Clinical validation of the avidin/indium-111 biotin approach for imaging infection/inflammation in orthopaedic patients.

We report here the results of a validation study of the avidin/indium-111 biotin approach in patients with skeletal lesions. This study involved 54 patients with orthopaedic conditions: 20 patients with intermediate suspected osteomyelitis of the trunk, 19 patients with infection/inflammation of prosthetic joint replacements, and 15 patients with suspected osteomyelitis of appendicular bones. Avidin (3 mg) was injected as an i.v. bolus, followed 4 h later by 111In-biotin; imaging was acquired 30 min and 16-18 h after administration of 111In-biotin. Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocyte scintigraphy was performed in 39/54 patients. The overall sensitivity of the avidin/111In-biotin scan was 97.7% (versus 88.9% for 99mTc-HMPAO leucocyte scintigraphy). While the diagnostic performance of avidin/111In-biotin scintigraphy was similar to that of 99mTc-HMPAO leucocyte scintigraphy in patients with prosthetic joint replacements or osteomyelitis of appendicular bones, the avidin/111In-biotin approach clearly performed better than 99mTc-HMPAO leucocyte scintigraphy in patients with suspected osteomyelitis of the trunk (100% sensitivity, specificity and accuracy versus 50% sensitivity, 100% specificity and 66.7% accuracy for 99mTc-HMPAO-leucocyte scintigraphy). These results demonstrate the feasibility of the avidin/111In-biotin approach for imaging sites of infection/inflammation in the clinical setting. Although no systematic advantages of avidin/111In-biotin scintigraphy were found versus 99mTc-HMPAO leucocyte scintigraphy, the newer scintigraphic method is more practicable and involves lower biological risk for the operators.     

Role of indium-111 labelled platelet scintigraphy in the management of thrombocytopenic patients with malignant neoplasms

This study was done to investigate the role of indium-111 labelled platelet scintigraphy in the treatment of thrombocytopenia in patients with malignant neoplasms. The study involved 20 consecutive patients with thrombocytopenia associated with malignant neoplasms or hematological disorders and without evidence of underproduction of megakaryocytes due to chemotherapy or bone marrow infiltration by the malignancy. Splenic sequestration of platelets was evaluated by measuring splenic uptake of ¹¹¹In-labelled platelets, and findings were correlated with the outcome of splenectomy and medication. Of the 20 patients, 13 had splenic sequestration of platelets. Seven of the 13 patients underwent splenectomy; six of these seven patients experienced a complete response. The other six patients received medication only and showed no response. Of the seven patients without splenic sequestration of platelets, five received medication, and four of them responded to it. ¹¹¹In-labelled platelet scintigraphy has a role in selecting appropriate therapy and predicting its efficacy in patients with thrombocytopenia associated with malignant neoplasms. Received: 6 September and in revised form 13 November 1997     

Indium-111 pentetreotide in the diagnostic work-up of patients with bronchogenic carcinoma

In a prospective study we examined 38 patients with primary bronchogenic carcinoma to validate the use of indium- I 11 pentetreotide (IPT) as a diagnostic tool. Of these 38 patients, 25 had small cell lung cancer (SCLC) and 13, non-small cell lung cancer (NSCLC). The aim of the study was to investigate whether (a) the disease can be reliably detected, (b) IPT allows differentiation between SCLC and NSCLC and (c) IPT provides further information on metastatic disease. After giving their informed consent the patients were injected and imaged 4 and 24 h later using a planar whole-body technique. In addition single-photon emission tomography of the thorax and, if necessary, other areas of the body was performed at 24 h. In the 25 patients with SCLC 22 sites of primary tumour were correctly identified (true-positive, TP); one was false-negative (FN) and two were true-negative (TN), the patients being in full remission. Metastases were correctly identified in ten instances (lung,bone and brain), while the findings were FN in five cases. An additional six FN findings resulted in the area of the upper abdomen due to the physiological uptake in the liver, spleen and kidneys. In the 13 patients with NSCLC, ten findings were TP and 3 FN with respect to the primary tumour. Two FN_s were squamous cell carcinoma, and one, adenocarcinoma. Metastases were TP in nine cases and FN in one. We therefore conclude: (1) IPT is a highly sensitive method for the detection of primary bronchogenic carcinoma, and in particular for SCLC, (2) differentiation between SCLC and NSCLC cannot be achieved and (3) the method is of limited use in the search for metastatic disease. Compared with the conventional imaging modalities like X-ray, CT and bone scintigraphy, IPT provides only a small amount of additional diagnostic information.     

