18F-Fluorodeoxyglucose positron emission tomography and infectious diseases: current applications and future perspectives

Bassetti, Matteo; Carnelutti, Alessia; Muser, Daniele; Righi, Elda; Petrosillo, Nicola; Di Gregorio, Fernando; Werner, Thomas J.; Alavi, Abass

Current Opinion in Infectious Diseases: April 2017 - Volume 30 - Issue 2 - p 192–200
doi: 10.1097/QCO.0000000000000354

Purpose of review: 18F-Fluorodeoxyglucose positron emission tomography/computed tomography is a well-established technique for diagnosis and management of a number of neoplastic conditions. However, in recent years the body of literature regarding its potential role in infectious diseases has progressively increased, with promising results.

Recent findings: So far 18F-fluorodeoxyglucose positron emission tomography/computed tomography has a well-established role and is recommended by guidelines only in a few settings, such as prosthetic valve endocarditis, vascular device infections, and chronic osteomyelitis. However, even the lack of large, prospective randomized trials, an increasing number of small series and case reports suggest a potential role in the diagnosis, disease staging, and monitoring of treatment response of several other infective conditions.

Summary: In this article, we summarize the available evidence and potential future applications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the diagnosis and management of infectious diseases.

aInfectious Diseases Division, Santa Maria Misericordia University Hospital

bCardiovascular Medicine Division, Santa Maria Misericordia University Hospital, Udine

cNational Institute for Infectious Diseases Lazzaro Spallanzani-INMI IRCCS, Rome

dNuclear Medicine Division, Santa Maria Misericordia University Hospital, Udine, Italy

eDivision of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Dr Matteo Bassetti, MD, PhD, Clinica Malattie Infettive, Azienda Ospedaliera Universitaria Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy. Tel: +39 0432 559355; fax: +39 0432 559360; e-mail: mattba@tin.it

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In the last few years, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) has shown an increasing role in nononcologic fields like infective and inflammatory disorders. Infectious diseases are characterized by a wide spectrum of clinical manifestations ranging from mild, nonspecific symptoms to septic shock [1▪]. Common imaging techniques like echography, computed tomography (CT), and magnetic resonance imaging (MRI) provide structural data that may not be sufficient to differentiate infective lesions from other conditions. Moreover, artifacts related to metallic implants may deeply affect the diagnostic accuracy of such methodologies. Combining functional and anatomic data is of great value to confirm/rule out the disease when infection is suspected and to diagnose multiple organ involvement. In this setting, scintigraphic techniques like radiolabeled white blood cell imaging have been developed. Unfortunately, such techniques are affected by a substantial lack of sensitivity particularly in hematopoietic structures [2,3]. Moreover, the planar imaging may affect precise localization and they are usually expensive and time consuming. Techniques based on evaluation of glucose metabolism (FDG-uptake), like PET/CT and more recently PET/MRI, have overcome those limitations, increasing the use of nuclear imaging in the setting of infectious diseases. Finally, assessment of therapy response by serial PET/CT scans can lead to a patient-tailored approach either for the choice of specific drugs in case of failure of first-line therapies or for the proper timing of drug discontinuation. The optimal indications for PET/CT in case of suspected infections and the appropriate time to repeat the scan remains unclear, with information mostly from small retrospective series and a few meta-analyses. In this review, we summarize the evidence for the use and the potential future applications of FDG-PET in the setting of infectious diseases.

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Central nervous system (CNS) infections represent a major problem in immunocompromised hosts (i.e., patients with HIV/AIDS and patients affected by hematologic malignancies). In patients with HIV infection, differentiation between malignant and infectious CNS lesions is challenging and in many cases requires a brain biopsy to reach a conclusive diagnosis [4]. The first studies suggesting a potential role of FDG-PET/CT in this setting date to the 1990s and reported a significantly greater FDG-uptake in malignant CNS lesions compared with infective foci [5–7]. In a recent prospective analysis involving 10 HIV-positive patients with MRI evidence of equivocal CNS lesions, FDG-PET/CT was demonstrated to be able to correctly differentiate CNS lymphoma (high metabolic activity) from cerebral toxoplasmosis (reduced intralesional metabolic activity compared with adjacent brain parenchyma) when the diagnosis was subsequently confirmed by brain biopsy. Potential pitfalls were found only in one patient presenting with hemorrhagic brain metastases and in one case of progressive multifocal leukoencephalopathy [8]. All together, these data suggest the ability of FDG-PET/CT to differentiate malignant from nonmalignant CNS lesions, potentially avoiding the need for brain biopsy in selected patients. However, the daily use of FDG-PET/CT in clinical practice still requires further investigations in larger prospective cohorts. Moreover, there is a complete lack of information on the potential role of FDG-PET/CT in other kinds of immunocompromised hosts with well-recognized risk factors for opportunistic CNS infections (i.e., hematopoietic stem-cell transplant and solid-organ transplant recipients) [9,10]. In the setting of nonimmunocompromised patients, a recent small study found FDG-PET effective in discriminating brain abscess from necrotizing high-grade gliomas [11]. Isolate case reports have also suggested a potential role of FDG-PET in the diagnosis of meningomyelitis, ventriculitis, herpes simplex virus encephalitis, neurosyphilis, mucormycosis, and neurocysticercosis [12–16].

