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Goodman AL, Packham A, Sharkey AR, Cook GJR. Advanced Imaging for Detection of Foci of Infection in Staphylococcus aureus Bacteremia- Can a Scan Save Lives? Semin Nucl Med 2023; 53:175-183. [PMID: 36690574 PMCID: PMC10016027 DOI: 10.1053/j.semnuclmed.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/23/2023]
Abstract
Bloodstream infection or sepsis is a common cause of mortality globally. Staphylococcus aureus (S. aureus) is of particular concern, through its ability to seed metastatic infections in almost any organ after entering the bloodstream (S. aureus bacteraemia), often without localising signs. A positive blood culture for S. aureus bacteria should lead to immediate and urgent identification of the cause. Failure to detect a precise focus of infection is associated with higher mortality, sometimes despite appropriate antibiotics. This is likely due to the limited ability to effectively target therapy in occult lesions. Early detection of foci of metastatic S. aureus infection is therefore key for optimal diagnosis and subsequent therapeutic management. 18F-FDG-PET/CT and MRI offer us invaluable tools in the localisation of foci of S. aureus infection. Crucially, they may identify unexpected foci at previously unsuspected locations in the body, for example vertebral osteomyelitis in the absence of back pain. S. aureus bloodstream infections are further complicated by their microbiological recurrence; 18F-FDG-PET/CT provide a means of localising, thus enabling source control. More evidence is emerging as to the utility of 18F-FDG-PET/CT in this setting, perhaps even to the point of reducing mortality. 18 F-FDG-PET/MRI may have a similar impact. The available evidence demonstrates a need to investigate the impact of 18F-FDG-PET/CT and MRI scanning in clinical management and outcomes of S. aureus infection further in a randomised prospective clinical trial.
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Affiliation(s)
- Anna L Goodman
- Medical Research Council Clinical Trials Unit at University College London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Alice Packham
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical Research Facility, University Hospitals Birmingham Foundation Trust, London, UK
| | - Amy R Sharkey
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gary J R Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College London and Guy's and St Thomas' PET Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Afzelius P, Morsing MK, Nielsen OL, Alstrup AKO, Jensen SB, Jødal L. Lymph Nodes Draining Infections Investigated by PET and Immunohistochemistry in a Juvenile Porcine Model. Molecules 2022; 27:molecules27092792. [PMID: 35566137 PMCID: PMC9104488 DOI: 10.3390/molecules27092792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND [18F]FDG and [11C]methionine accumulate in lymph nodes draining S. aureus -infected foci. The lymph nodes were characterized by weight, [11C]methionine- and [18F]FDG-positron emissions tomography (PET)/computed tomography (CT), and immunohistochemical (IHC)-staining. METHODS 20 pigs inoculated with S. aureus into the right femoral artery were PET/CT-scanned with [18F]FDG, and nine of the pigs were additionally scanned with [11C]methionine. Mammary, medial iliac, and popliteal lymph nodes from the left and right hind limbs were weighed. IHC-staining for calculations of area fractions of Ki-67, L1, and IL-8 positive cells was done in mammary and popliteal lymph nodes from the nine pigs. RESULTS The pigs developed one to six osteomyelitis foci. Some pigs developed contiguous infections of peri-osseous tissue and inoculation-site abscesses. Weights of mammary and medial iliac lymph nodes and their [18F]FDG maximum Standardized Uptake Values (SUVFDGmax) showed a significant increase in the inoculated limb compared to the left limb. Popliteal lymph node weight and their FDG uptake did not differ significantly between hind limbs. Area fractions of Ki-67 and IL-8 in the right mammary lymph nodes and SUVMetmax in the right popliteal lymph nodes were significantly increased compared with the left side. CONCLUSION The PET-tracers [18F]FDG and [11C]methionine, and the IHC- markers Ki-67 and IL-8, but not L1, showed increased values in lymph nodes draining soft tissues infected with S. aureus. The increase in [11C]methionine may indicate a more acute lymph node response, whereas an increase in [18F]FDG may indicate a more chronic response.
