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Radiology
Scintigraphic Diagnosis of Inflammation and Infection
Built from Fundamentals of Diagnostic Radiology
What’s inside
7 sections · 71 slides
Overview
When anatomy is not enough, radiotracers find infection and inflammation
- Roles of radionuclide imaging in suspected infection
- Principal radiotracers
Gallium-67
A nonspecific tracer that reaches inflammation through several routes
- Gallium-67 uptake mechanisms
- Gallium-67 physics and imaging technique
- Normal gallium-67 distribution
- Normal gallium-67 whole-body studies
- Indications for gallium-67 imaging
- Fever of undetermined origin
- Gallium-67 in fever of undetermined origin
- Spinal osteomyelitis: gallium-67 with a bone scan
- Interpretation of the combined bone and gallium study
- Positive bone and gallium-67 study
- Equivocal bone and gallium-67 study
- Negative bone and gallium-67 study
- Opportunistic infection in the immunocompromised
- Pneumocystis pneumonia on gallium-67
- Other pulmonary inflammation
- Sarcoidosis
- Sarcoidosis on gallium-67
- Interstitial nephritis
- Interstitial nephritis on gallium-67
Radiolabeled leukocytes
Labelling a patient's own white cells so they home to neutrophil-driven infection
- In vitro leukocyte labeling
- Indium-111 labeled leukocytes
- Technetium-99m labeled leukocytes
- Technetium-99m strengths and limits
- Indium-111 versus technetium-99m leukocytes
- Normal white blood cell studies compared
- Mechanism of leukocyte accumulation
- Diseases best suited to leukocyte imaging
- Sarcoidosis: WBC versus gallium-67
- Indications for labeled leukocyte imaging
- Fever of undetermined origin: leukocyte timing
- Limitations of bone scintigraphy in osteomyelitis
- Complicating osteomyelitis and the spine
- Spinal osteomyelitis on WBC imaging
- Dual-isotope imaging with indium-111
- Complementary sulfur colloid marrow imaging
- Interpretation of the WBC and marrow study
- Infected hardware: WBC and marrow
- Aseptic loosening: WBC and marrow
- Postoperative infection
- Pelvic abscess on WBC imaging
- Postoperative infection on WBC imaging
- False positives after surgery
- WBC uptake at a tracheostomy site
- Cardiovascular infections
- Prosthetic vascular graft infection
- Graft infection false positives
- Central nervous system infections
- Pulmonary imaging: focal uptake
- Focal WBC pulmonary activity
- Pulmonary imaging: diffuse uptake
- Diffuse WBC pulmonary activity
- Inflammatory bowel disease: indium-111
- Colitis on WBC imaging
- Inflammatory bowel disease: technetium-99m
- Crohn disease on WBC imaging
SPECT-CT
Fusing tracer function with CT anatomy to localise uptake precisely
- SPECT-CT image fusion
- SPECT-CT of calcaneal osteomyelitis
FDG PET
A glucose analog that lights up active inflammation as well as cancer
- FDG PET for inflammation and infection
- FDG PET in fever of undetermined origin
- FDG PET beyond fever of undetermined origin
- FDG PET of sarcoidosis
- FDG PET and gallium-67 of spinal osteomyelitis
Key takeaways
Choosing the right tracer for the clinical question
- Test selection
- Summary of tracer roles
- 78.3 h
References
Suggested readings from the chapter
- References
- References
- References
- Brant and Helms' Fundamentals of Diagnostic Radiology