title: Diagnostic Value of Positron Emission Tomography Combined with Computed Tomography for Evaluating Critically Ill Neurological Patients.
abstract: OBJECTIVE
  18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) is a promising new tool for the identification of inflammatory, infectious, and neoplastic foci. The aim of our work was to evaluate the diagnostic value of FDG-PET/CT in patients treated on a neurological/neurosurgical ICU or stroke unit.
  
  
  METHODS
  We performed a single-center, 10-year, retrospective evaluation of the value of FDG-PET/CT in critically ill adult patients with severe neurological disease.
  
  
  RESULTS
  42 patients underwent FDG-PET/CT. Of these, 15 were ventilated and 10 were under vasopressor support. We identified four indications for performing FDG-PET/CT: (1) excluding a paraneoplastic etiology in an otherwise unexplained encephalitis, encephalopathy or neuropathy, (2) detecting a large-vessel vasculitis in patients with ischemic stroke, (3) detecting an infectious focus in sepsis, and less frequently (4) evaluating cerebral metabolism. In 22 patients who were evaluated for an unknown malignancy, 5 scans revealed either a previously unknown tumor or unknown metastases of a previously treated malignancy. Of 11 patients investigated for large-vessel vasculitis, 2 showed an inflammation of arteries supplying the brain. Of six sepsis cases, FDG-PET/CT identified an infectious focus in four.
  
  
  CONCLUSIONS
  We found FDG-PET/CT to be a helpful tool in critically ill neurological patients. The results of the FDG-PET/CT had direct therapeutic consequences in the 12 true-positive cases. In 24 of the 29 negative cases, FDG-PET/CT helped exclude alternative diagnoses and/or influenced therapy. Our findings demonstrate the feasibility and diagnostic benefit of FDG-PET/CT in this group of patients.
authors.affiliation: Department of Intensive Care, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Knut Kurt William
authors.initials: KK
authors.lastname: Kampe
authors.affiliation: Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Rotermund
authors.affiliation: Nuclear Medicine, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Milena
authors.initials: M
authors.lastname: Tienken
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Götz
authors.initials: G
authors.lastname: Thomalla
authors.affiliation: Diagnostic and Interventional Radiology, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Regier
authors.affiliation: Nuclear Medicine, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Klutmann
authors.affiliation: Department of Intensive Care, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kluge
keywords: FDG-PET/CT; cerebral vasculitis; critical care; paraneoplastic; sepsis