Abstract
18F-FDG PET/CT imaging may help non-invasively disprove the diagnosis of acute kidney allograft rejection (AR) in kidney transplant recipients (KTR). The present study aims at evaluating the repeatability and reproducibility of the quantification of renal 18F-FDG uptake in KTR. We prospectively performed 18F-FDG PET/CT in 95 adult KTR who underwent surveillance transplant biopsy between 3 to 6 months post transplantation. Images were obtained 180 minutes after injecting 3 MBq 18F-FDG per kg body weight. Mean standard uptake value (SUVmean) of kidney cortex was independently measured by 2 experienced observers in 4 volumes of interest (VOI) distributed in the upper (n = 2) and lower (n = 2) poles. The first observer repeated SUV assessment in the uppermost VOI, blinded to the initial results. Intra-class correlation coefficients (ICC) and Bland-Altman plots were calculated. An ICC of 0.96 with 95%CI of [0.94; 0.97] was calculated for the intra-observer measurements. The ICC for inter-observer reproducibility for each VOI was 0.87 [0.81–0.91], 0.87 [0.81–0.91], 0.85 [0.78–0.89] and 0.83 [0.76–0.88] for the upper to the lower renal poles, respectively. The repeatability and reproducibility of the quantification of kidney allograft 18F-FDG uptake are both consistent, which makes it transferrable to the clinical routine.
Highlights
18F-FDG positron-emission tomography coupled with computed tomography (PET/CT) imaging may help non-invasively disprove the diagnosis of acute kidney allograft rejection (AR) in kidney transplant recipients (KTR)
Promising preclinical and clinical observations have been reported on the role of 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography coupled with computed tomography (PET/CT) in kidney allograft AR, in both diagnosis and therapeutic monitoring[16,17,18]
No significant difference was observed between the SUVmean of the 4 volumes of interest (VOI) of the same kidney (p = 0.41) in observer 1, while SUVmean of the superior pole was significantly lower than the 3 others values in observer 2 (p = 0.0001)
Summary
18F-FDG PET/CT imaging may help non-invasively disprove the diagnosis of acute kidney allograft rejection (AR) in kidney transplant recipients (KTR). Mean standard uptake value (SUVmean) of kidney cortex was independently measured by 2 experienced observers in 4 volumes of interest (VOI) distributed in the upper (n = 2) and lower (n = 2) poles. Systematic studies focusing on the clinical value of protocol biopsies (by definition performed in stable kidney transplant recipients (KTR)) have demonstrated a non-negligible prevalence of subclinical AR4–8. Transplant needle biopsy (TNB) using Banff classification is the gold standard for AR diagnosis[11] Still, it is associated with a substantial risk of complications, such as hemorrhage or infection[12]. The purpose of this study is to evaluate the intra- and inter-observer variability in the assessment of renal 18F-FDG uptake in KTR
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