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18F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography can reliably rule-out infection and cancer in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis suspected of disease relapse.

Abstract Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune diseases characterized by systemic inflammation in small- to medium-sized blood vessels. Although immunosuppressive therapy has greatly improved the prognosis for these patients, there are still significant comorbidities, such as cancer and infection, associated with AAV. These comorbidities are often indistinguishable from an underlying AAV disease relapse, and create a clinical conundrum, as these conditions are normally contraindications for immunosuppressive treatment. Thus, it is important to be able to rule out these comorbidities before initiation of immunosuppressive treatment. We examined F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography (FDG-PET/CT)'s value in ruling out cancer or infection in patients with AAV.Data were obtained retrospectively for a clinically based cohort of AAV patients who underwent FDG-PET/CT during 2009 to 2014 owing to a suspicion of cancer, infection, or both cancer and infection indistinguishable from disease relapse. FDG-PET/CT conclusions were compared to the final diagnoses after follow-up analysis (mean 43 months).A total of 19 patients were included who underwent a total of 26 scans. The results of FDG-PET/CT outcome compared to final diagnosis were: 9 true positives, 3 false positives, 13 true negatives, and 1 false negative. The diagnostic probabilities for FDG-PET/CT with respect to overall comorbidity (i.e., cancer or infection) were: sensitivity 90% ( 95% confidence interval [CI] 60%-98%), specificity 81% ( 95% CI 57%-93%), positive predictive value 75% (95% CI 47%-91%), negative predictive value 93% (95% CI 68%-99%), and accuracy 84% (95% CI 66%-94%).FDG-PET/CT had a high negative predictive value and ruled out the comorbidities correctly in all but one case of urinary tract infection, a well-known limitation. Our study showed FGD-PET/CT's promise as an effective tool for ruling out cancer or infection in patients with AAV albeit in a limited population.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28746217
OWN - NLM
STAT- In-Process
DA  - 20170726
LR  - 20170726
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 30
DP  - 2017 Jul
TI  - 18F-fluoro-deoxy-glucose positron emission tomography combined with computed
      tomography can reliably rule-out infection and cancer in patients with
      anti-neutrophil cytoplasmic antibody-associated vasculitis suspected of disease
      relapse.
PG  - e7613
LID - 10.1097/MD.0000000000007613 [doi]
AB  - Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a
      group of autoimmune diseases characterized by systemic inflammation in small- to 
      medium-sized blood vessels. Although immunosuppressive therapy has greatly
      improved the prognosis for these patients, there are still significant
      comorbidities, such as cancer and infection, associated with AAV. These
      comorbidities are often indistinguishable from an underlying AAV disease relapse,
      and create a clinical conundrum, as these conditions are normally
      contraindications for immunosuppressive treatment. Thus, it is important to be
      able to rule out these comorbidities before initiation of immunosuppressive
      treatment. We examined F-fluoro-deoxy-glucose positron emission tomography
      combined with computed tomography (FDG-PET/CT)'s value in ruling out cancer or
      infection in patients with AAV.Data were obtained retrospectively for a
      clinically based cohort of AAV patients who underwent FDG-PET/CT during 2009 to
      2014 owing to a suspicion of cancer, infection, or both cancer and infection
      indistinguishable from disease relapse. FDG-PET/CT conclusions were compared to
      the final diagnoses after follow-up analysis (mean 43 months).A total of 19
      patients were included who underwent a total of 26 scans. The results of
      FDG-PET/CT outcome compared to final diagnosis were: 9 true positives, 3 false
      positives, 13 true negatives, and 1 false negative. The diagnostic probabilities 
      for FDG-PET/CT with respect to overall comorbidity (i.e., cancer or infection)
      were: sensitivity 90% ( 95% confidence interval [CI] 60%-98%), specificity 81% ( 
      95% CI 57%-93%), positive predictive value 75% (95% CI 47%-91%), negative
      predictive value 93% (95% CI 68%-99%), and accuracy 84% (95% CI
      66%-94%).FDG-PET/CT had a high negative predictive value and ruled out the
      comorbidities correctly in all but one case of urinary tract infection, a
      well-known limitation. Our study showed FGD-PET/CT's promise as an effective tool
      for ruling out cancer or infection in patients with AAV albeit in a limited
      population.
FAU - Frary, Evan C
AU  - Frary EC
AD  - aDepartment of Nuclear Medicine, Odense University Hospital, Odense C bDepartment
      of Radiology and Nuclear Medicine, Hospital of Southwest Jutland, Esbjerg
      cDepartment of Clinical Research, Faculty of Health Sciences, University of
      Southern Denmark, Odense C dCenter of Health Economics Research, University of
      Southern Denmark, Odense M eDepartment of Rheumatology, Odense University
      Hospital, Odense C, Denmark.
FAU - Hess, Soren
AU  - Hess S
FAU - Gerke, Oke
AU  - Gerke O
FAU - Laustrup, Helle
AU  - Laustrup H
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/07/27 06:00
MHDA- 2017/07/27 06:00
CRDT- 2017/07/27 06:00
AID - 10.1097/MD.0000000000007613 [doi]
AID - 00005792-201707280-00048 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jul;96(30):e7613. doi: 10.1097/MD.0000000000007613.