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Among all the infective conditions affecting the respiratory tract, pulmonary tuberculosis (TB) represents the field wherein FDG-PET/CT has been more extensively studied. Active tuberculous lesions are generally characterized by a large amount of activated inflammatory cells, resulting in an intense FDG-uptake [17▪]. Unfortunately, as pointed out by a recent meta-analysis, the high sensitivity of FDG-PET is countered by a substantial lack of specificity in distinguishing tuberculous pulmonary lesions from other conditions showing high-glucose metabolism like lung cancer, particularly in endemic areas [18,19]. This scenario is further complicated by the fact that tuberculous nodules may present variable degrees of inflammatory activity, resulting in a wide variability of FDG-uptake and different radiological patterns [20,21]. However, when the diagnosis of TB is well established, FDG-PET/CT has been shown to be highly effective in assessing early treatment response [22]. In particular, a significant decrease in FDG-uptake has been found after 1 month of effective antimicrobial therapy, either in pulmonary and extrapulmonary disease, including lymph nodal and skeletal tuberculosis [22–26]. The opportunity to evaluate early treatment response seems particularly attractive considering the possibility to promptly modify the antimicrobial regimen in patients with multidrug-resistant isolates or the possibility to consider alternative diagnosis in cases without microbiological documentation available [27,28].

A potential role of FDG-PET beyond TB has been recently pointed out in the setting of invasive fungal infections [29]. Pulmonary lesions related to Aspergillus spp. can be responsible for a wide range of clinical manifestations and radiologic patterns potentially mutating one into the other depending on the immune status of the host (Fig. 1). In this misleading scenario, several case reports have described high FDG-uptake in patients with pulmonary aspergillosis [30–35]. Kim et al. retrospectively reviewed 24 consecutive patients with diagnosis of pulmonary aspergillosis presenting with a lung mass or fever of unknown origin who underwent PET/CT evaluation, finding a significant different FDG-PET/CT pattern in invasive and noninvasive forms of aspergillosis. Specifically, invasive forms were characterized by a hypermetabolic nodular pattern, whereas noninvasive forms showed an isometabolic halo or nodular pattern [36]. However, as mentioned above for TB, a nonnegligible overlap of FDG-PET/CT findings exists between pulmonary aspergillosis and lung cancer, making standalone FDG-PET/CT not sufficient for a conclusive diagnosis [37]. Conversely, an attractive role for FDG-PET in pulmonary aspergillosis might be represented by evaluation of treatment response as demonstrated by complete reversion to normality of FDG-PET/CT findings after appropriate antimicrobial therapy for invasive aspergillosis [38,39]. In current clinical practice, radiologic follow-up of aspergillosis is mostly done by serial CT scans and represents a challenge, because patients are frequently affected by underlying pulmonary diseases (i.e., chronic obstructive pulmonary disease, previous TB, cancer) with baseline CT pathologic findings of difficult interpretation [40,41]. In this setting, FDG-PET/CT may represent a very attractive tool, but further investigations with large prospective studies are needed before safely recommending its routinely use.

A possible application of FDG-PET in diagnosis and monitoring of treatment response has been recently described in other pulmonary fungal infections like Pneumocystis jirovecii pneumonia, cryptococcosis, actinomycosis, and coccidiomycosis as well as for the diagnosis and management of atypical mycobacteriosis [42–48].

