18F-FDG-PET/MR in Alveolar Echinococcosis: Multiparametric Imaging in a Real-World Setting.

Nina Eberhardt,Wolfgang M Thaiss,Lynn Peters,Beate Grüner,Silke Kapp-Schwoerer,Ambros J Beer,Meinrad Beer

doi:10.3390/pathogens11030348

Nina Eberhardt, Wolfgang M Thaiss + Show 5 more

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https://doi.org/10.3390/pathogens11030348

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Journal: Pathogens	Publication Date: Mar 12, 2022
Citations: 1	License type: CC BY 4.0

Affiliation: University Hospital Ulm, University of Ulm

Abstract

Recent improvements in alveolar echinococcosis (AE) therapy can provide long-term disease control, and even allow structured treatment interruption in selected cases. Imaging has a pivotal role in monitoring disease activity, with 18-fluoro-deoxyglucose positron emission and computed tomography (18F-FDG-PET/CT) in particular having proven beneficial for assessing disease activity. Repetitive regular examinations to monitor therapy response, however, can lead to substantial radiation burden. Therefore, by combining metabolic information and excellent tissue contrast in magnetic resonance imaging (MRI), PET/MR appears ideally suited for this task. Here, we retrospectively analyzed 51 AE patients that underwent 18F-FDG-PET/MR. Patients had a ‘confirmed/probable’ diagnosis in 22/29 cases according to the WHO classification. FDG uptake, diffusion restriction, and MRI morphology were evaluated. We found significant differences in FDG uptake between responders to benzimidazole therapy and progressive manifestations (SUVavg 2.7 ± 1.3 vs. 5.4 ± 2.2, p < 0.001) as well as between Kodama Types 1 and 3 (F = 9.9, p < 0.003). No significant differences were detected for ADC values or MRI morphology concerning response and no correlations were present between FDG uptake and ADC values. The mean radiation dose was 5.9–6.5 mSv. We conclude that the combination of metabolic information and MRI morphology at a low radiation dose proposes PET/MR as a suitable imaging modality for AE assessment. Longitudinal studies are needed to define the role of this imaging modality.

Highlights

Introduction published maps and institutional affilAs a rare parasitic disease, alveolar echinococcosis (AE) affects countries in the Northern Hemisphere, especially the western regions of China, Western Europe, and Turkey, as well as eastern Russia, North America, and Japan [1–3]
No significant differences were detected for ADC values or magnetic resonance imaging (MRI) morphology concerning response and no correlations were present between FDG uptake and ADC values
We conclude that the combination of metabolic information and MRI morphology at a low radiation dose proposes PET/MR as a suitable imaging modality for AE assessment

Summary

Introduction

As a rare parasitic disease, alveolar echinococcosis (AE) affects countries in the Northern Hemisphere, especially the western regions of China, Western Europe, and Turkey, as well as eastern Russia, North America, and Japan [1–3]. Prognosis is poor when left untreated, with a mortality close to 100% after 10 years [4,5]. With the liver being the main target organ, the parasitic manifestation can lead to failure in liver function and spread beyond the liver. With the introduction of benzimidazoles (BZM) in the late 1970s, survival rates gradually improved, especially when supplemented with surgery as a possible long-term therapeutic option. As BZM have a parasitostatic effect, they require continued and permanent medication in most cases. Successful treatment strategies can lead to long-term remission and the BZM therapy might be discontinued (structured treatment interruption, STI) [6,7]. There is no single laboratory or imaging marker that iations

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