Research ArticleClinical Investigations

PET/CT with 18F-FDG–Labeled Autologous Leukocytes for the Diagnosis of Infected Fluid Collections in Acute Pancreatitis

Anish Bhattacharya, Rakesh Kochhar, Sarika Sharma, Pallab Ray, Naveen Kalra, Niranjan Khandelwal and Bhagwant R. Mittal
Journal of Nuclear Medicine August 2014, 55 (8) 1267-1272; DOI: https://doi.org/10.2967/jnumed.114.137232

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    18F-FDG–labeled leukocyte PET/CT images of patient with noninfected peripancreatic fluid collection. (A) Maximum-intensity-projection image showing no tracer uptake in central abdomen. (B–D) Coronal fused PET/CT (B), transaxial CT (C), and corresponding transaxial fused PET/CT (D) images showing large cystic non–tracer-avid peripancreatic fluid collection extending into lesser sac region. Fluid aspirated from collection was sterile on culture.

  • FIGURE 2.
    FIGURE 2.

    18F-FDG–labeled leukocyte PET/CT images of patient with peripancreatic fluid collection showing mild inflammation. (A) Maximum-intensity-projection image showing minimal tracer uptake in central abdomen, with nonhomogeneous uptake in liver and patchy uptake in basal segment of left lung. (B–D) Coronal fused PET/CT (B), transaxial CT (C), and corresponding transaxial fused PET/CT (D) images showing fluid collection with mildly tracer-avid margins (SUVmax, 3.0) in neck, body, and tail of pancreas. Fluid aspirated from collection was sterile on culture.

  • FIGURE 3.
    FIGURE 3.

    18F-FDG–labeled leukocyte PET/CT images of patient with infected peripancreatic fluid collection. (A) Maximum-intensity-projection image showing intense tracer uptake in central abdomen (SUVmax, 35), extending to spleen and left paracolic region. Mild irregular tracer uptake can be seen in both lungs. (B) Coronal fused PET/CT image showing large fluid collection with markedly tracer-avid margins replacing body and tail of pancreas. (C) Transaxial CT image at level of pancreas showing air bubbles in fluid collection. (D) Corresponding transaxial fused PET/CT image showing intense tracer uptake along margins of fluid collection. Fluid aspirated from collection showed growth of E. coli on culture.

  • FIGURE 4.
    FIGURE 4.

    Maximum-intensity-projection images showing normal physiologic distribution of 18F-FDG–labeled autologous leukocytes in liver, spleen, and bone marrow, with minimal uptake in brain (A), and normal physiologic distribution of 18F-FDG alone (B).

Tables

  • TABLE 1

    Characteristics of Patients

    Patients
    CharacteristicTotalWith positive scan resultsWith negative scan results
    No. of patients411229
    No. of febrile patients219 (75%)12 (41%)
    Blood glucose level (mg/100 mL)
     Mean ± SD118 ± 30140 ± 42109 ± 19
     Range83–21294–21283–175
    TLC/mm3
     Mean ± SD11,648 ± 5,37613,064 ± 5,30511,062 ± 5,387
     Range4,600–24,2005,600–20,9004,600–24,200
    Percentage of neutrophils
     Mean ± SD73 ± 1075 ± 772 ± 10
     Range55–9066–8555–90
    18F-FDG used (MBq)
     Mean ± SD429.2 ± 62.9462.5 ± 77.7418.1 ± 51.8
     Range314.5–555314.5–555336.7–529.1
    Radiotracer injected (MBq)
     Mean ± SD262.7 ± 70.3266.4 ± 66.6259 ± 70.3
     Range96.2–473.696.2–344.1111–473.6
    Percentage of labeling efficiency
     Mean ± SD81 ± 1784 ± 1980 ± 17
     Range31–9732–9731–96

    • TLC = total leukocyte count.

  • TABLE 2

    Details of Fluid Collections with Positive Scan and Culture Results

    No. of patients
    Type of collectionTotalWith positive scan resultsWith positive culture results
    Acute necrotic collection2131*
    Walled-off necrosis1899
    Pseudocyst200

    • ↵* Aspirate was inadequate for culturing in 2 patients.

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