG uptake around the suspected CyI was scored using a semiquantitative 4-point scale in comparison to blood and liver activities.

Results

Sixty [18F]FDG PET/CT scans were performed for suspected CyI in 38 ADPKD patients. Twenty-nine episodes met the gold-standard criteria for CyI. The visual assessment of PET/CT images reached a sensitivity of 73.1% and a specificity of 70.6%. Using the 4-point scale, an [18F]FDG score ≥ 3 (i.e., cyst uptake > liver) improved the specificity to 85.3%.

Conclusion

[18F]FDG PET-CT is helpful in CyI diagnosis in ADPKD, and the use of a 4-point scoring of [18F]FDG uptake improves its diagnostic yield, with positive and negative predictive values of 78.3 and 78.4%, respectively. External validation is required.

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Funding

MFN and FJ are Fellows of the Fonds National de la Recherche Scientifique (FNRS), Brussels, Belgium.

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Correspondence to François Jouret.

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The authors declare that they have no conflict of interest.

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All procedures were performed in accordance with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study design and exemption from informed consent were approved by the Institutional Review Board of Liege University Hospital.

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For this type of retrospective study based on the systematic reviewing of medical files, formal consent is not required.

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This article is part of the Topical Collection on Infection and inflammation.

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Neuville, M.F., Lovinfosse, P., Jadoul, A. et al. The use of a visual 4-point scoring scale improves the yield of 18F-FDG PET-CT imaging in the diagnosis of renal and hepatic cyst infection in patients with autosomal dominant polycystic kidney disease. Eur J Nucl Med Mol Imaging 48, 254–259 (2021). https://doi.org/10.1007/s00259-020-04903-x

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Keywords

  • Autosomal dominant polycystic kidney disease
  • 18F-fluorodeoxyglucose positron emission tomography
  • Cyst infection
  • Diagnosis
  • Performance