Bar-Shalom Rachel, Yefremov Nikolay, Guralnik Luda, Keidar Zohar, Engel Ahuva, Nitecki Samy, Israel Ora
Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel.
J Nucl Med. 2006 Apr;47(4):587-94.
The present study evaluated the role of SPECT/CT as an adjunct to (67)Ga (GS) or (111)In-labeled white blood cell (WBC) scintigraphy for diagnosis or localization of infection.
Eighty-two patients (56 male and 26 female; mean age, 62 y) assessed for known or suspected infectious processes underwent 88 SPECT/CT studies. Forty-seven patients underwent GS SPECT/CT (13 with fever of unknown origin, 21 with suspected osteomyelitis, and 13 with suspected soft-tissue infection), and 35 patients underwent WBC SPECT/CT (24 with suspected vascular graft infection, and 11 with suspected osteomyelitis). Ninety-eight suggestive sites were identified (52 on GS and 46 on WBC). Additional information provided by SPECT/CT for diagnosis or localization of infection, as compared with planar and SPECT scintigraphy, was recorded. The SPECT/CT contribution was analyzed on a patient and site basis and was compared for the 2 tracers and clinical indications.
SPECT/CT provided additional information for infection diagnosis and localization in 39 (48%) of 82 patients and in 47 (48%) of 98 sites. SPECT/CT defined the extent of infection in 35 patients (43%) in 43 sites (44%) and excluded infection in 4 suggestive sites defined as physiologic bowel uptake on GS. SPECT/CT was incorrect in 2 suggestive sites (1 GS and 1 WBC). The contribution of SPECT/CT was significantly higher for WBC than for GS (P < 0.05)--in 63% versus 36% of patients, respectively, and in 61% versus 36% of sites, respectively.
SPECT/CT made an incremental contribution to GS and WBC in 48% of patients with suspected infections, by improving diagnosis, localization, and definition of extent of disease. SPECT/CT has an important role mainly with highly specific, low-background infection-seeking tracers such as WBC.
本研究评估了SPECT/CT作为（67）镓（GS）或（111）铟标记白细胞（WBC）闪烁扫描的辅助手段在感染诊断或定位中的作用。
82例（56例男性和26例女性；平均年龄62岁）因已知或疑似感染性疾病接受评估的患者接受了88次SPECT/CT检查。47例患者接受了GS SPECT/CT检查（13例不明原因发热、21例疑似骨髓炎、13例疑似软组织感染），35例患者接受了WBC SPECT/CT检查（24例疑似血管移植物感染、11例疑似骨髓炎）。共确定了98个可疑部位（GS检查发现52个，WBC检查发现46个）。记录SPECT/CT与平面闪烁扫描和SPECT闪烁扫描相比为感染诊断或定位提供的额外信息。在患者和部位基础上分析SPECT/CT的贡献，并比较两种示踪剂和临床指征的情况。
SPECT/CT为82例患者中的39例（48%）和98个部位中的47个（48%）的感染诊断和定位提供了额外信息。SPECT/CT明确了43个部位（44%）中35例患者（43%）的感染范围，并排除了GS检查中4个被定义为生理性肠道摄取的可疑部位的感染。SPECT/CT在2个可疑部位（1个GS检查部位和1个WBC检查部位）出现错误。SPECT/CT对WBC的贡献显著高于对GS的贡献（P<0.05）——分别在63%的患者和61%的部位与36%的患者和36%的部位。
SPECT/CT通过改善疾病诊断、定位和范围界定，对48%的疑似感染患者的GS和WBC检查有增量贡献。SPECT/CT主要在使用如WBC等高度特异性、低背景感染寻踪示踪剂时发挥重要作用。
