sodium-pertechnetate-tc-99m and Bacterial-Infections

To evaluate clinical efficacy of a dual-time acquisition protocol, which included 4 and 20/24-h imaging with antigranulocyte antibody scintigraphy (LeukoScan) combined with semiquantitative analysis in the diagnosis of infection in painful hip prosthesis.. Sixty-seven consecutive patients with hip prosthesis were enrolled in this research project: 35 females, 32 males, mean age of 56.3 years. All patients had clinical and biochemical suspicious of infection. Each prosthesis had been implanted 3 months to 12 years before enrollment in this study. Twenty-four patients were on antibiotic therapy at the time of scintigraphy. Seven patients had bilateral hip prosthesis, one painful and the other painless: the seven painless prostheses were considered controls. LeukoScan examination was performed both at early (4 h) and delayed (20/24 h) times. The scintigraphic data were assessed both by visual and semiquantitative methods by three experienced nuclear medicine physicians blinded to clinical, laboratory and radiographic results. The uptake was graded visually by a 4-point scale: intense=3, moderate=2, mild=1 and absent=0. The semiquantitative analysis was obtained by a region of interest (ROI) analysis used in the anterior views to measure the ratio between the mean radioactivity in the prosthesis and the background radioactivity in the early and delayed images. An increase in the intensity of uptake of at least one scale-step at visual analysis and 20% at semiquantitative ROI analysis at the dual-time (early vs. delayed) LeukoScan was considered consistent with infection, whereas a stable or decreasing pattern was judged a negative result. Three-phase 99mTc-hydroxymethane diphosphonate bone scan was also performed routinely. Final diagnosis was determined at surgery and/or long-term clinical and imaging follow-up.. At visual analysis, sensitivity for both early and delayed imaging was 94%, whereas specificity was 71% for early imaging and 83% for early and delayed imaging approach. At semiquantitative ROI analysis, sensitivity remained 94%, whereas specificity rose slightly to 73% for early imaging and to 90% for early and delayed imaging combined. Of note, four false-positive early scans were diagnosed correctly as negative on delayed imaging showing a decreasing pattern in uptake intensity. Sensitivity and specificity were similar whether patients were on or off antibiotic therapy.. Our data show that early imaging LeukoScan is highly sensitive in evaluating septic prosthesis, but it is not optimally specific. Although the dual-time LeukoScan is capable of significantly increasing specificity for detecting infection. The semiquantitative ROI analysis further increased the specificity. Concomitant antibiotic treatment did not seem to influence the diagnostic efficacy of LeukoScan scintigraphy in detecting infected hip prosthesis.

Topics: Aged; Animals; Arthroplasty, Replacement, Knee; Bacterial Infections; Epitopes; Female; Granulocytes; Hip Prosthesis; Humans; Immunoglobulin Fab Fragments; Inflammation; Knee Joint; Male; Mice; Middle Aged; Prospective Studies; Pseudomonas aeruginosa; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Staphylococcus aureus

This study investigated radiolabeled bacteriophages for specific detection of infection through gamma imaging. Previously, a (99m)Tc-labeled M13 phage demonstrated specific binding for its host Escherichia coli in vitro and in mice through imaging.. This study was extended to phages P22, E79, VD-13 and phage 60. Each was radiolabeled with (99m)Tc using the chelator MAG(3), and were evaluated for binding to host and non-host bacteria in vitro and in a mouse infection model.. In vitro, each (99m)Tc-phage bound to its host at least 4-fold higher than to non-host bacteria. For example, (99m)Tc-E79 showed 10- to 20-fold greater binding to host Pseudomonas aeruginosa compared to non-host Escherichia coli and Salmonella enterica, and (99m)Tc-phage 60 showed 20-fold greater binding to host Klebsiella pneumoniae over non-hosts. Mice received host or non-host bacteria in one thigh, and 3 h later, the (99m)Tc-phages were administered intravenously. After a further 3 h, the tissues were counted. Liver accumulation was highest for (99m)Tc-E79, averaging 39% compared to an average of 13% for the other (99m)Tc-phages. Animals infected with host bacteria showed infected thigh/normal thigh ratios of 14.2 for (99m)Tc-E79, 2.9 for (99m)Tc-P22, 3.5 for (99m)Tc-VD-13 and 2.1 for (99m)Tc-phage 60.. Although specific host binding was observed in vitro for each of these four (99m)Tc-phages, only (99m)Tc-E79 showed specificity for its host in an in vivo model.

