sodium-pertechnetate-tc-99m and Fever-of-Unknown-Origin

Topics: Abdominal Pain; Child; Diverticulitis; Fever of Unknown Origin; Gastric Mucosa; Humans; Kidney Failure, Chronic; Male; Meckel Diverticulum; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Tomography, X-Ray Computed

The aim of our study was to evaluate the clinical value of immunoscintigraphy with the monoclonal antibody 99mTc-BW 250/183 in patients with fever of unknown origin (FUO). The antibody BW 250/183 is an immunoglobulin G1 subtype that binds to the antigen NCA-95, which is expressed on the cell membrane surface of granulocytes.. We studied 51 patients who were referred with the diagnosis of FUO. Thirty-five percent of the patients suffered from infection, 17% had autoimmune diseases, 14% had neoplasms and 8% had other diseases. The remaining 28% of the patients did not have a diagnosis. Planar imaging was performed in all patients, and 19 patients underwent SPECT. In our analysis, both cold and hot spots were considered diagnostic.. Pyogenic infections were visualized correctly in 13 foci. The diagnosis of endocarditis (n = 4) could be determined only by SPECT. False-negative results were found in 4 patients and false-positive uptake was seen in 2 patients. No false-positive uptake or cold spots in the central bone marrow were found in patients with viral, granulomatous and autoimmune diseases or in those patients in whom no FUO cause was found in a 6-mo follow-up. In these patients, a negative scan did not change their diagnostic work-up. Cold spots in the central bone marrow were correctly interpreted in 5 of 6 patients. Sensitivity in detecting pyogenic foci was 73% and specificity was 97%. Positive and negative predictive values were 93% and 87%, respectively. Including areas of decreased uptake in the analysis, sensitivity for detecting an underlying inflammatory or malignant process for FUO was 81 % and specificity was 87%. Positive and negative predictive values were 81% and 87%, respectively.. Immunoscintigraphy with 99mTc-BW 250/183 in patients with FUO has clinical potential for the diagnosis and exclusion of pyogenic causes of FUO. Metastatic malignant disease and high-grade spondylodiskitis could be diagnosed early in a diagnostic work-up by a characteristic cold spot pattern in the bone marrow. SPECT is indispensible for scintigraphic imaging of endocarditis.

Topics: Adult; Antibodies, Monoclonal; Autoimmune Diseases; Female; Fever of Unknown Origin; Humans; Infections; Leukocytes; Male; Neoplasms; Predictive Value of Tests; Radioimmunodetection; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Tomography, Emission-Computed, Single-Photon

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

Two elderly adults presented with fever of undetermined origin. Radiogallium imaging showed intense concentration in the thyroid, without abnormal localization elsewhere. In the first case, a repeat radiogallium study performed three weeks later was within normal limits. The patient had 0% uptake of radioiodide, and no demonstrable iodine within the thyroid. This probably represented thyroiditis. In the second case, an elevated T4 (RIA) and borderline elevated T3 resin uptake suggested the "dumping phase" of thyroiditis. The two cases indicate that "benign" diseases of the thyroid can be associated with diffuse radiogallium concentration in the gland.

Topics: Aged; Female; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroiditis