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Clinical Investigation |
1 Department of Nuclear Medicine and PET/Biomedical Cyclotron Unit, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; 2 Department of Medical Imaging, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; 3 Department of Pathology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; 4 Department of Dermatology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and 5 Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
Correspondence: For correspondence or reprints contact: Nicolas Dumarey, MD, Department of Nuclear Medicine, Université Libre de Bruxelles Hôpital Erasme, 808 route de Lennik, B-1070 Brussels, Belgium. E-mail: ndumarey{at}ulb.ac.be
The aim of this study was to assess the feasibility and the potential role of PET/CT with 18F-FDG–labeled autologous leukocytes in the diagnosis and localization of infectious lesions. Methods: Twenty-one consecutive patients with suspected or documented infection were prospectively evaluated with whole-body PET/CT 3 h after injection of autologous 18F-FDG–labeled leukocytes. Two experienced nuclear medicine physicians who were unaware of the clinical end-diagnosis reviewed all PET/CT studies. A visual score (0–3)—according to uptake intensity—was used to assess studies. The results of PET/CT with 18F-FDG–labeled white blood cell (18F-FDG–WBC) assessment were compared with histologic or biologic diagnosis in 15 patients and with clinical end-diagnosis after complete clinical work-up in 6 patients. Results: Nine patients had fever of unknown etiology, 6 patients had documented infection but with unknown extension of the infectious disease, 4 patients had a documented infection with unfavorable evolution, and 2 patients had a documented infection with known extension. The best trade-off between sensitivity and specificity was obtained when a visual score of 
2 was chosen to identify increased tracer uptake as infection. With this threshold, sensitivity, specificity, and accuracy were each 86% on a patient-per-patient basis and 91%, 85%, and 90% on a lesion-per-lesion basis. In this small group of patients, the absence of areas with increased WBC uptake on WBC PET/CT had a 100% negative predictive value. Conclusion: Hybrid 18F-FDG–WBC PET/CT was found to have a high sensitivity and specificity for the diagnosis of infection. It located infectious lesions with a high precision. In this small series, absence of areas with increased uptake virtually ruled out the presence of infection. 18F-FDG–WBC PET/CT for infection detection deserves further investigation in a larger prospective series.
Key Words: imaging infection • 18F-FDG–labeled leukocytes • PET/CT
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