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Molecular nuclear imaging has a well-established role in the setting of infective endocarditis and has recently been introduced as a major criterion for the diagnosis of prosthetic valve infections in international guidelines (Fig. 2) [49,50]. The diagnosis of infective endocarditis is multiparametric and includes clinical, microbiological, and imaging findings classically summarized in the Duke's criteria [51]. Original Duke's criteria considered echocardiography as the only imaging tool for diagnosis of infective endocarditis. In particular, findings like oscillating intracardiac masses on valves or on implanted material as well as abscess and new dehiscence of prosthetic valves were considered highly suspicious and led to the diagnosis of infective endocarditis if combined with other microbiological (positive blood cultures for typical infective endocarditis organisms) or clinical (i.e., predisposing heart conditions, vascular phenomena) elements. Overall sensitivity of Duke's criteria reaches 80% but significantly decreases to less than 30% when they are applied to prosthetic valve endocarditis (PVE) and pace-maker or implantable cardioverter-defibrillator leads infective endocarditis [52]. This lack of sensitivity is mostly driven by inconclusive or normal echocardiography [53,54].

The addition of FDG-PET to standard echocardiography was shown to significantly improve diagnostic sensitivity and specificity, reducing the rate of misdiagnosed infective endocarditis particularly in the setting of PVE [55,56▪]. Moreover, FDG-PET has shown to be extremely helpful in local and systemic disease staging. Perivalvular extensions can be extremely harmful leading to conditions like complete heart block that requires urgent medical care and are frequently missed by standard echocardiography because of its limited resolution power in case of small abscesses or artifacts preventing a clear evaluation in case of valvular annular calcifications or metallic structures [57]. Whole-body PET scan can also allow for early identification of septic embolisms, coexistence of vertebral osteomyelitis or infective endocarditis associated with occult cancer that may deeply modify the therapeutic approach (i.e., large splenic abscesses or splenic rupture may require splenectomy) [58–60].

Abnormal FDG-uptake should be considered with extreme caution in patients who recently underwent cardiac surgery, because of the postoperatory inflammatory tissue reaction leading to nonspecific increase in glycolytic activity. In this regard, abnormal FDG-uptake around the site of a prosthetic valve implanted less than 3 months before should be considered aspecific [49].

Cardiovascular electronic implanted device infections represent a real challenge for the difficulty in accurate diagnosis and their relevant clinical consequences (need for prolonged antibiotic therapy associated with complete device removal in patients frequently dependent from the device). Infections of the subcutaneous pocket of the device can be easily suspected by clinical examination (presence of local signs of inflammation) whereas infection limited or extending to the electrode leads is extremely difficult to diagnose [61]. Documented vegetations on device leads and positive blood cultures represent the cornerstones of the diagnosis. Presence of aseptic thrombi along the lead course is a common finding but their differentiation from septic vegetations in patients with unexplained fever can be extremely challenging. In this difficult setting, FDG-PET was shown to be able to confirm the spread of infection along the cardiovascular electronic implanted device. As mentioned above for PVE, even in this setting, abnormal FDG-uptake between 4 and 8 weeks after device implantation should be considered with extreme caution [62].

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Although acute osteomyelitis usually does not represent a diagnostic challenge by putting together local signs of inflammation (i.e., reduced motion, pain, and tenderness of the involved bone) with conventional imaging findings, accurate diagnosis of chronic osteomyelitis is often difficult [63]. Chronic osteomyelitis is a severe orthopedic complication which may be extremely difficult to diagnose and treat, particularly in presence of pre-existing alterations because of previous trauma or surgery. Compared with conventional imaging or other nuclear medicine modalities, FDG-PET has shown a robust sensitivity and specificity reaching 96 and 91%, respectively, in a published meta-analysis [64]. More recently, another large meta-analysis by Wang et al.[65] confirmed this result, finding a pooled sensitivity and specificity of approximately 92% for the diagnosis of chronic osteomyelitis compared with other radionuclide imaging modalities like labeled leukocyte scintigraphy, thus supporting the routine use of FDG-PET/CT in clinical practice.

In the subset of spondylodiscitis FDG-PET/CT should probably be considered the imaging modality of choice having demonstrated an overall sensitivity of 97% and specificity of 88% even in patients treated with antibiotics prior to imaging [66▪▪,67,68] or in cases of uncommon pathogens like Mycobacterium tuberculosis or Brucella[69–71]. Interestingly, FDG-PET was demonstrated to be capable to distinguish degenerative disc changes from infection, and is unaffected by the presence of metallic implants, which may limit the diagnostic accuracy of other imaging modalities (Fig. 2) [66▪▪]. Moreover, FDG-PET/CT has recently shown a higher performance compared with MRI in early diagnosis of spondylodiscitis within 2 weeks after symptoms onset [72]. The potential role of FDG-PET/CT in evaluation of treatment response has been proposed and looks extremely attractive in a condition that often requires several months of antibiotic treatment, but larger, prospective studies are required [73–75].

