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DOI: 10.1148/radiol.2382041993
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PET with FDG-labeled Leukocytes versus Scintigraphy with 111In-Oxine–labeled Leukocytes for Detection of Infection1

Josephine N. Rini, MD, Kuldeep K. Bhargava, PhD, Gene G. Tronco, MD, Carol Singer, MD, Russell Caprioli, DPM, Scott E. Marwin, MD, Hugh L. Richardson, DPM, Kenneth J. Nichols, PhD, Paul V. Pugliese, RT and Christopher J. Palestro, MD

1 From the Division of Nuclear Medicine (J.N.R., K.K.B., G.G.T., K.N., P.V.P., C.J.P.), Division of Infectious Diseases (C.S.), Division of Vascular Surgery (R.C., H.L.R.), and Department of Orthopedic Surgery (S.M.), Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040. From the 2004 RSNA Annual Meeting. Received November 23, 2004; revision requested January 27, 2005; revision received February 16; accepted March 15; final version accepted, May 3. Address correspondence to J.N.R. (e-mail: rini{at}LIJ.edu).


Figure 1
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  		Figure 1a: Patient 4. Coronal images in 68-year-old man with end-stage renal disease who had undergone aortobifemoral bypass 6 years previously. (a) Maximum intensity projection from FDG-labeled leukocyte PET and (b) 111In-oxine–labeled leukocyte scintigraphic planar anterior view show diffuse tracer uptake around the graft (arrows). Fine-needle aspiration biopsy revealed abscess formation.

 

Figure 1
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  		Figure 1b: Patient 4. Coronal images in 68-year-old man with end-stage renal disease who had undergone aortobifemoral bypass 6 years previously. (a) Maximum intensity projection from FDG-labeled leukocyte PET and (b) 111In-oxine–labeled leukocyte scintigraphic planar anterior view show diffuse tracer uptake around the graft (arrows). Fine-needle aspiration biopsy revealed abscess formation.

 

Figure 2
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  		Figure 2a: Patient 12. Images in 83-year-old man with diabetes and possible malignant otitis externa. (a) Coronal and (b) transverse FDG-labeled leukocyte PET images show faint uptake (arrow) in region of right temporal bone; this uptake was interpreted as indicating osteomyelitis. (c) Anterior and (d) posterior static views and (e) coronal tomograms from 111In-oxine–labeled leukocyte scintigraphy do not show findings of infection. The patient's ear infection resolved after administration of topical antibiotics alone. Therefore, findings at FDG-labeled leukocyte PET were classified as false-positive, while those at 111In-oxine–labeled leukocyte scintigraphy were classified as true-negative. Note the faint cerebral activity seen on a and b; this activity reflects free FDG.

 

Figure 2
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  		Figure 2b: Patient 12. Images in 83-year-old man with diabetes and possible malignant otitis externa. (a) Coronal and (b) transverse FDG-labeled leukocyte PET images show faint uptake (arrow) in region of right temporal bone; this uptake was interpreted as indicating osteomyelitis. (c) Anterior and (d) posterior static views and (e) coronal tomograms from 111In-oxine–labeled leukocyte scintigraphy do not show findings of infection. The patient's ear infection resolved after administration of topical antibiotics alone. Therefore, findings at FDG-labeled leukocyte PET were classified as false-positive, while those at 111In-oxine–labeled leukocyte scintigraphy were classified as true-negative. Note the faint cerebral activity seen on a and b; this activity reflects free FDG.

 

Figure 2
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  		Figure 2c: Patient 12. Images in 83-year-old man with diabetes and possible malignant otitis externa. (a) Coronal and (b) transverse FDG-labeled leukocyte PET images show faint uptake (arrow) in region of right temporal bone; this uptake was interpreted as indicating osteomyelitis. (c) Anterior and (d) posterior static views and (e) coronal tomograms from 111In-oxine–labeled leukocyte scintigraphy do not show findings of infection. The patient's ear infection resolved after administration of topical antibiotics alone. Therefore, findings at FDG-labeled leukocyte PET were classified as false-positive, while those at 111In-oxine–labeled leukocyte scintigraphy were classified as true-negative. Note the faint cerebral activity seen on a and b; this activity reflects free FDG.

 

Figure 2
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  		Figure 2d: Patient 12. Images in 83-year-old man with diabetes and possible malignant otitis externa. (a) Coronal and (b) transverse FDG-labeled leukocyte PET images show faint uptake (arrow) in region of right temporal bone; this uptake was interpreted as indicating osteomyelitis. (c) Anterior and (d) posterior static views and (e) coronal tomograms from 111In-oxine–labeled leukocyte scintigraphy do not show findings of infection. The patient's ear infection resolved after administration of topical antibiotics alone. Therefore, findings at FDG-labeled leukocyte PET were classified as false-positive, while those at 111In-oxine–labeled leukocyte scintigraphy were classified as true-negative. Note the faint cerebral activity seen on a and b; this activity reflects free FDG.

