Pijl et al [12] performed a single-center retrospective cohort study of all ICU patients with culture-proven blood stream infection over a 10 year period who had undergone FDG-PET/CT specifically to assess for source of Sepsis infection after an initial negative conventional workup. Of the 30 patients included in the study, FDG-PET/CT identified a source of infection in 70% of patients and had a sensitivity of 90.9% and a specificity of 87.5% with discharge diagnosis serving as the reference standard. The most common sources of infection found were pneumonia and septic arthritis. The overall PPV was 95.2%, and the NPV was 77.8% for identifying a focus of infection. Of the positive FDG-PET/CTs, 52% identified a new infectious focus that led to treatment modifications such as abscess drainage, removal of infected material, or change in antimicrobial therapy. FDG-PET/CT still resulted in treatment changes in an additional 14% who already had a known infectious focus. Given that PET/CT does not provide the same degree of anatomic localization as a dedicated diagnostic dose CT, PET/CT is not considered useful as the next imaging modality after chest radiograph. Therefore, it should only be considered for use after source localization with CT has failed. MRI Chest Without and With IV Contrast Although MRI can readily detect pulmonary and pleural infection, there are no data to support the use of MRI chest without and with IV contrast as the next diagnostic imaging study after normal, equivocal, or nonspecific chest radiography in the diagnosis of sepsis. MRI Chest Without IV Contrast Although MRI can readily detect pulmonary and pleural infection, there are no data to support the use of MRI chest without IV contrast as the next diagnostic imaging study after normal, equivocal, or nonspecific chest radiography in the diagnosis of sepsis. Variant 3: Suspected or confirmed sepsis. Acute abdominal pain. Initial imaging.
Sepsis. Pijl et al [12] performed a single-center retrospective cohort study of all ICU patients with culture-proven blood stream infection over a 10 year period who had undergone FDG-PET/CT specifically to assess for source of Sepsis infection after an initial negative conventional workup. Of the 30 patients included in the study, FDG-PET/CT identified a source of infection in 70% of patients and had a sensitivity of 90.9% and a specificity of 87.5% with discharge diagnosis serving as the reference standard. The most common sources of infection found were pneumonia and septic arthritis. The overall PPV was 95.2%, and the NPV was 77.8% for identifying a focus of infection. Of the positive FDG-PET/CTs, 52% identified a new infectious focus that led to treatment modifications such as abscess drainage, removal of infected material, or change in antimicrobial therapy. FDG-PET/CT still resulted in treatment changes in an additional 14% who already had a known infectious focus. Given that PET/CT does not provide the same degree of anatomic localization as a dedicated diagnostic dose CT, PET/CT is not considered useful as the next imaging modality after chest radiograph. Therefore, it should only be considered for use after source localization with CT has failed. MRI Chest Without and With IV Contrast Although MRI can readily detect pulmonary and pleural infection, there are no data to support the use of MRI chest without and with IV contrast as the next diagnostic imaging study after normal, equivocal, or nonspecific chest radiography in the diagnosis of sepsis. MRI Chest Without IV Contrast Although MRI can readily detect pulmonary and pleural infection, there are no data to support the use of MRI chest without IV contrast as the next diagnostic imaging study after normal, equivocal, or nonspecific chest radiography in the diagnosis of sepsis. Variant 3: Suspected or confirmed sepsis. Acute abdominal pain. Initial imaging.