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Mokoala KMG, Ndlovu H, Lawal I, Sathekge MM. PET/CT and SPECT/CT for Infection in Joints and Bones: An Overview and Future Directions. Semin Nucl Med 2024; 54:394-408. [PMID: 38016897 DOI: 10.1053/j.semnuclmed.2023.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023]
Abstract
Infections of the bones and joints, if misdiagnosed, may result in serious morbidity and even mortality. A prompt diagnosis followed by appropriate management may reduce the socioeconomic impact of bone and joint infections. Morphologic imaging such as ultrasound and plain radiographs form the first line investigations, however, in early infections findings may be negative or nonspecific. Nuclear medicine imaging techniques play a complementary role to morphologic imaging in the diagnosis of bone and joint infections. The availability of hybrid systems (SPECT/CT, SPECT/MRI, PET/CT or PET/MRI) offers improved specificity with ability to assess the extent of infection. Bone scans are useful as a gatekeeper wherein negative scans rule out sepsis with a good accuracy, however positive scans are nondiagnostic and more specific tracers should be considered. These include the use of labeled white blood cells and antigranulocyte antibodies. Various qualitative and quantitative interpretation criteria have been suggested to improve the specificity of the scans. PET has better image resolution and 18F-FDG is the major tracer for PET imaging with applications in oncology and inflammatory/infective disorders. It has demonstrated improved sensitivity over the SPECT based tracers, however, still suffers from lack of specificity. 18F-FDG PET has been used to monitor therapy in bone and joint infections. Other less studied, noncommercialized SPECT and PET tracers such as 111In-Biotin, 99mTc-Ubiquicidin, 18F-Na-Fluoride, 18F-labeled white blood cells and 124I-Fialuridine to name a few have shown great promise, however, their role in various bone and joint infections has not been established. Hybrid imaging with PET or PET/MRI offers huge potential for improving diagnostics in infections of the joints and bones.
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Affiliation(s)
- Kgomotso M G Mokoala
- University of Pretoria, Pretoria, Gauteng, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, Gauteng, South Africa
| | - Honest Ndlovu
- Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, Gauteng, South Africa
| | - Ismaheel Lawal
- University of Pretoria, Pretoria, Gauteng, South Africa; Emory University, Atlanta, Georgia, United States
| | - Mike Machaba Sathekge
- University of Pretoria, Pretoria, Gauteng, South Africa; Nuclear Medicine Research Infrastructure (NuMeRI), Pretoria, Gauteng, South Africa.
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2
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Valero-Martínez C, Castillo-Morales V, Gómez-León N, Hernández-Pérez I, Vicente-Rabaneda EF, Uriarte M, Castañeda S. Application of Nuclear Medicine Techniques in Musculoskeletal Infection: Current Trends and Future Prospects. J Clin Med 2024; 13:1058. [PMID: 38398371 PMCID: PMC10889833 DOI: 10.3390/jcm13041058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Nuclear medicine has become an indispensable discipline in the diagnosis and management of musculoskeletal infections. Radionuclide tests serve as a valuable diagnostic tool for patients suspected of having osteomyelitis, spondylodiscitis, or prosthetic joint infections. The choice of the most suitable imaging modality depends on various factors, including the affected area, potential extra osseous involvement, or the impact of previous bone/joint conditions. This review provides an update on the use of conventional radionuclide imaging tests and recent advancements in fusion imaging scans for the differential diagnosis of musculoskeletal infections. Furthermore, it examines the role of radionuclide scans in monitoring treatment responses and explores current trends in their application. We anticipate that this update will be of significant interest to internists, rheumatologists, radiologists, orthopedic surgeons, rehabilitation physicians, and other specialists involved in musculoskeletal pathology.
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Affiliation(s)
- Cristina Valero-Martínez
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
| | - Valentina Castillo-Morales
- Nuclear Medicine Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (V.C.-M.); (I.H.-P.)
| | - Nieves Gómez-León
- Radiology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain;
| | - Isabel Hernández-Pérez
- Nuclear Medicine Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (V.C.-M.); (I.H.-P.)
| | - Esther F. Vicente-Rabaneda
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
| | - Miren Uriarte
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
| | - Santos Castañeda
- Rheumatology Service, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain; (C.V.-M.); (E.F.V.-R.); (M.U.)
- Cathedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), 28006 Madrid, Spain
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3
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Signore A, Bentivoglio V, Varani M, Lauri C. Current Status of SPECT Radiopharmaceuticals for Specific Bacteria Imaging. Semin Nucl Med 2023; 53:142-151. [PMID: 36609002 DOI: 10.1053/j.semnuclmed.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Imaging infection still represents a challenge for researchers. Despite nuclear medicine (NM) offers valuable tools able to discriminate between infections and inflammation, there is an unmet clinical need to develop new strategies able to specifically target the causative pathogen, to select the best antimicrobial treatment for each patient and to accurately assess therapeutic efficacy. These aspects are commonly addressed by microbiology or histology but the diagnosis often relies on invasive procedures that are prone to contamination or sample bias and do not reflect the spatial heterogeneity of the infective process. Therefore, in the era of personalized medicine and treatment, a lot of efforts are in play to improve a personalized diagnosis. Molecular imaging is an ideal candidate for this purpose and, indeed, research is going fast to this direction aiming to find more selective and proper antimicrobial treatments and to overcome broad-spectrum antibiotic use, which still represents the major cause of bacterial drug-resistance. Several approaches for specifically image bacteria have been proposed and provided encouraging perspectives in preclinical studies. Nevertheless, the majority of these promising approaches are still confined in "bench stages" and crucial issues still need to be addressed before their translation in clinical practice. This review will focus on radiolabeled antibiotics for SPECT imaging of bacteria, their mechanisms of action, their potentiality and limitations for "bed-side" applications.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Italy.
| | - Valeria Bentivoglio
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Italy
| | - Michela Varani
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Italy
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Italy
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Woong Yoo S, Young Kwon S, Kang SR, Min JJ. Molecular imaging approaches to facilitate bacteria-mediated cancer therapy. Adv Drug Deliv Rev 2022; 187:114366. [PMID: 35654213 DOI: 10.1016/j.addr.2022.114366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 12/14/2022]
Abstract
Bacteria-mediated cancer therapy is a potential therapeutic strategy for cancer that has unique properties, including broad tumor-targeting ability, various administration routes, the flexibility of delivery, and facilitating the host's immune responses. The molecular imaging of bacteria-mediated cancer therapy allows the therapeutically injected bacteria to be visualized and confirms the accurate delivery of the therapeutic bacteria to the target lesion. Several hurdles make bacteria-specific imaging challenging, including the need to discriminate therapeutic bacterial infection from inflammation or other pathologic lesions. To realize the full potential of bacteria-specific imaging, it is necessary to develop bacteria-specific targets that can be associated with an imaging assay. This review describes the current status of bacterial imaging techniques together with the advantages and disadvantages of several imaging modalities. Also, we describe potential targets for bacterial-specific imaging and related applications.
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Affiliation(s)
- Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeonnam, Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeonnam, Korea; Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun, Jeonnam, Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeonnam, Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeonnam, Korea; Department of Nuclear Medicine, Chonnam National University Medical School, Hwasun, Jeonnam, Korea.