Prosthetic joint infections represent a relevant clinical problem and a diagnostic challenge. The risk of infective complications after initial arthroplasty is estimated within 1–4% and approximately 25% after revision arthroplasty. Moreover, even if approximately 10% of patients suffer from chronic pain after surgery, only 1% is finally diagnosed having a periprosthetic infection [76]. Aseptic loosening is a common long-term complication of hip arthroplasty related with significant chronic pain and it can be extremely difficult to differentiate from superimposed infection. Standard FDG-PET imaging (not PET/CT) is highly sensitive and is not affected by artifacts caused by metal implants. Unfortunately, noninfectious reactions around the neck of the prosthesis are common findings even years after surgery [77]. Consequently, increased FDG-uptake in this location should not be considered suggestive of infection whereas infections usually show increased FDG-uptake at the interface between prosthesis and bone. According to this finding, patterns of FDG-uptake seem to be more important than intensity of uptake in differentiating septic and aseptic loosening [78]. Imaging with FDG-PET/CT has been reported also for the diagnosis of implant-related infections, as suggested by studies conducted both in murine models and humans [79,80]. The major limitation is represented by early diagnosis of postsurgical and posttraumatic osteomyelitis due to a substantial lack of specificity for differentiating acute infection from sterile inflammatory reaction related to normal healing, particularly during the first 2 weeks after surgery/trauma [81,82].

In complicated diabetic foot, FDG-PET/CT has been demonstrated not only to be highly sensitive in excluding osteomyelitis but also highly specific in differentiation from Charcot neuropathy compared with MRI that often shows misleading findings caused by soft tissue edema [83–85].

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Monitoring of treatment response currently represents the most promising application of FDG-PET/CT in the setting of infectious diseases [86]. Establishing optimal treatment duration is of great value considering potential drug toxicity, resistance selection, and healthcare costs related to prolonged antibiotic therapies. While evaluating infective lesions, FDG-PET analysis is often based on visual-normalized interpretation with only a few reports analyzing a quantitative approach and a substantial lack of standardized methods [87]. Quantitative FDG-PET analysis has been proven to be more sensitive and specific than visual-normalized interpretation and to be superior in the evaluation of response to therapy in noninfective disorders like sarcoidosis and hematologic malignancies [88]. Visual reduction of FDG-uptake has already been associated with treatment response in various conditions like pulmonary tuberculosis, aspergillosis, and spondylodiscitis. However, it remains to be determined how quantitative changes in FDG-uptake are associated with improved clinical outcomes as well as the clinical relevance of persistent residual FDG-uptake after effective treatment. Moreover, even if available data on tuberculosis and spondylodiscitis suggest the possibility of observing a significant reduction of FDG-uptake after only 1 month of effective therapy, the optimal timing for serial FDG-PET/CT scans has not been established yet. In the future, quantitative parameters taking into account the extension of inflammation in terms of FDG-avid lesion volume (metabolic volume) and/or product of standardized uptake value and lesion volume (glycolytic activity) may help to accurately assess the severity of the disease and objectify treatment response guiding escalation/de-escalation therapy and treatment duration. The potential advantages and limitations of FDG-PET/TC in different settings in infectious diseases are reported in Table 1. Table 2 describes some possible fields of application of FDG-PET/TC for the management of infectious diseases into the everyday clinical practice.

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The data presented in this review clearly demonstrate how FDG-PET/CT will increasingly play a major role in the assessment of patients affected by a wide range of infectious diseases like osteomyelitis, infected prostheses, endocarditis, and even lung and CNS infections. FDG-PET has proven to be an excellent imaging modality not only for the diagnosis, but also for the staging and evaluation of treatment response overcoming many limitations associated with structural imaging techniques or conventional scintigraphic methodologies. The ability of FDG-PET to quantify disease activity seems particularly attractive, providing the possibility to avoid invasive diagnostic tests, to identify multifocal infection and to monitor early response to antibiotic treatment. At this juncture, FDG-PET should be used to improve the clinical management of infectious disorders although further validation with prospective randomized/controlled studies is strongly encouraged.

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Financial support and sponsorship


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Conflicts of interest

There are no conflicts of interest.

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Papers of particular interest, published within the annual period of review, have been highlighted as:

▪ of special interest

▪▪ of outstanding interest

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1▪. Hess S, Alavi A, Basu S. PET-based personalized management of infectious and inflammatory disorders. PET Clin 2016; 11:351–361.

A review article regarding the role of FDG-PET/CT in the management of infectious and inflammatory disorders.

