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Imaging Infection with ¹⁸F-FDG–Labeled Leukocyte PET/CT: Initial Experience in 21 Patients

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

View larger version (47K): [in a new window]   FIGURE 1.  Anterior (A) and posterior (B) maximum-intensity projections of 18F-FDG–WBC PET show biodistribution of tracer, with accumulation of labeled leukocytes in reticuloendothelial system (hemopoietic bone marrow, liver, and spleen). Faint activity is seen in 18F-FDG–avid organs—that is, brain and myocardium—and no significant activity is found either in intestines or in kidneys.

View larger version (31K): [in a new window]   FIGURE 2.  (A) Coronal 18F-FDG–WBC PET and (B) fused coronal 18F-FDG–WBC PET/CT in 78-y-old patient treated unsuccessfully with antibiotics for septic arthritis of knee caused by Staphylococcus aureus. 18F-FDG–WBC PET/CT reveals intense leukocyte accumulation in several colon diverticula, corresponding with diverticulitis on CT.

View larger version (47K): [in a new window]   FIGURE 3.  (A) Transverse 18F-FDG–WBC PET and (B) fused transverse 18F-FDG–WBC PET/CT in 84-y-old man admitted for fever and weight loss with history of biologic aortic valve replacement 5 y earlier, followed 2 y later by bacterial endocarditis. 18F-FDG–WBC PET/CT reveals intense focal accumulation of leukocytes in aortic valve. Final diagnosis was bacterial endocarditis caused by Streptococcus bovis.

View larger version (72K): [in a new window]   FIGURE 4.  Sagittal 18F-FDG–WBC PET (A) and fused 18F-FDG–WBC PET/CT (B) of infected foot of 66-y-old diabetic man. Intense accumulation of 18F-FDG–WBC at site of large plantar abscess is seen; accumulation extends across distal part of second metatarsal bone (center of cross) to dorsal side of foot. (C) On sagittal MRI (fat-saturated, gadolinium-enhanced T1-weighted image), collection (asterisk) with parietal enhancement (arrows) is observed at site of intense WBC uptake. (D) Microscopic view (40x) of hematoxylin–eosin staining of second metatarsal bone shows foci of acute as well as chronic OM. Dors. = dorsal side of foot; Plant. = plantar side; M = head of second metatarsal bone; P = base of phalanx of second digit.