title: Positron-emission computed tomography in cyst infection diagnosis in patients with autosomal dominant polycystic kidney disease.
abstract: BACKGROUND
  Cyst infection remains a challenging issue in patients with autosomal dominant polycystic kidney disease (ADPKD). In most patients, conventional imaging techniques are inconclusive. Isolated observations suggest that (18)fluorodeoxyglucose (¹⁸FDG) positron-emission computed tomography (PET/CT) might help detect cyst infection in ADPKD patients.
  
  
  METHODS
  Comparative assessment of administrative databases from January 2005 to December 2009 identified 27 PET/CT scans performed in 24 ADPKD patients for suspicion of abdominal infection. Cyst infection was definite if confirmed by cyst fluid analysis. Cyst infection was probable if all four of the following criteria were met: temperature of >38°C for >3 days, loin or liver tenderness, C-reactive protein plasma level of >5 mg/dl, and no CT evidence for intracystic bleeding. Episodes with only two or three criteria were grouped as "fever of unknown origin".
  
  
  RESULTS
  Thirteen infectious events in 11 patients met all criteria for kidney (n = 3) or liver (n = 10) cyst infection. CT was contributive in only one patient, whereas PET/CT proved cyst infection in 11 patients (84.6%). In addition, 14 episodes of "fever of unknown origin" in 13 patients were recorded. PET/CT identified the source of infection in nine patients (64.3%), including 2 renal cyst infections. Conversely, PET/CT showed no abnormal ¹⁸FDG uptake in 5 patients, including 2 intracystic bleeding. The median delay between the onset of symptoms and PET/CT procedure was 9 days.
  
  
  CONCLUSIONS
  This retrospective series underscores the usefulness of PET/CT to confirm and locate cyst infection and identify alternative sources of abdominal infection in ADPKD patients.
authors.affiliation: Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium. francois.jouret@uclouvain.be
authors.forename: François
authors.initials: F
authors.lastname: Jouret
authors.forename: Renaud
authors.initials: R
authors.lastname: Lhommel
authors.forename: Claire
authors.initials: C
authors.lastname: Beguin
authors.forename: Olivier
authors.initials: O
authors.lastname: Devuyst
authors.forename: Yves
authors.initials: Y
authors.lastname: Pirson
authors.forename: Ziad
authors.initials: Z
authors.lastname: Hassoun
authors.forename: Nada
authors.initials: N
authors.lastname: Kanaan
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D001530:Belgium; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000209:etiology; D005335:Fever of Unknown Origin / Q000175:diagnosis* / Q000000981:diagnostic imaging; D019788:Fluorodeoxyglucose F18; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18