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^99mTc-PEG Liposomes for the Scintigraphic Detection of Infection and Inflammation: Clinical Evaluation

Departments of Nuclear Medicine, Internal Medicine, and Clinical Pharmaceutics, University Hospital Nijmegen, Nijmegen
Institute for Pharmaceutical Science, Department of Pharmaceutics, Utrecht University, Utrecht, The Netherlands

Correspondence: For correspondence or reprints contact: Wim J.G. Oyen, MD, Department of Nuclear Medicine, University Hospital Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

ABSTRACT

Polyethyleneglycol (PEG) liposomes have been shown to be excellent vehicles for scintigraphic imaging of infection and inflammation in various experimental models. In this article we report on a series of patients with possible infectious and inflammatory disease in whom the performance of ^99mTc-PEG liposomes was evaluated. The results of ^99mTc-PEG liposome scintigraphy were directly compared with those of ¹¹¹In-immuno-globulin G (IgG) scintigraphy. Methods: Thirty-five patients (22 men, 13 women; mean age, 51 y; range, 20–76 y), suspected of having infectious or inflammatory disease, received 740 MBq ^99mTc-PEG liposomes intravenously. Imaging was performed at 4 and 24 h after injection. Patients received 75 MBq ¹¹¹In-lgG 24 h after administration of the liposomes. The scintigraphic results were compared and verified by culture, biopsy, surgery, and follow-up of at least 6 mo. Results: Of the 16 proven infections and inflammations, 15 were detected by ^99mTc-PEG liposome scintigraphy: soft-tissue infection (n = 3), septic arthritis (n = 3), autoimmune polyarthritis (n = 2), infected hip prosthesis (n = 1), infected osteosynthesis (n = 1), spondylodiscitis (n = 1), infected aortic prosthesis (n = 1), colitis (n = 1), abdominal abscess (n -1), and pneumonia (n = 1). Tc-PEG liposome and ¹¹¹In-lgG scintigraphy both missed 1 case of endocarditis. In addition, an ¹¹¹In-lgG scan of a patient with mild soft-tissue infection was false-negative. Concordantly false-positive scans were recorded from 2 patients, both with uninfected pseudarthrosis and focal signs of sterile inflammation. During liposomal administration, 1 patient experienced flushing and chest tightness, which rapidly disappeared after lowering the infusion rate. No other adverse events were observed. Conclusion: This clinical evaluation of ^99mTc-PEG liposomes shows that focal infection and inflammation can be adequately imaged with this new agent. The performance of ^99mTc-PEG liposomes is at least as effective as that of ¹¹¹In-lgG. With the simple and safe preparation and the physical and logistic advantages of a ^99mTc label, ^99mTc-PEG liposomes could be an attractive agent for infection or inflammation imaging.

Key Words: ^99mTc • liposomes, polyethyleneglycol • ¹¹¹In • immunoglobulin G • imaging • infection • inflammation

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