The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) in Management of Nocardiosis: A Retrospective Study and Review of the Literature,Infectious Diseases and Therapy

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The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) in Management of Nocardiosis: A Retrospective Study and Review of the Literature
Infectious Diseases and Therapy ( IF 4.7 ) Pub Date : 2021-07-20 , DOI: 10.1007/s40121-021-00495-7
Ili Margalit _{1,

2} , Anat Yahav ₃ , Yaara Ben Ari ₂ , Haim Ben-Zvi ₄ , Avivit Shoham ₅ , Elad Goldberg _{2,

6} , Michal Weiler-Sagie _{7,

8} , Noam Tau _{2,

9} , Khitam Muhsen ₁₀ , Jihad Bishara _{1,

2} , Mical Paul _{8,

11} , Hanna Bernstine _{2,

12} , Dafna Yahav _{1,

2}

Affiliation

Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv-Yafo, Israel.
Radiology Institute, Rambam Health Care Campus, Haifa, Israel.
Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Department of Diagnostic Imaging, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Department of Internal Medicine F, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Nuclear Medicine Department, Rambam Health Care Campus, Haifa, Israel.
Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel.
Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv-Yafo, Israel.
Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.
Nuclear Medicine Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.

Introduction

18-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a well-established tool for managing metastatic infections. Nocardiosis, a primarily pulmonary infection, disseminates at high rates. Routine imaging includes chest CT and brain imaging. We examined the use of FDG-PET/CT in nocardiosis and assessed its contribution to diagnosis and management.

Methods

A retrospective study in two tertiary medical centers during 2011–2020. Individuals with nocardiosis for whom FDG-PET/CT was implemented for any reason were included and their medical records were reviewed. A board-certified nuclear medicine physician independently reviewed all scans. Additionally, a systematic review was conducted according to the PRISMA guidelines, to extract data from publications reporting FDG-PET/CT use for the management of nocardiosis.

Results

FDG-PET/CT contributed to the management of all seven patients who met inclusion criteria. It assisted in ruling out an underlying malignancy (29%, 2/7); establishing a wide infection extent (57%, 4/7); and affecting decisions regarding treatment (57%, 4/7), including drug regimen, oral step-down, and duration of therapy. We identified 20 published case reports on this topic. In 80% (16/20), FDG-PET/CT contributed to the management of nocardiosis similar to our study. In addition, in most of the literature cases, FDG-PET/CT guided the diagnostic biopsy.

Conclusion

FDG-PET/CT is valuable in the diagnosis and management of individuals with nocardiosis. The contribution of incorporating FDG-PET/CT to the management of individuals with nocardiosis and its role in monitoring treatment response and shortening treatment duration should be evaluated in prospective studies.

中文翻译：

18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在诺卡菌病治疗中的作用：回顾性研究和文献回顾

介绍

18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描 (FDG-PET/CT) 是一种成熟的转移性感染管理工具。诺卡菌病是一种主要的肺部感染，以高速率传播。常规成像包括胸部CT和脑部成像。我们检查了 FDG-PET/CT 在诺卡菌病中的应用，并评估了其对诊断和管理的贡献。

方法

2011-2020 年在两个三级医疗中心的回顾性研究。包括因任何原因实施 FDG-PET/CT 的诺卡菌病患者，并审查了他们的医疗记录。一名获得委员会认证的核医学医师独立审查了所有扫描结果。此外，根据 PRISMA 指南进行了系统评价，以从报告 FDG-PET/CT 用于管理诺卡菌病的出版物中提取数据。

结果

FDG-PET/CT 有助于管理所有符合纳入标准的 7 名患者。它有助于排除潜在的恶性肿瘤（29%，2/7）；建立广泛的感染范围（57%，4/7）；并影响有关治疗的决定 (57%, 4/7)，包括药物治疗方案、口服降压药和治疗持续时间。我们确定了 20 篇关于该主题的已发表病例报告。在 80% (16/20) 中，FDG-PET/CT 有助于管理与我们的研究相似的诺卡菌病。此外，在大多数文献案例中，FDG-PET/CT 指导诊断性活检。