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5
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El-Kawy OA, Abdelaziz G, Abdel-Razek AS. Radiolabeling, characterization and preclinical evaluation of plazomicin: a potential tracer for bacterial infection. Chem Biol Drug Des 2021; 99:688-702. [PMID: 34923759 DOI: 10.1111/cbdd.14007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/06/2021] [Accepted: 11/28/2021] [Indexed: 11/28/2022]
Abstract
In this study, 99m Tc-plazomicin, a new radio-antibiotic complex, was prepared specifically for bacterial infection localization and monitoring. Factors affecting the labeling reaction were studied and optimized to obtain a high yield (98.8 ± 0.2%). In-silico, radiochemical and physicochemical characterization and biodistribution were performed to assess the complex aptness as a radiopharmaceutical. The complex was biologically evaluated in-vitro using bacteria and in-vivo using different inflammation models (sterile, bacterial, and fungal). Uptake in the bacterial model was highest (7.8 ± 0.3%). Results indicated that the technetium label did not alter the antibiotic biological behavior and backed the usefulness of 99m Tc-plazomicin as a potential tracer.
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Affiliation(s)
- O A El-Kawy
- Egyptian Atomic Energy Authority, Cairo, 13759, Egypt
| | - G Abdelaziz
- Egyptian Atomic Energy Authority, Cairo, 13759, Egypt
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Rubitschung K, Sherwood A, Crisologo AP, Bhavan K, Haley RW, Wukich DK, Castellino L, Hwang H, La Fontaine J, Chhabra A, Lavery L, Öz OK. Pathophysiology and Molecular Imaging of Diabetic Foot Infections. Int J Mol Sci 2021; 22:11552. [PMID: 34768982 PMCID: PMC8584017 DOI: 10.3390/ijms222111552] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/27/2022] Open
Abstract
Diabetic foot infection is the leading cause of non-traumatic lower limb amputations worldwide. In addition, diabetes mellitus and sequela of the disease are increasing in prevalence. In 2017, 9.4% of Americans were diagnosed with diabetes mellitus (DM). The growing pervasiveness and financial implications of diabetic foot infection (DFI) indicate an acute need for improved clinical assessment and treatment. Complex pathophysiology and suboptimal specificity of current non-invasive imaging modalities have made diagnosis and treatment response challenging. Current anatomical and molecular clinical imaging strategies have mainly targeted the host's immune responses rather than the unique metabolism of the invading microorganism. Advances in imaging have the potential to reduce the impact of these problems and improve the assessment of DFI, particularly in distinguishing infection of soft tissue alone from osteomyelitis (OM). This review presents a summary of the known pathophysiology of DFI, the molecular basis of current and emerging diagnostic imaging techniques, and the mechanistic links of these imaging techniques to the pathophysiology of diabetic foot infections.
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Affiliation(s)
- Katie Rubitschung
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (K.R.); (A.S.); (A.C.)
| | - Amber Sherwood
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (K.R.); (A.S.); (A.C.)
| | - Andrew P. Crisologo
- Department of Plastic Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0558, USA;
| | - Kavita Bhavan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (K.B.); (L.C.)
| | - Robert W. Haley
- Department of Internal Medicine, Epidemiology Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA;
| | - Dane K. Wukich
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA;
| | - Laila Castellino
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (K.B.); (L.C.)
| | - Helena Hwang
- Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA;
| | - Javier La Fontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (J.L.F.); (L.L.)
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (K.R.); (A.S.); (A.C.)
| | - Lawrence Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (J.L.F.); (L.L.)
| | - Orhan K. Öz
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA; (K.R.); (A.S.); (A.C.)
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7
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Rubitschung K, Sherwood A, Crisologo AP, Bhavan K, Haley RW, Wukich DK, Castellino L, Hwang H, La Fontaine J, Chhabra A, Lavery L, Öz OK. Pathophysiology and Molecular Imaging of Diabetic Foot Infections. Int J Mol Sci 2021; 22:ijms222111552. [PMID: 34768982 DOI: 10.3390/ijms222111552.pmid:34768982;pmcid:pmc8584017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 05/27/2023] Open
Abstract
Diabetic foot infection is the leading cause of non-traumatic lower limb amputations worldwide. In addition, diabetes mellitus and sequela of the disease are increasing in prevalence. In 2017, 9.4% of Americans were diagnosed with diabetes mellitus (DM). The growing pervasiveness and financial implications of diabetic foot infection (DFI) indicate an acute need for improved clinical assessment and treatment. Complex pathophysiology and suboptimal specificity of current non-invasive imaging modalities have made diagnosis and treatment response challenging. Current anatomical and molecular clinical imaging strategies have mainly targeted the host's immune responses rather than the unique metabolism of the invading microorganism. Advances in imaging have the potential to reduce the impact of these problems and improve the assessment of DFI, particularly in distinguishing infection of soft tissue alone from osteomyelitis (OM). This review presents a summary of the known pathophysiology of DFI, the molecular basis of current and emerging diagnostic imaging techniques, and the mechanistic links of these imaging techniques to the pathophysiology of diabetic foot infections.
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Affiliation(s)
- Katie Rubitschung
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Amber Sherwood
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Andrew P Crisologo
- Department of Plastic Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0558, USA
| | - Kavita Bhavan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Robert W Haley
- Department of Internal Medicine, Epidemiology Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Dane K Wukich
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Laila Castellino
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Helena Hwang
- Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Javier La Fontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Lawrence Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
| | - Orhan K Öz
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8542, USA
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Naqvi SAR. 99m Tc-labeled antibiotics for infection diagnosis: Mechanism, action, and progress. Chem Biol Drug Des 2021; 99:56-74. [PMID: 34265177 DOI: 10.1111/cbdd.13923] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023]
Abstract
Discovery of penicillin marked a turning point in the history of infection therapy which also led to the emergence of bacterial resistance. It is now 100 years to fight with ever-muted variants of pathogens by developing more and more antibiotics. Since 1987 to todate, no successful class of antibiotic was introduced; this three decade period is known as "the discovery void" period. While, the clinically approved antibiotics are gradually dying in front of bacterial resistance due to which bacterial infections are appearing leading cause of death and disability. Nuclear medicine imaging technique is the strongest modality to diagnose and follow-up of deep-seated and complicated infections. However, the selection of radiolabeled antimicrobial agents plays critical role in gaining sensitivity and specificity of the imaging results. This review comprises of two main sections; first section explains antibiotic targets, and second section explains the imaging efficacy of 99m Tc-labeled antimicrobial agents against bacterial infection along with the emphasis on progress and update of 99m Tc-labeled antibiotics as infection imaging probes. The review, in conclusion, could be an acceleration for radiopharmaceutical chemists for designing and developing 99m Tc-labeled antimicrobial agents to improve infection imaging quality.
