FDG PET and PET?CT in the diagnosis of infection and inflammation.ppt
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FDG PET and PET?CT in the diagnosis of infection and inflammation
O. Belohlavek and M. Jaruskova
PET Center, Na Homolce Hospital, Prague
Infection and inflammation
Inflammation (immune reaction)
* Sterile
* Reactive/repair changes (after surgery, after irradiation)
* Reactions to foreign bodies (endoprothesis)
* Reactions to modified cells (tumors)
* Autoimmune disease (RA, IBD, vasculitis, SLE)
* Infection (reaction against microorganisms)
* Acquired (SPN, spondylodiscitis)
* Iatrogenic (after an invasive examination or surgery)
Common symptoms
Local
* Pain
* Swelling
* Redness
* Warmth
Laboratory
* Increased number of WBC
* Higher proportion of non-segmented neutrophils
* Increased erythrocyte sedimentation rate (ESR)
* Increased level of C-reactive protein (CRP)
Clinical situations
Fever of unknown origin (FUO)
* Autoimmune diseases
* Neoplasm
* Infection
Infection after surgery
Low back pain
Role of imaging
CT and MRI
* Excellent spatial resolution
* Surgical planning
* Biopsy guidance
Limitations of anatomic imaging
* Distorted tissue post surgery
* Scar tissue
* Orthopedic prostheses
2-[18F]fluoro-2-deoxy-D-glucose (FDG): Non-specific tracer
Imaging technique*
Patient preparation (the same as an oncology scan)
* Prior to scan:
* Fast >6 hours
* Good hydration (no sugar)
* Limit strenuous exercise for 3 days
* Special preparation for patients with diabetes
* For the scan:
* Oral contrast media (diluted iodine-based) in case of PET?CT
* I.V. administration of FDG
* Uptake time of 60-90 minutes
*Any of the protocol(s) presented herein are for informational purposes are not meant to substitute for clinician judgment in how best to use any medical devices.It is the clinician who makes all diagnostic determinations based upon education, learning, and experience.
Imaging technique
Data acquisition (the same as an oncology scan)
* FOV: torso at a minimum, lower extremities recommended in case of FUO or endoprosthesis
* I.V. contrast (PET?CT) is recommended for vascular infection
* Spiral CT
Data processing (the same as an oncology scan)
* Multiplanar reconstruction of PET and CT, MIP in PET
* Review of AC and non-AC PET scans (essential for implants)
* Review of CT in lung, bone and soft tissue windows
* Review fused images
* Interpretation by a physician skilled in both imaging modalities
Fever of unknown origin(FUO)
Fever of unknown origin(FUO)
Fever of unknown origin (FUO)
Infection associated with implants
Infection associated with implants
Infection associated with implants
Infection associated with implants
Low back pain
Limitations of FDG PET and PET?CT
Limitations of FDG PET and PET?CT
Conclusion
FDG PET?CT:
* A sensitive modality for detection of inflammation
* Limited to macroscopic foci (e.g. large vessels)
* Low sensitivity in the brain, heart, urinary tract
* In many cases not specific enough to determine the ethiology of a disease
* False positives: bowels and prostheses
* May replace other NM procedures (67Ga, WBC)
* Higher sensitivity
* Same day results
* No in vitro blood labeling
* Lower radiation exposure compared to 67Ga
* Benefits may outweigh the higher cost of the examination
FDG PET and PET?CT in the diagnosis of infection and inflammation
O. Belohlavek and M. Jaruskova
PET Center, Na Homolce Hospital, Prague
Infection and inflammation
Inflammation (immune reaction)
* Sterile
* Reactive/repair changes (after surgery, after irradiation)
* Reactions to foreign bodies (endoprothesis)
* Reactions to modified cells (tumors)
* Autoimmune disease (RA, IBD, vasculitis, SLE)
* Infection (reaction against microorganisms)
* Acquired (SPN, spondylodiscitis)
* Iatrogenic (after an invasive examination or surgery)
Common symptoms
Local
* Pain
* Swelling
* Redness
* Warmth
Laboratory
* Increased number of WBC
* Higher proportion of non-segmented neutrophils
* Increased erythrocyte sedimentation rate (ESR)
* Increased level of C-reactive protein (CRP)
Clinical situations
Fever of unknown origin (FUO)
* Autoimmune diseases
* Neoplasm
* Infection
Infection after surgery
Low back pain
Role of imaging
CT and MRI
* Excellent spatial resolution
* Surgical planning
* Biopsy guidance
Limitations of anatomic imaging
* Distorted tissue post surgery
* Scar tissue
* Orthopedic prostheses
2-[18F]fluoro-2-deoxy-D-glucose (FDG): Non-specific tracer
Imaging technique*
Patient preparation (the same as an oncology scan)
* Prior to scan:
* Fast >6 hours
* Good hydration (no sugar)
* Limit strenuous exercise for 3 days
* Special preparation for patients with diabetes
* For the scan:
* Oral contrast media (diluted iodine-based) in case of PET?CT
* I.V. administration of FDG
* Uptake time of 60-90 minutes
*Any of the protocol(s) presented herein are for informational purposes are not meant to substitute for clinician judgment in how best to use any medical devices.It is the clinician who makes all diagnostic determinations based upon education, learning, and experience.
Imaging technique
Data acquisition (the same as an oncology scan)
* FOV: torso at a minimum, lower extremities recommended in case of FUO or endoprosthesis
* I.V. contrast (PET?CT) is recommended for vascular infection
* Spiral CT
Data processing (the same as an oncology scan)
* Multiplanar reconstruction of PET and CT, MIP in PET
* Review of AC and non-AC PET scans (essential for implants)
* Review of CT in lung, bone and soft tissue windows
* Review fused images
* Interpretation by a physician skilled in both imaging modalities
Fever of unknown origin(FUO)
Fever of unknown origin(FUO)
Fever of unknown origin (FUO)
Infection associated with implants
Infection associated with implants
Infection associated with implants
Infection associated with implants
Low back pain
Limitations of FDG PET and PET?CT
Limitations of FDG PET and PET?CT
Conclusion
FDG PET?CT:
* A sensitive modality for detection of inflammation
* Limited to macroscopic foci (e.g. large vessels)
* Low sensitivity in the brain, heart, urinary tract
* In many cases not specific enough to determine the ethiology of a disease
* False positives: bowels and prostheses
* May replace other NM procedures (67Ga, WBC)
* Higher sensitivity
* Same day results
* No in vitro blood labeling
* Lower radiation exposure compared to 67Ga
* Benefits may outweigh the higher cost of the examination