 

Figure 2
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  		Figure 2e: Patient 12. Images in 83-year-old man with diabetes and possible malignant otitis externa. (a) Coronal and (b) transverse FDG-labeled leukocyte PET images show faint uptake (arrow) in region of right temporal bone; this uptake was interpreted as indicating osteomyelitis. (c) Anterior and (d) posterior static views and (e) coronal tomograms from 111In-oxine–labeled leukocyte scintigraphy do not show findings of infection. The patient's ear infection resolved after administration of topical antibiotics alone. Therefore, findings at FDG-labeled leukocyte PET were classified as false-positive, while those at 111In-oxine–labeled leukocyte scintigraphy were classified as true-negative. Note the faint cerebral activity seen on a and b; this activity reflects free FDG.

 

Figure 3
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  		Figure 3a: Patient 3. Images in 55-year-old man with diabetes and (a) an ulcer overlying the second metatarsal bone of the right foot. (b) Sagittal tomograms from FDG-labeled leukocyte PET show uptake (arrow) in the soft tissue of the right forefoot but no evidence of osteomyelitis. (c) Dorsal and (d) plantar views from 111In-oxine–labeled leukocyte scintigraphy show intense focal tracer uptake (arrow) that is equally well seen on both views and was interpreted as being consistent with osteomyelitis. Resection of the second metatarsal bone of the right foot revealed no evidence of osteomyelitis and no other abnormalities.

 

Figure 3
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  		Figure 3b: Patient 3. Images in 55-year-old man with diabetes and (a) an ulcer overlying the second metatarsal bone of the right foot. (b) Sagittal tomograms from FDG-labeled leukocyte PET show uptake (arrow) in the soft tissue of the right forefoot but no evidence of osteomyelitis. (c) Dorsal and (d) plantar views from 111In-oxine–labeled leukocyte scintigraphy show intense focal tracer uptake (arrow) that is equally well seen on both views and was interpreted as being consistent with osteomyelitis. Resection of the second metatarsal bone of the right foot revealed no evidence of osteomyelitis and no other abnormalities.

 

Figure 3
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  		Figure 3c: Patient 3. Images in 55-year-old man with diabetes and (a) an ulcer overlying the second metatarsal bone of the right foot. (b) Sagittal tomograms from FDG-labeled leukocyte PET show uptake (arrow) in the soft tissue of the right forefoot but no evidence of osteomyelitis. (c) Dorsal and (d) plantar views from 111In-oxine–labeled leukocyte scintigraphy show intense focal tracer uptake (arrow) that is equally well seen on both views and was interpreted as being consistent with osteomyelitis. Resection of the second metatarsal bone of the right foot revealed no evidence of osteomyelitis and no other abnormalities.

 

Figure 3
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  		Figure 3d: Patient 3. Images in 55-year-old man with diabetes and (a) an ulcer overlying the second metatarsal bone of the right foot. (b) Sagittal tomograms from FDG-labeled leukocyte PET show uptake (arrow) in the soft tissue of the right forefoot but no evidence of osteomyelitis. (c) Dorsal and (d) plantar views from 111In-oxine–labeled leukocyte scintigraphy show intense focal tracer uptake (arrow) that is equally well seen on both views and was interpreted as being consistent with osteomyelitis. Resection of the second metatarsal bone of the right foot revealed no evidence of osteomyelitis and no other abnormalities.

 

Figure 4
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  		Figure 4a: Patient 9. Images in 50-year-old woman with diabetes and with cellulitis that involved the fourth digit of the right hand. (a) Maximum intensity projection image from FDG-labeled leukocyte PET shows intense tracer uptake in the fourth digit (arrow) that was classified as being consistent with osteomyelitis. (b) Dorsal and (c) palmar views from 111In-oxine–labeled leukocyte scintigraphy show ill-defined, faint tracer uptake (arrow) that is best seen on the dorsal view and was classified as soft-tissue infection. Excisional biopsy of the distal interphalangeal joint revealed bone necrosis with inflammatory cells in marrow spaces, a finding indicative of osteomyelitis. Culture was positive for heavy growth of Staphylococcus aureus.

 

Figure 4
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  		Figure 4b: Patient 9. Images in 50-year-old woman with diabetes and with cellulitis that involved the fourth digit of the right hand. (a) Maximum intensity projection image from FDG-labeled leukocyte PET shows intense tracer uptake in the fourth digit (arrow) that was classified as being consistent with osteomyelitis. (b) Dorsal and (c) palmar views from 111In-oxine–labeled leukocyte scintigraphy show ill-defined, faint tracer uptake (arrow) that is best seen on the dorsal view and was classified as soft-tissue infection. Excisional biopsy of the distal interphalangeal joint revealed bone necrosis with inflammatory cells in marrow spaces, a finding indicative of osteomyelitis. Culture was positive for heavy growth of Staphylococcus aureus.

 

Figure 4
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  		Figure 4c: Patient 9. Images in 50-year-old woman with diabetes and with cellulitis that involved the fourth digit of the right hand. (a) Maximum intensity projection image from FDG-labeled leukocyte PET shows intense tracer uptake in the fourth digit (arrow) that was classified as being consistent with osteomyelitis. (b) Dorsal and (c) palmar views from 111In-oxine–labeled leukocyte scintigraphy show ill-defined, faint tracer uptake (arrow) that is best seen on the dorsal view and was classified as soft-tissue infection. Excisional biopsy of the distal interphalangeal joint revealed bone necrosis with inflammatory cells in marrow spaces, a finding indicative of osteomyelitis. Culture was positive for heavy growth of Staphylococcus aureus.

 




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