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18-Fluorine-Fluorodeoxyglucose Positron Emission Computer Tomography Imaging in Melioidosis: Valuable but Not
Joshua Bramwell1,2, Natalia Kovaleva3, Joshua J Morigi3,4
1Infectious Diseases Department, Royal Darwin Hospital, Darwin, NT 0810, Australia.
Abstract:
Melioidosis is an endemic tropical disease caused by Burkholderia pseudomallei. It typically causes pulmonary disease and bacteraemia but can disseminate to cause multi-organ disease. 18-F FDG PET/CT has an evolving role in diagnosing other infectious diseases, especially where the pathogen or extent of infection is challenging to elucidate clinically and with conventional imaging (CT, US and MRI). We present a case series of patients diagnosed with melioidosis who also underwent 18-F FDG PET/CT from December 18th 2018 to September 30th 2022. Indications for imaging were categorised and analysed as to whether 18-F FDG PET/CT changed management over conventional imaging. Twenty-one 18-F FDG PET/CT scans were performed for sixteen patients. Two scans (9.5%) performed for pyrexia of unknown origin changed management in both cases. Twelve scans (57.1%) performed to ascertain the extent of dissemination of melioidosis changed management in only three (25%) cases. Five scans (23.8%) performed to monitor the response to treatment of known foci changed management in all five cases. Five scans (23.8%) performed for suspected or known malignancy changed management in three (60%) cases. 18-F FDG PET/CT is an emerging tool which improves diagnosis and changes the management of melioidosis when applied judiciously and for well-selected indications.
Insights
18-F FDG PET/CT aids in diagnosing melioidosis, a tropical disease caused by Burkholderia pseudomallei. This imaging technique effectively changes patient management when used for specific indications, improving diagnostic accuracy.
Area of Science:
- Infectious Diseases
- Nuclear Medicine
- Radiology
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is an endemic tropical disease.
- It commonly presents as pulmonary disease or bacteremia but can lead to multi-organ involvement.
- 18-F FDG PET/CT is increasingly utilized for diagnosing infections, particularly when conventional imaging is inconclusive.
Purpose of the Study:
- To evaluate the role of 18-F FDG PET/CT in diagnosing and managing melioidosis.
- To assess whether 18-F FDG PET/CT alters patient management compared to conventional imaging.
- To analyze the impact of 18-F FDG PET/CT across different clinical indications in melioidosis patients.
Main Methods:
- A case series of 16 patients diagnosed with melioidosis who underwent 21 scans of 18-F FDG PET/CT between December 2018 and September 2022.
- Categorization of imaging indications: pyrexia of unknown origin, extent of dissemination, monitoring treatment response, and suspected malignancy.
- Analysis of management changes attributed to 18-F FDG PET/CT findings versus conventional imaging.
Main Results:
- 18-F FDG PET/CT changed management in 2 out of 2 scans for pyrexia of unknown origin (100%).
- For assessing dissemination, 18-F FDG PET/CT changed management in 3 out of 12 cases (25%).
- Management was changed in all 5 cases (100%) when used to monitor treatment response and in 3 out of 5 cases (60%) for suspected malignancy.
Conclusions:
- 18-F FDG PET/CT is a valuable emerging tool for diagnosing melioidosis.
- Judicious use of 18-F FDG PET/CT for well-selected indications significantly improves patient management.
- The impact of 18-F FDG PET/CT on management varies depending on the clinical indication.
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