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Affiliation(s)
- Pia Afzelius
- Department of Clinical Physiology and Nuclear Medicine Zealand Koege, University Hospital of Copenhagen, 4600 Copenhagen, Denmark
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (S.B.J.); (L.J.)
- Correspondence:
| | - Malene Kjelin Morsing
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark; (M.K.M.); (O.L.N.)
| | - Ole Lerberg Nielsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, 1870 Frederiksberg C, Denmark; (M.K.M.); (O.L.N.)
| | - Aage Kristian Olsen Alstrup
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, Skejby, 8200 Aarhus, Denmark
| | - Svend Borup Jensen
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (S.B.J.); (L.J.)
- Department of Chemistry and Biosciences, Aalborg University, 9220 Aalborg, Denmark
| | - Lars Jødal
- Department of Nuclear Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark; (S.B.J.); (L.J.)
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Attempts to Target Staphylococcus aureus Induced Osteomyelitis Bone Lesions in a Juvenile Pig Model by Using Radiotracers. Molecules 2020; 25:molecules25184329. [PMID: 32967275 PMCID: PMC7570567 DOI: 10.3390/molecules25184329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023] Open
Abstract
Background [18F]FDG Positron Emission Tomography cannot differentiate between sterile inflammation and infection. Therefore, we, aimed to develop more specific radiotracers fitted for differentiation between sterile and septic infection to improve the diagnostic accuracy. Consequently, the clinicians can refine the treatment of, for example, prosthesis-related infection. Methods: We examined different target points; Staphylococcus aureus biofilm (68Ga-labeled DOTA-K-A9 and DOTA-GSGK-A11), bone remodeling ([18F]NaF), bacterial cell membranes ([68Ga]Ga-Ubiquicidin), and leukocyte trafficking ([68Ga]Ga-DOTA-Siglec-9). We compared them to the well-known glucose metabolism marker [18F]FDG, in a well-established juvenile S. aureus induced osteomyelitis (OM) pig model. Results: [18F]FDG accumulated in the OM lesions seven days after bacterial inoculation, but disappointingly we were not able to identify any tracer accumulation in OM with any of the supposedly more specific tracers. Conclusion: These negative results are, however, relevant to report as they may save other research groups from conducting the same animal experiments and provide a platform for developing and evaluating other new potential tracers or protocol instead.
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Sammer MBK, Sher AC, States LJ, Trout AT, Seghers VJ. Current trends in pediatric nuclear medicine: a Society for Pediatric Radiology membership survey. Pediatr Radiol 2020; 50:1139-1147. [PMID: 32399687 DOI: 10.1007/s00247-020-04670-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric nuclear medicine is evolving, and its practice patterns are uncertain. Knowledge of the current trends in pediatric nuclear medicine might be helpful to direct local decisions, including expectations for patient care, needs for capital acquisitions, and staffing recruitment strategies. OBJECTIVE To provide data regarding the current practice of pediatric nuclear medicine via a Society for Pediatric Radiology (SPR) membership survey. MATERIALS AND METHODS The SPR emailed our 25-question survey to all 1,847 SPR members in August 2018 and we accepted responses until April 2019. Questions focused on nuclear medicine staffing, positron emission tomography (PET) utilization, and radiotherapy availability. Respondents could indicate their affiliated hospital, which we used for data cataloguing only. Analysis of survey responses was blinded to reported institution. We analyzed response data using contingency tables. Independence testing between categorical variables based on proportions of physicians with additional nuclear medicine board certification was performed on a subset of questions regarding PET and therapy practices. RESULTS Sixty-seven people from at least 29 hospitals responded to the survey, including all 10 of the 2018-2019 U.S. News & World Report best children's hospitals. The majority (48/67, 71.6%) of respondents indicated that pediatric nuclear medicine examinations were interpreted in the pediatric radiology department by pediatric radiologists and that most physicians interpreting the exams (43/67, 64.2%) did not have subspecialty certification in nuclear medicine or nuclear radiology. Most facilities offered PET/CT (57/67, 85.1%); few offered PET/MRI (12/67, 17.9%). Most facilities offered radiotherapies (57/67, 85.1%) but at most of these facilities (30/57, 52.6%), fewer than half the physicians who cover nuclear medicine were approved to administer therapies. In the subset analyses based on proportion of physicians with additional nuclear medicine board certification, there were statistically significant differences between the groups in availability of PET/MRI, lutetium-177 dotatate therapy programs, and percentages of physicians approved to administer therapies. CONCLUSION Pediatric nuclear medicine is largely practiced by pediatric radiologists without subspecialty certification. Staffing, PET practices and therapies vary among practices, in part associated with the number of radiologists with nuclear medicine board certification.
