title: Diagnostic role of whole-body [18F]-FDG positron emission tomography in patients with symptoms suspicious for malignancy after heart transplantation.
abstract: BACKGROUND
  Increased rates of malignancies and infections occur in transplant patients under immunosuppression, but the resultant clinical symptoms, and results of physical examination, chest X-ray, abdominal ultrasonography and laboratory findings are frequently difficult to interpret or inconclusive. The aim of the present study was to investigate the usefulness of whole-body [(18)F]-FDG PET for investigation of heart transplant patients suffering from suspicious symptoms, with a previously ambiguous diagnosis.
  
  
  METHODS
  Seventeen consecutive patients (8 women; 48 ± 22 years) with non-specific symptoms (lymphadenopathy, fever of unknown origin or recurrent febrile temperatures, weight loss, abdominal pain, night sweating, cough or generally reduced physical condition) were evaluated retrospectively. All patients underwent whole-body [(18)F]-FDG examinations by PET (7 patients) or PET/CT (10 patients) at 8 ± 6 (range 0.1 to 21) years after orthotopic heart transplantation (OHT). During a follow-up of 28 ± 25 months, results of bone marrow biopsies, and histologic and/or microbiologic findings were registered and retrospectively compared with the PET results.
  
  
  RESULTS
  PET revealed the cause of non-specific symptoms in 9 of 17 patients; there were 5 cases of lymphoproliferative disease (PTLD), 2 carcinomas and 2 cases of infection. Four patients were rated false positive, 1 patient false negative and 3 patients were correctly rated as negative. Sensitivity, specificity and positive and negative predictive values were 0.90, 0.43, 0.69 and 0.75, respectively, giving an overall diagnostic accuracy of 0.71.
  
  
  CONCLUSIONS
  A non-invasive strategy of using whole-body [(18)F]-FDG PET or PET/CT in heart transplant recipients with non-specific unexplained symptoms may offer diagnostic stratification for malignancy and infections with a high sensitivity and modest diagnostic accuracy. These findings require prospective confirmation.
authors: Department of Nuclear Medicine, University of Munich, Munich, Germany.
authors: Vera
authors: V
authors: Graute
authors: Nathalie
authors: N
authors: Jansen
authors: Hae-Young
authors: HY
authors: Sohn
authors: Alexander
authors: A
authors: Becker
authors: Barbara
authors: B
authors: Klein
authors: Irene
authors: I
authors: Schmid
authors: Sabine
authors: S
authors: Greil
authors: Sebastian
authors: S
authors: Lehner
authors: Peter
authors: P
authors: Bartenstein
authors: Thomas
authors: T
authors: Pfluger
authors: Marcus
authors: M
authors: Hacker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18