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Affiliation(s)
- Syed Ali Raza Naqvi
- Department of Chemistry, Government College University, Faisalabad, Pakistan
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9
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Silindir-Gunay M, Ozer AY. 99mTc-radiolabeled Levofloxacin and micelles as infection and inflammation imaging agents. J Drug Deliv Sci Technol 2020; 56:101571. [PMID: 32288835 PMCID: PMC7104933 DOI: 10.1016/j.jddst.2020.101571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/01/2023]
Abstract
Easy and early detection of infection and inflammation is essential for early and effective treatment. In this study, PEGylated micelles were designed and both micelles and Levofloxacin were radiolabeled with 99mTcO4 - to develop potential radiotracers for detection of infection/inflammation. Radiolabeling efficiency, in vitro stability and bacterial binding of 99mTc-Levofloxacin and 99mTc-micelles were compared. The aim of this study is to formulate and compare 99mTc-Levofloxacin and 99mTc-micelles as infection and inflammation agents having different mechanisms for the accumulation at infection and inflammation site. PEGylated micelles were designed with a particle size of 80 ± 0.7 nm and proper characterization properties. High radiolabeling efficiency was achieved for 99mTc-Levofloxacin (96%) and 99mTc-micelles (87%). The radiolabeling efficiency was remained stable with some insignificant alterations for both radiotracers at 25 °C for 24 h. Although in vitro bacterial binding of 99mTc-levofloxacine was higher than 99mTc-micelles, 99mTc-micelles may also be evaluated potential agent due to long circulation and passive accumulation mechanisms at infection/inflammation site. Both radiopharmaceutical agents exhibit potential results in design, characterization, radiolabeling efficiency and in vitro bacterial binding point of view.
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Affiliation(s)
- Mine Silindir-Gunay
- Hacettepe University, Faculty of Pharmacy, Department of Radiopharmacy, 06100, Sıhhiye, Ankara, Turkey
| | - Asuman Yekta Ozer
- Hacettepe University, Faculty of Pharmacy, Department of Radiopharmacy, 06100, Sıhhiye, Ankara, Turkey
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Radiolabeled Cationic Peptides for Targeted Imaging of Infection. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2019:3149249. [PMID: 32063807 PMCID: PMC7008241 DOI: 10.1155/2019/3149249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/20/2019] [Accepted: 06/16/2019] [Indexed: 11/18/2022]
Abstract
Molecular probes targeting bacteria provide opportunities to target bacterial infections in vivo for both imaging and therapy. In the current study, we report the development of positron emission tomography (PET) probes for imaging of live bacterial infection based on the small molecules HLys-DOTA, a polycationic peptide synthesized as the D-isomer (RYWVAWRNRG) conjugated to 1, 4, 7, 10-tetraazacyclododecane-N',N″,N‴,N-tetraacetic acid (DOTA) and AB1-HLys-DOTA, which includes an unnatural amino acid AB1 that preferentially binds to bacteria membrane lipids with amine groups via formation of iminoboronates. HLys-DOTA and AB1-HLys-DOTA peptides were radiolabeled with 64Cu and investigated as PET imaging agents to track bacterial infection in vitro and in intramuscularly infected (IM) mice models. Cell uptake studies at 37°C in Staphylococcus aureus (SA) show higher uptake of 64Cu-AB1-HLys-DOTA; 98.47 ± 3.54% vs 64Cu-HLys-DOTA; 39.12 ± 3.27% at 24 h. Standard uptake values (SUV) analysis of the PET images resulted in mean SUV of 0.70 ± 0.08, 0.49 ± 0.04, and 0.31 ± 0.01 for 64Cu-AB1-HLys-DOTA and 0.17 ± 0.06, 0.16 ± 0.02, and 0.13 ± 0.01 for 64Cu-HLys-DOTA at 1, 4, and 24 h post injection, respectively, in the infected muscles. Similarly, in the biodistribution studies, dose uptake in the infected muscles was 4 times higher in the targeted 64Cu-AB1-HLys-DOTA group than in the 64Cu-HLys-DOTA group and 2-3 times higher than in the PBS control group at 1, 4, and 24 h post injection. 64Cu-AB1-HLys-DOTA was able to distinguish between SA-infected muscle and Pseudomonas aeruginosa (PA) infected muscle with lower mean SUV of 0.28 ± 0.10 at 1 h post injection. This illustrates the utility of the AB1 covalently targeting group in synergy with the HLys peptide, which noncovalently binds to bacterial membranes. These results suggest that 64Cu-labeled AB1-HLys-DOTA peptide could be used as an imaging probe for detection of bacterial infection in vivo with specificity for Gram-positive bacteria.
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Naqvi SAR, Roohi S, Iqbal A, Sherazi TA, Zahoor AF, Imran M. Ciprofloxacin: from infection therapy to molecular imaging. Mol Biol Rep 2018; 45:1457-1468. [PMID: 29974398 DOI: 10.1007/s11033-018-4220-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/25/2018] [Indexed: 12/19/2022]
Abstract
Diagnosis of deep-seated bacterial infection remains a serious medical challenge. The situation is becoming more severe with the increasing prevalence of bacteria that are resistant to multiple antibiotic classes. Early efforts to develop imaging agents for infection, such as technetium-99m (99mTc) labeled leukocytes, were encouraging, but they failed to differentiate between bacterial infection and sterile inflammation. Other diagnostic techniques, such as ultrasonography, magnetic resonance imaging, and computed tomography, also fail to distinguish between bacterial infection and sterile inflammation. In an attempt to bypass these problems, the potent, broad-spectrum antibiotic ciprofloxacin was labeled with 99mTc to image bacterial infection. Initial results were encouraging, but excitement declined when controversial results were reported. Subsequent radiolabeling of ciprofloxacin with 99mTc using tricarbonyl and nitrido core, fluorine and rhenium couldn't produce robust infection imaging agent and remained in discussion. The issue of developing a robust probe can be approached by reviewing the broad-spectrum activity of ciprofloxacin, labeling strategies, potential for imaging infection, and structure-activity (specificity) relationships. In this review we discuss ways to accelerate efforts to improve the specificity of ciprofloxacin-based imaging.
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Affiliation(s)
- Syed Ali Raza Naqvi
- Department of Chemistry, Government College University, Faisalabad, 38000, Pakistan.
| | - Samina Roohi
- Isotope Production Division, Pakistan Institute of Nuclear Science and Technology (PINSTECH), Nilore-Islamabad, Pakistan
| | - Anam Iqbal
- Department of Chemistry, Government College University, Faisalabad, 38000, Pakistan
| | - Tauqir A Sherazi
- Department of Chemistry, COMSATS University Islamabad, Abbottabad Campus, Abbottabad, 22060, Pakistan
| | - Ameer Fawad Zahoor
- Department of Chemistry, Government College University, Faisalabad, 38000, Pakistan
| | - Muhammad Imran
- State Key Laboratory of Fine Chemicals, School of Chemical Engineering, Dalian University of Technology, E-208 West Campus, 2 Ling Gong Rd., Dalian, 116024, China
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12
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Fluorescent Antibiotics: New Research Tools to Fight Antibiotic Resistance. Trends Biotechnol 2018; 36:523-536. [PMID: 29478675 DOI: 10.1016/j.tibtech.2018.01.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 01/02/2023]
Abstract
Better understanding how multidrug-resistant (MDR) bacteria can evade current and novel antibiotics requires a better understanding of the chemical biology of antibiotic action. This necessitates using new tools and techniques to advance our knowledge of bacterial responses to antibiotics, ideally in live cells in real time, to selectively investigate bacterial growth, division, metabolism, and resistance in response to antibiotic challenge. In this review, we discuss the preparation and biological evaluation of fluorescent antibiotics, focussing on how these reporters and assay methods can help elucidate resistance mechanisms. We also examine the potential utility of such probes for real-time in vivo diagnosis of infections.