Serial indium-111-labelled IgG biodistribution in ratPneumocystis carinii pneumonia: a tool to monitor the course and severity of the infection

To study the effect of new therapeutic strategies, we developed an animal model to monitor the course and severity of experimentalPneumocystis carinii pneumonia (PCP) in rats.P. carinii density scores in Giemsa-stained impression smears were used to followP. carinii load. Indium-111 labelled IgG scintigraphy and biodistribution, histology of paraffin-embedded tissue sections, lung body weight (L/B wt) ratio and cell count and differentiation of broncho-alveolar lavage (BAL) fluid were used as parameters of host inflammatory response. Statistically significant differences in L/B wt ratio, number of neutrophils in BAL fluid,P. carinii density score, histological extent of inflammation and¹¹¹In-IgG accumulation in the lung were seen between the rats sacrificed at various time points.¹¹¹In-IgG accumulation in the lung correlated well with L/B wt ratio andP. carinii density score and correlated moderately with number of neutrophils in BAL fluid and with the histological extent of inflammation.     

Clinical feasibility of two-step streptavidin/111In-biotin scintigraphy in patients with suspected vertebral osteomyelitis

Purpose Streptavidin accumulates at sites of inflammation and infection as a result of increased capillary permeability. In addition to being utilised by bacteria for their own growth, biotin forms a stable, high-affinity non-covalent complex with avidin. The objective of this investigation was to determine the diagnostic performance of two-step streptavidin/¹¹¹In-biotin imaging for evaluating patients with suspected vertebral osteomyelitis.Methods We evaluated 55 consecutive patients with suspected vertebral osteomyelitis (34 women and 21 men aged 27–86 years), within 2 weeks after the onset of clinical symptoms. Thirty-two of the patients underwent magnetic resonance imaging (MRI) and 24, computed tomography (CT). DTPA-conjugated biotin was radiolabelled by incubating 500 g of DTPA-biotin with 111 MBq of ¹¹¹In-chloride. Two-step scintigraphy was performed by first infusing 3 mg streptavidin intravenously, followed 4 h later by ¹¹¹In-biotin. Imaging was begun 60 min later.Results Streptavidin/¹¹¹In-biotin scintigraphy was positive in 32/34 patients with spinal infection (94.12% sensitivity). The study was negative in 19/21 patients without infection (95.24% specificity). The corresponding results for MRI and CT were 54.17% and 35.29% (sensitivity), and 75% and 57.14% (specificity), respectively. All statistical parameters of diagnostic performance (Youdens J index, kappa measure of agreement with correct classification, accuracy, sensitivity, specificity, positive likelihood and negative likelihood) were clearly better for streptavidin/¹¹¹In-biotin scintigraphy than for either MRI or CT.Conclusion Streptavidin/¹¹¹In-biotin scintigraphy is highly sensitive and specific for detecting vertebral osteomyelitis in the first 2 weeks after the onset of clinical symptoms, and is potentially very useful for guiding clinical decisions on instituting appropriate therapy.     

Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft

The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft. We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6±12 years). The mean duration of PFS was 35 days (range 7–122). Forty-six of the 91 patients underwent steroid therapy (2– 10 mg/day). Platelet labelling was carried out following Thakur’s method. Platelet scans were performed 48 h after reinjection of labelled platelets. The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI. The final diagnosis of PFS was established depending on the outcome after treatment. In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy. In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin). The PUI in patients with immunological PFS was 1.80±0.7, while in patients with non-immunological PFS it was 1.12±0.1 (P<0.05). When a PUI of ≥1.5 was considered as the threshold to establish PFS of immunological origin, the sensitivity of platelet scan was 76%, the specificity 100%, and the negative and positive predictive values 69% and 100%, respectively. In patients classified with immunological PFS who underwent steroid therapy, the PUI was significantly lower than in patients without steroids (P<0.05). These results suggest that ¹¹¹In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft. Therapy with steroids could reduce the sensitivity of ¹¹¹In-labelled platelet scintigraphy in detecting immunological PFS. Received 23 September and in revised form 3 November 1999     

