title: 18F-FDG PET/CT for diagnosing infectious complications in patients with severe neutropenia after intensive chemotherapy for haematological malignancy or stem cell transplantation.
abstract: OBJECTIVE
  Between 30 and 50% of febrile neutropenic episodes are accounted for by infection. C-reactive protein (CRP) is a nonspecific parameter for infection and inflammation but might be employed as a trigger for diagnosis. The aim of the study was to evaluate whether (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT can be used to detect inflammatory foci in neutropenic patients with elevated CRP and whether it helps to direct treatment.
  
  
  METHODS
  Twenty-eight consecutive patients with neutropenia as a result of intensive chemotherapy for haematological malignancies or myeloablative therapy for haematopoietic stem cell transplantation were prospectively included. (18)F-FDG PET/CT was added to the regular diagnostic workup once the CRP level rose above 50 mg/l.
  
  
  RESULTS
  Pathological FDG uptake was found in 26 of 28 cases despite peripheral neutrophil counts less than 0.1 × 10(-9)/l in 26 patients: in the digestive tract in 18 cases, around the tract of the central venous catheter (CVC) in 9 and in the lungs in 7 cases. FDG uptake in the CVC tract was associated with coagulase-negative staphylococcal bacteraemia (p < 0.001) and deep venous thrombosis (p = 0.002). The number of patients having Streptococcus mitis bacteraemia appeared to be higher in patients with grade 3 oesophageal FDG uptake (p = 0.08). Pulmonary FDG uptake was associated with the presence of invasive fungal disease (p = 0.04).
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT scanning during chemotherapy-induced febrile neutropenia and increased CRP is able to detect localized foci of infection and inflammation despite the absence of circulating neutrophils. Besides its potential role in detecting CVC-related infection during febrile neutropenia, the high negative predictive value of (18)F-FDG PET/CT is important for avoiding unnecessary diagnostic tests and therapy.
authors.affiliation: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. f.vos@aig.umcn.nl
authors.forename: Fidel J
authors.initials: FJ
authors.lastname: Vos
authors.forename: J Peter
authors.initials: JP
authors.lastname: Donnelly
authors.forename: Wim J G
authors.initials: WJ
authors.lastname: Oyen
authors.forename: Bart-Jan
authors.initials: BJ
authors.lastname: Kullberg
authors.forename: Chantal P
authors.initials: CP
authors.lastname: Bleeker-Rovers
authors.forename: Nicole M A
authors.initials: NM
authors.lastname: Blijlevens
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D016470:Bacteremia / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism; D001692:Biological Transport; D002097:C-Reactive Protein / Q000378:metabolism; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D019337:Hematologic Neoplasms / Q000188:drug therapy*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism; D008172:Lung Diseases, Fungal / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009503:Neutropenia / Q000150:complications* / Q000209:etiology / Q000473:pathology; D049268:Positron-Emission Tomography; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D013290:Streptococcal Infections / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism; D034361:Streptococcus mitis / Q000472:pathogenicity; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D019788:Fluorodeoxyglucose F18; D002097:C-Reactive Protein