Diagnostic Performance of PET or PET/CT Using 18F-FDG Labeled White Blood Cells in Infectious Diseases: A Systematic Review and a Bivariate Meta-Analysis

Marie Meyer; Nathalie Testart; Mario Jreige; Christel Kamani; Mohammed Moshebah; Barbara Muoio; Marie Nicod-Lalonde; Niklaus Schaefer; Luca Giovanella; John O Prior; Giorgio Treglia

doi:10.3390/diagnostics9020060

Diagnostic Performance of PET or PET/CT Using ¹⁸F-FDG Labeled White Blood Cells in Infectious Diseases: A Systematic Review and a Bivariate Meta-Analysis

Diagnostics (Basel). 2019 Jun 15;9(2):60. doi: 10.3390/diagnostics9020060.

Authors

Marie Meyer¹, Nathalie Testart², Mario Jreige³, Christel Kamani⁴, Mohammed Moshebah⁵, Barbara Muoio⁶, Marie Nicod-Lalonde⁷, Niklaus Schaefer⁸, Luca Giovanella⁹, John O Prior¹⁰, Giorgio Treglia^{11

12

13}

Affiliations

¹ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Marie-Madeleine.Meyer@chuv.ch.
² Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Nathalie.Testart@chuv.ch.
³ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Mario.Jreige@chuv.ch.
⁴ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Christel-Hermann.Kamani@chuv.ch.
⁵ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Mohammed.Moshebah@chuv.ch.
⁶ Department of Internal Medicine, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland. Barbara.Muoio@eoc.ch.
⁷ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Marie.Nicod-Lalonde@chuv.ch.
⁸ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Niklaus.Schaefer@chuv.ch.
⁹ Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland. Luca.Giovanella@eoc.ch.
¹⁰ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. John.Prior@chuv.ch.
¹¹ Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland. Giorgio.Treglia@eoc.ch.
¹² Clinic of Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland. Giorgio.Treglia@eoc.ch.
¹³ Health Technology Assessment Unit, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland. Giorgio.Treglia@eoc.ch.

Abstract

Background: Diagnostic performance of positron emission tomography using white blood cells labeled with fluorine-18-fluorodeoxyglucose (¹⁸F-FDG-WBC PET or PET/CT) in patients with suspicious infectious diseases has been evaluated in several studies; however, there is no consensus about the diagnostic accuracy of this method. Therefore, a systematic review and meta-analysis was carried out on this topic.

Methods: A comprehensive computer literature search screening PubMed/MEDLINE, Embase and Cochrane library databases through March 2019 was performed. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) of ¹⁸F-FDG-WBC PET or PET/CT in patients with infectious diseases were calculated.

Results: Eight studies on the use of ¹⁸F-FDG-WBC PET or PET/CT in suspicious infectious diseases were discussed in the systematic review. The meta-analysis of seven studies (236 patients) provided these pooled results on a per patient-based analysis: sensitivity was 86.3% [95% confidence interval (95%CI) 75-92.9%], specificity 92% (95%CI 79.8-97.1%), LR+ 6.6 (95%CI: 3.1-14.1), LR- 0.2 (95%CI: 0.12-0.33), DOR 43.5 (95%CI: 12.2-155). A statistically significant heterogeneity was not detected.

Conclusions: Despite limited literature data, ¹⁸F-FDG-WBC PET or PET/CT demonstrated a good diagnostic accuracy for the diagnosis of infectious diseases; nevertheless, larger studies are needed.

Keywords: 18F-FDG; PET; infection; leukocytes; meta-analysis; white blood cells.

Publication types

Review