389例成人HIV/AIDS肺部感染的临床和影像学分析

目的：探讨成人HIV／AIDS合并肺部感染的临床特点和影像学征象。方法：收集在援博茨瓦纳玛丽娜公主医院临床确证的HIV／AIDS肺部感染389例，对其常见类型的临床特点和影像征象进行综合分析。结果：HIV／AIDS肺部感染最常见的类型为肺结核、卡氏肺囊虫肺炎和细菌性肺炎，临床特点、X线和CT表现具有一定的特征。结论：肺部感染是艾滋病患者晚期的主要机会性感染。肺内出现斑片、大片或弥漫病变，或肺门、纵隔淋巴结肿大，结合临床资料应考虑这些感染的可能。     

白细胞核素显像探针的临床应用和研究进展

炎症是机体对抗侵入性病原体和其他损伤的第一道防线,它在组织修复和消除有害病原体方面起着重要作用,但过度炎症反应或炎症消退的延迟将破坏组织中的正常细胞。因此,寻求一种理想的炎症显像方法一直都是临床和科研工作者所追求的目标。白细胞核素显像探针通过即时示踪白细胞,高特异性地反映炎症的病理过程,能早期准确反映炎症程度和预后评价。笔者就此类炎症显像剂的临床应用和研究进行综述。     

Monoclonal antibody BW431/26 labelled with technetium 99m and indium 111: an investigation of the biodistribution and the dosimetry in patients

As a competitive diagnostic tool for the detection of malignant tumours and other pathological conditions, monoclonal antibodies have long been established. Herein we give the biokinetic data of the antibody BW 431/26 and the consequent radiation dose to patients. These parameters were recorded in 39 patients, using the antibody labelled either with technetium 99m or indium 111. Remarkable differences were observed between the two radionuclides. Whereas the indium-labelled one showed biexponential elimination kinetics, the technetium-labelled one is eliminated linearly over time. The distribution pattern of the two is identical, although the radiation dose varies quite a lot, being 20-fold higher with indium 111 when total body exposure is taken into account (for ¹¹¹In the whole-body radiation exposure is 0.1 mGy/MBq; for ^99mTc it is 0.0047 mGy/MBq). With respect to these results and considering the general availability of the technetium-labelled Ab, it is the best choice for diagnostic use.Offprint requests to: P. Benz     

<Superscript>99m</Superscript>Tc-Ciprofloxacin planar and tomographic imaging for the diagnosis of infection in the postoperative spine: experience in 48 patients

The non-invasive assessment of postoperative spinal infections can pose a substantial diagnostic challenge, especially in the presence of orthopaedic devices. Whereas white blood cell scanning is of limited use in the spine, the low normal bone marrow uptake of technetium-99m ciprofloxacin combined with its claimed bacterial specificity makes it theoretically an ideal candidate for the evaluation of postoperative spinal infections. This study aimed to evaluate ^99mTc-ciprofloxacin planar and single-photon emission tomography (SPET) imaging in relation to microbiological and clinical diagnosis in the postoperative spine. Planar imaging was performed at 1, 3 and 24 h and SPET was performed at 3 h post injection of 370 MBq ^99mTc-ciprofloxacin. Images were scored by two independent certified nuclear medicine physicians, blinded to the final diagnosis. Within the 48 patients, there were 13 deep infections. Sensitivity, specificity and accuracy at visual scoring were respectively 54%, 71% and 67% (1 h), 62%, 77% and 73% (3 h), 42%, 91% and 77% (24 h) for planar imaging and 100%, 74% and 81% for SPET. When recently operated patients (<6 months) were excluded, the specificity of the SPET imaging rose to 81%. In conclusion, unlike white blood cell scanning, ^99mTc-ciprofloxacin SPET is sensitive in evaluating infections in the postoperative spine. Sensitivity is much higher for SPET than for planar imaging. However, the results presented prove that its specificity is limited, especially in recently operated patients. Taking this limitation into account, we advise planar and SPET imaging at 3 h post injection and an interval of at least 6 months after surgery to minimise the likelihood of false positives.     

