Division of Nuclear Medicine, Department of Medical Physics, University of Liège Hospital, Liège, Belgium.
Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium.
Am J Transplant. 2016 Jan;16(1):310-6. doi: 10.1111/ajt.13429. Epub 2015 Aug 24.
Management of kidney transplant recipients (KTRs) with suspected acute rejection (AR) ultimately relies on kidney biopsy; however, noninvasive tests predicting nonrejection would help avoid unnecessary biopsy. AR involves recruitment of leukocytes avid for fluorodeoxyglucose F(18) ((18) F-FDG), thus (18) F-FDG positron emission tomography (PET) coupled with computed tomography (CT) may noninvasively distinguish nonrejection from AR. From January 2013 to February 2015, we prospectively performed 32 (18) F-FDG PET/CT scans in 31 adult KTRs with suspected AR who underwent transplant biopsy. Biopsies were categorized into four groups: normal (n = 8), borderline (n = 10), AR (n = 8), or other (n = 6, including 3 with polyoma BK nephropathy). Estimated GFR was comparable in all groups. PET/CT was performed 201 ± 18 minutes after administration of 3.2 ± 0.2 MBq/kg of (18) F-FDG, before any immunosuppression change. Mean standard uptake values (SUVs) of both upper and lower renal poles were measured. Mean SUVs reached 1.5 ± 0.2, 1.6 ± 0.3, 2.9 ± 0.8, and 2.2 ± 1.2 for the normal, borderline, AR, and other groups, respectively. One-way analysis of variance demonstrated a significant difference of mean SUVs among groups. A positive correlation between mean SUV and acute composite Banff score was found, with r(2) = 0.49. The area under the receiver operating characteristic curve was 0.93, with 100% sensitivity and 50% specificity using a mean SUV threshold of 1.6. In conclusion, (18) F-FDG PET/CT may help noninvasively prevent avoidable transplant biopsies in KTRs with suspected AR.
管理疑似急性排斥反应 (AR) 的肾移植受者 (KTR) 最终依赖于肾活检; 然而，预测非排斥反应的非侵入性测试将有助于避免不必要的活检。AR 涉及白细胞对氟脱氧葡萄糖 F(18) ((18) F-FDG) 的招募，因此 (18) F-FDG 正电子发射断层扫描 (PET) 与计算机断层扫描 (CT) 相结合可以无创地区分非排斥反应和 AR。从 2013 年 1 月至 2015 年 2 月，我们前瞻性地对 31 例疑似 AR 的成年 KTR 进行了 32 次 (18) F-FDG PET/CT 扫描，这些患者均接受了移植活检。活检分为四组：正常 (n=8)、边缘 (n=10)、AR (n=8) 或其他 (n=6，包括 3 例多瘤 BK 肾病)。所有组的估计肾小球滤过率 (eGFR) 相似。PET/CT 在给予 3.2 ± 0.2 MBq/kg 的 (18) F-FDG 后 201 ± 18 分钟进行，在任何免疫抑制改变之前进行。测量上下肾极的平均标准摄取值 (SUV)。正常、边缘、AR 和其他组的平均 SUV 分别为 1.5 ± 0.2、1.6 ± 0.3、2.9 ± 0.8 和 2.2 ± 1.2。单因素方差分析显示各组间 SUV 均值存在显著差异。发现平均 SUV 与急性综合 Banff 评分之间存在正相关，r(2)=0.49。受试者工作特征曲线下面积为 0.93，当使用 1.6 的平均 SUV 阈值时，灵敏度为 100%，特异性为 50%。总之，(18) F-FDG PET/CT 可能有助于非侵入性地避免疑似 AR 的 KTR 进行不必要的移植活检。
