Fischman A J, Rubin R H, Khaw B A, Callahan R J, Wilkinson R, Keech F, Nedelman M, Dragotakes S, Kramer P B, LaMuraglia G M
Department of Radiology, Massachusetts General Hospital, Boston 02114.
Semin Nucl Med. 1988 Oct;18(4):335-44. doi: 10.1016/s0001-2998(88)80042-4.
The detection of focal sites of inflammation is an integral part of the clinical evaluation of the febrile patient. When anatomically distinct abscesses are present, lesion detection can be accomplished by standard radiographic techniques, particularly in patients with normal anatomy. At the phlegmon stage, however, and in patients who have undergone surgery, these techniques are considerably less effective. While radionuclide methods, such as Gallium-67 (67Ga)-citrate and Indium-111 (111In)-labeled WBCs have been relatively successful for the detection of early inflammation, neither approach is ideal. In the course of studies addressing the use of specific organism-directed antibodies for imaging experimental infections in animals, we observed that nonspecific polyclonal immunoglobulin G (IgG) localized as well as specific antibodies. Preliminary experiments suggested that the Fc portion of IgG is necessary for effective inflammation localization. Since polyclonal IgG in gram quantities has been safely used for therapy in patients with immune deficiency states, we decided to test whether milligram quantities of radiolabeled IgG could image focal sites of inflammation in humans. Thus far, we have studied a series of 84 patients with suspected lesions in the abdomen, pelvis, vascular grafts, lungs, or bones/joints. In 48 of 52 patients with focal lesions detected by surgery, computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound (US), the IgG scan correctly localized the site, while 31 patients without focal inflammation had no abnormal focal localization of the radiopharmaceutical. Four patients had false negative scans and one patient had a false positive scan. For this small series, the overall sensitivity and specificity were 92% and 95%, respectively. In this report, we review our experience with this exciting new agent.
检测炎症病灶是发热患者临床评估的一个重要组成部分。当存在解剖学上不同的脓肿时，病变检测可通过标准的放射学技术完成，尤其是在解剖结构正常的患者中。然而，在蜂窝织炎阶段以及接受过手术的患者中，这些技术的效果要差得多。虽然放射性核素方法，如枸橼酸镓 - 67（67Ga）和铟 - 111（111In）标记的白细胞，在检测早期炎症方面相对成功，但这两种方法都不理想。在研究针对动物实验性感染使用特定病原体导向抗体进行成像的过程中，我们观察到非特异性多克隆免疫球蛋白G（IgG）与特异性抗体一样能定位。初步实验表明，IgG的Fc部分对于有效的炎症定位是必需的。由于克量级的多克隆IgG已被安全地用于免疫缺陷状态患者的治疗，我们决定测试毫克量级的放射性标记IgG是否能对人体炎症病灶进行成像。到目前为止，我们已经研究了一系列84例怀疑腹部、骨盆、血管移植物、肺部或骨骼/关节有病变的患者。在52例通过手术、计算机断层扫描（CT）、磁共振成像（MRI）或超声（US）检测出有局灶性病变的患者中，有48例IgG扫描正确定位了病变部位，而31例没有局灶性炎症的患者中，放射性药物没有异常的局灶性定位。4例患者扫描结果为假阴性，1例患者为假阳性。对于这个小样本系列，总体敏感性和特异性分别为92%和95%。在本报告中，我们回顾了我们使用这种令人兴奋的新型药物的经验。
