Whole body nuc-med imaging a solid contributor to inpatient infection management
PET/CT with the common radiotracer 18F-FDG has been found useful for workups and monitoring of infections in real-world hospitalized patients, according to a study conducted by researchers at Yale and Stanford published Nov. 14 in PLOS One.
Used with whole-body protocols, the imaging modality is especially strong when the infection has been identified but the anatomic site of its initial attack is obscure.
It’s also helpful when assessing patients with fever of unknown cause as well as those with infected endovascular grafts.
For these reasons, infection-management 18F-FDG PET deserves reconsideration for reimbursement and updated appropriate use criteria.
Corresponding author Marwan Azar, MD, and colleagues made the findings and recommendations after reviewing the charts of 61 inpatients at an academic medical center who met the team’s inclusion criteria after undergoing 18F-FDG PET/CT for infection workups over a 6½-year span.
They found the exam affected diagnosis or clinical management for 36% of the patients (22 of 61).
The cases included 43% of patients with known infection, 30% of those with fever of unknown origin and 30% with other indications.
Further, an 18F-FDG PET/CT exam confirmed suspected prosthetic endovascular infection in 38% of patients with that diagnosis (6 of 16).
From these results the authors conclude that prospective studies are warranted to “better define how to incorporate 18F-FDG PET/CT into diagnostic algorithms for infection based on clinical utility, cost-effectiveness and prognostic impact” [1].
‘A Powerful Tool to Evaluate Certain Infections and Inflammatory Conditions’
In their discussion Azar and co-authors acknowledge their reliance on data from a single hospital among several limitations.
They also note their focus on infection management, to the exclusion of length of stay, mortality and other clinical outcomes.
Nevertheless, they point out, whole-body 18F-FDG PET/CT “is a powerful tool to evaluate certain infections and inflammatory conditions and has gradually become the standard of care for a number of conditions.”
Path Opens to Reimbursement, Appropriate Use Criteria
Azar and colleagues additionally note CMS’s retirement of a national non-coverage policy for FDG PET infection and inflammation effective New Year’s Day of 2021.
Further back, in 2008, CMS had ruled that PET imaging for infection and inflammation would not be covered for reimbursement. The issue was the limited data available at the time.
The 2021 removal of the 2008 coverage determination, Azar et al. write,
… opens a path to reimbursement, which ultimately will improve care for patients. Appropriate use criteria for 18F-FDG PET/CT for infection and inflammation and to diagnose fever of unknown origin will be needed.”
The study is available in full for free.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.