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Radiosynthesis and Biodistribution of 99mTc-Metronidazole as an Escherichia coli Infection Imaging Radiopharmaceutical. Appl Biochem Biotechnol 2017; 185:127-139. [DOI: 10.1007/s12010-017-2641-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
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14
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Abstract
Diagnosis of deep-seated bacterial infection is difficult, as neither standard anatomical imaging nor radiolabeled, autologous leukocytes distinguish sterile inflammation from infection. Two recent imaging efforts are receiving attention: (1) radioactive derivatives of sorbitol show good specificity with Gram-negative bacterial infections, and (2) success in combining anatomical and functional imaging for cancer diagnosis has rekindled interest in 99mTc-fluoroquinolone-based imaging. With the latter, computed tomography (CT) would be combined with single-photon-emission-computed tomography (SPECT) to detect 99mTc-fluoroquinolone-bacterial interactions. The present minireview provides a framework for advancing fluoroquinolone-based imaging by identifying gaps in our understanding of the process. One issue is the reliance of 99mTc labeling on the reduction of sodium pertechnetate, which can lead to colloid formation and loss of specificity. Specificity problems may be reduced by altering the quinolone structure (for example, switching from ciprofloxacin to sitafloxacin). Another issue is the uncharacterized nature of 99mTc-ciprofloxacin binding to, or sequestration in, bacteria: specific interactions with DNA gyrase, an intracellular fluoroquinolone target, are unlikely. Labeling with 68Ga rather than 99mTc enables detection by positron emission tomography, but with similar biological uncertainties. Replacing the C6-F of the fluoroquinolone with 18F provides an alternative to pertechnetate and gallium that may lead to imaging based on drug interactions with gyrase. Gyrase-based imaging requires knowledge of fluoroquinolone action, which we update. We conclude that quinolone-based probes show promise for the diagnosis of infection, but improvements in specificity and sensitivity are needed. These improvements include the optimization of the quinolone structure; such chemistry efforts can be accelerated by refining microbiological assays.
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Affiliation(s)
- Syed Ali Raza Naqvi
- Department of Chemistry, Government College University, Faisalabad-38000, Pakistan
| | - Karl Drlica
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Science, Newark NJ USA
- Department of Microbiology, Biochemistry & Molecular Genetics, New Jersey Medical School, Rutgers Biomedical and Science, Newark, NJ USA
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15
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Auletta S, Baldoni D, Varani M, Galli F, Hajar IA, Duatti A, Ferro-Flores G, Trampuz A, Signore A. Comparison of 99mTc-UBI 29-41, 99mTc-ciprofloxacin, 99mTc-ciprofloxacin dithiocarbamate and 111In-biotin for targeting experimental Staphylococcus aureus and Escherichia coli foreign-body infections: an ex-vivo study. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2017; 63:37-47. [PMID: 28849632 DOI: 10.23736/s1824-4785.17.02975-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diagnosis of implant-associated infection is challenging. Several radiopharmaceuticals have been described but direct comparisons are limited. Here we compared in vitro and in an animal model 99mTc-UBI, 99mTc-ciprofloxacin, 99mTcN-CiproCS2 and 111In-DTPA-biotin for targeting E. coli (ATCC 25922) and S. aureus (ATCC 43335). METHODS Stability controls were performed with the labelled radiopharmaceuticals during 6 hours in saline and serum. The in vitro binding to viable or killed bacteria was evaluated at 37 °C and 4 °C. For in vivo studies, Teflon cages were subcutaneously implanted in mice, followed by percutaneous infection. Biodistribution of i.v. injected radiolabelled radiopharmaceuticals were evaluated during 24 h in cages and dissected tissues. RESULTS Labelling efficiency of all radiopharmaceuticals ranged between 94% and 98%, with high stability both in saline and in human serum. In vitro binding assays displayed a rapid but poor bacterial binding for all tested agents. Similar binding kinetic occurred also with heat-killed and ethanol-killed bacteria. In the tissue cage model, infection was detected at different time points: 99mTc-UBI and 99mTcN-CiproCS2 showed higher infected cage/sterile cage ratio at 24 hours for both E. coli and S. aureus; 99mTc-Ciprofloxacin at 24 hours for both E. coli and at 4 hours for S. aureus; 111In-DTPA-biotin accumulates faster in both E. coli and S. aureus infected cages. CONCLUSIONS 99mTc-UBI, 99mTcN-CiproCS2 showed poor in vitro binding but good in vivo binding to E. coli only. 111In-DTPA-biotin showed poor in vitro binding but good in vivo binding to S. aureus and poor to E. coli. 99mTc-Ciprofloxacin showed poor in vitro binding but good in vivo binding to all tested bacteria. The mechanism of accumulation in infected sites remains to be elucidated.
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Affiliation(s)
- Sveva Auletta
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Daniela Baldoni
- Infectious Diseases Research Laboratory, Department of Biomedicine, University Hospital, Basel, Switzerland
| | - Michela Varani
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Filippo Galli
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Iman A Hajar
- Laboratory of Nuclear Medicine, Department of Radiological Sciences, University of Ferrara, Ferrara, Italy
| | - Adriano Duatti
- Laboratory of Nuclear Medicine, Department of Radiological Sciences, University of Ferrara, Ferrara, Italy
| | - Guillermina Ferro-Flores
- Department of Radioactive Material, National Institute of Nuclear Investigations, Center of Nuclear Applications on Health, Ocoyoacac, Mexico
| | - Andrej Trampuz
- Unit of Septic Surgery, Center for Musculoskeletal Surgery, Charité, University of Medicine, Berlin, Germany
| | - Alberto Signore
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy -
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16
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Rasheed R, Naqvi SAR, Gillani SJH, Zahoor AF, Jielani A, Saeed N. 99m
Tc-tazobactam, a novel infection imaging agent: Radiosynthesis, quality control, biodistribution, and infection imaging studies. J Labelled Comp Radiopharm 2017; 60:242-249. [DOI: 10.1002/jlcr.3494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/31/2017] [Accepted: 02/05/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Rashid Rasheed
- Institute of Nuclear Medicine Oncology and Radiotherapy (INOR); Abbottabad Pakistan
- Department of Chemistry; Government College University; Faisalabad-38000 Pakistan
| | - Syed Ali Raza Naqvi
- Department of Chemistry; Government College University; Faisalabad-38000 Pakistan
| | | | - Ameer Fawad Zahoor
- Department of Chemistry; Government College University; Faisalabad-38000 Pakistan
| | - Asif Jielani
- Institute of Nuclear Medicine Oncology and Radiotherapy (INOR); Abbottabad Pakistan
| | - Nidda Saeed
- Department of Pharmacy, Clinical Practice; COMSATS Institute of Information Technology; Abbottabad Pakistan
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17
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Auletta S, Galli F, Lauri C, Martinelli D, Santino I, Signore A. Imaging bacteria with radiolabelled quinolones, cephalosporins and siderophores for imaging infection: a systematic review. Clin Transl Imaging 2016; 4:229-252. [PMID: 27512687 PMCID: PMC4960278 DOI: 10.1007/s40336-016-0185-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/17/2016] [Indexed: 12/20/2022]
Abstract
Bacterial infections are still one of the main causes of patient morbidity and mortality worldwide. Nowadays, many imaging techniques, like computed tomography or magnetic resonance imaging, are used to identify inflammatory processes, but, although they recognize anatomical modifications, they cannot easily distinguish bacterial infective foci from non bacterial infections. In nuclear medicine, many efforts have been made to develop specific radiopharmaceuticals to discriminate infection from sterile inflammation. Several compounds (antimicrobial peptides, leukocytes, cytokines, antibiotics…) have been radiolabelled and tested in vitro and in vivo, but none proved to be highly specific for bacteria. Indeed factors, including the number and strain of bacteria, the infection site, and the host condition may affect the specificity of tested radiopharmaceuticals. Ciprofloxacin has been proposed and intensively studied because of its easy radiolabelling method, broad spectrum, and low cost, but at the same time it presents some problems such as low stability or the risk of antibiotic resistance. Therefore, in the present review studies with ciprofloxacin and other radiolabelled antibiotics as possible substitutes of ciprofloxacin are reported. Among them we can distinguish different classes, such as cephalosporins, fluoroquinolones, inhibitors of nucleic acid synthesis, inhibitors of bacterial cell wall synthesis and inhibitors of protein synthesis; then also others, like siderophores or maltodextrin-based probes, have been discussed as bacterial infection imaging agents. A systematic analysis was performed to report the main characteristics and differences of each antibiotic to provide an overview about the state of the art of imaging infection with radiolabelled antibiotics.
