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Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series

BACKGROUND: Intracystic infection, in Autosomal Dominant Polycystic Kidney Disease (ADPKD) and in kidneys with multiple cysts, is a diagnostic and therapeutic challenge, as conventional imaging techniques may not discriminate among "complicated" cysts (infection, bleeding, neoplasia), and...

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Autores principales: Piccoli, Giorgina B, Arena, Vincenzo, Consiglio, Valentina, Deagostini, Maria Chiara, Pelosi, Ettore, Douroukas, Anastasios, Penna, Daniele, Cortese, Giancarlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197475/
https://www.ncbi.nlm.nih.gov/pubmed/21957932
http://dx.doi.org/10.1186/1471-2369-12-48
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author Piccoli, Giorgina B
Arena, Vincenzo
Consiglio, Valentina
Deagostini, Maria Chiara
Pelosi, Ettore
Douroukas, Anastasios
Penna, Daniele
Cortese, Giancarlo
author_facet Piccoli, Giorgina B
Arena, Vincenzo
Consiglio, Valentina
Deagostini, Maria Chiara
Pelosi, Ettore
Douroukas, Anastasios
Penna, Daniele
Cortese, Giancarlo
author_sort Piccoli, Giorgina B
collection PubMed
description BACKGROUND: Intracystic infection, in Autosomal Dominant Polycystic Kidney Disease (ADPKD) and in kidneys with multiple cysts, is a diagnostic and therapeutic challenge, as conventional imaging techniques may not discriminate among "complicated" cysts (infection, bleeding, neoplasia), and as the clinical picture may be attenuated, in particular in early phases. Positron Emission Tomography with fluorodeoxyglucose (FDG-PET) was recently suggested as a tool to detect infection in ADPKD, in single cases and small series. The aim of the study was to report on the role of FDG-PET in the work-up of 10 cases of suspected cystic infections, affected by ADPKD or with multiple kidney cysts. METHODS: Observational study. Review of clinical charts and of the imaging data since the use of FDG-PET for detecting cystic infections (2008-2010). RESULTS: In 2008-2010, 6 patients with ADPKD and 4 with multiple kidney cysts were referred for suspected intracystic infections (3 males, 7 females, aged 55-83 years, in all CKD stages); in one case the imaging was done in the work-up of a complicated "uremic" cyst. The clinical picture, the usual inflammatory markers and/or the conventional imaging techniques did not allow conclusive diagnosis at referral or during follow-up (ultrasounds in all, CT in 8/10). Nine patients displayed inflammatory signs (increase in C-reactive protein and other biochemical markers) and constitutional symptoms (fever in 9/10). FDG-PET was positive in 6 cases (5 kidney and 1 liver cyst), was repeated during follow-up in 4 patients and was negative in 4 cases. In the positive cases, FDG-PET guided the therapeutic choices; in particular, the duration of therapy was supported by imaging data in the 4 cases with multiple scans. No relapse was recorded after discontinuation of antibiotic therapy in the treated patients. The negative cases did not develop clinical signs of cystic infection over follow-up. CONCLUSION: In this case series, the largest prospective one so far published and the only one including different types of renal cysts, FDG-PET is confirmed as a promising diagnostic tool for detecting intracystic infection in ADPKD and in multiple kidney cysts, and a potential guide for tailoring therapy. Further larger and multicenter studies are needed to evaluate the cost-benefit ratio and the limits of this imaging technique in the clinical setting.
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spelling pubmed-31974752011-10-21 Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series Piccoli, Giorgina B Arena, Vincenzo Consiglio, Valentina Deagostini, Maria Chiara Pelosi, Ettore Douroukas, Anastasios Penna, Daniele Cortese, Giancarlo BMC Nephrol Research Article BACKGROUND: Intracystic infection, in Autosomal Dominant Polycystic Kidney Disease (ADPKD) and in kidneys with multiple cysts, is a diagnostic and therapeutic challenge, as conventional imaging techniques may not discriminate among "complicated" cysts (infection, bleeding, neoplasia), and as the clinical picture may be attenuated, in particular in early phases. Positron Emission Tomography with fluorodeoxyglucose (FDG-PET) was recently suggested as a tool to detect infection in ADPKD, in single cases and small series. The aim of the study was to report on the role of FDG-PET in the work-up of 10 cases of suspected cystic infections, affected by ADPKD or with multiple kidney cysts. METHODS: Observational study. Review of clinical charts and of the imaging data since the use of FDG-PET for detecting cystic infections (2008-2010). RESULTS: In 2008-2010, 6 patients with ADPKD and 4 with multiple kidney cysts were referred for suspected intracystic infections (3 males, 7 females, aged 55-83 years, in all CKD stages); in one case the imaging was done in the work-up of a complicated "uremic" cyst. The clinical picture, the usual inflammatory markers and/or the conventional imaging techniques did not allow conclusive diagnosis at referral or during follow-up (ultrasounds in all, CT in 8/10). Nine patients displayed inflammatory signs (increase in C-reactive protein and other biochemical markers) and constitutional symptoms (fever in 9/10). FDG-PET was positive in 6 cases (5 kidney and 1 liver cyst), was repeated during follow-up in 4 patients and was negative in 4 cases. In the positive cases, FDG-PET guided the therapeutic choices; in particular, the duration of therapy was supported by imaging data in the 4 cases with multiple scans. No relapse was recorded after discontinuation of antibiotic therapy in the treated patients. The negative cases did not develop clinical signs of cystic infection over follow-up. CONCLUSION: In this case series, the largest prospective one so far published and the only one including different types of renal cysts, FDG-PET is confirmed as a promising diagnostic tool for detecting intracystic infection in ADPKD and in multiple kidney cysts, and a potential guide for tailoring therapy. Further larger and multicenter studies are needed to evaluate the cost-benefit ratio and the limits of this imaging technique in the clinical setting. BioMed Central 2011-09-29 /pmc/articles/PMC3197475/ /pubmed/21957932 http://dx.doi.org/10.1186/1471-2369-12-48 Text en Copyright ©2011 Piccoli et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Piccoli, Giorgina B
Arena, Vincenzo
Consiglio, Valentina
Deagostini, Maria Chiara
Pelosi, Ettore
Douroukas, Anastasios
Penna, Daniele
Cortese, Giancarlo
Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
title Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
title_full Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
title_fullStr Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
title_full_unstemmed Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
title_short Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
title_sort positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and "cystic" kidneys. a case series
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197475/
https://www.ncbi.nlm.nih.gov/pubmed/21957932
http://dx.doi.org/10.1186/1471-2369-12-48
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