Evaluation of Musculoskeletal and Pulmonary Bacterial Infections With [124I]FIAU PET/CT.

Abstract

PURPOSE:

Imaging is limited in the evaluation of bacterial infection. Direct imaging of in situ bacteria holds promise for noninvasive diagnosis. We investigated the ability of a bacterial thymidine kinase inhibitor ([124I]FIAU) to image pulmonary and musculoskeletal infections.

METHODS:

Thirty-three patients were prospectively accrued: 16 with suspected musculoskeletal infection, 14 with suspected pulmonary infection, and 3 with known rheumatoid arthritis without infection. Thirty-one patients were imaged with [124I]FIAU PET/CT and 28 with [18F]FDG PET/CT. Patient histories were reviewed by an experienced clinician with subspecialty training in infectious diseases and were determined to be positive, equivocal, or negative for infection.

RESULTS:

Sensitivity, specificity, positive-predictive value, negative-predictive value, and accuracy of [124I]FIAU PET/CT for diagnosing infection were estimated as 7.7% to 25.0%, 0.0%, 50%, 0.0%, and 20.0% to 71.4% for musculoskeletal infections and incalculable-100.0%, 51.7% to 72.7%, 0.0% to 50.0%, 100.0%, and 57.1% to 78.6% for pulmonary infections, respectively. The parameters for [18F]FDG PET/CT were 75.0% to 92.3%, 0.0%, 23.1% to 92.3%, 0.0%, and 21.4% to 85.7%, respectively, for musculoskeletal infections and incalculable to 100.0%, 0.0%, 0.0% to 18.2%, incalculable, and 0.0% to 18.2% for pulmonary infections, respectively.

CONCLUSIONS:

The high number of patients with equivocal clinical findings prevented definitive conclusions from being made regarding the diagnostic efficacy of [124I]FIAU. Future studies using microbiology to rigorously define infection in patients and PET radiotracers optimized for image quality are needed.

• Authors: Steve Y Cho, Steven P Rowe, Sanjay K Jain, Lew C Schon, Rex C Yung, Tariq A Nayfeh, Clifton O Bingham 3rd, Catherine A Foss, Sridhar Nimmagadda, Martin G Pomper
• Journal: Molecular imaging (Mol Imaging) 2020 Jan-Dec Vol. 19 Pg. 1536012120936876 ISSN: 1536-0121 [Electronic] England
• PMID: 32598214 (Publication Type: Evaluation Study, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Iodine Radioisotopes
• Iodine-124
• Fluorodeoxyglucose F18
• Arabinofuranosyluracil
• fialuridine

Topics

• Adult
• Aged
• Aged, 80 and over
• Arabinofuranosyluracil (analogs & derivatives, chemistry)
• Bacterial Infections (diagnostic imaging)
• Female
• Fluorodeoxyglucose F18 (chemistry)
• Humans
• Iodine Radioisotopes (chemistry)
• Male
• Middle Aged
• Musculoskeletal Diseases (diagnostic imaging, microbiology)
• Positron Emission Tomography Computed Tomography
• Predictive Value of Tests
• Respiratory Tract Infections (diagnostic imaging, microbiology)
• Sensitivity and Specificity