Does 18F-FDG PET/CT add value to conventional imaging in clinical assessment of chronic disseminated candidiasis?

• Published in: Frontiers in medicine 2022-12, Vol.9, p.1026067-1026067
• Main Authors: Rammaert, Blandine, Maunoury, Christophe, Rabeony, Tioka, Correas, Jean-Michel, Elie, Caroline, Alfandari, Serge, Berger, Pierre, Rubio, Marie-Thérèse, Braun, Thorsten, Bakouboula, Prissile, Candon, Sophie, Montravers, Françoise, Lortholary, Olivier
• Format: Article
• Language: English
• Subjects: acute leukemia; Candida; candidiasis; hematological malignancy; immune reconstitution inflammatory syndrome; invasive fungal disease; Medicine
• ISSN: 2296-858X; 2296-858X
• DOI: 10.3389/fmed.2022.1026067

BackgroundChronic disseminated candidiasis (CDC) classically occurs after profound and prolonged neutropenia. The aim of the CANHPARI study was to assess the clinical value of adding 18F-fluorodeoxyglucose PET/CT to conventional radiology for initial and subsequent evaluations of CDC. Materials and methodsA pilot prospective study was conducted in 23 French onco-hematological centers from 2013 to 2017 (NCT01916057). Patients ≥ 18 y.o. suspected for CDC on abdominal conventional imaging (CT or MRI) were included. PET/CT and conventional imaging were performed at baseline and month 3 (M3). Follow-up was assessed until M12. The primary outcome measure was the global response at M3, i.e., apyrexia and complete response to PET/CT. The secondary outcome measure consists in comparison between responses to PET/CT and conventional imaging at diagnosis and M3. ResultsAmong 52 included patients, 44 were evaluable (20 probable and 24 possible CDC); 86% had acute leukemia, 55% were male (median age 47 years). At diagnosis, 34% had fever and conventional imaging was always abnormal with microabscesses on liver and spleen in 66%, liver in 25%, spleen in 9%. Baseline PET/CT showed metabolic uptake on liver and/or spleen in 84% but did not match with lesion localizations on conventional imaging in 32%. M3 PET/CT showed no metabolic uptake in 13 (34%) patients, 11 still having pathological conventional imaging. Global response at M3 was observed in eight patients. ConclusionBaseline PET/CT does not replace conventional imaging for initial staging of CDC lesions but should be performed after 3 months of antifungal therapy. Clinical trial registration[www.clinicaltrials.gov], identifier [NCT01916057].