Positron emission tomography in the diagnostic pathway for intracystic infection in adpkd and cystic kidneys. a case seriesReportar como inadecuado




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BMC Nephrology

, 12:48

First Online: 29 September 2011Received: 25 October 2010Accepted: 29 September 2011

Abstract

BackgroundIntracystic 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.

MethodsObservational study. Review of clinical charts and of the imaging data since the use of FDG-PET for detecting cystic infections 2008-2010.

ResultsIn 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.

ConclusionIn 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.

KeywordsPositron emission tomography polycystic kidney disease infection kidney cysts long-term antibiotic therapy Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-12-48 contains supplementary material, which is available to authorized users.

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Autor: Giorgina B Piccoli - Vincenzo Arena - Valentina Consiglio - Maria Chiara Deagostini - Ettore Pelosi - Anastasios Douroukas

Fuente: https://link.springer.com/







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