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Affiliation(s)
- S. Auletta
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - F. Galli
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - C. Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - D. Martinelli
- Microbiology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - I. Santino
- Microbiology Unit, Department of Clinical and Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, “Sapienza” University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
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18
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Heuker M, Gomes A, van Dijl JM, van Dam GM, Friedrich AW, Sinha B, van Oosten M. Preclinical studies and prospective clinical applications for bacteria-targeted imaging: the future is bright. Clin Transl Imaging 2016; 4:253-264. [PMID: 27512688 PMCID: PMC4960279 DOI: 10.1007/s40336-016-0190-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/03/2016] [Indexed: 12/20/2022]
Abstract
Bacterial infections are a frequently occurring and major complication in human healthcare, in particular due to the rapid increase of antimicrobial resistance and the emergence of pan-drug-resistant microbes. Current anatomical and functional imaging modalities are insufficiently capable of distinguishing sites of bacterial infection from sterile inflammation. Therefore, definitive diagnosis of an infection can often only be obtained by tissue biopsy and subsequent culture and, occasionally, a definite diagnosis even appears to be impossible. To accurately diagnose bacterial infections early, novel imaging modalities are urgently needed. In this regard, bacteria-targeted imaging is an attractive option due to its specificity. Here, different bacteria-targeted imaging approaches are reviewed, and their promising future perspectives are discussed.
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Affiliation(s)
- Marjolein Heuker
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Anna Gomes
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Gooitzen M. van Dam
- Department of Surgery, Division of Surgical Oncology, Nuclear Medicine and Molecular Imaging, Intensive Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Alexander W. Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Bhanu Sinha
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Marleen van Oosten
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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19
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Abstract
The rise in multidrug resistant (MDR) bacteria has become a global crisis. Rapid and accurate diagnosis of infection will facilitate antibiotic stewardship and preserve our ability to treat and cure patients from bacterial infection. Direct in situ imaging of bacteria offers the prospect of accurately diagnosing disease and monitoring patient outcomes and response to treatment in real-time. There have been many recent advances in the field of optical imaging of infection; namely in specific probe and fluorophore design. This combined with the advances in imaging device technology render direct optical imaging of infection a feasible approach for accurate diagnosis in the clinic. Despite this, there are currently no licensed molecular probes for clinical optical imaging of infection. Here we report some of the most promising and interesting probes and approaches under development for this purpose, which have been evaluated in in vivo models within the laboratory setting.
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20
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van Oosten M, Hahn M, Crane LMA, Pleijhuis RG, Francis KP, van Dijl JM, van Dam GM. Targeted imaging of bacterial infections: advances, hurdles and hopes. FEMS Microbiol Rev 2015; 39:892-916. [PMID: 26109599 DOI: 10.1093/femsre/fuv029] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 02/06/2023] Open
Abstract
Bacterial infections represent an increasing problem in modern health care, in particular due to ageing populations and accumulating bacterial resistance to antibiotics. Diagnosis is rarely straightforward and consequently treatment is often delayed or indefinite. Therefore, novel tools that can be clinically implemented are urgently needed to accurately and swiftly diagnose infections. Especially, the direct imaging of infections is an attractive option. The challenge of specifically imaging bacterial infections in vivo can be met by targeting bacteria with an imaging agent. Here we review the current status of targeted imaging of bacterial infections, and we discuss advantages and disadvantages of the different approaches. Indeed, significant progress has been made in this field and the clinical implementation of targeted imaging of bacterial infections seems highly feasible. This was recently highlighted by the use of so-called smart activatable probes and a fluorescently labelled derivative of the antibiotic vancomycin. A major challenge remains the selection of the best imaging probes, and we therefore present a set of target selection criteria for clinical implementation of targeted bacterial imaging. Altogether, we conclude that the spectrum of potential applications for targeted bacterial imaging is enormous, ranging from fundamental research on infectious diseases to diagnostic and therapeutic applications.
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Affiliation(s)
- Marleen van Oosten
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Markus Hahn
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Lucia M A Crane
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Rick G Pleijhuis
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands
| | | | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands
| | - Gooitzen M van Dam
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, the Netherlands
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21
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Bunschoten A, Welling MM, Termaat MF, Sathekge M, van Leeuwen FWB. Development and Prospects of Dedicated Tracers for the Molecular Imaging of Bacterial Infections. Bioconjug Chem 2013; 24:1971-89. [PMID: 24200346 DOI: 10.1021/bc4003037] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- A. Bunschoten
- Department
of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - M. M. Welling
- Department
of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
| | - M. F. Termaat
- Department
of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M. Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - F. W. B. van Leeuwen
- Department
of Radiology, Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Leiden, The Netherlands
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22
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Abstract
BACKGROUND Nanoparticles are increasingly being incorporated into the design of diagnostic imaging agents. Significant research efforts have been conducted with one class of lipid nanoparticle (liposomes) radiolabeled with gamma-emitting radionuclides as radiopharmaceuticals for scintigraphic imaging of cancer, inflammation/infection and sentinel lymph node detection. OBJECTIVE This article reviews the current literature with special emphasis on the clinical studies performed with liposome radiopharmaceuticals for detection of tumors, infectious/inflammatory sites or metastatic lymph nodes. Future uses of liposome radiopharmaceuticals are also described. METHODS Characteristics required of the radionuclide, liposome formulation and radiolabeling method for an effective radiopharmaceutical are discussed. A description of the procedures and instrumentation for conducting an imaging study with liposome radiopharmaceutical is included. Clinical studies using liposome radiopharmaceuticals are summarized. Future imaging applications of first- and second-generation radiolabeled liposomes for chemodosimetry and the specific targeting of a disease process are also described. RESULTS/CONCLUSION The choice of radionuclide, liposome formulation and radiolabeling method must be carefully considered during the design of a liposome radiopharmaceutical for a given application. After-loading and surface chelation methods are the most efficient and practical. Clinical studies with liposome radiopharmaceuticals demonstrated that a wide variety of tumors could be detected with good sensitivity and specificity. Liposome radiopharmaceuticals could also clearly detect various soft tissue and bone inflammatory/infectious lesions, and performed equal to or better than infection imaging agents that are approved at present. Yet, despite these favorable results, no liposome radiopharmaceutical has been approved for any indication. Some of the reasons for this can be attributed to reports of an unexpected infusion-related adverse reaction in two studies, the requirement of more complex liposome manufacturing procedures, and the adoption of other competing imaging procedures. Continued research of liposome radiopharmaceutical design based on a better understanding of liposome biology, improved radiolabeling methodologies and advances in gamma camera technology is warranted.