2. Kwee TC, Basu S, Alavi A. Letter: Opinion on favoring labeled leukocyte imaging over 18F-FDG-PET for diagnosing prosthetic joint infection: rectifying ongoing misconceptions. J Nucl Med 2016; [Epub ahead of print].
3. Basu S, Kwee TC, Saboury B, et al. FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clin Nucl Med 2014; 39:609–615.
4. Albarillo F, O’Keefe P. Opportunistic neurologic infections in patients with acquired immunodeficiency syndrome (AIDS). Curr Neurol Neurosci Rep 2016; 16:10.
5. Heald AE, Hoffman JM, Bartlett JA, Waskin HA. Differentiation of central nervous system lesions in AIDS patients using positron emission tomography (PET). Int J STD AIDS 1996; 7:337–346.
6. Menendez JA, Lilien DL, Nanda A, et al. Use of fluorodeoxyglucose-positron emission tomography for the differentiation of cerebral lesions in patients with acquired immune deficiency syndrome. Neurosurg Focus 2000; 8:1–4.
7. Villringer K, Jäger H, Dichgans M, et al. Differential diagnosis of CNS lesions in AIDS patients by FDG-PET. J Comput Assist Tomogr 1995; 19:532–536.
8. Westwood TD, Hogan C, Julyan PJ, et al. Utility of FDG-PETCT and magnetic resonance spectroscopy in differentiating between cerebral lymphoma and non-malignant CNS lesions in HIV-infected patients. Eur J Radiol 2013; 82:e374–e379.
9. Saiz A, Graus F. Neurologic complications of hematopoietic cell transplantation. Semin Neurol 2010; 30:287–295.
10. Gavaldà J, Meije Y, Fortún J, et al. Invasive fungal infections in solid organ transplant recipients. Clin Microbiol Infect 2014; 20:27–48.
11. Shi X, Yi C, Wang X, et al. 13N-ammonia combined with 18F-FDG could discriminate between necrotic high-grade gliomas and brain abscess. Clin Nucl Med 2015; 40:195–199.
12. Tseng J-R, Su Y-Y, Lee M-H, et al. Clinical usefulness of FDG PET/CT in the detection of unusual central nervous system infections. J Neurol Sci 2014; 345:244–247.
13. Schillaci O, Chiaravalloti A, Chiaravalloti A, et al. 18F-FDG PET/MR in herpes simplex virus encephalitis: a case study. Rev Esp Med Nucl E Imagen Mol 2014; 33:249–250.
14. Omer TA, Fitzgerald DE, Sheehy N, Doherty CP. Neurosyphilis presenting with unusual hippocampal abnormalities on magnetic resonance imaging and positron emission tomography scans: a case report. J Med Case Rep 2012; 6:389.
15. Altini C, Niccoli AA, Ferrari C, et al. (18)F-FDG PET/CT contribution to diagnosis and treatment response of rhino-orbital-cerebral mucormycosis. Hell J Nucl Med 2014; 18:68–70.
16. Jolepalem P, Wong C-YO. Neurocysticercosis on 18F-FDG PET/MRI: co-registered images. Clin Nucl Med 2014; 39:e110–e113.
17▪. Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis 2015; 32:87–93.

A review describing imaging findings in both pulmonary and extrapulmonary tuberculosis, including FDG-PET/CT patterns.

