Diagnostic role of whole-body [¹⁸F]-FDG positron emission tomography in patients with symptoms suspicious for malignancy after heart transplantation

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• 作者：Vera Graute ; Nathalie Jansen ; Hae-Young Sohn ; Alex ; er Becker ; Barbara Klein ; Irene Schmid ; Sabine Greil ; Sebastian Lehner ; Peter Bartenstein ; Thomas Pfluger ; Marcus Hacker
• 关键词：heart transplantation ; immunosuppression ; infection ; malignancy ; FDG ; PET
• 刊名：The Journal of Heart and Lung Transplantation
• 出版年：2012
• 出版时间：September, 2012
• 年：2012
• 卷：31
• 期：9
• 页码：958-966
• 全文大小：1231 K

文摘

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Background

Increased rates of malignancies and infections occur in transplant patients under immunosuppression, but the resultant clinical symptoms, and results of physical examination, chest X-ray, abdominal ultrasonography and laboratory findings are frequently difficult to interpret or inconclusive. The aim of the present study was to investigate the usefulness of whole-body [¹⁸F]-FDG PET for investigation of heart transplant patients suffering from suspicious symptoms, with a previously ambiguous diagnosis.

Methods

Seventeen consecutive patients (8 women; 48 ¡À 22 years) with non-specific symptoms (lymphadenopathy, fever of unknown origin or recurrent febrile temperatures, weight loss, abdominal pain, night sweating, cough or generally reduced physical condition) were evaluated retrospectively. All patients underwent whole-body [¹⁸F]-FDG examinations by PET (7 patients) or PET/CT (10 patients) at 8 ¡À 6 (range 0.1 to 21) years after orthotopic heart transplantation (OHT). During a follow-up of 28 ¡À 25 months, results of bone marrow biopsies, and histologic and/or microbiologic findings were registered and retrospectively compared with the PET results.

Results

PET revealed the cause of non-specific symptoms in 9 of 17 patients; there were 5 cases of lymphoproliferative disease (PTLD), 2 carcinomas and 2 cases of infection. Four patients were rated false positive, 1 patient false negative and 3 patients were correctly rated as negative. Sensitivity, specificity and positive and negative predictive values were 0.90, 0.43, 0.69 and 0.75, respectively, giving an overall diagnostic accuracy of 0.71.

Conclusions

A non-invasive strategy of using whole-body [¹⁸F]-FDG PET or PET/CT in heart transplant recipients with non-specific unexplained symptoms may offer diagnostic stratification for malignancy and infections with a high sensitivity and modest diagnostic accuracy. These findings require prospective confirmation.