Inflammation / Infection Detection

J. Anthony Parker, MD PhD

Case


Radiopharmaceuticals

Agents

Agent of Choice

Pitfalls


Technique

Ga-67 Citrate

In-111 Oxine labeled White Blood Cells

Tc-99m Exametazime (HMPAO) labeled White Blood Cells

Tc-99m Leutech Anti-CD15 Antibody


Non-specific IgG


Dosimetry

Radiopharmaceutical Administered Activity Effective Dose 
MBq mCi cSv 
In-111 IgG 75 2 1.5 
Tc-99m IgG 370 10 0.3 
In-111 WBCs 25 0.7 1.5 
Tc-99m WBCs 370 10 0.6 
Ga-67 citrate 220 6 2.7 
Tc99m Leutech 370-740 5-10 TBA

Mechanisms of Uptake


Indications

Acute Appendicitis
Tc-99m WBC Tc-99m Leutech
N = 58 N = 49
D+ D-
T+ 27 8
T- 0 23
D+ D-
T+ 26 4
T- 0 19
Sens = 100%
Spec = 74%
Sens = 100%
Spec = 83%
t(positive) = 72 min
t(nuke->Sx) = 6.8 h
t(positive) = 42 min
t(nuke->Sx) = 5.5 h

 
Acute Appendicitis
N = 200 (including prior table)
123F / 79M
5-86 y
D+ D-
T+ 53 19*
T- 6 122
*5/19 other infection
Sens = 90%
Spec = 87%
t < 30 min for 84% of poitives


Interpretation

Normal Sites of Uptake

Abnormalities

Gallium lung uptake

Pitfalls


Cases


J. Anthony Parker, MD PhD, Tony_Parker@CareGroup.Harvard.edu