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PET/CT helps to determine treatment duration in patients with resected as well as inoperable alveolar echinococcosis

Husmann, Lars; Muehlematter, Urs J; Grimm, Felix; Ledergerber, Bruno; Messerli, Michael; Kudura, Ken; Gruenig, Hannes; Muellhaupt, Beat; Hasse, Barbara; Huellner, Martin W (2021). PET/CT helps to determine treatment duration in patients with resected as well as inoperable alveolar echinococcosis. Parasitology International, 83:102356.

Abstract

Purpose: The aim of the study was to determine the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) at the end of benzimidazole therapy in alveolar echinococcosis.

Methods: A total of 22 patients undergoing PET/CT at the end of benzimidazole therapy were retrospectively registered. Maximum standardized uptake values (SUVmax) were measured in remaining echinococcus manifestations and compared to normal liver tissue. Long-term clinical follow-up was performed, and recorded data included laboratory parameters, clinical information and imaging.

Results: All patients had no detectable levels of Em-18 antibodies and all echinococcus manifestations were negative on PET/CT, i.e. without focally increased FDG uptake or uptake higher than normal/non-infected liver tissue. All manifestations displayed significantly less FDG-uptake than normal liver tissue, i.e. SUVmax 1.8 (interquartile range (IQR) 1.5-3.5) vs. 3.0 (IQR 2.6-5.7), (p < 0.001). Patients were clinically followed for a median of 9.5 years (IQR 6.5-32.0 years) after their initial diagnosis and for 4.5 years (IQR 3.0-14.0 years) after discontinuation of benzimidazole therapy. No patient showed signs of recurrent infection at the last clinical visit. The 10-year and 20-year freedom from all-cause mortality was 95.0% (95% confidence interval 69.5% - 99.3%), for both. Two events occurred in 292 patient years of follow-up; i.e. two patients (9%) died, one because of pancreatic cancer, the other one because of unknown reasons with no detectable antibody levels.

Conclusions: Negative FDG-PET/CT results combined with no detectable levels of Em-18 antibodies may allow for the safe discontinuation of benzimidazole therapy in patients with alveolar echinococcosis.

Keywords: Alveolar echinococcosis; FDG; PET/CT; Therapy control.

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Life Sciences > Parasitology
Health Sciences > Infectious Diseases
Language:English
Date:August 2021
Deposited On:09 Nov 2021 16:25
Last Modified:15 Sep 2024 03:35
Publisher:Elsevier
ISSN:1383-5769
OA Status:Hybrid
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1016/j.parint.2021.102356
PubMed ID:33872794
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  • Licence: Creative Commons: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)

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