New Imaging Tools for the Diagnosis of Infection

Abstract

Infection imaging became widespread in 1971 with the release of 67Ga citrate. Multiphase skeletal scintigraphy and radiolabeled white blood cells (WBCs) have since become the most widespread clinically used agents for the imaging of infection. A wide variety of other radiolabeled probes are under investigation, based on antibodies, cytokines, assorted proteins and other molecules, alone or in various combinations. However, these latter agents, with a few exceptions, are not routinely used clinically. Radiolabeled ciprofloxacin represents the first attempt to develop an infection-specific imaging agent (most infection-imaging probes localized nonspecifically to inflammation as well), but it has not proven superior to radiolabeled WBCs or 18F-fluoro-deoxy-glucose (FDG) PET. Because of the ability to combine exquisite anatomic detail with focal uptake of 18F-FDG, PET-computed tomography has achieved great success in the detection and localization of infection, including in clinically adverse conditions. Despite these advances, at this time an infection-specific imaging agent does not exist.

Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias

“…Melphalan-based myeloablation preparatory for stem cell transplantation, a mainstay of MM treatment, often results in both significant neutropenia and immunosuppression, reducing the accuracy of radiolabeled leukocyte scans to identify a site of infection. A sudden elevation of C-reactive protein is suggestive of but not specific for infection (76). In this difficult setting, 18 F-FDG PET/CT is superior to other imaging methods for detection of occult infection (76).…”

“…A sudden elevation of C-reactive protein is suggestive of but not specific for infection (76). In this difficult setting, 18 F-FDG PET/CT is superior to other imaging methods for detection of occult infection (76).…”

“…Although a variety of organisms are responsible for perioral infections, fungal infection is frequently seen, often associated with osteonecrosis. 18 F-FDG PET/CT contributes significantly to patient management by identifying the presence and site of possible infection, establishing the extent of infection, and modifying the diagnosis or therapy (47,50,76).…”

Lymphopenia at 4 Days Postoperatively Is the Most Significant Laboratory Marker for Early Detection of Surgical Site Infection Following Posterior Lumbar Instrumentation Surgery

“…Preventing SSI is important; however, when an infection does occur, early diagnosis and treatment are crucial to avoid aggravation [4111213]. A diagnosis of SSI should be made based on indicators of systemic infection, such as body temperature (BT), laboratory data, imaging techniques (e.g., computed tomography, magnetic resonance imaging, and fluorine-18-fluorodeoxglucose positron emission tomography) [14151617], and local findings such as tenderness, swelling, redness, and purulent discharge [1113]. However, high BT is not a specific sign of SSI [11121819], and the above-mentioned imaging techniques are expensive when used as screening tools.…”

Besilesomab for imaging inflammation and infection in peripheral bone in adults with suspected osteomyelitis

“…Such developments have been the subject of recent reviews. 9,[20][21][22][23][24][25] For example, ultrasound, 26,27 computed tomography (CT), 21,22,28 magnetic resonance imaging (MRI), [29][30][31][32] optical 20 and nuclear medicine techniques 20,23,24,[33][34][35][36][37] have all been used to improve diagnostic confidence. [38][39][40] The numerous advantages of FDG-PET imaging include a higher spatial resolution in comparison to conventional nuclear medicine modalities, fast examination time (result available within 1-2 hours after tracer administration), the ability to differentiate between hematopoietic bone marrow and activated white blood cells (WBCs), and potential application to treatment monitoring.…”