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Affiliation(s)
- Marla B K Sammer
- Edward B. Singleton Department of Pediatric Radiology,, Texas Children's Hospital, 6107 Fannin St., Suite 470, Houston, TX, 77030, USA. .,Department of Radiology, Baylor College of Medicine,, Houston, TX, USA.
| | - Andrew C Sher
- Edward B. Singleton Department of Pediatric Radiology,, Texas Children's Hospital, 6107 Fannin St., Suite 470, Houston, TX, 77030, USA.,Department of Radiology, Baylor College of Medicine,, Houston, TX, USA
| | - Lisa J States
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Victor J Seghers
- Edward B. Singleton Department of Pediatric Radiology,, Texas Children's Hospital, 6107 Fannin St., Suite 470, Houston, TX, 77030, USA.,Department of Radiology, Baylor College of Medicine,, Houston, TX, USA
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Afzelius P, Heegaard PMH, Jensen SB, Alstrup AKO, Schønheyder HC, Eek A, Boerman O, Nielsen OL. [ 99mTc]-labelled interleukin-8 as a diagnostic tool compared to [ 18F]FDG and CT in an experimental porcine osteomyelitis model. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2020; 10:32-46. [PMID: 32211217 PMCID: PMC7076304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
Osteomyelitis (OM) is an important cause of morbidity and sometimes mortality in children and adults. Long-term complications can be reduced when treatment is initiated in an early phase. The diagnostic gold standard is microbial examination of a biopsy and current non-invasive imaging methods are not always optimal. [111In]-leukocyte scintigraphy is recommended for peripheral OM, but is time-consuming and not recommended in children. [18F]FDG PET/CT is recommended for vertebral OM in adults, but has the disadvantage of false positive findings and a relatively high radiation exposure; the latter is a problem in children. [99mTc]-based tracers are consequently preferred in children. We, therefore, aimed to find a [99mTc]-marked tracer with high specificity and sensitivity for early detection of OM. Suppurating inflammatory lesions like OM caused by Staphylococcus aureus (S. aureus) will attract large numbers of neutrophils and macrophages. A preliminary study has shown that [99m Tc]-labelled IL8 may be a possible candidate for imaging of peripheral OM. We investigated [99mTc]IL8 scintigraphy in a juvenile pig model of peripheral OM and compared it with [18F]FDG PET/CT. The pigs were experimentally inoculated with S. aureus to induce OM and scanned one week later. We also examined leukocyte count, serum CRP and IL8, as well as performed histopathological and microbiological investigations. [ 99m Tc]IL8 was easily and relatively quickly prepared and was shown to be suitable for visualization of OM lesions in peripheral bones detecting 70% compared to a 100% sensitivity of [18F]FDG PET/CT. [ 99m Tc]IL8 is a promising candidate for detection of OM in peripheral bones in children.
