RESUMEN
Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection (CI) management in autosomal dominant polycystic kidney disease (ADPKD). The determinants of kidney and/or liver involvement, however, remain uncertain. In this study, we evaluated clinical and imaging factors associated with CI in kidney (KCI) and liver (LCI) in ADPKD. A retrospective cohort study was performed in hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney (TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction. CI was detected in 18 patients who experienced 24 episodes during an interval of 30 months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT, magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria (P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05) were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein levels (P<0.05) were associated with LCI. PET/CT revealed that three or more infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7% sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5% specificity). A greater need for invasive procedures was observed in LCI (P<0.01), and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive imaging method for diagnosis of cyst infection, confirms the multifocal nature of most hospital-admitted episodes, and reveals an association of kidney and liver volumes with this complication.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Quistes/microbiología , Hospitalización , Riñón/patología , Hígado/patología , Riñón Poliquístico Autosómico Dominante/microbiología , Brasil/epidemiología , Proteína C-Reactiva/análisis , Distribución de Chi-Cuadrado , Quistes/patología , Disuria/microbiología , Hematuria/microbiología , Técnicas para Inmunoenzimas , Hallazgos Incidentales , Hígado/microbiología , Tomografía de Emisión de Positrones , Riñón Poliquístico Autosómico Dominante/mortalidad , Riñón Poliquístico Autosómico Dominante/patología , Estudios Retrospectivos , Sensibilidad y Especificidad , Estadísticas no Paramétricas , Pérdida de PesoRESUMEN
OBJETIVO: O diagnóstico de osteomielite crônica em atividade ou sobreposta a outras patologias é difícil, pois estas situações mascaram os achados radiológicos de infecção. A especificidade da cintilografia do esqueleto ou com gálio-67 também é reduzida pela influência da remodelação óssea na captação destes radiofármacos. Anticorpos policlonais marcados com tecnécio-99m (Tc-99m-IgG) apresentam captação independente do metabolismo ósseo, sendo um dos radiofármacos em investigação para avaliação mais específica de infecção. CASUÍSTICA E MÉTODO: Neste estudo comparou-se a cintilografia com Tc-99m-IgG, cintilografia óssea trifásica e cintilografia com gálio-67 no diagnóstico da osteomielite crônica em atividade em 23 segmentos ósseos; correlacionando-as com dados clínico-laboratoriais e radiológicos. RESULTADOS: Oito dos 23 segmentos foram classificados como infectados, 11 não infectados e quatro inconclusivos. A sensibilidade e especificidade encontradas para cintilografia óssea, com gálio-67 e com Tc-99m-IgG foram, respectivamente, 88 e 36 por cento, 75 e 73 por cento, 88 e 82 por cento. CONCLUSÃO: Os resultados sugerem que a Tc-99m-IgG possa ser utilizada no diagnóstico da osteomielite crônica em atividade.