Value of F-18-FDG PET/CT in diagnosing chronic Q fever in patients with central vascular disease

Background: The aim of this study is to describe the value of 2-deoxy-2-[18F] fluoro-D-glucose positron emission tomography/computed tomography (F-18-FDG PET/CT) in diagnosing chronic Q fever in patients with central vascular disease and the added value of F-18-FDG PET/CT in the diagnostic combination strategy as described in the Dutch consensus guideline for diagnosing chronic Q fever. Methods: F-18-FDG PET/CT was performed in patients with an abdominal aortic aneurysm or aorto-iliac reconstruction and chronic Q fever, diagnosed by serology and positive PCR for Coxiella burnetii DNA in blood and/or tissue (PCR-positive study group). Patients with an abdominal aortic aneurysm or aorto-iliac reconstruction without clinical and serological findings indicating Q fever infection served as a control group. Patients with a serological profile of chronic Q fever and a negative PCR in blood were included in additional analyses (PCR-negative study group). Results: Thirteen patients were evaluated in the PCR-positive study group and 22 patients in the control group. F-18-FDG PET/CT indicated vascular infection in 6/13 patients in the PCR-positive study group and 2/22 patients in the control group. F-18-FDG PET/CT demonstrated a sensitivity of 46% (95% CI: 23-71%), specificity of 91% (95% CI: 71-99%), positive predictive value of 75% (95% CI: 41-93%) and negative predictive value of 74% (95% CI: 55-87%). In the PCR-negative study group, F-18-FDG PET/CT was positive in 10/20 patients (50%). Conclusion: The combination of F-18-FDG PET/CT, as an imaging tool for identifying a focus of infection, and Q fever serology is a valid diagnostic strategy for diagnosing chronic Q fever in patients with central vascular disease.