Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Semin Nucl Med. 2023 Nov;53(6):809-819. doi: 10.1053/j.semnuclmed.2023.05.003. Epub 2023 May 29.
F-FDG-PET/CT imaging has become a key tool to evaluate infectious and inflammatory diseases. However, application of F-FDG-PET/CT in patients in the intensive care unit (ICU) is limited, which is remarkable since the development of critical illness is closely linked to infection and inflammation. This limited use is caused by perceived complexity and risk of planning and executing F-FDG-PET/CT in such patients. The aim of this systematic review was to investigate the feasibility of F-FDG-PET/CT in ICU patients with special emphasis on patient preparation, transport logistics and safety. Therefore, a systematic search was performed in PubMed, Embase, and Web of Science using the search terms: intensive care, critically ill, positron emission tomography and F-FDG or derivates. A total of 1183 articles were found of which 10 were included. Three studies evaluated the pathophysiology of acute respiratory distress syndrome, acute lung injury and acute chest syndrome. Three other studies applied F-FDG-PET/CT to increase understanding of pathophysiology after traumatic brain injury. The remaining four studies evaluated infection of unknown origin. These four studies showed a sensitivity and specificity between 85%-100% and 57%-88%, respectively. A remarkable low adverse event rate of 2% was found during the entire F-FDG-PET/CT procedure, including desaturation and hypotension. In all studies, a team consisting of an intensive care physician and nurse was present during transport to ensure continuation of necessary critical care. Full monitoring during transport was used in patients requiring mechanical ventilation or vasopressor support. None of the studies used specific patient preparation for ICU patients. However, one article described specific recommendations in their discussion. In conclusion, F-FDG-PET/CT has been shown to be feasible and safe in ICU patients, even when ventilated or requiring vasopressors. Specific recommendations regarding patient preparation, logistics and scanning are needed. Including F-FDG-PET/CT in routine workup of infection of unknown origin in ICU patients showed potential to identify source of infection and might improve outcome.
18F-FDG-PET/CT 成像已成为评估感染和炎症性疾病的重要工具。然而，18F-FDG-PET/CT 在重症监护病房（ICU）患者中的应用受到限制，这是因为危重病的发展与感染和炎症密切相关。这种应用受限的原因是由于人们认为在这些患者中规划和执行 18F-FDG-PET/CT 既复杂又有风险。本系统评价的目的是研究 18F-FDG-PET/CT 在 ICU 患者中的可行性，特别强调患者准备、转运物流和安全性。因此，我们在 PubMed、Embase 和 Web of Science 中使用了以下搜索词进行了系统搜索：重症监护、危重病、正电子发射断层扫描和 F-FDG 或衍生物。共发现 1183 篇文章，其中 10 篇被纳入。三项研究评估了急性呼吸窘迫综合征、急性肺损伤和急性胸痛综合征的病理生理学。另外三项研究应用 18F-FDG-PET/CT 来增加对创伤性脑损伤后病理生理学的理解。其余四项研究评估了不明原因的感染。这四项研究的敏感性和特异性分别为 85%-100%和 57%-88%。在整个 18F-FDG-PET/CT 过程中，发现不良事件发生率非常低，为 2%，包括低氧血症和低血压。在所有研究中，在转运过程中都有一个由重症监护医生和护士组成的团队，以确保持续进行必要的重症监护。在需要机械通气或升压支持的患者中，使用了全程监测。所有研究均未对 ICU 患者进行特定的患者准备，但有一篇文章在讨论中描述了具体建议。总之，18F-FDG-PET/CT 在 ICU 患者中是可行且安全的，即使患者需要通气或升压支持。需要针对患者准备、物流和扫描制定具体建议。在 ICU 患者中对不明原因感染进行常规检查中纳入 18F-FDG-PET/CT 可能有助于确定感染源，并可能改善预后。
