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Inflammation and Infection: Imaging Properties of ¹⁸F-FDG–Labeled White Blood Cells Versus ¹⁸F-FDG

¹ Nuclear Medicine Division, Department of Oncology, University of Pisa Medical School, Pisa, Italy
² Nuclear Medicine Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

¹⁸F-FDG and ¹⁸F-FDG–labeled white blood cells (¹⁸F-FDG–WBCs) are valuable radiopharmaceuticals for imaging focal sites of inflammation and infection. In the present study, the imaging properties of both radiotracers were compared in sterile and septic inflammation models. Methods: Groups of adult male Sprague–Dawley rats (100–120 g) were injected in the left posterior thigh muscle with saline solution (group 1: controls, n = 15), 0.100 mL of turpentine oil (group 2: sterile inflammation, n = 26), 10⁹ viable Escherichia coli bacteria (group 3: E. coli septic inflammation, n = 29), or 10⁸ viable Pseudomonas aeruginosa bacteria (group 4: P. aeruginosa septic inflammation, n = 25). Twenty-four hours later, the animals were divided into 2 groups: One received ¹⁸F-FDG intravenously and the other received human white blood cells (WBCs) labeled in vitro with ¹⁸F-FDG injected intravenously. Biodistribution and microPET studies were performed 1 h after radiotracer injection. One hour after injection with cell-associated or free ¹⁸F-FDG, phosphorimaging of abscess and contralateral muscle was performed in specimens collected from animals in groups 1, 2, and 3. The region of interest was selected within the abscess wall and values were converted to kBq/g using a ¹⁴C calibration standard curve. Thin-layer radiochromatography (TLRC) was performed to study the chemical forms of ¹⁸F within the WBCs. Results: Whole-body biodistribution demonstrated a significantly higher uptake ratio of ¹⁸F-FDG–WBCs compared with ¹⁸F-FDG in all sterile and septic inflammation models (t test: sterile, P = 0.048; E. coli, P = 0.040; P. aeruginosa, P = 0.037). microPET imaging confirmed the greater performance of ¹⁸F-FDG–WBCs versus ¹⁸F-FDG in the sterile inflammation model and in both E. coli and P. aeruginosa septic models. Phosphorimaging analysis showed higher ¹⁸F-FDG–WBC uptake than ¹⁸F-FDG in the sterile inflammation and P. aeruginosa septic models and similar tissue uptake in the E. coli septic model. Time course labeling and TLRC of lysed WBCs demonstrated that ¹⁸F-FDG was retained as ¹⁸F-FDG-6-phosphate inside WBCs for at least 2 h, corresponding to the time frame of analysis. Conclusion: ¹⁸F-FDG–WBCs gave better results compared with ¹⁸F-FDG in all sterile and septic inflammation models. These data suggest that ¹⁸F-FDG–WBC PET may be a useful technique for tracking focal inflammatory lesions in the body.

Key Words: ¹⁸F-FDG–labeled white blood cells • infection • inflammation • biodistribution • microPET • phosphorimaging

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