Hepatic fat quantification using chemical shift MR imaging and MR spectroscopy in the presence of hepatic iron deposition: validation in phantoms and in patients with chronic liver disease

Purpose:

To compare the accuracy of four chemical shift magnetic resonance imaging (MRI) (CS‐MRI) analysis methods and MR spectroscopy (MRS) with and without T2‐correction in fat quantification in the presence of excess iron.

Materials and Methods:

CS‐MRI with six opposed‐ and in‐phase acquisitions and MRS with five‐echo acquisitions (TEs of 20, 30, 40, 50, 60 msec) were performed at 1.5 T on phantoms containing various fat fractions (FFs), on phantoms containing various iron concentrations, and in 18 patients with chronic liver disease. For CS‐MRI, FFs were estimated with the dual‐echo method, with two T2*‐correction methods (triple‐ and multiecho), and with multiinterference methods that corrected for both T2* and spectral interference effects. For MRS, FF was estimated without T2‐correction (single‐echo MRS) and with T2‐correction (multiecho MRS).

Results:

In the phantoms, T2*‐ or T2‐correction methods for CS‐MRI and MRS provided unbiased estimations of FFs (mean bias, ?1.1% to 0.5%) regardless of iron concentration, whereas the dual‐echo method (?5.5% to ?8.4%) and single‐echo MRS (12.1% to 37.3%) resulted in large biases in FFs. In patients, the FFs estimated with triple‐echo (R = 0.98), multiecho (R = 0.99), and multiinterference (R = 0.99) methods had stronger correlations with multiecho MRS FFs than with the dual‐echo method (R = 0.86; P ≤ 0.011). The FFs estimated with multiinterference method showed the closest agreement with multiecho MRS FFs (the 95% limit‐of‐agreement, ?0.2 ± 1.1).

Conclusion:

T2*‐ or T2‐correction methods are effective in correcting the confounding effects of iron, enabling an accurate fat quantification throughout a wide range of iron concentrations. Spectral modeling of fat may further improve the accuracy of CS‐MRI in fat quantification. J. Magn. Reson. Imaging 2011;33:1390–1398. © 2011 Wiley‐Liss, Inc.

     

Water excitation MPRAGE: an alternative sequence for postcontrast imaging of the abdomen in noncooperative patients at 1.5 Tesla and 3.0 Tesla MRI

PURPOSE: To evaluate the diagnostic image quality of postgadolinium water excitation-magnetization-prepared rapid gradient-echo (WE-MPRAGE) sequence in abdominal examinations of noncooperative patients at 1.5 Tesla (T) and 3.0T MRI. MATERIALS AND METHODS: Eighty-nine consecutive patients (48 males and 41 females; mean age +/- standard deviation, 54.6 +/- 16.6 years) who had MRI examinations including postgadolinium WE-MPRAGE were included in the study. Of 89 patients, 33 underwent noncooperative protocol at 1.5T, 10 underwent noncooperative protocol at 3.0T, and 46 underwent cooperative protocol at 3.0T. Postgadolinium WE-MPRAGE, MPRAGE, and three-dimensional gradient-echo sequences of these three different groups were qualitatively evaluated for image quality, extent of artifacts, lesion conspicuity, and homogeneity of fat-attenuation by two reviewers retrospectively, independently, and blindly. The results were compared using Wilcoxon signed rank and Mann-Whitney U tests. Kappa statistics were used to measure the extent of agreement between the reviewers. RESULTS: The average scores indicated that the images were diagnostic for WE-MPRAGE at 1.5T and 3.0T in noncooperative patients. WE-MPRAGE achieved homogenous fat-attenuation in 31/33 (94%) of noncooperative patients at 1.5T and 10/10 (100%) of noncooperative patients at 3.0T. WE-MPRAGE at 3.0T had better results for image quality, extent of artifacts, lesion conspicuity and homogeneity of fat-attenuation compared with WE-MPRAGE at 1.5T, in noncooperative patients (P = 0.0008, 0.0006, 0.0024, and 0.0042; respectively). Kappa statistics varied between 0.76 and 1.00, representing good to excellent agreement. CONCLUSION: WE-MPRAGE may be used as a T1-weighted postgadolinium fat-attenuated sequence in noncooperative patients, particularly at 3.0T MRI.     

