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Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

In this study we evaluated the diagnostic performance of 99mTc-HMPAO-leucocyte (99mTc-HMPAO-WBC) scintigraphy in a consecutive series of 55 patients (46 men and 9 women, mean age 71 ± 9 years, range 50 – 88 years) with a suspected late or a low-grade late vascular prosthesis infection (VPI), also comparing the diagnostic accuracy of WBC with that of other radiological imaging methods.

Methods

All patients suspected of having VPI underwent clinical examination, blood tests, microbiology, US and CT, and were classified according to the Fitzgerald criteria. A final diagnosis of VPI was established in 47 of the 55 patients, with microbiological confirmation after surgical removal of the prosthesis in 36 of the 47. In the 11 patients with major contraindications to surgery, the final diagnosis was based on microbiology and clinical follow-up of at least 18 months.

Results

99mTc-HMPAO-WBC planar, SPECT and SPECT/CT imaging identified VPI in 43 of 47 patients (20 of these also showed infection at extra-prosthetic sites). In the remaining eight patients without VPI, different sites of infections were found. The use of SPECT/CT images led to a significant reduction in the number of false-positive findings in 37 % of patients (sensitivity and specificity 100 %, versus 85.1 % and 62.5 % for stand-alone SPECT). Sensitivity and specificity were 34 % and 75 % for US, 48.9 % and 83.3 % for CT, and 68.1 % and 62.5 % for the FitzGerald classification. Perioperative mortality was 5.5 %, mid-term mortality 12 %, and long-term mortality 27 %. Survival rates were similar in patients treated with surgery and antimicrobial therapy compared to patients treated with antimicrobial therapy alone (61 % versus 63 %, respectively), while infection eradication at 12 months was significantly higher following surgery (83.3 % versus 45.5 %).

Conclusion

99mTc-HMPAO-WBC SPECT/CT is useful for detecting, localizing and defining the extent of graft infection in patients with late and low-grade late VPI with inconclusive radiological findings. 99mTc-HMPAO-WBC SPECT/CT might be used to optimize patient management.

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Acknowledgments

The authors thank G. A. Cataldi for her assistance in radiolabelling and quality controls for 99mTc-HMPAO-WBC.

Conflicts of interest

None.

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Authors and Affiliations

  1. Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technology in Medicine, University of Pisa, and University Hospital of Pisa, Pisa, Italy

    P. A. Erba, R. Boni, E. Lazzeri & G. Mariani

  2. ASL Lecce, U.O. Gestione Rapporti Convenzionali, U.O. Chirurgia Generale, Lecce, Pisa, Italy

    G. Leo

  3. Nuclear Medicine Unit, Department of Oncology and Advanced Technology, Az. Osp. S.Maria Nuova - IRCCS Reggio Emilia, Via Risorgimento 80, 42123, Reggio Emilia, Italy

    M. Sollini

  4. Division of Infectious Diseases, University Hospital of Pisa, Pisa, Italy

    C. Tascini & F. Menichetti

  5. Division of Vascular Surgery, Department of Translational Research and Advanced Technology in Medicine, University of Pisa, and University Hospital of Pisa, Pisa, Italy

    G. Leo, R. N. Berchiolli & M. Ferrari

  6. Regional Center of Nuclear Medicine, University of Pisa, Via Roma 55, I-56125, Pisa, Italy

    P. A. Erba

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  1. P. A. Erba
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Correspondence to P. A. Erba.

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Erba, P.A., Leo, G., Sollini, M. et al. Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections. Eur J Nucl Med Mol Imaging 41, 357–368 (2014). https://doi.org/10.1007/s00259-013-2582-9

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  • DOI: https://doi.org/10.1007/s00259-013-2582-9

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