18. Deppen SA, Blume JD, Kensinger CD, et al. Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis. JAMA 2014; 312:1227–1236.
19. Vorster M, Sathekge MM, Bomanji J. Advances in imaging of tuberculosis: the role of 18F-FDG PET and PET/CT. Curr Opin Pulm Med 2014; 20:287–293.
20. Soussan M, Brillet P-Y, Mekinian A, et al. Patterns of pulmonary tuberculosis on FDG-PET/CT. Eur J Radiol 2012; 81:2872–2876.
21. Yago Y, Yukihiro M, Kuroki H, et al. Cold tuberculous abscess identified by FDG PET. Ann Nucl Med 2005; 19:515–518.
22. Martinez V, Castilla-Lievre MA, Guillet-Caruba C, et al. F-FDG PET/CT in tuberculosis: an early noninvasive marker of therapeutic response. Int J Tuberc Lung Dis 2012; 16:1180–1185.
23. Park YH, Yu CM, Kim ES, et al. Monitoring therapeutic response in a case of extrapulmonary tuberculosis by serial F-18 FDG PET/CT. Nucl Med Mol Imaging 2012; 46:69–72.
24. Hu N, Tan Y, Cheng Z, et al. FDG PET/CT in monitoring antituberculosis therapy in patient with widespread skeletal tuberculosis. Clin Nucl Med 2015; 40:919–921.
25. Dureja S, Sen IB, Acharya S. Potential role of F18 FDG PET-CT as an imaging biomarker for the noninvasive evaluation in uncomplicated skeletal tuberculosis: a prospective clinical observational study. Eur Spine J 2014; 23:2449–2454.
26. Arbind A, D′souza M, Jaimini A, et al. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in response monitoring of extra-pulmonary tuberculosis. Indian J Nucl Med 2016; 31:59–61.
27. Chen RY, Dodd LE, Lee M, et al. PET/CT imaging correlates with treatment outcome in patients with multidrug-resistant tuberculosis. Sci Transl Med 2014; 6: 265ra166.
28. Shejul Y, Chhajed PN, Basu S. 18F-FDG PET and PET/CT in diagnosis and treatment monitoring of pyrexia of unknown origin due to tuberculosis with prominent hepatosplenic involvement. J Nucl Med Technol 2014; 42:235–237.
29. Sharma P, Mukherjee A, Karunanithi S, et al. Potential role of 18F-FDG PET/CT in patients with fungal infections. AJR Am J Roentgenol 2014; 203:180–189.
30. Nakajima H, Sawaguchi H, Hoshi S, et al. [Intense 18F-fluorodeoxyglucose uptake due to allergic bronchopulmonary aspergillosis]. Arerugi 2009; 58:1426–1432.
31. Mucha K, Foroncewicz B, Orłowski T, et al. Atypical presentation of invasive pulmonary aspergillosis in a liver transplant recipient. Ann Transplant 2013; 18:238–242.
32. Garcia-Olivé I, Andreo F, Rosiñol O, et al. Bronchial stump aspergillosis after lobectomy for lung cancer as an unusual cause of false positive fluorodeoxyglucose positron emission tomography and computed tomography: a case report. J Med Case Rep 2011; 5:72.
33. Casal RF, Adachi R, Jimenez CA, et al. Diagnosis of invasive aspergillus tracheobronchitis facilitated by endobronchial ultrasound-guided transbronchial needle aspiration: a case report. J Med Case Rep 2009; 3:9290.
34. Ahn B-C, Lee S-W, Lee J, et al. Pulmonary aspergilloma mimicking metastasis from papillary thyroid cancer. Thyroid 2011; 21:555–558.
35. Baxter CG, Bishop P, Low SE, et al. Pulmonary aspergillosis: an alternative diagnosis to lung cancer after positive [18F]FDG positron emission tomography. Thorax 2011; 66:638–640.
36. Kim JY, Yoo J-W, Oh M, et al. (18)F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography findings are different between invasive and noninvasive pulmonary aspergillosis. J Comput Assist Tomogr 2013; 37:596–601.
37. Zhang Y, Li B, Shi H, et al. Sarcomatoid carcinoma of the lung mimics aspergilloma on 18F-FDG PET/CT. Hell J Nucl Med 2015; 18:268–270.
38. Ozsahin H, von Planta M, Müller I, et al. Successful treatment of invasive aspergillosis in chronic granulomatous disease by bone marrow transplantation, granulocyte colony-stimulating factor-mobilized granulocytes, and liposomal amphotericin-B. Blood 1998; 92:2719–2724.
39. Hot A, Maunoury C, Poiree S, et al. Diagnostic contribution of positron emission tomography with [18F]fluorodeoxyglucose for invasive fungal infections. Clin Microbiol Infect 2011; 17:409–417.
40. Patterson TF, Thompson GR, Denning DW, et al. Executive summary: Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:433–442.
41. Denning DW. The ambitious ‘95–95 by 2025’ roadmap for the diagnosis and management of fungal diseases. Thorax 2015; 70:613–614.
42. Kono M, Yamashita H, Kubota K, et al. FDG PET imaging in pneumocystis pneumonia. Clin Nucl Med 2015; 40:679–681.
43. Lee C-H, Tzao C, Chang T-H, et al. Case of pulmonary cryptococcosis mimicking hematogeneous metastases in an immunocompetent patient: value of absent 18F-fluorodeoxyglucose uptake on positron emission tomography/CT scan. Korean J Radiol 2013; 14:540–543.
44. Guy JP, Raza S, Bondi E, et al. Cryptococcus pneumonia presenting in an immunocompetent host with pulmonary asbestosis: a case report. J Med Case Rep 2012; 6:170.
45. Wang J, Ju H-Z, Yang M-F. Pulmonary cryptococcosis and cryptococcal osteomyelitis mimicking primary and metastatic lung cancer in (18)F-FDG PET/CT. Int J Infect Dis 2014; 18:101–103.
46. Ghimire P, Sah AK. Pulmonary cryptococcosis and tuberculoma mimicking primary and metastatic lung cancer in 18F-FDG PET/CT. Nepal Med Coll J 2011; 13:142–143.
47. Qiu L, Lan L, Feng Y, et al. Pulmonary actinomycosis imitating lung cancer on (18)F-FDG PET/CT: a case report and literature review. Korean J Radiol 2015; 16:1262–1265.
48. Treglia G, Taralli S, Calcagni ML, et al. Is there a role for fluorine 18 fluorodeoxyglucose-positron emission tomography and positron emission tomography/computed tomography in evaluating patients with mycobacteriosis? A systematic review. J Comput Assist Tomogr 2011; 35:387–393.
49. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075–3128.
50. Millar BC, Prendergast BD, Alavi A, et al. 18FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection. Int J Cardiol 2013; 167:1724–1736.
51. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30:633–638.
52. Habib G, Derumeaux G, Avierinos J-F, et al. Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol 1999; 33:2023–2029.
53. Hill EE, Herijgers P, Claus P, et al. Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome. Am Heart J 2007; 154:923–928.
54. Vieira MLC. Repeated echocardiographic examinations of patients with suspected infective endocarditis. Heart 2004; 90:1020–1024.
55. Saby L, Laas O, Habib G, et al. Positron emission tomography/computed tomography for diagnosis of prosthetic valve endocarditis. J Am Coll Cardiol 2013; 61:2374–2382.
56▪. Musso M, Petrosillo N. Nuclear medicine in diagnosis of prosthetic valve endocarditis: an update. BioMed Res Int 2015; 2015:127325.