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Affiliation(s)
- Beth A Goins
- The University of Texas Health Science Center at San Antonio, TX Department of Radiology, Mail Code 7800, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA +1 210 567 5575 ; +1 210 567 5549 ;
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The value of successive Infecton scans in assessing the presence of chronic bone and joint infection and in predicting its evolution after treatment and after a prolonged follow-up. Nucl Med Commun 2012; 32:1060-9. [PMID: 21869728 DOI: 10.1097/mnm.0b013e32834a837c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our objective was to monitor the evolution of bone and/or joint infections with the aid of successive radiolabelled ciprofloxacin (Infecton) scans during antimicrobial treatment and to compare the results of an Infecton scan at the end of therapy with the respective results of clinical evaluation, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in predicting resolution or recurrence of infection after a long period of posttreatment follow-up. METHODS Thirty-three patients with documented bone and/or joint infection were subjected to successive Infecton scans on two or three visits. Infecton scans were evaluated visually and scored accordingly. Clinical evaluation was scored by the referring clinicians. ESR and CRP values were evaluated independently. A minimum of 2-year free-of-infection follow-up after discontinuation of the antibiotic treatment served as a measure of successful antimicrobial therapy and nonrecurrence of infection. Statistics included survival analysis (Cox regression). RESULTS During follow-up, five patients in the study presented with recurrence, and three died as a result of an irrelevant cause. The remaining patients were followed up for a median of 108 months (range 97-132 months) without any signs of recurrence of infection. Recurrence of infection was 4.2 times more likely to occur in patients with positive Infecton scans [hazard ratio (HR): 4.2, confidence intervals 95%: 1.39-12.67, P=0.011]. Infecton had the highest sensitivity (83.3%), accuracy (69.69%) and negative predictive value (94.74%), whereas CRP had the highest specificity (76.92%). CONCLUSION Infecton scintigraphy proved to be more sensitive and accurate and had a higher negative predictive value compared with clinical evaluation, ESR and CRP in predicting infection resolution or recurrence in patients with chronic bone and joint infections.
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24
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Hankin D, Bowling FL, Metcalfe SA, Whitehouse RA, Boulton AJM. Critically evaluating the role of diagnostic imaging in osteomyelitis. Foot Ankle Spec 2011; 4:100-5. [PMID: 21193593 DOI: 10.1177/1938640010390934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early diagnosis, essential for timely appropriate treatment and reduction of complications, can be difficult. This article aims to give an overview of the role that different imaging modalities have to play in the diagnosis of osteomyelitis. Osteomyelitis is a heterogeneous disease in its pathophysiology, clinical presentation, and management. It infers inflammation of bone and marrow, whereas osteitis is inflammation of the bone only. Thus, a soft-tissue infection that reaches the bone surface but has not infected the marrow is osteitis and not osteomyelitis. Chronic osteomyelitis is divided into active and inactive forms. Newly appearing periosteal reaction or bone destruction within the chronic involucrum are indicators of activation. Imaging modalities represent different underlying pathophysiological processes that may be represented in differing types and differing phases of osteomyelitis. Sequential selection of appropriate imaging modalities requires a thorough understanding of the disease processes and the process by which each modality visualizes this dynamic disease process.
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Affiliation(s)
- David Hankin
- Central Manchester Foundation Trust, Manchester Diabetes Centre, Manchester Diabetes Centre, UK
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25
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Lambrecht FY. Evaluation of 99mTc-labeled antibiotics for infection detection. Ann Nucl Med 2010; 25:1-6. [DOI: 10.1007/s12149-010-0417-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
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26
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Specificity of 99mTc-UBI for detecting infection foci in patients with fever in study. Nucl Med Commun 2010; 31:889-95. [DOI: 10.1097/mnm.0b013e32833d96d1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Lee M, Yoon M, Hwang KH, Choe W. Tc-99m Ciprofloxacin SPECT of Pulmonary Tuberculosis. Nucl Med Mol Imaging 2010; 44:116-22. [PMID: 25013523 DOI: 10.1007/s13139-010-0021-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 02/01/2010] [Accepted: 02/16/2010] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Tc-99m ciprofloxacin is available for imaging infection. However, there has been no study on employing single photon emission computed tomography (SPECT) with using Tc-99m ciprofloxacin to image active pulmonary tuberculosis. Therefore, we conducted this study to assess the efficacy of Tc-99m ciprofloxacin SPECT for imaging active pulmonary tuberculosis. METHODS Twenty-one participants were enrolled in this prospective study. They were divided into two groups according to the clinical and radiological assessment. Group one (Gr. 1) consisted of five normal volunteers and six patients with inactive pulmonary tuberculosis. Group two (Gr. 2) consisted of ten patients with active pulmonary tuberculosis. SPECT was performed 3 h after injecting 555 MBq (15 mCi) of Tc-99m ciprofloxacin. The findings of Tc-99m ciprofloxacin SPECT were interpreted by a nuclear medicine specialist and then the results were analyzed according to the patients' clinical and radiological classifications. RESULTS The results of Tc-99m ciprofloxacin SPECT were as follows: eight true-positive cases, ten true-negative cases, one false-positive case and two false-negative cases. The sensitivity and specificity was 80.0% and 90.9%, respectively. The positive predictive value was 88.9% and the negative predictive value was 83.3%. CONCLUSIONS Tc-99m ciprofloxacin SPECT is feasible for imaging active pulmonary tuberculosis. It is a useful nuclear-imaging method for discriminating between the active and inactive tuberculosis states in patients with a past medical history of pulmonary tuberculosis.
