F-18-FDG-hybrid-camera-PET in patients with postoperative fever

J. Meller; C. O. Sahlmann; K. Lehmann; U. Siefker; I. Meyer; K. Schreiber; G. Altenvoerde; W. Becker

doi:10.1055/s-0038-1623997

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2002; 41(01): 22-29
DOI: 10.1055/s-0038-1623997

Originalarbeiten – Original Articles

Schattauer GmbH

F-18-FDG-hybrid-camera-PET in patients with postoperative fever

F-18-FDG-Hybrid-Kamera-PET bei Patienten mit postoperativem Fieber

Authors

J. Meller

¹Abteilung Nuklearmedizin
C. O. Sahlmann

²Zentrum Innere Medizin, Georg August Universität, Göttingen, Deutschland
K. Lehmann

¹Abteilung Nuklearmedizin
U. Siefker

¹Abteilung Nuklearmedizin
I. Meyer

¹Abteilung Nuklearmedizin
K. Schreiber

²Zentrum Innere Medizin, Georg August Universität, Göttingen, Deutschland
G. Altenvoerde

¹Abteilung Nuklearmedizin
W. Becker

¹Abteilung Nuklearmedizin

Abstract

Summary

Aim: Evaluation of F-18-FDG-hybrid-camera-PET imaging in patients with undetermined postoperative fever (POF). Methods: Prospective study of 18 patients (9 women, 9 men; age 23-85 years) suffering from POF with 2-fluoro-2’-deoxyglucose (F-18-FDG) using a dual headed coincidence camera (DHCC). Surgery had been performed 5-94 days prior to our investigation. 13 of the 18 patients received antibiotic therapy during the time of evaluation. Ten (55%) had an infectious and eight (45%) a non infectious cause of fever. Results: Increased F-18-FDG-uptake outside the surgical wound occurred in 13 regions (infection n = 11, malignancy n = 2). The sensitivity of F-18-FDG-hybrid-camera-PET in imaging infection in areas outside the surgical wound was 86% and the specificity 100%, respectively. Antibiotic therapy did not negatively influence the results of F-18-FDG-scanning. Increased F-18-FDG-uptake within the surgical wound was seen in 8 of 18 patients. The sensitivity of F-18-FDG-hybrid-camera-PET in imaging infection within the surgical wound was 100% and the specificity 56%, respectively. The interval between surgery and F-18-FDG-scanning was significantly shorter in patients with false positive results compared with patients showing true negative results (median 34 vs. 54 days; p = 0,038). Conclusion: In POF-Patients, F-18-FDG transaxial tomography performed with a F-18-FDG-hybrid-camera-PET is sensitive in the diagnosis of inflammation and malignant disease within and outside the surgical wound. Because of the accumulation of the tracer both in granulation tissue and infection, the specificity in detecting the focus of fever within the surgical wound is poor.

Zusammenfassung

Ziel: Evaluation des Stellenwerts der F-18-FDG-Hybrid-Kamera-PET bei Patienten mit unklarem postoperativen Fieber (POF). Methoden: Prospektive Studie an 18 POF-Patienten (9 Frauen, 9 Männer; Alter 23-85 Jahre) mit Fluor-2’-deoxyglucose (F-18-FDG) und einer koinzidenzfähigen Doppelkopfkamera. Die chirurgischen Interventionen erfolgten 5-94 Tage vor der Untersuchung. Von den Patienten wurden zum Zeitpunkt der F-18-FDG-Hybrid-Kamera-PET 13 mit Anti-biotika therapiert. Zehn (55%) hatten eine Infektion, bei acht (45%) lag eine nicht infektiöse Fieberursache vor. Ergebnisse: Eine pathologisch erhöhte Aktivitätsaufnahme außerhalb des Wundbettes fand sich in 13 Regionen (Infektion n = 11, Tumor n = 2). Bei zwei Patienten mit Infektion fand sich ein normales Aktivitätsverteilungsmuster. Die Sensitivität der F-18-FDG-Hybrid-Kamera-PET bezogen auf Infektionen außerhalb des Operationsgebietes war 86% und die Spezifität 100%. Eine gleichzeitige antibiotische Therapie beeinflusste die diagnostische Richtigkeit der Methode nicht. Ein pathologischer FDG-Uptake innerhalb des Operationsgebietes fand sich bei 8 der 18 Patienten. Die Sensitivität der F-18-FDG-Hybrid-Kamera-PET war 100% und die Spezifität 63%. Das zeitliche Intervall zwischen Operation und F-18-FDG-Hybrid-Kamera-PET war bei falsch positivem Befund signifikant kürzer als bei richtig negativem Befund (Median 34 vs. 54 Tage; p = 0,038). Schlussfolgerung: Bei der Abklärung von POF stellt die F-18-FDG-Hybrid-Kamera-PET eine sensitive Methode zur Entzündungsdiagnostik inner- und außerhalb des Operationsgebietes dar. Die Spezifität der Methode im Operationsgebiet ist unzureichend, da nicht zwischen Anreicherung in Granulationsgewebe und infektiösen Prozess differenziert werden kann.

Keywords

F-18-FDG-PET - postoperative fever - infection

Schlüsselwörter

F-18-FDG-PET - postoperatives Fieber - Infektion

Full Text

References

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