Does Antibiotic Treatment Affect the Diagnostic Accuracy of ¹⁸F-FDG PET/CT Studies in Patients with Suspected Infectious Processes?

Abstract

¹⁸F-FDG PET/CT plays a significant role in the assessment of various infectious processes. Patients with suspected or known sites of infection are often referred for ¹⁸F-FDG imaging while already receiving antibiotic treatment. The current study assessed whether antibiotic therapy affected the detectability rate of infectious processes by ¹⁸F-FDG PET/CT. <b>Methods:</b> A 5-y retrospective study of all adult patients who underwent ¹⁸F-FDG PET/CT in search of a focal source of infection was performed. The presence, duration, and appropriateness of antibiotic treatment before ¹⁸F-FDG imaging were recorded. Diagnosis of an infectious process was based on microbiologic or pathologic data as well as on clinical and radiologic follow-up. <b>Results:</b> Two hundred seventeen patients underwent 243 PET/CT studies in search of a focal source of infection and were included in the study. Sixty-seven studies were excluded from further analysis because of a final noninfectious etiology or lack of further follow-up or details regarding the antibiotic treatment. The final study population included 176 ¹⁸F-FDG PET/CT studies in 153 patients (107 men, 46 women; age range, 18-86 y). One hundred nineteen studies (68%) were performed in patients receiving antibiotic therapy for a range of 1-73 d. A diagnosis of infection was made in 107 true-positive cases (61%), including 63 studies (59%) in patients receiving appropriate antibiotic therapy started before the performance of the ¹⁸F-FDG PET/CT study. There were 52 true-negative (29%) and 17 false-positive (10%) ¹⁸F-FDG PET/CT studies. No false-negative results were found. <b>Conclusion:</b>¹⁸F-FDG PET/CT correctly identified foci of increased uptake compatible with infection in most patients, including all patients receiving appropriate antimicrobial therapy, with no false-negative cases. On the basis of the current study results, the administration of antibiotics appears to have no clinically significant impact on the diagnostic accuracy of ¹⁸F-FDG PET/CT performed for evaluation of known or suspected infectious processes.