Diagnostic value of positron emission tomography combined with computed tomography for evaluating patients with septic shock of unknown origin

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• 作者：Stefan Kluge ; MD^a ; ¹ ; ^{skluge@uke.de} ; Stephan Braune ; MD^a ; ¹ ; Axel Nierhaus ; MD^a ; Dominic Wichmann ; MD^a ; Thorsten Derlin ; MD^b ; Janos Mester ; MD^b ; Susanne Klutmann ; MD^b
• 关键词：Severe sepsis ; Septic shock ; FDG-PET/CT ; Outcome ; Infection ; Management
• 刊名：Journal of Critical Care
• 出版年：2012
• 期刊代码：167_08839441
• 类别：med
• 出版时间：June, 2012
• 卷：27
• 期：3
• 页码：316.e1-316.e7
• 文件大小：470 K

摘要

Purpose

¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with computed tomography (CT) is a promising new tool for the identification of infectious foci. The aim of our work was to evaluate the diagnostic value of FDG-PET/CT in critically ill patients with septic shock of unknown origin.

Methods

We performed a single-center, 6-year retrospective evaluation of the value of FDG-PET/CT in critically ill patients with severe sepsis or septic shock of unknown origin.

Results

Eighteen patients underwent FDG-PET/CT. Microbiological tests (blood culture, urine, and respiratory secretions), chest x-rays, CT scans, and transesophageal echocardiography were performed on all patients before FDG-PET/CT scanning. Pathologic FDG accumulation could be demonstrated in 14 of 18 FDG-PET/CT scans. On a per-patient basis, 11 were 鈥渢rue positive,鈥?3 were 鈥渇alse positive,鈥?4 were true negative, and there were no false negatives. In 6 cases, the results of the PET/CT scan had direct therapeutic consequences (surgery, 2; pacemaker removal, 2; initiation of antibiotic therapy, 1; and prolonged antibiotic therapy, 1); 12 (66%) of the 18 patients survived to hospital discharge.

Conclusions

The FDG-PET/CT is a valuable tool for the localization of infectious foci in critically ill patients with severe sepsis/septic shock in whom conventional diagnostic methods fail to detect these foci. Prospective studies with more patients are warranted to further evaluate the diagnostic accuracy and feasibility of this diagnostic tool in critically ill patients with severe sepsis.