Limitations of indium-111 leukocyte scanning in febrile renal transplant patients

Sebrechts, Christopher; Biberstein, Michael; Klein, J. B.; Witztum, Kathryn F.

doi:10.2214/ajr.146.4.823

Cited by 5 publications

(5 citation statements)

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“…111 In-leukocyte scintigraphy is characterized by low image resolution, uneasy coregistration, and high interobserver variability (19). Moreover, the use of 111 In-leukocyte scanning in febrile RTR is inadequate because of unspecific accumulation of leukocytes in renal and pulmonary parenchymae (20). Recently, PET/CT using the glucose analog, 18 FDG, has been proposed in the detection and localization of tissue infection.…”

Section: Discussionmentioning

confidence: 99%

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Jouret

Lhommel²,

Beguin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground Cyst infection remains a challenging issue in patients with autosomal dominant polycystic kidney disease (ADPKD). In most patients, conventional imaging techniques are inconclusive. Isolated observations suggest that 18 fluorodeoxyglucose ( 18 FDG) positron-emission computed tomography (PET/CT) might help detect cyst infection in ADPKD patients.Design, setting, participants, & measurements Comparative assessment of administrative databases from January 2005 to December 2009 identified 27 PET/CT scans performed in 24 ADPKD patients for suspicion of abdominal infection. Cyst infection was definite if confirmed by cyst fluid analysis. Cyst infection was probable if all four of the following criteria were met: temperature of Ͼ38°C for Ͼ3 days, loin or liver tenderness, C-reactive protein plasma level of Ͼ5 mg/dl, and no CT evidence for intracystic bleeding. Episodes with only two or three criteria were grouped as "fever of unknown origin".Results Thirteen infectious events in 11 patients met all criteria for kidney (n ϭ 3) or liver (n ϭ 10) cyst infection. CT was contributive in only one patient, whereas PET/CT proved cyst infection in 11 patients (84.6%). In addition, 14 episodes of "fever of unknown origin" in 13 patients were recorded. PET/CT identified the source of infection in nine patients (64.3%), including 2 renal cyst infections. Conversely, PET/CT showed no abnormal 18 FDG uptake in 5 patients, including 2 intracystic bleeding. The median delay between the onset of symptoms and PET/CT procedure was 9 days.Conclusions This retrospective series underscores the usefulness of PET/CT to confirm and locate cyst infection and identify alternative sources of abdominal infection in ADPKD patients.

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Section: Discussionmentioning

confidence: 99%

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Jouret

Lhommel²,

Beguin³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…111 In scintigraphy is characterized by poor spatial resolution, low sensitivity, high radiation activity and significant inter-observer variability. Moreover, the use of 111 In-leucocyte scanning in febrile RTR raises concerns because of unspecific accumulation of white blood cells (WBC) in renal and pulmonary parenchymae [14].…”

Section: Radiolabelled-leucocyte Scintigraphy In the Diagnosis Of Kidney And Liver Cyst Infectionmentioning

confidence: 99%

Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities

Jouret

Lhommel

Devuyst

et al. 2012

Nephrology Dialysis Transplantation

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Cyst infection is a diagnostic challenge in patients with autosomal dominant polycystic kidney disease (ADPKD) because of the lack of specific manifestations and limitations of conventional imaging procedures. Still, recent clinical observations and series have highlighted common criteria for this condition. Cyst infection is diagnosed if confirmed by cyst fluid analysis showing bacteria and neutrophils, and as a probable diagnosis if all four of the following criteria are concomitantly met: temperature of >38°C for >3 days, loin or liver tenderness, C-reactive protein plasma level of >5 mg/dL and no evidence for intracystic bleeding on computed tomography (CT). In addition, the elevation of serum carbohydrate antigen 19-9 (CA19-9) has been proposed as a biomarker for hepatic cyst infection. Positron-emission tomography after intravenous injection of 18-fluorodeoxyglucose, combined with CT, proved superior to radiological imaging techniques for the identification and localization of kidney and liver pyocyst. This review summarizes the attributes and limitations of these recent clinical, biological and imaging advances in the diagnosis of cyst infection in patients with ADPKD.

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“…Forstrom et al (1981) found pulmonary uptake in 13 out of 14 patients with CMV infection, but also in 5 out of 8 patients with no evidence of CMV infection. Sebrechts et al (1986) also found such deposits in patients with no infection or other signs of lung disease. It has been recognized that different systemic conditions such as sepsis, adult respiratory distress syndrome, trauma, pancreatitis, and HD cause a complement-mediated sequestration of leukocytes in pulmonary circulation (Craddock et al, 1977;Rinaldo et al, 1982;Ascher et al, 1979).…”

Section: Scintigraphic Diagnosis Of Infectious Complications In Rtmentioning

confidence: 74%

“…The existence of these histological changes in RT should therefore be taken into account, and the multiple non-infectious causes responsible for a positive 67 Gallium uptake, even in the transplanted kidney (Table 1), should be known. Some studies have suggested the value of scintigraphy with 111 Indium-labeled leukocytes in clinical evaluation of RTs, despite the uncertain effects of immunosuppression and/or uremia on leukocyte function (Frick et al, 1979;Forstrom et al, 1981), while other studies acknowledge their limitations and nonspecificity (Sebrechts et al, 1986). Sebrechts et al (1986) conducted a retrospective study on ten patients with RT and fever receiving immunosuppressive treatment for rejection, acute tubular necrosis (ATN), or UTI.…”

Section: Scintigraphic Diagnosis Of Infectious Complications In Rtmentioning

confidence: 99%

“…Some studies have suggested the value of scintigraphy with 111 Indium-labeled leukocytes in clinical evaluation of RTs, despite the uncertain effects of immunosuppression and/or uremia on leukocyte function (Frick et al, 1979;Forstrom et al, 1981), while other studies acknowledge their limitations and nonspecificity (Sebrechts et al, 1986). Sebrechts et al (1986) conducted a retrospective study on ten patients with RT and fever receiving immunosuppressive treatment for rejection, acute tubular necrosis (ATN), or UTI. They found that all subjects showed a mild, diffuse uptake with 111 In-labeled leukocytes, and in two of the subjects, focal deposits of greater intensity existed as a result of a segmental infarction and a perinephritic hematoma.…”

Section: Scintigraphic Diagnosis Of Infectious Complications In Rtmentioning

confidence: 99%

See 1 more Smart Citation

Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant

Vicente

Solís

Castrejón

et al. 2005

Braz. arch. biol. technol.

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Patients with end-stage renal disease have two therapeutic options, dialysis and renal transplantation. Infectious complications occurring in such patients will not only condition the effectiveness of such treatments, but are among the main causes of morbidity and mortality in such cases. Knowledge of the advantages and limitations of nuclear techniques is essential for management of these conditions.
Pacientes em estágio final de doença renal têm duas opções terapêuticas, diálise e transplante renal. Complicações infecciosas que ocorrem em cada paciente são as principais causas de morbidade e mortalidade nestes casos. Conhecimentos das vantagens e limitações de técnicas nucleares são essenciais para o acompanhamento nestas condições

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Limitations of indium-111 leukocyte scanning in febrile renal transplant patients

Cited by 5 publications

References 0 publications

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Positron-Emission Computed Tomography in Cyst Infection Diagnosis in Patients with Autosomal Dominant Polycystic Kidney Disease

Diagnosis of cyst infection in patients with autosomal dominant polycystic kidney disease: attributes and limitations of the current modalities

Scintigraphic diagnosis of infectious complications in renal failure patients undergoing hemodialysis, continuous ambulatory peritoneal dialysis or renal transplant

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