ORIGINAL ARTICLE   

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 December;63(4):371-8

DOI: 10.23736/S1824-4785.17.02964-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Estimation of the added value of 99mTc-HMPAO-labelled white blood cell scintigraphy for the diagnosis of infectious foci

Cécile MALHERBE ^{1, 2, 3} ✉, Anne-Claire DUPONT ^{1, 2, 3}, Serge MAIA ^{1, 3}, Yann VENEL ⁴, Benoit ERRA ⁴, Maria-Joao SANTIAGO-RIBEIRO ^{2, 3, 4}, Nicolas ARLICOT ^{1, 2, 3}

¹ Radiopharmacy Department, University Hospital of Tours, Tours, France; ² François Rabelais University, Tours, France; ³ UMR Inserm, U930 “Imaging and Brain”, Tours, France; ⁴ Nuclear Medicine Department, University Hospital of Tours, Tours, France

BACKGROUND: Leucocytes scintigraphy (LS) is an in-vivo imaging technique investigating infectious foci, performed in our nuclear medicine department after a 99mTc-bisphophonates bone scintigraphy (BS) or an 18F-FDG-PET, in osteoarticular or vascular localizations, respectively. The aim of this study was to reassert the relevance of LS in the diagnostic of occult infections and its impact in therapeutic management.
METHODS: A 45-month retrospective study (2012-2015), including 34 patients, was conducted. Patients who underwent LS were identified and classified according to the location of the suspected infection and the feature of first-line imaging exploration. The final diagnosis (infected or non-infected lesion) was established regarding patients’ follow-up care, including clinical, biological biomarkers and therapeutic interventions. Sensitivity and specificity were calculated for each imaging modality.
RESULTS: LS were conducted for exploration of joint prosthesis (N.=14), vascular prosthesis (N.=7), bone infection or osteitis (N.=8), algoneurodystrophia (N.=2), symphisis infection (N.=1), acute infection on chronicle inflammation (N.=1), and cancer (N.=1). All patients underwent a previous imaging exploration: BS (N.=20, 59%), 18FDG-PET (N.=10, 29%), or another exploration (N.=4, 12%). The sensitivity and specificity of BS were 67% and 36%, respectively, and 100% and 50% for 18FDG-PET, evidencing the lack of specificity of these approaches. Fourteen LS were positive (41%), with sensitivity, specificity and diagnostic accuracy of 85%, 86% and 85%, respectively.
CONCLUSIONS: Despite a long, delicate, and costly radiopharmaceutical and nuclear imaging process, the high specificity of LS supports its qualitative added value in the diagnosis of infectious foci, by improving clinical and therapeutic patient’s outcomes.

KEY WORDS: Radionuclide imaging; Fluorodeoxyglucose F18; Positron-emission tomography; Infection