18F-fluorodeoxyglucose positron emission tomography contributes to the diagnosis and management of infections in patients with multiple myeloma: a study of 165 infectious episodes.
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.
Mahfouz
T
T
University of Arkansas for Medical Sciences, Myeloma Institute for Research and Therapy, Little Rock, 72205, USA.
Miceli
M H
MH
Saghafifar
F
F
Stroud
S
S
Jones-Jackson
L
L
Walker
R
R
Grazziutti
M L
ML
Purnell
G
G
Fassas
A
A
Tricot
G
G
Barlogie
B
B
Anaissie
E
E
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
D000900:Anti-Bacterial Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18