1. Radionuclide imaging in infection and inflammation

2. Inflammation
A basic way in which the body reacts to infection, irritation or other injury
Inflammation is now recognized as a type of nonspecific immune response

3. Morfology of inflammation
Blood hyperperfussion
Increased cappilars permeability
Exudation
Swelling
Leukocytes migration
Dysfunction of organ or tissue

4. Diagnosis of inflammation
Physical examination
Laboratory tests
X-ray
Ultrasound
MRI

5. Symptoms Dolor Rubor Tumor Calor
Hallmarks of inflammation were first described by Aulus (Aurelius) Cornelius Celsus, a Roman physician and medical writer, who lived from about 30 B.C. to 45 A.D.

6. X-ray and ultrasound Do we really need other modalities?
What we see in X-ray or ultrasound?
Is X-ray or ultrasound specific technique for inflammatory process?

7. Acute hematogenous osteomyelitis in a peadriatric patient

8. Hematogenous osteomyelitis in a peadriatric patient

9. Hematogenous osteomyelitis in a peadriatric patient

10. Diagnosis of inflammation
Physical examination
Laboratory tests
X-ray
Ultrasound
MRI
Scintigraphy

11. Specific radionuclide techniques
In vitro labelled leukocytes
In vivo labelled leukocytes
Labelled poliklonal IgG
Labelled antibiotics
Gallium-67 scan

12. Non specific radiomuclide techniques
Bone scintigraphy
Renal static scintigraphy
Salivary gland scintigraphy
Brain perfussion scan

13. In vitro labelled leukocytes
Indium-111 oxin
Technetium-99m – HmPAO
Labelling process outside of body
Separation of leucocytes in centrifugal machine
Labelling by diffusion of radioactive complex into a cell

14. In vitro labelling

15. In vitro labelling

16. In vivo labelled leucocytes
Immunoscintigraphy
Monoclonal IgG antibody Fab’ fragment labeled with Technetium-99m
Injected targets NCA-90, found on the cell membrane of graunlocytes

17. In vivo labelling

18. In vivo labelling

19. After injection

20. Indications Abscess in abdomen (appendicitis) Fever of unknown origin
Artery graft infections
Infection ortopaedic prothesis
Bowel inflamatory disease

21. Tc99m-HmPAO labelled leukocytes – normal abdominal scan

22. Appendicitis
Atypical presentation of acute appendicitis in high-risk populations, such as children, make correct diagnosis difficult.
Rate of complications, including death, is directly correlated with delay in diagnosis and surgery.

23. Appendicitis
Tc99m-HmPAO labelled leukocytes scintigraphy is a rapid and very accurate method for detecting acute appendicitis in patients with acute lower abdominal pain and equivocal clinical findings.

24. Appendicitis

25. Fever of Unknown Origin (FUO)
30% of patiens with FUO have silent infection
After surgery 60%
Very often negative X-ray and US
Tc99m-HmPAO labelled scintygraphy is method of choice

26. Arterial graft infections
2-6% of grafts
Mortality very high 25-75%
The highest sensitivity of Tc99m-HmPAO labelled leukocytes scintigraphy
100% !
Early diagnosis saves live

27. Bowel inflamatory diseases
Crohn disease
Colitis ulcerosa
Non specific bowel inflamation
The same efficacy that colonoscopy with mucosa biopsy
Control of treatement

28. Crohn disease

29. Colitis ulcerosa

30. Gallium-67 citrate Labelling in vivo leucocytes
Binds to transport protein laktoferrin
Expensive
Less specific than labelled leucocytes
Also binds transferrine in tumours cells (lymphoma, HCC, leucemia)

31. Gallium-67 scan
Spondyllitis VTh5

32. Pericarditis

33. Ga-67 - Acute pulmonary infection

34. Policlonal human immunoglobins IgG labelled with Tc99m
Accumulation in focus of inflammation
Circulating IgG`s are premeabling to intercellular space
Easy to preparation and cost effective
No differentiation between inflamation and infection

35. Policlonal IgG-Tc99m - normal

36. Policlonal IgG-Tc99m - normal

37. Policlonal IgG-Tc99m

38. Policlonal IgG-Tc99m

39. Bone scintigraphy Three-phase scintigraphy Early phase: perfussion
Late phase: bone metabolism
Usefull in incection and inflammation
Non specific

40. Bone scan - normal

41. Bone scan - three phase

42. Osteomyelitis

43. Osteomyelitis

44. Otitis media complication

45. Septic arthritis

46. Rheumatoid artritis
99mTc-MDP RA
99mTc-MDP Normal

47. Entesopaties
Achilles Tendinitis
99mTc-MDP

48. Seronegative arthritis

49. Pyelonephritis High incidence in children
1% leads to renal failure and transplantation
10% asymptomatic
Renal scars

50. DMSA-Tc99m scan
99m Tc -
DMSA

51. Static renal scintygraphy
Gold standard in detection of inflammatory scars!
Method of choice

52. Pyelonephritis
In acute pyelonephritis DMSA scan is ALWAYS abnormal!

53. Inflamatory scars Sens Spec. DMSA 92.1 93.8 ECHO - 74.3 56.7 DOPPLERCT
86.8
87.5 MR
89.5

54. Brain vasculitis Antiphospholipide Antybody Syndrom
Lupus cerebri and other colagenoses
High mortality!
Needs agressive treatement with cytostatics and high doses of steroids
rCBF=Brain perfussion scan
SPECT

55. Normal perfussion

56. Cerebral vasculitis

57. Cerebral vasculitis

58. Salivary gland function

59. Sjoegrens disease