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Kouijzer, I.J.E.; Kampschreur, L.M.; Wever, P.C.; Hoekstra, C.; Kasteren, M.E.E. van; Jager-Leclercq, M.G.L. de; ... ; Bleeker-Rovers, C.P. (2018)

The value of F-18-FDG PET/CT in diagnosis and during follow-up in 273 patients with chronic Q fever

Article / Letter to editor
In 1%–5% of all acute Q fever infections, chronic Q fever develops, mostly manifesting as endocarditis, infected aneurysms, or infected vascular prostheses. In this study, we investigated the diagnostic value of 18F-FDG PET/CT in chronic Q fever at diagnosis and during follow-up. Methods: All adult Dutch patients suspected of chronic Q fever who were diagnosed since 2007 were retrospectively included until March 2015, when at least one 18F-FDG PET/CT scan was obtained. Clinical data and results from 18F-FDG PET/CT at diagnosis and during follow-up were collected. 18F-FDG PET/CT scans were prospectively reevaluated by 3 nuclear medicine physicians using a structured scoring system. Results: In total, 273 patients with possible, probable, or proven chronic Q fever were included. Of all 18F-FDG PET/CT scans performed at diagnosis, 13.5% led to a change in diagnosis. Q fever–related mortality...Show moreIn 1%–5% of all acute Q fever infections, chronic Q fever develops, mostly manifesting as endocarditis, infected aneurysms, or infected vascular prostheses. In this study, we investigated the diagnostic value of 18F-FDG PET/CT in chronic Q fever at diagnosis and during follow-up. Methods: All adult Dutch patients suspected of chronic Q fever who were diagnosed since 2007 were retrospectively included until March 2015, when at least one 18F-FDG PET/CT scan was obtained. Clinical data and results from 18F-FDG PET/CT at diagnosis and during follow-up were collected. 18F-FDG PET/CT scans were prospectively reevaluated by 3 nuclear medicine physicians using a structured scoring system. Results: In total, 273 patients with possible, probable, or proven chronic Q fever were included. Of all 18F-FDG PET/CT scans performed at diagnosis, 13.5% led to a change in diagnosis. Q fever–related mortality rate in patients with and without vascular infection based on 18F-FDG PET/CT was 23.8% and 2.1%, respectively (P = 0.001). When 18F-FDG PET/CT was added as a major criterion to the modified Duke criteria, 17 patients (1.9-fold increase) had definite endocarditis. At diagnosis, 19.6% of 18F-FDG PET/CT scans led to treatment modification. During follow-up, 57.3% of 18F-FDG PET/CT scans resulted in treatment modification. Conclusion: 18F-FDG PET/CT is a valuable technique in diagnosis of chronic Q fever and during follow-up, often leading to a change in diagnosis or treatment modification and providing important prognostic information on patient survival.
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Q fever
F-18-FDG PET/CT
vascular infection
endocarditis
All authors
Kouijzer, I.J.E.; Kampschreur, L.M.; Wever, P.C.; Hoekstra, C.; Kasteren, M.E.E. van; Jager-Leclercq, M.G.L. de; Nabuurs-Franssen, M.H.; Wegdam-Blans, M.C.A.; Ammerlaan, H.S.M.; Buijs, J.; Geus-Oei, L.F. de; Oyen, W.J.G.; Bleeker-Rovers, C.P.
Date
2018-01-01
Journal
Journal of Nuclear Medicine
Volume
59
Issue
1
Pages
127 - 133
DOI
doi:10.2967/jnumed.117.192492