Radionuclide Imaging of Infection and Inflammation : A Pictorial Case-Based Atlas

This atlas explores the latest advances in radionuclide imaging in the field of inflammatory diseases and infections, which now typically includes multimodality fusion imaging (e.g. in SPECT/CT and in PET/CT). In addition to describing the pathophysiologic and molecular mechanisms on which the radionuclide imaging of infection/inflammation is based, the clinical relevance and impact of such procedures are demonstrated in a collection of richly illustrated teaching cases, which describe the most commonly observed scintigraphic patterns, as well as anatomic variants and technical pitfalls. Special emphasis is placed on using tomographic multimodality imaging to increase both the sensitivity and specificity of radionuclide imaging. The aim of the second edition of this book is to update the first (published in 2013) by reflecting the changes in this rapidly evolving field. Particular attention is paid to the latest advances in the radionuclide imaging of infection and inflammation, including the expanding role of hybrid imaging with [18F]FDG PET/CT SPECT/CT, without neglecting new radiotracers proposed for the imaging of infection/inflammation. Written by respected experts in the field, the book will be an invaluable tool for residents in nuclear medicine, as well as for other specialists. Foreword Preface List of International Guidelines on Radionuclide Imaging of Infection/Inflammation Imaging (Most Recent Publications Listed First) Contents Contributors 1: Normal Findings with Different Radiopharmaceuticals, Techniques, Variants, and Pitfalls 1.1 Introduction 1.2 67Ga-Citrate Scintigraphy 1.2.1 Normal Biodistribution of 67Ga-Citrate 1.2.2 Normal Variants in 67Ga-Citrate Scintigraphy 1.2.3 Pitfalls in 67Ga-Citrate Scintigraphy 1.3 99mTc-Diphosphonate (MDP/HDP) Scintigraphy 1.3.1 Normal Biodistribution of 99mTc-MDP/HDP 1.3.2 Normal Variants in 99mTc-MDP/HDP Scintigraphy 1.3.3 Pitfalls in 99mTc-MDP/HDP Scintigraphy 1.4 99mTc-Sulfur Colloid and 99mTc-Albumin Nanocolloids 1.4.1 Normal Biodistribution of Radiocolloids 1.4.2 Pitfalls in Radiocolloid Scintigraphy 1.5 99mTc-Besilesomab BW 250/183 (Scintimun®) 1.5.1 Normal Biodistribution of 99mTc-Besilesomab BW 250/183 1.5.2 Pitfalls in 99mTc-Besilesomab BW 250/183 Scintigraphy 1.6 99mTc-Falonesomab (Leu-Tech®, NeutroSpec®) 1.6.1 Normal Biodistribution of 99mTc-Falonesomab 1.6.2 Pitfalls in 99mTc-Falonesomab Scintigraphy 1.7 99mTc-Sulesomab (LeukoScan®) 1.7.1 Normal Biodistribution of 99mTc-Sulesomab 1.7.2 Pitfalls in 99mTc-Sulesomab Scintigraphy 1.8 111In-Oxine-Leukocyte Scintigraphy 1.8.1 Normal Distribution of 111In-Oxine-Leukocytes 1.8.2 Normal Variants in 111In-Oxine-Leukocyte Scintigraphy 1.8.3 Pitfalls in 111In-Oxine-Leukocyte Scintigraphy 1.9 99mTc-HMPAO-Leukocyte Scintigraphy 1.9.1 Normal Distribution of 99mTc-HMPAO-Leukocytes 1.9.2 Normal Variants in 99mTc-HMPAO-Leukocyte Scintigraphy 1.9.3 Pitfalls in 99mTc-HMPAO-Leukocyte Scintigraphy 1.10 [18F]FDG PET/CT (and PET/MR) 1.10.1 Normal Biodistribution of [18F]FDG 1.10.2 Normal Variants in [18F]FDG PET/CT 1.10.3 Pitfalls in [18F]FDG PET/CT 1.11 Novel Infection Imaging Agents 1.11.1 99mTc-Ubiquicidin Fragments and 68Ga-Ubiquicidin Fragments 1.11.2 Radiolabeled Antibiotics 1.11.3 [18F]FDG-Labeled Leukocytes 1.11.4 124I-Fialuridine 1.11.5 68Ga-Citrate References 2: Nuclear Medicine Imaging of Soft Tissue Infections 2.1 Introduction 2.2 General Background on Imaging of Soft Tissue Infection 2.2.1 Ultrasound Imaging of Soft Tissue Infections 2.2.2 Plain X-ray Imaging of Soft Tissue Infections 2.2.3 Computed Tomography (CT) Imaging of Soft Tissue Infections 2.2.4 Magnetic Resonance Imaging (MRI) of Soft Tissue Infections 2.2.5 Nuclear Medicine Imaging of Soft Tissue Infections 2.3 Conclusions Clinical Cases Case 2.1 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 2.2 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 2.3 Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 3: Nuclear Medicine Imaging of Bone and Joint Infection 3.1 Infection of Peripheral Bones 3.2 Infection of the Axial Skeleton 3.3 Joint Infection 3.4 Examples of Imaging in Patients with Bone and Joint Infection 3.5 Clinical Cases Case 3.1 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 3.2 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 3.3 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 3.4 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 3.5 Background Suspected Site of Infection Radiopharmaceutical Activities Imaging Conclusions/Teaching Point References 4: Radionuclide Imaging of Miscellaneous Bone and Joint Conditions 4.1 Introduction 4.2 General Background on Non-infection Imaging for Miscellaneous Bone/Joint Conditions 4.3 General Background on Infection Imaging for Miscellaneous Bone/Joint Conditions 4.4 Conclusions