Practice of 18F-FDG-PET/CT in ICU Patients: A Systematic Review

Bram van Leer; Nick D van Rijsewijk; Maarten W N Nijsten; Riemer H J A Slart; Janesh Pillay; Andor W J M Glaudemans

doi:10.1053/j.semnuclmed.2023.05.003

Practice of ¹⁸F-FDG-PET/CT in ICU Patients: A Systematic Review

Semin Nucl Med. 2023 Nov;53(6):809-819. doi: 10.1053/j.semnuclmed.2023.05.003. Epub 2023 May 29.

Authors

Bram van Leer¹, Nick D van Rijsewijk², Maarten W N Nijsten³, Riemer H J A Slart⁴, Janesh Pillay⁵, Andor W J M Glaudemans²

Affiliations

¹ 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. Electronic address: b.van.leer@umcg.nl.
² Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
³ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴ Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
⁵ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 37258380
DOI: 10.1053/j.semnuclmed.2023.05.003

Abstract

¹⁸F-FDG-PET/CT imaging has become a key tool to evaluate infectious and inflammatory diseases. However, application of ¹⁸F-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 ¹⁸F-FDG-PET/CT in such patients. The aim of this systematic review was to investigate the feasibility of ¹⁸F-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 ¹⁸F-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 ¹⁸F-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 ¹⁸F-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, ¹⁸F-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 ¹⁸F-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.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Critical Care
Fluorodeoxyglucose F18*
Humans
Intensive Care Units
Positron Emission Tomography Computed Tomography* / methods
Positron-Emission Tomography / methods
Radiopharmaceuticals
Sensitivity and Specificity

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals