Chiesa R, Melissano G, Castellano R, Fernandez Zamora C, Astore D, Samuel A, Paganelli G, Fazio F, Grossi A
Institute for Cardiovascular and Respiratory Disease, Scientific Institute H. San Raffaele, University of Milano, Italy.
Eur J Vasc Endovasc Surg. 1995 Nov;10(4):405-14. doi: 10.1016/s1078-5884(05)80162-5.
To evaluate a new imaging technique, for diagnosis of prosthetic vascular graft infection. Avidin is a protein which accumulates nonspecifically at sites of inflammation or infection. Due to its extremely low dissociation constant with biotin sites of infection can be imaged, using avidin as a pre-target, followed by injection of 111In-labelled biotin. This technique is much simpler than the common scintigraphic methods which employ labelling of blood components and its target-to-background ratio is greater than the methods employing radiolabelled proteins.
Prospective clinical study.
A single department of vascular surgery and one of nuclear medicine of a Northern Italian hospital.
Between May 1993 and May 1994, 31 grafts in 26 patients were studied; the series included 23 men and three women with a mean age of 65.5 years (range 54-76 years). The prosthetic graft (Dacron -16, ePTFE -15) were: aortoaortic 5, aortobifemoral 15, aortoiliac 1, and femoropopliteal 10. Sixteen patients were suspected of having a vascular graft infection (Group A), the other 10 patients served as controls (Group B). 20 mg of Avidin were injected iv, followed 24 h later by i.v. injection of 500 micrograms of Biotin labelled with 74 MBq of 111In.
Whole-body imaging was performed at 10 min and 2 h post-injection, along with SPECT imaging when indicated. Scan results were correlated with the traditional imaging modalities and the clinical outcome of the patients.
In Group A: two patients (three grafts) were excluded from the study, there were six true-positives, one false-positive and 11 true-negatives. Results in Group B: 10 true-negatives. The overall sensitivity was 100%, the specificity 95%, the accuracy 96%, the positive predictive value 86% and the negative predictive value 100%.
These data suggest that Avidin/111In-labelled Biotin scintigraphy is a useful non invasive diagnostic method for early diagnosis of suspected prosthetic vascular graft infection.
评估一种用于诊断人工血管移植物感染的新成像技术。抗生物素蛋白是一种在炎症或感染部位非特异性聚集的蛋白质。由于其与生物素的解离常数极低，因此可以使用抗生物素蛋白作为预靶向，然后注射111铟标记的生物素，对感染部位进行成像。该技术比采用血液成分标记的普通闪烁扫描方法简单得多，其靶本底比也高于采用放射性标记蛋白质的方法。
前瞻性临床研究。
意大利北部一家医院的一个血管外科科室和一个核医学科室。
1993年5月至1994年5月，对26例患者的31条移植物进行了研究；该系列包括23名男性和3名女性，平均年龄65.5岁（范围54 - 76岁）。人工移植物（涤纶 - 16条，膨体聚四氟乙烯 - 15条）分别为：主动脉 - 主动脉5条，主动脉 - 双股动脉15条，主动脉 - 髂动脉1条，股 - 腘动脉10条。16例患者疑似发生血管移植物感染（A组），另外10例患者作为对照（B组）。静脉注射20毫克抗生物素蛋白，24小时后静脉注射500微克用74兆贝可的111铟标记的生物素。
注射后10分钟和2小时进行全身成像，必要时进行单光子发射计算机断层扫描（SPECT）成像。扫描结果与传统成像方式以及患者的临床结局相关。
A组：2例患者（3条移植物）被排除在研究之外，有6例假阳性、1例假阴性和11例真阴性。B组结果：10例真阴性。总体敏感性为100%，特异性为95%，准确性为96%，阳性预测值为86%，阴性预测值为100%。
这些数据表明，抗生物素蛋白/111铟标记生物素闪烁扫描是一种用于早期诊断疑似人工血管移植物感染的有用的非侵入性诊断方法。
