Abstract
Purpose
Tc-99m ciprofloxacin is available for imaging infection. However, there has been no study on employing single photon emission computed tomography (SPECT) with using Tc-99m ciprofloxacin to image active pulmonary tuberculosis. Therefore, we conducted this study to assess the efficacy of Tc-99m ciprofloxacin SPECT for imaging active pulmonary tuberculosis.
Methods
Twenty-one participants were enrolled in this prospective study. They were divided into two groups according to the clinical and radiological assessment. Group one (Gr. 1) consisted of five normal volunteers and six patients with inactive pulmonary tuberculosis. Group two (Gr. 2) consisted of ten patients with active pulmonary tuberculosis. SPECT was performed 3 h after injecting 555 MBq (15 mCi) of Tc-99m ciprofloxacin. The findings of Tc-99m ciprofloxacin SPECT were interpreted by a nuclear medicine specialist and then the results were analyzed according to the patients’ clinical and radiological classifications.
Results
The results of Tc-99m ciprofloxacin SPECT were as follows: eight true-positive cases, ten true-negative cases, one false-positive case and two false-negative cases. The sensitivity and specificity was 80.0% and 90.9%, respectively. The positive predictive value was 88.9% and the negative predictive value was 83.3%.
Conclusions
Tc-99m ciprofloxacin SPECT is feasible for imaging active pulmonary tuberculosis. It is a useful nuclear-imaging method for discriminating between the active and inactive tuberculosis states in patients with a past medical history of pulmonary tuberculosis.
Similar content being viewed by others
References
Solanki KK, Bomanji J, Siraj Q, Small M, Britton KE (1993) Tc-99m “Infecton”—a new class of radiopharmaceutical for imaging infection. J Nucl Med 34(Suppl):119
Vinjamuri S, Hall AV, Solanki KK, Bomanji J, Siraj Q, O’Shaughnessy E et al (1996) Comparison of 99mTc infecton imaging with radiolabelled white-cell imaging in the evaluation of bacterial infection. Lancet 347:233–235
Britton KE, Wareham DW, Das SS, Solanki KK, Amaral H, Bhatnagar A et al (2002) Imaging bacterial infection with 99mTc-ciprofloxacin (Infecton). J Clin Pathol 55:817–823
Cherry SR, Sorenson JA, Phelps ME (2003) Physics in nuclear medicine, 3rd edn. Saunders, Philadelphia, pp 447–477
Mandell GL, Petri WA Jr (1996) Antimicrobial agents: sulfonamides, trimethoprim-sulfamethoxazole, quinolones, and agents for urinary tract infections. In: Hardman JG, Gilman AG, Limbird LE (eds) Goodman & Gilman’s The pharmacological basis of therapeutics, 9th edn. McGraw-Hill, New York, pp 1057–1072
Adams BK, Youssef I, Parkar S (2006) Tc-99m ciprofloxacin (Infecton) in abdominal tuberculosis. Clin Nucl Med 31:157–158
Neumann RD, McAfee JG (2003) Gallium-67 imaging in infection. In: Sandler MP, Coleman RE, Wackers FJ, Patton JA, Gottschalk A (eds) Diagnostic nuclear medicine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1205–1217
Coleman RE, Datz FL (2003) Detection of inflammatory disease with radiolabeled cells. In: Sandler MP, Coleman RE, Wackers FJ, Patton JA, Gottschalk A (eds) Diagnostic nuclear medicine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1219–1234
Fischman AJ, Rubin RH (2003) Detection of focal inflammation using radiolabeled, nonspecific human polyclonal immunoglobulin-G. In: Sandler MP, Coleman RE, Wackers FJ, Patton JA, Gottschalk A (eds) Diagnostic nuclear medicine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1235–1244
