Jamilla Cecilia L. Gomez, Allan Jay C. Domingo, Althea Camilla D. Robin,
Jonas Francisco Y. Santiago Related Institution
Introduction. Infectious cases require prompt diagnosis for effective therapy. Imaging infection in nuclear medicine uses radiotracers with different mechanisms of actions.
Objectives. The objective of this study was to determine the potential role of 18F-fluorodeoxyglucose labeled leukocytes (FDG-WBC) positron emission tomography with low-dose CT (PET-CT) in infection imaging in patients with diabetic foot and osteomyelitis at St. Luke's Medical Center.
Methodology. There were 11 participants (6 male, 5 female; mean age of 49±18.6 years) with diabetic foot or suspected with osteomyelitis from November 2009-October 2012. In vitro labeling of autologous human leukocytes with 18F-FDG was done. Labeling efficiency and cell viability values were obtained. A PET-CT of the infection site was performed 65.1±8.4 minutes after injection of 96.4±42.5 MBq of FDG-WBC. The scans were read as positive or negative for infection by 3 Nuclear Medicine physicians and subsequently compared to a reference standard (histopathology or clinical end-diagnosis).
Results. Radiochemical purity, cell viability and labeling effiency were >95%, 98.6±1%, and 17.4±6%, respectively. No adverse reactions were encountered. There were 10 positive PET-CT results. Nine had concordant final diagnosis of infection. The one false positive PET result had a final diagnosis of Giant cell tumor. One patient had a negative PET-CT finding but was diagnosed to have infection. There were 9 concordant and 2 discordant results.
Conclusion. FDG-WBC PET-CT scan is useful in imaging patients with diabetic foot and osteomyelitis. It has shorter radiotracer half-life, waiting time post-injection, scan duration and superior images than other infection scans.
1. Roca M, , de Vries EFJ, , Jamar F, . "Guidelines for the labeling of leukocytes with III In-oxine"
Eur J Nucl Med Mol Imaging 37, 835-841, 2010
2. Zeissman H, , O, , Thrall JR, . Nuclear Medicine The Requisites 2006. 400.
3. Meller J, , Sahlman CO, , Scheel AK, . "18F-FOG PET and PETCT in fever of unknown origin"
J Nucl Med 48, 35-45, 2007
4. Dumarey N, , Dominique E, , Blocklet D, . "maging infection with 18F- FOG-labeled leukocytePET/CT: initial experience in 21 patients"
J Nucl Med 47, 625-632, 2006
5. Kagna O, , Srour S, , Melamed E, . "FOG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot"
Eur J Nucl Med Mol Imaging 10, 1545-50, 2012
6. Osman S, , Danpure HJ, . "The use of2-[ 18FJftuoro-2-deoxy-O-glucose as a potential in vitroagent for labelling human granulocytes for clinical studies by positron emission tomography"
Int J Rad Appl lnstrum B 19, 183-90, 1992
7. Forstrom LA, , Mullan BP, , Lowe JC, . "18F-FDG labelling of human leukocytes"
Nucl Med Commun 21, 685-690, 2000
8. Rini J, , Bhargava KK, , Tronco GG, . " PET with FDG-labeled leukocytes versus scintigraphywith IIIIn-oxine-labeled leukocytes for detection of infection"
Radilogy 238, 978-987, 2006
9. Pelligrino D, , Bonab AA, , Dragotakes SC, . " Inflammation and infection: imaging propertiesof 18F-FDG-labeled white blood cells versusI8F-FDG"
J Nucl Med 46, 1522-1530, 2005