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Affiliation(s)
- Pia Afzelius
- Department of Nuclear Medicine, Aalborg University HospitalAalborg, Denmark
- North Zealand Hospital, Hillerød, University Hospital of CopenhagenDenmark
| | | | - Svend Borup Jensen
- Department of Nuclear Medicine, Aalborg University HospitalAalborg, Denmark
- Department of Chemistry and Biochemistry, Aalborg UniversityAalborg, Denmark
| | | | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University HospitalAalborg
- Department of Clinical Medicine, Aalborg UniversityAalborg
| | - Annemarie Eek
- Department of Radiology and Nuclear Medicine, Raboud UMCNijmegen, The Netherlands
| | - Otto Boerman
- Department of Radiology and Nuclear Medicine, Raboud UMCNijmegen, The Netherlands
| | - Ole Lerberg Nielsen
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of CopenhagenCopenhagen, Denmark
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Jødal L, Roivainen A, Oikonen V, Jalkanen S, Hansen SB, Afzelius P, Alstrup AKO, Nielsen OL, Jensen SB. Kinetic Modelling of [ 68Ga]Ga-DOTA-Siglec-9 in Porcine Osteomyelitis and Soft Tissue Infections. Molecules 2019; 24:molecules24224094. [PMID: 31766140 PMCID: PMC6891593 DOI: 10.3390/molecules24224094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND [68Ga]Ga-DOTA-Siglec-9 is a positron emission tomography (PET) radioligand for vascular adhesion protein 1 (VAP-1), a protein involved in leukocyte trafficking. The tracer facilitates the imaging of inflammation and infection. Here, we studied the pharmacokinetic modelling of [68Ga]Ga-DOTA-Siglec-9 in osteomyelitis and soft tissue infections in pigs. METHODS Eight pigs with osteomyelitis and soft tissue infections in the right hind limb were dynamically PET scanned for 60 min along with arterial blood sampling. The fraction of radioactivity in the blood accounted for by the parent tracer was evaluated with radio-high-performance liquid chromatography. One- and two-tissue compartment models were used for pharmacokinetic evaluation. Post-mortem soft tissue samples from one pig were analysed with anti-VAP-1 immunofluorescence. In each analysis, the animal's non-infected left hind limb was used as a control. RESULTS Tracer uptake was elevated in soft tissue infections but remained low in osteomyelitis. The kinetics of [68Ga]Ga-DOTA-Siglec-9 followed a reversible 2-tissue compartment model. The tracer metabolized quickly; however, taking this into account, produced more ambiguous results. Infected soft tissue samples showed endothelial cell surface expression of the Siglec-9 receptor VAP-1. CONCLUSION The kinetics of [68Ga]Ga-DOTA-Siglec-9 uptake in porcine soft tissue infections are best described by the 2-tissue compartment model.
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Affiliation(s)
- Lars Jødal
- Department of Nuclear Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
- Correspondence: ; Tel.: +45-9766-5500
| | - Anne Roivainen
- Turku PET Centre, Turku University Hospital, FI-20520 Turku, Finland; (A.R.); (V.O.)
- Turku PET Centre, University of Turku, FI-20520 Turku, Finland
| | - Vesa Oikonen
- Turku PET Centre, Turku University Hospital, FI-20520 Turku, Finland; (A.R.); (V.O.)
- Turku PET Centre, University of Turku, FI-20520 Turku, Finland
| | - Sirpa Jalkanen
- MediCity Research Laboratory and Institute of Biomedicine, University of Turku, FI-20520 Turku, Finland;
| | - Søren B. Hansen
- Department of Nuclear Medicine and PET, Aarhus University Hospital, DK-8200 Aarhus, Denmark; (S.B.H.); (A.K.O.A.)
| | - Pia Afzelius
- North Zealand Hospital, Hillerød, Copenhagen University Hospital, DK-3400 Hillerød, Denmark;
| | - Aage K. O. Alstrup
- Department of Nuclear Medicine and PET, Aarhus University Hospital, DK-8200 Aarhus, Denmark; (S.B.H.); (A.K.O.A.)
| | - Ole L. Nielsen
- Department of Veterinary and Animal Sciences, University of Copenhagen, DK-1870 Copenhagen, Denmark;
| | - Svend B. Jensen
- Department of Nuclear Medicine, Aalborg University Hospital, DK-9000 Aalborg, Denmark;
- Department of Chemistry and Biosciences, Aalborg University, DK-9100 Aalborg, Denmark
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