A review of the available evidence regarding the role of nuclear medicine techniques, including FDG-PET/CT, in the diagnosis of prosthetic valve endocarditis.

57. Thuny F, Gaubert J-Y, Jacquier A, et al. Imaging investigations in infective endocarditis: current approach and perspectives. Arch Cardiovasc Dis 2013; 106:52–62.
58. Bonfiglioli R, Nanni C, Morigi JJ, et al. 18F-FDG PET/CT diagnosis of unexpected extracardiac septic embolisms in patients with suspected cardiac endocarditis. Eur J Nucl Med Mol Imaging 2013; 40:1190–1196.
59. Vind SH, Hess S. Possible role of PET/CT in infective endocarditis. J Nucl Cardiol 2010; 17:516–519.
60. Thomsen RW, Farkas DK, Friis S, et al. Endocarditis and risk of cancer: a Danish Nationwide Cohort Study. Am J Med 2013; 126:58–67.
61. Klug D, Balde M, Pavin D, et al. Risk factors related to infections of implanted pacemakers and cardioverter-defibrillators: results of a large prospective study. Circulation 2007; 116:1349–1355.
62. Sarrazin J-F, Philippon F, Tessier M, et al. Usefulness of fluorine-18 positron emission tomography/computed tomography for identification of cardiovascular implantable electronic device infections. J Am Coll Cardiol 2012; 59:1616–1625.
63. Kwee TC, Basu S, Alavi A. Should the nuclear medicine community continue to underestimate the potential of 18F-FDG-PET/CT with present generation scanners for the diagnosis of prosthetic joint infection? Nucl Med Commun 2015; 36:756–757.
64. Termaat MF, Raijmakers PGHM, Scholten HJ, et al. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am 2005; 87:2464–2471.
65. Wang G, Zhao K, Liu Z, et al. A meta-analysis of fluorodeoxyglucose-positron emission tomography versus scintigraphy in the evaluation of suspected osteomyelitis. Nucl Med Commun 2011; 32:1134–1142.
66▪▪. Prodromou ML, Ziakas PD, Poulou LS, et al. FDG PET is a robust tool for the diagnosis of spondylodiscitis: a meta-analysis of diagnostic data. Clin Nucl Med 2014; 39:330–335.

A meta-analysis supporting the use of FDG-PET/CT as a diagnostic test in suspected spondylodiscitis.