Choe W, Chung MH, Kim WH, Kim S, Ryu JK, Kang KJ et al (2002) Imaging prostatitis with Tc-99m ciprofloxacin. Clin Nucl Med 27:527–529
Choe W, Ryu JK, Kim WH, Chung MH, Suh JK (2003) Imaging seminal vesiculitis with Tc-99m ciprofloxacin. Clin Nucl Med 28:501–502
Choe W, Im MW, Chung JK, Jeong JM (2000) Imaging pelvic inflammatory disease with Tc-99m ciprofloxacin. Clin Nucl Med 25:842–844
Ryu JK, Lee SM, Seong DW, Suh JK, Kim S, Choe W et al (2003) Tc-99m ciprofloxacin imaging in diagnosis of chronic bacterial prostatitis. Asian J Androl 5:179–183
Britton KE, Vinjamuri S, Hall AV, Solanki K, Siraj QH, Bomanji J et al (1997) Clinical evaluation of technetium-99m infecton for the localisation of bacterial infection. Eur J Nucl Med 24:553–556
Hall AV, Solanki KK, Vinjamuri S, Britton KE, Das SS (1998) Evaluation of the efficacy of 99mTc-Infecton, a novel agent for detecting sites of infection. J Clin Pathol 51:215–219
De Winter F, Van de Wiele C, Dumont F, Van Durme J, Solanki K, Britton K et al (2001) Biodistribution and dosimetry of 99mTc-ciprofloxacin, a promising agent for the diagnosis of bacterial infection. Eur J Nucl Med 28:570–574
Sharma R, Mondal A, Sharma M, Popli M, Chopra MK, Sawroop K et al (2001) Tc-99m Infecton scan in possible pelvic inflammatory disease. Clin Nucl Med 26:208–211
Sonmezoglu K, Sonmezoglu M, Halac M, Akgun I, Turkmen C, Onsel C et al (2001) Usefulness of 99mTc-ciprofloxacin (infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy. J Nucl Med 42:567–574
Larikka MJ, Ahonen AK, Niemela O, Puronto O, Junila JA, Hamalainen MM et al (2002) 99mTc-ciprofloxacin (Infecton) imaging in the diagnosis of knee prosthesis infections. Nucl Med Commun 23:167–170
Larikka MJ, Ahonen AK, Niemela O, Junila JA, Hamalainen MM, Britton K et al (2002) Comparison of 99mTc ciprofloxacin, 99mTc white blood cell and three-phase bone imaging in the diagnosis of hip prosthesis infections: improved diagnostic accuracy with extended imaging time. Nucl Med Commun 23:655–661
Malamitsi J, Giamarellou H, Kanellakopoulou K, Dounis E, Grecka V, Christakopoulos J et al (2003) Infecton: a 99mTc-ciprofloxacin radiopharmaceutical for the detection of bone infection. Clin Microbiol Infect 9:101–109
Artiko V, Davidovic B, Nikolic N, Petrovic M, Vlajkovic M, Pesko P et al (2005) Detection of gastrointestinal and abdominal infections by 99mTc-ciprofloxacin. Hepatogastroenterology 52:491–495
Falagas ME, Valotassiou VJ, Papadouli D, Papadopoulos A, Malamitsi J (2006) 99mTechnetium-ciprofloxacin scintigraphy for the evaluation of spinal infections: a preliminary report. Clin Orthop Relat Res 444:34–37
Amaral H, Morales B, Pruzzo R, Britton KE (1999) Cold-hot mismatch between Tc-99m HMPAO-labeled leukocytes and Tc-99m ciprofloxacin in axial skeleton infections: a report of three cases. Clin Nucl Med 24:855–858
Sharma R, Mondal A, Chopra MK, Rawat HS, Kashyap R (2002) Tc-99m infecton and Tc-99m MDP imaging in osteomyelitis of the hip joint. Clin Nucl Med 27:217–218
Dumarey N, Schoutens A (2003) Renal abscess: filling in with Tc-99m ciprofloxacin of defects seen on Tc-99m DMSA SPECT. Clin Nucl Med 28:68–69, Erratum in: Clin Nucl Med 2003;28:456
Gemmel F, Hamerlynck N, Vanderschueren G, Giri M, Goethals I, Jacobs F (2004) Multimodality SPECT imaging of multifocal spondylodiscitis. Clin Nucl Med 29:635–636
