title: 18F-fluorodeoxyglucose positron emission tomography contributes to the diagnosis and management of infections in patients with multiple myeloma: a study of 165 infectious episodes.
abstract: OBJECTIVE
  Correctly identifying infection in cancer patients can be challenging. Limited data suggest that positron emission tomography (PET) using fluorine-18 fluorodeoxyglucose (FDG) may be useful for diagnosing infection. To determine the role of FDG-PET in the diagnosis of infection in patients with multiple myeloma (MM).
  
  
  METHODS
  The medical records of 248 patients who had FDG-PET performed for MM staging or infection work-up revealing increased uptake at extramedullary sites and/or bones and joints that would be atypical for MM between October 2001 and May 2004 were reviewed to identify infections and evaluate FDG-PET contribution to patient outcome.
  
  
  RESULTS
  One hundred sixty-five infections were identified in 143 adults with MM. Infections involved the respiratory tract [99; pneumonia (93), sinusitis (six)], bone, joint and soft tissues [26; discitis (10), osteomyelitis (nine), septic arthritis (one), cellulitis (six)], vascular system [18; septic thrombophlebitis (nine), infection of implantable catheter (eight), septic emboli (one)], gastrointestinal tract [12; colitis (seven), abdominal abscess (three), and diverticulitis and esophagitis (one each)], and dentition [periodontal abscess (10)]. Infections were caused by bacteria, mycobacteria, fungi, and viruses. FDG-PET detected infection even in patients with severe neutropenia and lymphopenia (30 episodes). The FDG-PET findings identified infections not detectable by other methods (46 episodes), determined extent of infection (32 episodes), and led to modification of work-up and therapy (55 episodes). Twenty silent, but clinically relevant, infections were detected among patients undergoing staging FDG-PET.
  
  
  CONCLUSIONS
  In patients with MM, FDG-PET is a useful tool for diagnosing and managing infections even in the setting of severe immunosuppression.
authors.affiliation: University of Arkansas for Medical Sciences, Myeloma Institute for Research and Therapy, Little Rock, 72205, USA.
authors.forename: T
authors.initials: T
authors.lastname: Mahfouz
authors.forename: M H
authors.initials: MH
authors.lastname: Miceli
authors.forename: F
authors.initials: F
authors.lastname: Saghafifar
authors.forename: S
authors.initials: S
authors.lastname: Stroud
authors.forename: L
authors.initials: L
authors.lastname: Jones-Jackson
authors.forename: R
authors.initials: R
authors.lastname: Walker
authors.forename: M L
authors.initials: ML
authors.lastname: Grazziutti
authors.forename: G
authors.initials: G
authors.lastname: Purnell
authors.forename: A
authors.initials: A
authors.lastname: Fassas
authors.forename: G
authors.initials: G
authors.lastname: Tricot
authors.forename: B
authors.initials: B
authors.lastname: Barlogie
authors.forename: E
authors.initials: E
authors.lastname: Anaissie
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009101:Multiple Myeloma / Q000000981:diagnostic imaging* / Q000382:microbiology; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000000981:diagnostic imaging* / Q000382:microbiology; D013997:Time Factors; D014055:Tomography, Emission-Computed
chemical_list: D000900:Anti-Bacterial Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18