Topics: Animals; Bacteria; Bacterial Infections; Bacteriophages; Disease Models, Animal; Escherichia coli; Host-Pathogen Interactions; Infections; Isotope Labeling; Klebsiella pneumoniae; Male; Mice; Pseudomonas aeruginosa; Radionuclide Imaging; Radiopharmaceuticals; Salmonella enterica; Sodium Pertechnetate Tc 99m; Species Specificity; Tissue Distribution

Bacterial infection can pose a substantial diagnostic dilemma. Techniques involving radiolabelled leucocytes can pinpoint the site of inflammation. However, previous radiolabelling techniques have failed to distinguish between bacterial-mediated infection and non-bacterial inflammation. To overcome this difficulty, we have studied a radiopharmaceutical, technetium-99m (99mTc) Infecton, which is based on the antibiotic ciprofloxacin.. We used this agent to image bacterial infection in 56 patients (one twice) with known or suspected sites of infection. We then compared the imaging results of these patients with those from a radiolabelled leucocyte study.. The concordance rate was 68% (39 out of 57 images). In 18 discordant results 99mTc Infecton was correctly positive in 8 out of 9 positive studies and correctly negative in 4 out of 9 negative studies. 4 out of 5 of the falsely negative studies were in patients who had taken antibiotics for over 7 days. We found that 99mTc Infecton gave better imaging results than radiolabelled leucocytes. Comparison between 99mTc Infecton and leucocyte imaging gave sensitivities of 84% and 81%, and specificities of 96% and 77%, respectively.. We believe that the specificity 99mTc Infecton confers for bacterial infection and its ease of administration are the main advantages of this new agent.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Ciprofloxacin; Humans; Indium Radioisotopes; Leukocytes; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

The value of immunoscintigraphy with technetium-99m (99Tcm) labelled anti-granulocyte monoclonal antibody (BW250/183) was studied prospectively in human immunodeficiency virus (HIV-1) antibody-positive patients presenting with fever without localizing symptoms or signs. Twenty-three studies were performed in 23 patients and the results of 99Tcm-anti-granulocyte imaging were compared with the definitive microbiological or cytological diagnosis. Twenty-one patients had an infective cause of pyrexia, one patient had disseminated lymphoma and one Kaposi sarcoma. 99Tcm-anti-granulocyte antibody imaging correctly identified the sites of infection in only five (24%) patients, four of whom had infective colitis (one also had bacterial pneumonia) and one of whom had cellulitis. Sixteen foci of infection were not localized by 99Tcm-anti-granulocyte immunoscintigraphy (false-negative scans). Six of these patients had Pneumocystis carinii pneumonia; other diagnoses in this group included bacterial or fungal pneumonia and bacteraemia secondary to line infections. 99Tcm-anti-granulocyte antibody did not accumulate in the patients with disseminated lymphoma and Kaposi sarcoma (true-negative scans). 99Tcm-anti-granulocyte imaging, therefore, appears useful in identifying extrathoracic infection in HIV-1 positive patients. Its lack of sensitivity for the identification of pulmonary infection means that its role in the investigation of HIV-1 antibody-positive patients with fever without localizing symptoms or signs is limited.

Topics: Adult; AIDS-Related Opportunistic Infections; Antibodies, Monoclonal; Antibody Specificity; Bacterial Infections; False Negative Reactions; False Positive Reactions; Fever of Unknown Origin; Granulocytes; HIV Infections; Humans; Immunoconjugates; Lung Neoplasms; Lymphoma, AIDS-Related; Male; Middle Aged; Mycoses; Pneumonia; Pneumonia, Pneumocystis; Prospective Studies; Radioimmunodetection; Sarcoma, Kaposi; Sodium Pertechnetate Tc 99m; Virus Diseases