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The Quarterly Journal of Nuclear Medicine 1999 March;43(1):46-60


lingua: Inglese

Radionuclide imaging of nonosseous infection

Palestro Ch. J.*, Torres M. A.**

* Chief Nuclear Medicine Long Island Jewish Medical Center, New Hyde Park, NY Professor Nuclear Medicine of Radiology Albert Einstein College of Medicine of Yeshiva University, Bronx, NY ** Senior Fellow Nuclear Medicine Long Island Jewish Medical Center, New Hyde Park, NY


Nuclear med­i­cine is an impor­tant ­tool in the diag­nos­tic eval­u­a­tion of ­patients ­with a varie­ty of non­os­seous infec­tions. In the immu­no­com­pe­tent pop­u­la­tion ­labeled leu­ko­cyte imag­ing is the radio­nu­clide pro­ce­dure of ­choice, ­with Gal­li­um imag­ing ­reserved for ­those sit­u­a­tions in ­which the leu­ko­cyte ­study is non­di­ag­nos­tic or can­not be per­formed. Fever of ­unknown ori­gin is ­caused by infec­tion in ­less ­than one-­third of cas­es, and there­fore the num­ber of pos­i­tive leu­ko­cyte stud­ies ­will be rel­a­tive­ly low. The neg­a­tive leu­ko­cyte ­study is ­also use­ful, how­ev­er, as it has ­been dem­on­strat­ed ­that a neg­a­tive ­study ­excludes, ­with a ­high ­degree of cer­tain­ty, ­focal infec­tion as the ­cause of an FUO. In the car­di­o­vas­cu­lar ­system, ­labeled leu­ko­cyte scin­tig­ra­phy is ­very use­ful for diag­nos­ing mycot­ic aneu­rysms and infect­ed pros­thet­ic vas­cu­lar ­grafts, ­with a sen­si­tiv­ity of ­about 90%. The spec­i­fic­ity of the ­study is some­what ­more var­i­able - ­false pos­i­tive ­results ­have ­been ­described in per­i­graft hemat­o­mas, ­graft throm­bo­sis, bleed­ing, and pseu­do­an­eu­rysms. In the cen­tral ner­vous ­system, ­labeled leu­ko­cyte imag­ing can pro­vide impor­tant infor­ma­tion ­about the eti­ol­o­gy of con­trast enhanc­ing ­brain ­lesions iden­ti­fied on com­put­ed tomog­ra­phy, i.e., dis­tin­guish­ing ­between neo­plasm and infec­tion. In the immu­no­com­prom­ised pop­u­la­tion, typ­i­fied by the ­AIDS ­patient, Gal­li­um scin­tig­ra­phy is the radio­nu­clide pro­ce­dure of ­choice for diag­nos­ing oppor­tu­nis­tic dis­eas­es. In the tho­rax, a nor­mal Gal­li­um ­scan, in the set­ting of a neg­a­tive ­chest X-ray, vir­tu­al­ly ­excludes pul­mo­nary dis­ease. A neg­a­tive Gal­li­um ­scan in a ­patient ­with an abnor­mal ­chest X-ray and Kaposi’s sar­co­ma ­study sug­gests ­that the ­patient’s res­pir­a­to­ry prob­lems are relat­ed to Kaposi’s sar­co­ma. Focal pul­mo­nary paren­chy­mal ­uptake is ­most ­often asso­ciat­ed ­with bac­te­ri­al pneu­mo­nia, ­although Pneumocystis cari­nii pneu­mo­nia can occa­sion­al­ly ­present in ­this fash­ion. Diffuse pul­mo­nary paren­chy­mal ­uptake of Gal­li­um can be due to numer­ous caus­es, but in gen­er­al, the ­more ­intense the ­uptake, the great­er the like­li­hood ­that the ­patient has P. cari­niii pneu­mo­nia. Lymph ­node ­uptake is ­most ­often due to lym­pho­ma or myco­bac­te­ri­al dis­ease. In the abdo­men, Gal­li­um is ­also use­ful for detect­ing ­nodal dis­ease, but is not reli­able for detect­ing ­large bow­el dis­ease. Labeled leu­ko­cyte imag­ing ­should be per­formed ­when col­itis is a con­cern. Both 18FDG PET and 201Tl ­SPECT imag­ing of the ­brain are use­ful for dis­tin­guish­ing ­between cen­tral ner­vous ­system lym­pho­ma and tox­o­plas­mo­sis in the HIV (+) ­patient. On ­both stud­ies, lym­pho­ma man­i­fests as a ­focus of ­increased trac­er ­uptake, where­as tox­o­plas­mo­sis ­shows lit­tle or no ­uptake of ­either trac­er.

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