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Radionuclide imaging in infection and inflammation

Radionuclide imaging in infection and inflammation. 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. Morfology of inflammation. Blood hyperperfussion

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Radionuclide imaging in infection and inflammation

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  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 osteomyelitisin a peadriatric patient

  9. Hematogenous osteomyelitisin 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. 99mTc-MDP Normal 99mTc-MDP RA Rheumatoid artritis

  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. 99m Tc - DMSA - DMSA-Tc99m scan

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