Role of molecular imaging in the management of patients affected by inflammatory bowel disease: State-of-the-art

AIMTo present the current state-of-the art of molecular imaging in the management of patients affected by inflammatory bowel disease (IBD).METHODSA systematic review of the literature was performed in order to find important original articles on the role of molecular imaging in the management of patients affected by IBD. The search was updated until February 2016 and limited to articles in English.RESULTSFifty-five original articles were included in this review, highlighting the role of single photon emission tomography and positron emission tomography.CONCLUSIONTo date, molecular imaging represents a useful tool to detect active disease in IBD. However, the available data need to be validated in prospective multicenter studies on larger patient samples.     

~(11)C-CHO PET/CT显像与全身骨显像在前列腺癌复发患者骨转移中诊断价值

目的探讨~(11)C-CHO PET/CT显像与全身骨显像在前列腺癌复发患者骨转移中的诊断价值。方法回顾性分析自2011年5月至2015年5月沈阳军区总医院核医学科收治的前列腺癌复发患者96例(PSA:2.5-56.0 mg/L)。所有患者均在2周内行~(11)C-CHO PET/CT显像与全身骨显像,以活检、18F-FDG PET/CT、增强CT、MRI、临床随访等综合评价为诊断标准,比较两者诊断的灵敏度、特异度。结果 96例患者中,~(11)C-CHO PET/CT显像与全身骨显像,共发现57个阳性病灶,其中,46个病灶经后续确诊为转移瘤。~(11)C-CHO PET/CT显像与全身骨显像诊断转移灶灵敏度分别为93.3%、69.6%,特异度分别为90.9%、36.4%。~(11)C-CHO PET/CT显像发现骨外转移26处:局部复发10处、膈下淋巴结4处、膈上淋巴结2处、局部复发合并膈下淋巴结5处、膈上合并膈下淋巴结4处以及膈上淋巴结合并肺转移1处。结论在诊断前列腺癌复发患者骨转移方面,~(11)C-CHO PET/CT显像的诊断灵敏度和特异度优于传统全身骨显像,并且~(11)C-CHO PET/CT显像能够发现局部复发、淋巴结和远处器官转移病灶,获得更加准确的临床分期,有助于选择合适的治疗方案。     

Value of dual time point F-18 FDG-PET/CT imaging for the evaluation of prognosis and risk factors for recurrence in patients with stage I non-small cell lung cancer treated with stereotactic body radiation therapy

Purpose

To investigate prognostic and risk factors for recurrence after stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung carcinoma (NSCLC), focusing on dual time point [18]F-fluorodeoxyglucose positron emission tomography (FDG PET).

Materials and methods

We prospectively evaluated 57 patients with stage I NSCLC (45 T1N0M0 and 12 T2N0M0) who had undergone pretreatment FDG-PET/CT and were subsequently treated with SBRT. All patients received a whole-body PET/CT scan at 60 min and a whole-lung at 120 min after the injection. The maximum standardized uptake value (SUV) and retention index (RI) of the lesions were calculated. Local recurrence, regional lymph node metastasis, distant metastasis, and the recurrence pattern were evaluated. Cox proportional hazard regression analyses were performed to evaluate prognostic factors or risk factors of recurrence.

Results

During the median follow-up period of 27 months, local recurrence, regional lymph node metastasis, and distant metastasis were seen in 17 (30%), 12 (21%), and 17 (30%) of the 57 patients, respectively. The 3-year overall survival rate was 63.4%. SUV_max did not affect any recurrence, DFS, OS, or CSS. RI significantly predicted higher distant metastasis (HR 47.546, p = 0.026). In contrast, RI tended to predict lower local recurrence (HR 0.175, p = 0.246) and regional lymph node metastasis (HR 0.109, p = 0.115).

Conclusions

SUV_max at staging FDG-PET does not predict any recurrence, DFS, OS or CSS. In contrast, higher RI predicts higher distant metastasis and tended to predict lower local or regional lymph node metastasis.