Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Biomed Pharmacother. 2021 Dec;144:112296. doi: 10.1016/j.biopha.2021.112296. Epub 2021 Oct 8.
Septic thrombosis often complicates Staphylococcus aureus bacteremia (SAB) in patients with a central venous catheter. Currently there is no reference standard for diagnosis. We describe the diagnostic value of [F]FDG-PET/CT imaging in a patient cohort and the potential contribution of quantitative measurements in detecting septic thrombosis.
We selected patients with catheter-related SAB from our institutional database (2013-2020). The contribution of [F]FDG-PET/CT on clinical diagnosis of septic thrombosis was evaluated. Standardized Uptake Values (SUV) were measured and compared with a composite reference standard (clinical signs, initial [F]FDG-PET/CT result, Multidisciplinary Team (MDT) meeting outcome) to identify a cut-off value for detecting septic thrombosis.
We identified 93 patients with a catheter-related SAB. Quantitative measurements were possible for 43/56 patients in whom a [F]FDG-PET/CT scan was performed. Septic thrombosis was clinically diagnosed in 30% (13/43) of the cases. In 85% of these cases, significant [F]FDG-PET/CT uptake at the site of the thrombus was the deciding factor for diagnosis of septic thrombosis during the MDT meeting. All mean SUV's of thrombotic lesions were higher in patients with clinically proven septic thrombosis compared to patients in whom this diagnosis was rejected (p < 0.001). A SUV thrombus/SUV blood ratio of 1.6 (AUC-ROC value 0.982) as cut-off to differentiate between septic thrombosis and non-septic thrombosis had a sensitivity of 92% (95% CI 64-100) and specificity of 89% (95% CI 65-99). An algorithm was designed to guide diagnosis of septic thrombosis.
Quantitative [F]FDG-PET/CT-derived parameters seem helpful to differentiate between septic and non-septic thrombosis in patients with catheter-related SAB.
金黄色葡萄球菌菌血症（SAB）患者常并发中心静脉导管相关的脓毒性血栓。目前，尚无诊断的参考标准。我们描述了 [F]FDG-PET/CT 成像在患者队列中的诊断价值，并探讨了定量测量在检测脓毒性血栓方面的潜在作用。
我们从我们的机构数据库中选择了与导管相关的 SAB 患者（2013-2020 年）。评估了 [F]FDG-PET/CT 对脓毒性血栓临床诊断的贡献。测量了标准化摄取值（SUV）并与综合参考标准（临床症状、初始 [F]FDG-PET/CT 结果、多学科团队（MDT）会议结果）进行比较，以确定检测脓毒性血栓的截断值。
我们共纳入 93 例与导管相关的 SAB 患者。在 56 例行 [F]FDG-PET/CT 检查的患者中，有 43 例可进行定量测量。在这些患者中，30%（13/43）临床诊断为脓毒性血栓。在这些病例中，85%的情况下，在 MDT 会议期间，血栓部位的显著 [F]FDG-PET/CT 摄取是诊断脓毒性血栓的决定性因素。与临床诊断为非脓毒性血栓的患者相比，临床确诊为脓毒性血栓的患者的所有血栓病变平均 SUV 更高（p<0.001）。以区分脓毒性血栓和非脓毒性血栓的 SUV 血栓/SUV 血液比值为 1.6（AUC-ROC 值为 0.982），其灵敏度为 92%（95%CI 64-100），特异性为 89%（95%CI 65-99）。设计了一个算法来指导脓毒性血栓的诊断。
在与导管相关的 SAB 患者中，定量 [F]FDG-PET/CT 衍生参数似乎有助于区分脓毒性和非脓毒性血栓。