Adams BK, Youssef I, El-Tom el-F A (2006) Imaging in acute pyogenic spondylitis. Clin Nucl Med 31:85–86
Singh B, Mittal BR, Bhattacharya A, Aggarwal A, Nagi ON, Singh AK (2005) Technetium-99m ciprofloxacin imaging in the diagnosis of postsurgical bony infection and evaluation of the response to antibiotic therapy: a case report. J Orthop Surg (Hong Kong) 13:190–194
Adams BK, Youssef I, Parkar S (2006) Absent Tc-99m ciprofloxacin (Infecton) uptake in a renal abscess. Clin Nucl Med 31:211–212
Gemmel F, De Winter F, Van Laere K, Vogelaers D, Uyttendaele D, Dierckx RA (2004) 99mTc-ciprofloxacin imaging for the diagnosis of infection in the postoperative spine. Nucl Med Commun 25:277–283
Dumarey N, Blocklet D, Appelboom T, Tant L, Schoutens A (2002) Infecton is not specific for bacterial osteo-articular infective pathology [see comments]. Eur J Nucl Med Mol Imaging 29:530–535, Comment in: Eur J Nucl Med Mol Imaging 2003;30:181-2; Author reply: 183
Sarda L, Saleh-Mghir A, Peker C, Meulemans A, Cremieux AC, Le Guludec D (2002) Evaluation of 99mTc-ciprofloxacin scintigraphy in a rabbit model of Staphylococcus aureus prosthetic joint infection [see comments]. J Nucl Med 43:239–245, Comment in: J Nucl Med 2003;44:317-9; Author reply: 319-20
Sarda L, Cremieux AC, Lebellec Y, Meulemans A, Lebtahi R, Hayem G et al (2003) Inability of 99mTc-ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases [see comments]. J Nucl Med 44:920–926, Comment in: J Nucl Med 2003;44:927-9, 2004;45:922-3; Author reply: 923
Appelboom T, Emery P, Tant L, Dumarey N, Schoutens A (2003) Evaluation of technetium-99m-ciprofloxacin (Infecton) for detecting sites of inflammation in arthritis. Rheumatology (Oxford) 42:1179–1182
Adams BK, Youssef I, Parkar S (2006) Nonspecific infecton uptake in hyperemia secondary to a Ewing sarcoma. Clin Nucl Med 31:479–481
Yapar Z, Kibar M, Yapar AF, Togrul E, Kayaselcuk U, Sarpel Y (2001) The efficacy of technetium-99m ciprofloxacin (Infecton) imaging in suspected orthopaedic infection: a comparison with sequential bone/gallium imaging. Eur J Nucl Med 28:822–830
Tewson TJ (2005) Re: synthesis and comparison of 99mTc-enrofloxacin and 99mTc-ciprofloxacin [comment]. J Nucl Med 46:1077, Comment on: J Nucl Med 2004;45:2088-94
Ballinger JR (2005) Nomenclature of 99mTc-technetium-labeled radiopharmaceuticals [comment]. J Nucl Med 46:2121, Comment on: J Nucl Med 2005;46:1077
Mandell GL, Petri WA Jr (1996) Antimicrobial agents: drugs used in the chemotherapy of tuberculosis, mycobacterium avium complex disease, and leprosy. In: Hardman JG, Gilman AG, Limbird LE (eds) Goodman & Gilman’s The pharmacological basis of therapeutics, 9th edn. McGraw-Hill, New York, pp 1155–1174
Singh AK, Verma J, Bhatnagar A, Sen S, Bose M (2003) Tc-99m isoniazid: a specific agent for diagnosis of tuberculosis. World J Nucl Med 2:292–305
Samuel G, Kothari K, Banerjee S, Das T, Subramanian S, Kameshwaran M et al (2005) On the 99mTc-labeling of isoniazid with different 99mTc cores. J Label Compd Radiopharm 48:363–377
Kartamihardja AH, Rahim AH, Melinda H, Budiawan H, Sulistiani A (2006) Tc-99m-ethambutol imaging for detection of tuberculosis. World J Nucl Med 5(Suppl 1):S54
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, M., Yoon, M., Hwang, K.H. et al. Tc-99m Ciprofloxacin SPECT of Pulmonary Tuberculosis. Nucl Med Mol Imaging 44, 116–122 (2010). https://doi.org/10.1007/s13139-010-0021-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13139-010-0021-4