67. Gunes BY, Onsel C, Sonmezoglu K, et al. Diagnostic value of F-18 FDG PET/CT in patients with spondylodiscitis: is dual time point imaging time worthy? Diagn Microbiol Infect Dis 2016; 85:381–385.
68. Fuster D, Tomás X, Granados U, et al. Prospective comparison of whole-body (18)F-FDG PET/CT and MRI of the spine in the diagnosis of haematogenous spondylodiscitis: response to comments by Soussan. Eur J Nucl Med Mol Imaging 2015; 42:356–357.
69. Cobbaert K, Pieters A, Devinck M, et al. Brucellar spondylodiscitis: case report. Acta Clin Belg 2007; 62:304–307.
70. Abdul H, Abdul N, Nordin A. Dual time point imaging of FDG PET/CT in a tuberculous spondylodiscitis. Biomed Imaging Interv J 2010; 6:e18.
71. Ioannou S, Chatziioannou S, Pneumaticos SG, et al. Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan contributes to the diagnosis and management of brucellar spondylodiskitis. BMC Infect Dis 2013; 13:73.
72. Smids C, Kouijzer IJE, Vos FJ, et al. A comparison of the diagnostic value of MRI and (18)F-FDG-PET/CT in suspected spondylodiscitis. Infection 2016; [Epub ahead of print].
73. Nanni C, Boriani L, Salvadori C, et al. FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 2012; 39:1538–1544.
74. Riccio SA, Chu AKM, Rabin HR, Kloiber R. Fluorodeoxyglucose positron emission tomography/computed tomography interpretation criteria for assessment of antibiotic treatment response in pyogenic spine infection. Can Assoc Radiol J 2015; 66:145–152.
75. Skanjeti A, Penna D, Douroukas A, et al. PET in the clinical work-up of patients with spondylodiscitis: a new tool for the clinician? Q J Nucl Med Mol Imaging 2012; 56:569–576.
76. Basu S, Chryssikos T, Moghadam-Kia S, et al. Positron emission tomography as a diagnostic tool in infection: present role and future possibilities. Semin Nucl Med 2009; 39:36–51.
77. Chacko TK, Zhuang H, Stevenson K, et al. The importance of the location of fluorodeoxyglucose uptake in periprosthetic infection in painful hip prostheses. Nucl Med Commun 2002; 23:851–855.
78. Zoccali C, Teori G, Salducca N. The role of FDG-PET in distinguishing between septic and aseptic loosening in hip prosthesis: a review of literature. Int Orthop 2009; 33:1–5.
79. Odekerken JCE, Brans BT, Welting TJM, et al. (18)F-FDG microPET imaging differentiates between septic and aseptic wound healing after orthopedic implant placement: a longitudinal study of an implant osteomyelitis in the rabbit tibia. Acta Orthop 2014; 85:305–313.
80. Shemesh S, Kosashvili Y, Groshar D, et al. The value of 18-FDG PET/CT in the diagnosis and management of implant-related infections of the tibia: a case series. Injury 2015; 46:1377–1382.
81. Govaert GM, Glaudemans AWJM. Nuclear medicine imaging of posttraumatic osteomyelitis. Eur J Trauma Emerg Surg 2016; 42:397–410.
82. Brown TLY, Spencer HJ, Beenken KE, et al. Evaluation of dynamic [18F]-FDG-PET imaging for the detection of acute postsurgical bone infection. PLoS One 2012; 7:e41863.
83. Nawaz A, Torigian DA, Siegelman ES, et al. Diagnostic performance of FDG-PET, MRI, and plain film radiography (PFR) for the diagnosis of osteomyelitis in the diabetic foot. Mol Imaging Biol 2010; 12:335–342.
84. Basu S, Chryssikos T, Houseni M, et al. Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot's neuroarthropathy from osteomyelitis and soft-tissue infection? Nucl Med Commun 2007; 28:465–472.
85. Yang H, Zhuang H, Rubello D, et al. Mild-to-moderate hyperglycemia will not decrease the sensitivity of 18F-FDG PET imaging in the detection of pedal osteomyelitis in diabetic patients. Nucl Med Commun 2016; 37:259–262.
86. Kumar R, Karunanithi S, Zhuang H, Alavi A. Assessment of therapy response by FDG PET in infection and inflammation. PET Clin 2012; 7:233–243.
87. Basu S, Alavi A. Emerging role of FDG-PET for optimal response assessment in infectious diseases and disorders. Expert Rev Anti Infect Ther 2011; 9:143–145.
88. Lee P-I, Cheng G, Alavi A. The role of serial FDG PET for assessing therapeutic response in patients with cardiac sarcoidosis. J Nucl Cardiol 2016; [Epub ahead of print].

18F-fluorodeoxyglucose positron emission tomography; infection; treatment monitoring

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