Clinical Cases Case 4.1 Background Conclusion/Teaching Point Case 4.2 Background Conclusion/Teaching Point Case 4.3 Background Conclusion/Teaching Point Case 4.4 Background Conclusion/Teaching Point Case 4.5 Background Conclusion/Teaching Point Case 4.6 Background Conclusion/Teaching Point Case 4.7 Background Conclusion/Teaching Point Case 4.8 Background Conclusion/Teaching Point References 5: Nuclear Medicine Imaging of Joint Prosthesis Infections and Peripheral Bone Infections 5.1 Infection of Joint Prostheses 5.2 Nuclear Medicine Imaging for Periprosthetic Joint Infection 5.2.1 Three-Phase Bone Scintigraphy for Periprosthetic Joint Infection 5.2.2 67Ga-Citrate Scintigraphy for Periprosthetic Joint Infection 5.2.3 Scintigraphy with Labeled Autologous Leukocytes for Periprosthetic Joint Infection 5.2.4 Antigranulocyte Scintigraphy for Periprosthetic Joint Infection 5.2.5 [18F]FDG PET/CT for Periprosthetic Joint Infection 5.3 Conclusions References 6: Nuclear Medicine Imaging of Vascular Prosthesis Infections 6.1 Introduction 6.2 Clinical Presentations of Vascular Graft Infections 6.3 Microbiology of Vascular Graft Infections 6.4 Diagnosis of Vascular Graft Infections 6.5 Ultrasonography for Detecting Vascular Graft Infections 6.6 Computed Tomography (CT) for Detecting Vascular Graft Infections 6.7 Magnetic Resonance Imaging for Detecting Vascular Graft Infections 6.8 Nuclear Medicine Imaging for Detecting Vascular Graft Infections Clinical Cases Case 6.1 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points Case 6.2 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points Case 6.3 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points Case 6.4 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points Case 6.5 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points Case 6.6 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points Case 6.7 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Points References 7: Nuclear Medicine Imaging of Non-orthopedic or Cardiovascular Implantable Device Infection 7.1 Introductory Background 7.2 Infections of Central Venous Catheters 7.3 Neurosurgical Infections 7.3.1 Craniotomy Infections 7.3.2 Infection of Ventricular Shunts 7.3.3 Infections of Lumbar Drains 7.3.4 Infections of Deep Brain Stimulators 7.3.5 Infection of Spinal Cord Stimulators and Medication Pumps 7.4 Infection of Respiratory Assistance Devices 7.5 Infection of Peritoneal Dialysis Catheters 7.6 Infection of Penile Devices 7.7 Infection of Breast Implants 7.8 Infection of Cochlear Implants Clinical Cases Case 7.1 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.2 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.3 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.4 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.5 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.6 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.7 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.8 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.9 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.10 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.11 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 7.12 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 8: Nuclear Medicine Imaging of Infections and Inflammation of Central Nervous System and of the Head and Neck Structures 8.1 Introduction 8.2 CNS Infections 8.3 Otitis and Sinusitis 8.4 Infections Associated with Dermal Fillers 8.5 Dental Abscesses 8.6 Thyroiditis and Exophthalmos 8.6.1 Acute and Subacute Thyroiditis 8.6.2 Graves’ Disease and Autoimmune Exophthalmos 8.7 Other Neck Infections Clinical Cases Case 8.1 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 8.2 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 8.3 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 8.4 References 9: Infective Endocarditis and Cardiovascular Implantable Electronic Device Infection 9.1 Cardiovascular Infections 9.2 Infective Endocarditis 9.2.1 General Introduction 9.2.2 Clinical Presentation and Diagnosis of IE 9.2.3 Diagnosis and Prognostic Stratification of IE 9.2.4 Diagnosis of IE: From the Duke Criteria to the 2015 ESC Criteria 9.2.5 Left-Sided IE 9.2.6 Right-Sided IE 9.2.7 Embolic Burden in IE 9.3 Cardiovascular Implantable Electronic Devices 9.3.1 Clinical Classification and Management of CIED Infections 9.3.2 Diagnosis of CIED Infections 9.3.3 Microbiology of CIED Infections 9.3.4 Imaging of CIED Infections 9.4 Infections Associated with Left Ventricular Assist Devices 9.4.1 Diagnostic Work-Up of Infections Associated with Left Ventricular Assist Devices 9.5 Technical Considerations on Patient Preparation, Radiopharmaceutical Preparation, Acquisition Protocols, Post-acquisition Image Processing, and Image Reading/Interpretation 9.5.1 Labeled Leukocyte SPECT/CT 9.5.1.1 Patient Preparation 9.5.2 [18F]FDG PET/CT Clinical Cases Case 9.1 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 9.2 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 9.3 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 9.4 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 9.5 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 9.6 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 9.7 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 10: Nuclear Medicine Imaging of Fever of Unknown Origin Imaging in Patients with Fever of Unknown Origin Clinical Cases Case 10.1 Background Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 10.2 Background Suspected Site of Infection Radiopharmaceutical Activity Conclusion/Teaching Point Case 10.3 Background Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 11: Nuclear Medicine Imaging of Abdominal Infections and Inflammations 11.1 Introduction 11.2 Intra-abdominal Infections and Abscesses 11.3 Inflammatory Bowel Diseases (IBD) 11.4 Idiopathic Retroperitoneal Fibrosis 11.5 Miscellaneous Abdominal Infections Clinical Cases Case 11.1 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 11.2 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 11.3 Suspected Site of Disease Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 12: Nuclear Medicine Imaging of Diabetic Foot 12.1 Diabetic Foot Infection 12.2 Charcot Neuroarthropathy 12.3 Imaging of the Diabetic Foot Clinical Cases Case 12.1 Clinical Presentation Previous Diagnostic Work-Up Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 12.2 Clinical Presentation Previous Diagnostic Work-Up Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 13: Nuclear Medicine Imaging of Lung Infection 13.1 Introductory Background 13.2 Imaging Lung Infection with Single-Photon Emitting Agents 13.3 Imaging Lung Infection with Positron Emitting Agents Examples of Lung Infection Imaging Chest X-ray and 99mTc-HMPAO-Leukocyte Scintigraphy in Patient with Lung Infection (Figs. 13.1, 13.2, and 13.3) [18F]FDG PET/CT in Patient with Tuberculosis Infection of Left Pleura (Figs. 13.4, 13.5, 13.6, and 13.7) [18F]FDG PET/CT in Patient with “Ab Ingestis” Pneumonia (Fig. 13.8) [18F]FDG PET/CT in Patient with Hypereosinophilic Syndrome (Fig. 13.9) [18F]FDG PET/CT in Patient with Atypical Mycobacteria Pneumonia (Fig. 13.10) [18F]FDG PET/CT in Patients with Incidentally Detected Interstitial Pneumonia Associated with the Covid-19 Virus (SARS-CoV-2) (Figs. 13.11 and 13.12) Clinical Cases Case 13.1 Background Differential Diagnosis Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 13.2 Background Differential Diagnosis Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 14: Nuclear Medicine Imaging in Chronic Inflammatory Diseases 14.1 Introductory Background 14.2 Rheumatoid Arthritis 14.3 Vasculitis 14.4 Sarcoidosis 14.5 Sjögren Syndrome 14.6 Atherosclerosis Clinical Cases Case 14.1 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.2 Suspected Site of Inflammation Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.3 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.4 Suspected Site of Inflammation Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.5 Suspected Site of Inflammation Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.6 Suspected Site of Inflammation Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.7 Suspected Site of Inflammation Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.8 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point Case 14.9 Suspected Site of Infection Radiopharmaceutical Activity Imaging Conclusion/Teaching Point References 15: Radionuclide Imaging of Inflammatory Vascular Diseases: Vasculitis and Atherosclerosis 15.1 Introductory Background 15.2 Large Vessel Vasculitis 15.2.1 Background 15.2.2 Diagnostic Approach 15.2.3 [18F]FDG PET/CT 15.2.4 Patient Preparation and Imaging Protocol 15.2.5 Scoring [18F]FDG PET/CT 15.2.6 Diagnostic Performance of [18F]FDG PET/CT 15.2.7 Prognostic Value of [18F]FDG PET/CT and Assessment of Response to Treatments (Conventional and New Therapies) 15.3 Atherosclerosis 15.3.1 Background 15.3.2 Diagnostic Approach 15.3.3 [18F]FDG PET/CT 15.3.4 Patient Preparation and Imaging Protocol 15.3.5 Parameters for Quantification of Radiotracer Uptake in Atherosclerotic Plaques 15.3.6 [18F]FDG PET as Surrogate Endpoint in Interventional Studies 15.3.7 Diagnostic Performance 15.3.8 Prognostic Value and Clinical Relevance 15.3.9 Response Monitoring (Conventional and New Drugs) 15.4 Perspectives in Large Vessel Vasculitis and Atherosclerosis Imaging Glossary References 16: Radionuclide Imaging of Infection and Inflammation in Pediatrics Clinical Cases Case 16.1 Background Findings Conclusion/Teaching Points Case 16.2 Findings Conclusion/Teaching Points Case 16.3 Findings Conclusion/Teaching Points Case 16.4 Findings Conclusion/Teaching Points References Index