Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections

P. A. Erba, G. Leo, M. Sollini, C. Tascini, R. Boni, R. N. Berchiolli, F. Menichetti, M. Ferrari, E. Lazzeri, G. Mariani

Research output: Contribution to journalArticle

Abstract

Purpose: In this study we evaluated the diagnostic performance of 99mTc-HMPAO-leucocyte (99mTc-HMPAO-WBC) scintigraphy in a consecutive series of 55 patients (46 men and 9 women, mean age 71±9 years, range 50 - 88 years) with a suspected late or a low-grade late vascular prosthesis infection (VPI), also comparing the diagnostic accuracy of WBC with that of other radiological imaging methods. Methods: All patients suspected of having VPI underwent clinical examination, blood tests, microbiology, US and CT, and were classified according to the Fitzgerald criteria. A final diagnosis of VPI was established in 47 of the 55 patients, with microbiological confirmation after surgical removal of the prosthesis in 36 of the 47. In the 11 patients with major contraindications to surgery, the final diagnosis was based on microbiology and clinical follow-up of at least 18 months. Results: 99mTc-HMPAO-WBC planar, SPECT and SPECT/CT imaging identified VPI in 43 of 47 patients (20 of these also showed infection at extra-prosthetic sites). In the remaining eight patients without VPI, different sites of infections were found. The use of SPECT/CT images led to a significant reduction in the number of false-positive findings in 37 % of patients (sensitivity and specificity 100 %, versus 85.1 % and 62.5 % for stand-alone SPECT). Sensitivity and specificity were 34 % and 75 % for US, 48.9 % and 83.3 % for CT, and 68.1 % and 62.5 % for the FitzGerald classification. Perioperative mortality was 5.5 %, mid-term mortality 12 %, and long-term mortality 27 %. Survival rates were similar in patients treated with surgery and antimicrobial therapy compared to patients treated with antimicrobial therapy alone (61 % versus 63 %, respectively), while infection eradication at 12 months was significantly higher following surgery (83.3 % versus 45.5 %). Conclusion: 99mTc-HMPAO-WBC SPECT/CT is useful for detecting, localizing and defining the extent of graft infection in patients with late and low-grade late VPI with inconclusive radiological findings. 99mTc-HMPAO-WBC SPECT/CT might be used to optimize patient management.

Original languageEnglish
Pages (from-to)357-368
Number of pages12
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume41
Issue number2
DOIs
Publication statusPublished - 2014

Fingerprint

Blood Vessel Prosthesis
Radionuclide Imaging
Leukocytes
Technetium Tc 99m Exametazime
Infection
Microbiology
Single-Photon Emission-Computed Tomography
Mortality
Sensitivity and Specificity
Hematologic Tests
Prostheses and Implants
Survival Rate

Keywords

  • Bypass grafting
  • SPECT/CT
  • Vascular prosthesis infection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections. / Erba, P. A.; Leo, G.; Sollini, M.; Tascini, C.; Boni, R.; Berchiolli, R. N.; Menichetti, F.; Ferrari, M.; Lazzeri, E.; Mariani, G.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 41, No. 2, 2014, p. 357-368.

Research output: Contribution to journalArticle

Erba, P. A. ; Leo, G. ; Sollini, M. ; Tascini, C. ; Boni, R. ; Berchiolli, R. N. ; Menichetti, F. ; Ferrari, M. ; Lazzeri, E. ; Mariani, G. / Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections. In: European Journal of Nuclear Medicine and Molecular Imaging. 2014 ; Vol. 41, No. 2. pp. 357-368.
@article{a4f964a89e4f4ffcafa60222b8dc9223,
title = "Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections",
abstract = "Purpose: In this study we evaluated the diagnostic performance of 99mTc-HMPAO-leucocyte (99mTc-HMPAO-WBC) scintigraphy in a consecutive series of 55 patients (46 men and 9 women, mean age 71±9 years, range 50 - 88 years) with a suspected late or a low-grade late vascular prosthesis infection (VPI), also comparing the diagnostic accuracy of WBC with that of other radiological imaging methods. Methods: All patients suspected of having VPI underwent clinical examination, blood tests, microbiology, US and CT, and were classified according to the Fitzgerald criteria. A final diagnosis of VPI was established in 47 of the 55 patients, with microbiological confirmation after surgical removal of the prosthesis in 36 of the 47. In the 11 patients with major contraindications to surgery, the final diagnosis was based on microbiology and clinical follow-up of at least 18 months. Results: 99mTc-HMPAO-WBC planar, SPECT and SPECT/CT imaging identified VPI in 43 of 47 patients (20 of these also showed infection at extra-prosthetic sites). In the remaining eight patients without VPI, different sites of infections were found. The use of SPECT/CT images led to a significant reduction in the number of false-positive findings in 37 {\%} of patients (sensitivity and specificity 100 {\%}, versus 85.1 {\%} and 62.5 {\%} for stand-alone SPECT). Sensitivity and specificity were 34 {\%} and 75 {\%} for US, 48.9 {\%} and 83.3 {\%} for CT, and 68.1 {\%} and 62.5 {\%} for the FitzGerald classification. Perioperative mortality was 5.5 {\%}, mid-term mortality 12 {\%}, and long-term mortality 27 {\%}. Survival rates were similar in patients treated with surgery and antimicrobial therapy compared to patients treated with antimicrobial therapy alone (61 {\%} versus 63 {\%}, respectively), while infection eradication at 12 months was significantly higher following surgery (83.3 {\%} versus 45.5 {\%}). Conclusion: 99mTc-HMPAO-WBC SPECT/CT is useful for detecting, localizing and defining the extent of graft infection in patients with late and low-grade late VPI with inconclusive radiological findings. 99mTc-HMPAO-WBC SPECT/CT might be used to optimize patient management.",
keywords = "Bypass grafting, SPECT/CT, Vascular prosthesis infection",
author = "Erba, {P. A.} and G. Leo and M. Sollini and C. Tascini and R. Boni and Berchiolli, {R. N.} and F. Menichetti and M. Ferrari and E. Lazzeri and G. Mariani",
year = "2014",
doi = "10.1007/s00259-013-2582-9",
language = "English",
volume = "41",
pages = "357--368",
journal = "European Journal of Pediatrics",
issn = "0340-6199",
publisher = "Springer Berlin Heidelberg",
number = "2",

}

TY - JOUR

T1 - Radiolabelled leucocyte scintigraphy versus conventional radiological imaging for the management of late, low-grade vascular prosthesis infections

AU - Erba, P. A.

