Abstract
AIMS—To compare whole body positron emission tomography (PET) using fluorine-18-fluoro-2-deoxy-D-glucose (FDG) with computed tomography (CT) in detecting active infective foci in children with chronic granulomatous disease. METHODS—We performed 22 whole body FDG PET studies in seven children with X linked (n = 6) or autosomal recessive (n = 1) CGD. All had clinical signs of infection and/or were evaluated prior to bone marrow transplantation (BMT). Nineteen PET studies were also correlated with chest and/or abdominal CT. All PET scans were interpreted blinded to the CT findings. Diagnoses were confirmed histologically and bacteriologically. RESULTS—We detected 116 lesions in 22 FGD PETs and 126 lesions on 19 CTs. Only two of the latter could be classified reliably as active lesions by virtue of contrast enhancement suggesting abscess formation. PET excluded 59 lesions suspicious for active infection on CT and revealed 49 infective lesions not seen on CT. All seven active infective lesions were identified by PET, allowing targeted biopsy and identification of the infective agent followed by specific antimicrobial treatment, surgery, or subsequent BMT. CONCLUSIONS—Identification of infective organisms is more precise if active lesions are biopsied. CT does not discriminate between active and inactive lesions. Whole body FDG PET can be used to screen for active infective lesions in CGD patients.
Full Text
The Full Text of this article is available as a PDF (180.1 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bakheet S. M., Powe J., Ezzat A., Rostom A. F-18-FDG uptake in tuberculosis. Clin Nucl Med. 1998 Nov;23(11):739–742. doi: 10.1097/00003072-199811000-00003. [DOI] [PubMed] [Google Scholar]
- Bicik I., Bauerfeind P., Breitbach T., von Schulthess G. K., Fried M. Inflammatory bowel disease activity measured by positron-emission tomography. Lancet. 1997 Jul 26;350(9073):262–262. doi: 10.1016/S0140-6736(05)62225-8. [DOI] [PubMed] [Google Scholar]
- Fischer A., Segal A. W., Seger R., Weening R. S. The management of chronic granulomatous disease. Eur J Pediatr. 1993 Nov;152(11):896–899. doi: 10.1007/BF01957525. [DOI] [PubMed] [Google Scholar]
- Gupta N., Gill H., Graeber G., Bishop H., Hurst J., Stephens T. Dynamic positron emission tomography with F-18 fluorodeoxyglucose imaging in differentiation of benign from malignant lung/mediastinal lesions. Chest. 1998 Oct;114(4):1105–1111. doi: 10.1378/chest.114.4.1105. [DOI] [PubMed] [Google Scholar]
- Hawkins R. A., Hoh C., Glaspy J., Choi Y., Dahlbom M., Rege S., Messa C., Nietszche E., Hoffman E., Seeger L. The role of positron emission tomography in oncology and other whole-body applications. Semin Nucl Med. 1992 Oct;22(4):268–284. doi: 10.1016/s0001-2998(05)80121-7. [DOI] [PubMed] [Google Scholar]
- Lal N. R., Kazerooni E. A., Bree R. L. Development and implementation of an appropriateness guideline for use of CT in cases of suspected intraabdominal abscess. Acad Radiol. 2000 Sep;7(9):711–716. doi: 10.1016/s1076-6332(00)80528-0. [DOI] [PubMed] [Google Scholar]
- Leung T., Chik K., Li C., Shing M., Yuen P. Bone marrow transplantation for chronic granulomatous disease: long-term follow-up and review of literature. Bone Marrow Transplant. 1999 Sep;24(5):567–570. doi: 10.1038/sj.bmt.1701932. [DOI] [PubMed] [Google Scholar]
- Mouy R., Veber F., Blanche S., Donadieu J., Brauner R., Levron J. C., Griscelli C., Fischer A. Long-term itraconazole prophylaxis against Aspergillus infections in thirty-two patients with chronic granulomatous disease. J Pediatr. 1994 Dec;125(6 Pt 1):998–1003. doi: 10.1016/s0022-3476(05)82023-2. [DOI] [PubMed] [Google Scholar]
- Odell E. W., Segal A. W. Killing of pathogens associated with chronic granulomatous disease by the non-oxidative microbicidal mechanisms of human neutrophils. J Med Microbiol. 1991 Mar;34(3):129–135. doi: 10.1099/00222615-34-3-129. [DOI] [PubMed] [Google Scholar]
- Ozsahin H., von Planta M., Müller I., Steinert H. C., Nadal D., Lauener R., Tuchschmid P., Willi U. V., Ozsahin M., Crompton N. E. 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 Oct 15;92(8):2719–2724. [PubMed] [Google Scholar]
- Peters A. M. The use of nuclear medicine in infections. Br J Radiol. 1998 Mar;71(843):252–261. doi: 10.1259/bjr.71.843.9616233. [DOI] [PubMed] [Google Scholar]
- Reske S. N., Bares R., Büll U., Guhlmann A., Moser E., Wannenmacher M. F. Klinische Wertigkeit der Positronen-Emissions-Tomographie (PET) bei onkologischen Fragestellungen: Ergebnisse einer interdisziplinären Konsensuskonferenz. Nuklearmedizin. 1996 Apr;35(2):42–52. [PubMed] [Google Scholar]
- Rosh J. R., Tang H. B., Mayer L., Groisman G., Abraham S. K., Prince A. Treatment of intractable gastrointestinal manifestations of chronic granulomatous disease with cyclosporine. J Pediatr. 1995 Jan;126(1):143–145. doi: 10.1016/s0022-3476(95)70519-8. [DOI] [PubMed] [Google Scholar]
- Segal B. H., Leto T. L., Gallin J. I., Malech H. L., Holland S. M. Genetic, biochemical, and clinical features of chronic granulomatous disease. Medicine (Baltimore) 2000 May;79(3):170–200. doi: 10.1097/00005792-200005000-00004. [DOI] [PubMed] [Google Scholar]
- Seger R. A., Ezekowitz R. A. Treatment of chronic granulomatous disease. Immunodeficiency. 1994;5(2):113–130. [PubMed] [Google Scholar]
- Sugawara Y., Braun D. K., Kison P. V., Russo J. E., Zasadny K. R., Wahl R. L. Rapid detection of human infections with fluorine-18 fluorodeoxyglucose and positron emission tomography: preliminary results. Eur J Nucl Med. 1998 Sep;25(9):1238–1243. doi: 10.1007/s002590050290. [DOI] [PubMed] [Google Scholar]
- Weening R. S., Leitz G. J., Seger R. A. Recombinant human interferon-gamma in patients with chronic granulomatous disease--European follow up study. Eur J Pediatr. 1995 Apr;154(4):295–298. doi: 10.1007/BF01957365. [DOI] [PubMed] [Google Scholar]
- Winkelstein J. A., Marino M. C., Johnston R. B., Jr, Boyle J., Curnutte J., Gallin J. I., Malech H. L., Holland S. M., Ochs H., Quie P. Chronic granulomatous disease. Report on a national registry of 368 patients. Medicine (Baltimore) 2000 May;79(3):155–169. doi: 10.1097/00005792-200005000-00003. [DOI] [PubMed] [Google Scholar]