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Affiliation(s)
- Minkyung Lee
- Department of Nuclear Medicine, Gachon University Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 South Korea
| | - Minki Yoon
- Department of Nuclear Medicine, Good Samaritan Hospital, Pohang, South Korea
| | - Kyung Hoon Hwang
- Department of Nuclear Medicine, Gachon University Gil Hospital, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760 South Korea
| | - Wonsick Choe
- Nuclear Medicine, Kangbuk Samsung Hospital, 108 Pyung-dong, Jongro-gu, Seoul, 110-746 Korea
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Scintigraphic imaging using technetium-99m-labeled ceftizoxime in an experimental model of acute osteomyelitis in rats. Nucl Med Commun 2008; 29:830-6. [PMID: 18677212 DOI: 10.1097/mnm.0b013e3283000514] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate inflammatory (zymosan) and infectious (Staphylococcus aureus) processes in experimental models in rats using technetium-99m-labeled ceftizoxime (CFT). METHODS Male Wistar rats were used for the development of the inflammatory (zymosan) and infectious (S. aureus) processes in the medullary cavity of the left tibia. Sterile saline was used for the control group. At 48 h after induction of the processes, the animals were anesthetized and scintigraphic images were acquired at 1, 2, 4, and 6 h after intravenous injection of 0.1 ml of 99mTc-CFT (55 MBq). Quantitative analysis of the scintigraphic images was performed by counting the radioactivity in the regions of interest. Samples of tibia were taken for histopathological examination. RESULTS The images showed that 99mTc-CFT presented higher tropism to infectious foci than with the inflammatory site. The average value of the target/nontarget ratio of the 99mTc-CFT was significantly higher in the infected (2.40+/-0.22) than in the inflamed tibia (1.50+/-0.05) and the control group (1.05+/-0.04) for all of the investigated times. The histological data showed a similar inflammatory response for both the S. aureus and zymosan groups. CONCLUSION The 99mTc-CFT presented a high tropism and retention for an infected region in this model of osteomyelitis, thereby constituting an interesting strategy to distinguish aseptic from septic sites.
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29
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Accumulation of 99mTc-ciprofloxacin in Staphylococcus aureus and Pseudomonas aeruginosa. Antimicrob Agents Chemother 2008; 52:2691-2. [PMID: 18474577 DOI: 10.1128/aac.00217-08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The use of radiopharmaceuticals for the diagnosis of infection is increasing due to their ability to distinguish between septic and aseptic inflammation. The aim of this study was to analyze the intracellular accumulation of technetium-99m-ciprofloxacin in strains of Staphylococcus aureus and Pseudomonas aeruginosa harboring an overexpression of NorA and MexAB-OprM, respectively.
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Biswal S, Resnick DL, Hoffman JM, Gambhir SS. Molecular Imaging: Integration of Molecular Imaging into the Musculoskeletal Imaging Practice. Radiology 2007; 244:651-71. [PMID: 17709823 DOI: 10.1148/radiol.2443060295] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chronic musculoskeletal diseases such as arthritis, malignancy, and chronic injury and/or inflammation, all of which may produce chronic musculoskeletal pain, often pose challenges for current clinical imaging methods. The ability to distinguish an acute flare from chronic changes in rheumatoid arthritis, to survey early articular cartilage breakdown, to distinguish sarcomatous recurrence from posttherapeutic inflammation, and to directly identify generators of chronic pain are a few examples of current diagnostic limitations. There is hope that a growing field known as molecular imaging will provide solutions to these diagnostic puzzles. These techniques aim to depict, noninvasively, specific abnormal cellular, molecular, and physiologic events associated with these and other diseases. For example, the presence and mobilization of specific cell populations can be monitored with molecular imaging. Cellular metabolism, stress, and apoptosis can also be followed. Furthermore, disease-specific molecules can be targeted, and particular gene-related events can be assayed in living subjects. Relatively recent molecular and cellular imaging protocols confirm important advances in imaging technology, engineering, chemistry, molecular biology, and genetics that have coalesced into a multidisciplinary and multimodality effort. Molecular probes are currently being developed not only for radionuclide-based techniques but also for magnetic resonance (MR) imaging, MR spectroscopy, ultrasonography, and the emerging field of optical imaging. Furthermore, molecular imaging is facilitating the development of molecular therapies and gene therapy, because molecular imaging makes it possible to noninvasively track and monitor targeted molecular therapies. Implementation of molecular imaging procedures will be essential to a clinical imaging practice. With this in mind, the goal of the following discussion is to promote a better understanding of how such procedures may help address specific musculoskeletal issues, both now and in the years ahead.
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Affiliation(s)
- Sandip Biswal
- Department of Radiology, Molecular Imaging Program, Stanford University School of Medicine, 300 Pasteur Dr, S-062B, Stanford, CA 94305, USA.
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Abstract
Osteomyelitis frequently requires more than one imaging technique for an accurate diagnosis. Conventional radiography still remains the first imaging modality. MRI and nuclear medicine are the most sensitive and specific methods for the detection of osteomyelitis. MRI provides more accurate information regarding the extent of the infectious process. Ultrasound represents a noninvasive method to evaluate the involved soft tissues and cortical bone and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. CT scan can be a useful method to detect early osseous erosion and to document the presence of sequestra. PET and SPECT are highly accurate techniques for the evaluation of chronic osteomyelitis, allowing differentiation from soft tissue infection.
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Affiliation(s)
- Carlos Pineda
- Instituto Nacional de Rehabilitación, Avenida México-Xochimilco No. 289, Arenal de Guadalupe, Tlalpan, Mexico City, 14389, Mexico.
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Dutta P, Bhansali A, Mittal BR, Singh B, Masoodi SR. Instant 99mTc-ciprofloxacin scintigraphy for the diagnosis of osteomyelitis in the diabetic foot. Foot Ankle Int 2006; 27:716-22. [PMID: 17038284 DOI: 10.1177/107110070602700911] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The diagnosis of osteomyelitis of the foot in patients with diabetes mellitus remains a challenge. This study was conducted to evaluate bone infections using scintigraphy with instantly prepared single-vial kit, radio-labeled ciprofloxacin (Diagnobact TM) in comparison to a bacterial culture taken from the involved site. METHODS Twenty-five patients with type 2 diabetes mellitus having foot ulcers, including six with superficial ulcers and positive 99mTc-methylene diphosphonate (MDP) bone scan as a control, were subjected to 99mTc-ciprofloxacin scan and subsequent bacteriological culture. RESULTS 99mTc-ciprofloxacin scan was positive in 13 patients and negative in 12 patients, including the six with superficial ulcers. Bacterial culture was positive in 18 patients and negative in seven, including one with osteomyelitis on bone biopsy only. 99mTc-ciprofloxacin scan showed "true positive" results in 12, "true negative" in six, "false positive" in one, and "false negative" in six. The specificity and sensitivity of the test were 66.7% and 85.7%, respectively. The positive and negative predictive values and an accuracy of 92.8%, 50% and 72%, respectively. Staphylococcus aureus and Escherichia coli were the most frequently isolated organisms. CONCLUSION 99mTc-ciprofloxacin is a sensitive and specific marker to diagnose bone infection in patients with diabetes mellitus, but care must be taken in case of fastidious organisms and ciprofloxacin-resistant bacterial flora in which false results may be obtained.
