LaMuraglia G M, Fischman A J, Strauss H W, Keech F, Wilkinson R, Callahan R J, Khaw B A, Rubin R H
Vascular Surgery Unit, Massachusetts General Hospital, Boston 02114.
J Vasc Surg. 1989 Jul;10(1):20-7; discussion 27-8.
The ability to diagnose and localize vascular graft infections has been a major challenge. Recent studies in animal models and humans with focal bacterial infection have shown that radiolabeled, polyclonal, human immunoglobulin G accumulates at the site of inflammation and can serve as the basis for an imaging technique. This study investigated this new technique for the diagnosis and localization of vascular graft infections. Twenty-five patients with suspected vascular infections involving grafts (22), atherosclerotic aneurysms (2), and subclavian vein thrombophlebitis (1) were studied. Gamma camera images of the suspected area were obtained between 5 and 48 hours after intravenous administration of 1.5 to 2.0 mCi (56 to 74 mBq) of indium 111-labeled, human, polyclonal immunoglobulin G. Scan results were interpreted without clinical information about the patient and were subsequently correlated with surgical findings, other imaging modalities, and/or clinical follow-up. In 10 of 10 patients found to have positive scan results, localized infections were confirmed at the involved sites. In 14 of 15 patients whose scan results were interpreted as negative, no vascular infections were identified at follow-up. The patient with false-negative results and recurrent bacteremia from an aortoduodenal fistula was found to have a negative scan outcome at a time when his disease was quiescent. These data suggest that nonspecific, human, indium 111-labeled immunoglobulin G scanning can be a useful noninvasive means of localizing vascular infections.
诊断和定位血管移植物感染的能力一直是一项重大挑战。最近在动物模型和患有局灶性细菌感染的人类中的研究表明，放射性标记的多克隆人免疫球蛋白G会在炎症部位聚集，并可作为一种成像技术的基础。本研究调查了这种用于诊断和定位血管移植物感染的新技术。对25例疑似血管感染患者进行了研究，其中包括涉及移植物的患者22例、动脉粥样硬化性动脉瘤患者2例和锁骨下静脉血栓性静脉炎患者1例。在静脉注射1.5至2.0毫居里（56至74兆贝可）的铟111标记的人多克隆免疫球蛋白G后的5至48小时内，获取了疑似区域的γ相机图像。扫描结果在不了解患者临床信息的情况下进行解读，随后与手术结果、其他成像方式和/或临床随访结果进行关联。在扫描结果呈阳性的10例患者中，有10例在受累部位证实存在局部感染。在扫描结果被解读为阴性的15例患者中，有14例在随访中未发现血管感染。那例扫描结果为假阴性且患有主动脉十二指肠瘘并反复发生菌血症的患者，在其病情静止时扫描结果为阴性。这些数据表明，非特异性的铟111标记的人免疫球蛋白G扫描可成为定位血管感染的一种有用的非侵入性方法。