AU - Leo, G.

AU - Sollini, M.

AU - Tascini, C.

AU - Boni, R.

AU - Berchiolli, R. N.

AU - Menichetti, F.

AU - Ferrari, M.

AU - Lazzeri, E.

AU - Mariani, G.

PY - 2014

Y1 - 2014

N2 - Purpose: In this study we evaluated the diagnostic performance of 99mTc-HMPAO-leucocyte (99mTc-HMPAO-WBC) scintigraphy in a consecutive series of 55 patients (46 men and 9 women, mean age 71±9 years, range 50 - 88 years) with a suspected late or a low-grade late vascular prosthesis infection (VPI), also comparing the diagnostic accuracy of WBC with that of other radiological imaging methods. Methods: All patients suspected of having VPI underwent clinical examination, blood tests, microbiology, US and CT, and were classified according to the Fitzgerald criteria. A final diagnosis of VPI was established in 47 of the 55 patients, with microbiological confirmation after surgical removal of the prosthesis in 36 of the 47. In the 11 patients with major contraindications to surgery, the final diagnosis was based on microbiology and clinical follow-up of at least 18 months. Results: 99mTc-HMPAO-WBC planar, SPECT and SPECT/CT imaging identified VPI in 43 of 47 patients (20 of these also showed infection at extra-prosthetic sites). In the remaining eight patients without VPI, different sites of infections were found. The use of SPECT/CT images led to a significant reduction in the number of false-positive findings in 37 % of patients (sensitivity and specificity 100 %, versus 85.1 % and 62.5 % for stand-alone SPECT). Sensitivity and specificity were 34 % and 75 % for US, 48.9 % and 83.3 % for CT, and 68.1 % and 62.5 % for the FitzGerald classification. Perioperative mortality was 5.5 %, mid-term mortality 12 %, and long-term mortality 27 %. Survival rates were similar in patients treated with surgery and antimicrobial therapy compared to patients treated with antimicrobial therapy alone (61 % versus 63 %, respectively), while infection eradication at 12 months was significantly higher following surgery (83.3 % versus 45.5 %). Conclusion: 99mTc-HMPAO-WBC SPECT/CT is useful for detecting, localizing and defining the extent of graft infection in patients with late and low-grade late VPI with inconclusive radiological findings. 99mTc-HMPAO-WBC SPECT/CT might be used to optimize patient management.

AB - Purpose: In this study we evaluated the diagnostic performance of 99mTc-HMPAO-leucocyte (99mTc-HMPAO-WBC) scintigraphy in a consecutive series of 55 patients (46 men and 9 women, mean age 71±9 years, range 50 - 88 years) with a suspected late or a low-grade late vascular prosthesis infection (VPI), also comparing the diagnostic accuracy of WBC with that of other radiological imaging methods. Methods: All patients suspected of having VPI underwent clinical examination, blood tests, microbiology, US and CT, and were classified according to the Fitzgerald criteria. A final diagnosis of VPI was established in 47 of the 55 patients, with microbiological confirmation after surgical removal of the prosthesis in 36 of the 47. In the 11 patients with major contraindications to surgery, the final diagnosis was based on microbiology and clinical follow-up of at least 18 months. Results: 99mTc-HMPAO-WBC planar, SPECT and SPECT/CT imaging identified VPI in 43 of 47 patients (20 of these also showed infection at extra-prosthetic sites). In the remaining eight patients without VPI, different sites of infections were found. The use of SPECT/CT images led to a significant reduction in the number of false-positive findings in 37 % of patients (sensitivity and specificity 100 %, versus 85.1 % and 62.5 % for stand-alone SPECT). Sensitivity and specificity were 34 % and 75 % for US, 48.9 % and 83.3 % for CT, and 68.1 % and 62.5 % for the FitzGerald classification. Perioperative mortality was 5.5 %, mid-term mortality 12 %, and long-term mortality 27 %. Survival rates were similar in patients treated with surgery and antimicrobial therapy compared to patients treated with antimicrobial therapy alone (61 % versus 63 %, respectively), while infection eradication at 12 months was significantly higher following surgery (83.3 % versus 45.5 %). Conclusion: 99mTc-HMPAO-WBC SPECT/CT is useful for detecting, localizing and defining the extent of graft infection in patients with late and low-grade late VPI with inconclusive radiological findings. 99mTc-HMPAO-WBC SPECT/CT might be used to optimize patient management.

KW - Bypass grafting

KW - SPECT/CT

KW - Vascular prosthesis infection

UR - http://www.scopus.com/inward/record.url?scp=84897849935&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897849935&partnerID=8YFLogxK

U2 - 10.1007/s00259-013-2582-9

DO - 10.1007/s00259-013-2582-9

M3 - Article

C2 - 24142027

AN - SCOPUS:84897849935

VL - 41

SP - 357

EP - 368

JO - European Journal of Pediatrics

JF - European Journal of Pediatrics

SN - 0340-6199

IS - 2

ER -