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SPECT/CT Using 67Ga and 111In-Labeled Leukocyte Scintigraphy for Diagnosis of Infection

Rachel Bar-Shalom, MD1,2, Nikolay Yefremov, MD1, Luda Guralnik, MD3, Zohar Keidar, MD, PhD1,2, Ahuva Engel, MD2,3, Samy Nitecki, MD2,4 and Ora Israel, MD1,2

1 Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel; 2 Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel; 3 Deparment of Diagnostic Radiology, Rambam Medical Center, Haifa, Israel; and 4 Department of Vascular Surgery, Rambam Medical Center, Haifa, Israel


Figure 1
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  		FIGURE 1.  SPECT/CT for suspected bone infection on GS. A 56-y-old woman presented with fever, low back pain, and infected scar 1 mo after spinal surgery and was referred for GS for suspected vertebral osteomyelitis. (A) Planar posterior whole-body GS image (left) shows prominent abnormal uptake in left lower back, corresponding in part to regions of increased irregular uptake seen on planar posterior whole-body 99mTc-MDP image (right) along operated vertebrae. (B) Transaxial GS SPECT/CT image (left) localizes abnormal uptake on GS (center) to paravertebral soft-tissue abscess seen on corresponding CT image (right), thus defining soft-tissue infection without osteomyelitis. There was no evidence of vertebral osteomyelitis on follow-up CT 4 wk later.

 

Figure 2
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  		FIGURE 2.  SPECT/CT for suspected vascular graft infection on WBC. A 54-y-old man, 2 y after left femoropopliteal bypass and 1 mo after right femoral-popliteal bypass, was referred for WBC for suspected vascular graft infection in presence of infected surgical wound in right groin. (A) Planar anterior WBC image shows focal uptake in right groin. Precise anatomic location of this lesion with regard to potential involvement of adjacent vascular graft could not be determined. (B) Transaxial WBC SPECT/CT image (left) shows that suggestive right inguinal uptake seen on WBC (center, arrowhead) is localized to subcutaneous fat blurring seen on corresponding low-dose CT image in region of surgical scar (right, arrowhead), with no involvement of adjacent vascular graft (right, arrow). Signs and symptoms of surgical wound infection resolved rapidly with systemic antibiotic and local treatment. Patient had no further evidence of wound or graft infection during follow-up of 10 mo.

 




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