News | August 06, 2014

PET/CT Using FDG-labeled Leucocytes May Detect Infection in Acute Pancreatitis

August 6, 2014 — A new clinical study diagnosing infection in patients with pancreatic fluid collections may swiftly and accurately rule out active infection in the body. As reported in the August issue of The Journal of Nuclear Medicine, this treatment may assist in bringing nuclear medicine to the forefront of clinical management.

Acute pancreatitis (AP) is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment. While mild cases of AP are often successfully treated with conservative measures, such as nil per os (NPO) and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process. Early detection of infection in AP affects the choice of treatment and clinical outcome.

"Documenting infection of pancreatic necrosis/pancreatic or peripancreatic fluid collections is one of the key questions in managing such patients. So far only fine needle aspiration under radiological guidance could establish that with limitations of invasive procedure and at times insufficient amount of aspirate," said Anish Bhattacharya, M.D., lead author of the study "PET/CT using 18F-fluorodeoxyglucose-labeled autologous leucocytes in the diagnosis of infected fluid collections in acute pancreatitis." He continued, "The present study, for the first time, gives evidence of a non-invasive investigation that can answer the question of infected pancreatic fluid collections. It even distinguishes two collections, one with and the other without infection. It could also be used to follow up with such patients after a radiological or endoscopic intervention."

In the study, researchers from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, studied 41 patients — 28 male and 13 female — aged 21-69 with AP and radiological evidence of fluid collection in or around the pancreas. Leucocytes were separated from the patient's venous blood, labeled with 18F-fluorodeoxyglucose (FDG) and re-injected intravenously, followed by positron emission tomography/computed tomography (PET/CT) imaging two hours later. A final diagnosis of infection was based on microbiological culture of fluid aspirated from the collection. Patients were managed with supportive care and antibiotics; percutaneous drainage/laparotomy were performed when indicated.

Blood glucose, total leucocyte count, neutrophil count and leucocyte labeling efficiency varied from 83 to 212 (118±30) mg/100ml, 4600 to 24,200 (11648 ± 5376)/mm3, 55% to 90% (73 ± 10) and 31% to 97% (81 ± 17) respectively. Increased tracer uptake was seen in the collection in 12 out of 41 patients; 10 had culture-proven infection and underwent percutaneous drainage, while aspiration was unsuccessful in two. The scan was negative for infection in 29 patients (25 out of 29 fluid cultures negative for infection and aspiration unsuccessful in four). Sensitivity, specificity and accuracy of the scan were 100% in 35 patients in whom fluid culture reports were available.

"This research uses a new technique to diagnose infection occurring in patients with pancreatic fluid collections. The patient is spared empirical antibiotic therapy or radiological intervention followed by time-consuming microbiological work-up," noted Bhattacharya.

The search for the ideal infection imaging radiopharmaceutical agent/technique has continued for several decades now, noted Bhattacharya. "This study suggests that PET-CT using FDG-labeled leucocytes may be useful in swiftly and accurately detecting or ruling out active infection in any part of the body, bringing nuclear medicine to the forefront of clinical management in these situations. This would encourage researchers to identify more such techniques in future," he said.

For more information: jnm.snmjournals.org

Related Content

#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2

Getty Images

Feature | Coronavirus (COVID-19) | April 03, 2020 | By Melinda Taschetta-Millane and Dave Fornell
In an effort to keep the imaging field updated on the latest information being released on coronavirus (COVID-19), th
Recommended best practices for nuclear imaging departments under the COVIF-19 pandemic have been issues by the ASNC and SNMMI. #COVID19 #ASNC #SNMMI #Coronavirus #SARScov2
News | Coronavirus (COVID-19) | April 03, 2020
April 3, 2020 — A new guidance document on best practices to maintain safety and minimize contamination in nuclear im
#COVID19 #Coronavirus #2019nCoV #Wuhanvirus #SARScov2 New studies use SIRD model to forecast COVID-19 spread; examine patient CT scans to correlate clinical features with mortality

Fig 1. A sample scoring on CT images of a 63-year-old woman from mortality group demonstrated a total score of 63. It was calculated as: for upper zone (A), 3 (consolidation) × 3 (50–75% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) ×1 (< 25% distribution) × 2 (both right and left lungs); for middle zone (B), 3 (consolidation) × 2 (25–50% distribution) × 2 (both right and left lungs) + 2 (ground glass opacity) × 2 (25–50% distribution) × 2 (both right and left lungs); for lower zone (C), 3 (consolidation) × (2 (25–50% distribution of the right lung) + 3 (50–75% distribution of the left lung)) + 2 (ground glass opacity) × (2 (25–50% distribution of the right lung) + 1 (< 25% distribution of the left lung)) Yuan et al, 2020 (CC BY 4.0)

News | Coronavirus (COVID-19) | April 01, 2020
April 1, 2020 — A new study, ...
Novel scanners may open door for prognostic assessment in patients receiving cochlear implants

Iva Speck, MD, explains research showing that novel, fully digital, high-resolution positron emission tomography/computed tomography imaging of small brain stem nuclei can provide clinicians with valuable information concerning the auditory pathway in patients with hearing impairment. The research is featured in The Journal of Nuclear Medicine (read more at http://jnm.snmjournals.org/content/current). Video courtesy of Iva Speck, University Hospital Freiburg, Germany.

News | PET-CT | March 26, 2020
March 26, 2020 — Novel, fully digital, high-resolution...
A University of Colorado Cancer Center study published in the Journal of the National Cancer Institute shows an important predictor of PET-CT use

Rustain Morgan, M.D., and colleagues show racial/ethnic disparities in use of important imaging during lung cancer diagnosis. Photo courtesy of University of Colorado Cancer Center

News | PET-CT | March 12, 2020
March 12, 2020 — The use of PET-CT
 “Cyclotrons used in Nuclear Medicine Report & Directory, Edition 2020” that describes close to 1,500 medical cyclotrons worldwide
News | Nuclear Imaging | March 10, 2020
March 10, 2020 — MEDraysintell released its new and unique report “...
SoftVue image stacks of sound speed, as shown for cases ranging across the four Breast Imaging Reporting and Data System (BI-RADS) breast density categories

Example: SoftVue image stacks of sound speed, as shown for cases ranging across the four Breast Imaging Reporting and Data System (BI-RADS) breast density categories ((a), fatty; (b), scattered; (c), heterogeneously dense; (d), extremely dense). Note the quantitative scale indicating that absolute measurements are obtained. Image courtesy of MDPI

News | Breast Imaging | March 10, 2020
March 10, 2020 — ...