Clinical Usefulness of ¹⁸F-FDG PET/CT for the Detection of Infections of Unknown Origin in Patients Undergoing Maintenance Hemodialysis

J Nucl Med. 2015 May;56(5):681-7. doi: 10.2967/jnumed.114.151696. Epub 2015 Mar 12.

Abstract

Patients with end-stage renal disease undergoing maintenance hemodialysis (MHD) are highly prone to infections. The potential clinical usefulness of (18)F-FDG PET/CT for the detection of infections of unknown origin in this patient population remains unclear. This study was designed to investigate this issue.

Methods: Between October 2011 and July 2014, a total of 104 adult MHD patients with sepsis underwent (18)F-FDG PET/CT for the detection of unknown infection foci. Follow-up was continued until October 2014. Positive (18)F-FDG PET/CT findings and mortality served as the main outcome measures.

Results: Of the 104 study patients, 73 (70.2%) had positive (18)F-FDG PET/CT findings, and a total of 95 major infection foci were identified. Eighteen patients (24.6%) had at least 2 infection foci on (18)F-FDG PET/CT scans. Seven (53.8%) of the 13 patients with primary vascular access-related infections had concurrent metastatic foci. Twenty-eight patients (26.9%) had their treatments modified by (18)F-FDG PET/CT results. Multivariate logistic regression analysis demonstrated that low hemoglobin and high C-reactive protein levels at diagnosis were the independent predictors of positive (18)F-FDG PET/CT results. Twenty-seven patients (26.0%) died during their hospital stay, and 24 of them had positive (18)F-FDG PET/CT findings (P = 0.014). Positive (18)F-FDG PET/CT results were an independent predictor of mortality (hazard ratio, 3.896; 95% confidence interval, 1.039-14.613; P = 0.044).

Conclusion: Our results suggest that (18)F-FDG PET/CT may be clinically useful for detecting occult infection foci in end-stage renal disease patients undergoing MHD. In this population, positive (18)F-FDG PET/CT findings may lead to a significant change in clinical management and independently predict mortality.

Keywords: FDG PET/CT; end-stage renal disease; infection; maintenance hemodialysis; mortality.

MeSH terms

  • Aged
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Infections / complications
  • Infections / diagnostic imaging*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Multimodal Imaging*
  • Positron-Emission Tomography*
  • Renal Dialysis*
  • Tomography, X-Ray Computed*

Substances

  • Fluorodeoxyglucose F18