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Adams BK, Youssef I, Parkar S. Nonspecific infecton uptake in hyperemia secondary to a ewing sarcoma. Clin Nucl Med 2006; 31:479-81. [PMID: 16855437 DOI: 10.1097/01.rlu.0000227416.41188.cc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bruce Keith Adams
- Department of Nuclear Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
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Falagas ME, Valotassiou VJ, Papadouli D, Papadopoulos A, Malamitsi J. 99mTechnetium-ciprofloxacin scintigraphy for the evaluation of spinal infections: a preliminary report. Clin Orthop Relat Res 2006; 444:34-7. [PMID: 16523125 DOI: 10.1097/01.blo.0000201173.02883.6e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Currently available laboratory and imaging tests have limitations diagnosing and following patients with spinal infections. We evaluated 17 Technetium-99m labeled ciprofloxacin scintigraphy studies in 11 patients who had the diagnosis of a spinal infection based on the Centers for Disease Control and Prevention criteria. Three of the 17 studies were performed in three patients within 2 months from the onset of the symptoms. All of these three studies showed increased uptake of the radiopharmaceutical in the area of the spinal infection. Fourteen studies were performed during the followup period (from 210 to 690 days after the onset of symptoms) in nine patients with spinal infections. Ten of the 14 studies performed in five patients with an active spine infection showed positive results while the patients had evidence for active spinal infection at the time of the testing. Four studies were performed during the followup period in four patients who at the time of the nuclear imaging testing had no symptoms, signs, or laboratory or other imaging evidence for active infection. All four studies showed negative results. The results of this preliminary study show that scintigraphy with 99mTc-ciprofloxacin may be useful in the diagnosis of active spinal infections. LEVEL OF EVIDENCE Diagnostic study, level II-1 (Testing of previously developed diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). Please see Guidelines for Authors for a complete description of levels of evidence.
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Adams BK, Youssef I, El-Tom EFA. Persistent infecton uptake in an infected prosthetic knee. Clin Nucl Med 2006; 31:149-50. [PMID: 16495734 DOI: 10.1097/01.rlu.0000200785.86278.fe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Bruce K Adams
- Department of Nuclear Medicine, Mafraq Hospital, Abu Dhabi, United Arab Emirates.
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Alexander K, Drost WT, Mattoon JS, Anderson DE. (99M)Tc-ciprofloxacin in imaging of clinical infections in camelids and a goat. Vet Radiol Ultrasound 2005; 46:340-7. [PMID: 16229438 DOI: 10.1111/j.1740-8261.2005.00064.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
(99M)Tc-ciprofloxacin was used to image five adult camelids and a juvenile goat with clinical and/or radiographic signs of infection. (99m)Tc-ciprofloxacin (range 10-33 MBq/kg) was injected intravenously and a series of 2-min static images were acquired at 1- and 4-h postinjection. At 24-h postinjection, 5-min static images were acquired. Only the skull or abdomen was imaged in the adults; the whole body was imaged in the goat. The quality of the 1-, 4-, and 24-h studies was evaluated subjectively. Normal and abnormal areas of (99m)Tc-ciprofloxacin uptake were recorded and subjectively graded as mild, moderate or intense. Image quality was best 4-h postinjection. Twenty-four-hour images were poor because of insufficient radioactivity. (99m)Tc-ciprofloxacin imaging resulted in true positive or true negative scans in four of six animals. Two false-negative studies occurred. Intense (99m)Tc-cirofloxacin activity was seen in the lungs and urinary bladder, moderate/intense activity in the kidneys, and mild activity in the physes/epiphyses, liver and intermittently in the gastrointestinal tract. The normal distribution of (99m)Tc-ciprofloxacin in camelids/small ruminants differed from people. Further studies to determine the sensitivity and specificity of infection detection using (99m)Tc-ciprofloxacin in animals are warranted.
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Affiliation(s)
- Kate Alexander
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, 601 Vernon L, Tharp Street, Columbus, OH 43210, USA.
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Bernard L, Lübbeke A, Stern R, Bru JP, Feron JM, Peyramond D, Denormandie P, Arvieux C, Chirouze C, Perronne C, Hoffmeyer P. Value of preoperative investigations in diagnosing prosthetic joint infection: retrospective cohort study and literature review. ACTA ACUST UNITED AC 2004; 36:410-6. [PMID: 15307559 DOI: 10.1080/00365540410015240] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The diagnosis of a prosthetic joint infection is difficult, but crucial for appropriate treatment. Scintigraphy with specific markers for infection (labelled white cells or immunoglobulin-G) has been reported as a more reliable diagnostic tool than clinical assessment (fever, fistula), laboratory studies (polynuclear neutrophil count, erythrocyte rate sedimentation, and C-reactive protein), and preoperative aspiration. In the first part of this study, we retrospectively reviewed 230 patients admitted with a suspected prosthetic joint infection, and examined the validity of the different diagnostic tools for the group as a whole and for subgroups according to the Coventry classification. In the second part, we reviewed 35 articles about preoperative evaluation of infection in prosthetic joints and compared them to our findings. Our study indicates that C-reactive protein and joint aspiration are the most useful tools to diagnose prosthetic joint infection even in situations of chronic infection (Coventry type II).
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Affiliation(s)
- Louis Bernard
- Division of Infectious Diseases, Geneva University Hospital, Geneva, Switzerland.
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Gemmel F, De Winter F, Van Laere K, Vogelaers D, Uyttendaele D, Dierckx RA. 99mTc ciprofloxacin imaging for the diagnosis of infection in the postoperative spine. Nucl Med Commun 2004; 25:277-83. [PMID: 15094447 DOI: 10.1097/00006231-200403000-00011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The non-invasive assessment of postoperative spinal infections can pose a substantial diagnostic challenge, especially in the presence of orthopaedic devices. In contrast to white blood cell scanning, which is of limited use in the spine, the low uptake of 99mTc ciprofloxacin into normal bone marrow, combined with its claimed bacterial specificity, makes it, theoretically, an ideal candidate for evaluating postoperative spinal infections. AIM This study aimed to evaluate 99mTc ciprofloxacin planar and single photon emission tomography (SPET) imaging in relation to microbiological diagnosis in the postoperative spine. METHODS Only patients with a microbiologically confirmed diagnosis were included in this analysis. Planar imaging was performed at 1, 3 and 24 h, and SPET was performed at 3 h post-injection of 370 MBq 99mTc ciprofloxacin. Images were scored by two independent, certified, nuclear medicine physicians, blinded for the final diagnosis. RESULTS Within the first 22 consecutive patients with microbiological diagnosis, there were nine deep infections. Sensitivity, specificity and accuracy at visual scoring were, respectively, 67%, 77%, 73% (1 h), 78%, 69%, 73% (3 h), and 56%, 92%, 77% (24 h) for planar imaging, and 100%, 54%, and 73% for SPET. CONCLUSION In contrast to white blood cell scanning, SPET with Tc ciprofloxacin is sensitive in evaluating infections in the postoperative spine. Sensitivity is higher for SPET than for planar imaging. However, the results presented prove that its specificity is limited, especially in patients who have recently (< 6 months) undergone surgery. Taken this limitation into account, we advise planar and SPET imaging at 3 h post-injection and at an interval of at least 6 months after surgery to minimize the chance for false positives.
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Affiliation(s)
- Filip Gemmel
- Division of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
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