PET/CT with 18F-FDG-Labeled Autologous Leukocytes for the Diagnosis of Infected Fluid Collections in Acute Pancreatitis
PET/CT with 18F-FDG-Labeled Autologous Leukocytes for the Diagnosis of Infected Fluid Collections in Acute Pancreatitis
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DOI：
10.2967/jnumed.114.137232
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发表时间：
2014-08-01
影响因子：
9.3
通讯作者：
Mittal, Bhagwant R.
中科院分区：
文献类型：
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作者：
Bhattacharya, Anish;Kochhar, Rakesh;Mittal, Bhagwant R.
急性胰腺炎（AP）感染的早期检测影响治疗的选择和临床结局。我们使用F-18-FDG标记的自体白细胞PET/CT检测AP患者胰腺或胰周积液中的感染。研究方法：研究了41名患者（28名男性和13名女性），年龄21-69岁（平均值+/- SD，41 +/- 11.5），患有AP和胰腺内或周围积液的放射学证据。从患者的静脉血中分离白细胞，用F-18-FDG标记，并静脉内重新注射; 2小时后采集PET/CT图像。感染的最终诊断是基于从收集的液体抽吸的微生物培养。患者接受了支持性护理和抗生素治疗;经皮引流或剖腹探查术在指征。结果如下：血糖水平、总白细胞计数、中性粒细胞计数和白细胞标记效率在83 - 212 mg/100 mL之间变化（118 +/- 30）、4，600 - 24，200/mm（3）（11，648 +/-5，376）、55%-90%（73 +/- 10）和31%-97%（81 +/- 17）。41例患者中有12例在液体收集中观察到示踪剂摄取增加; 10例培养证实感染并接受经皮引流，2例抽吸不成功。29名患者的扫描结果为感染阴性; 25名患者的液体培养结果为感染阴性，4名患者的抽吸失败。在35例有液体培养报告的患者中，扫描的敏感性、特异性和准确性均为100%。结论：F-18-FDG标记的白细胞PET/CT是诊断AP患者胰腺或胰周积液感染的无创和可靠的方法。
Early detection of infection in acute pancreatitis (AP) affects the choice of treatment and clinical outcome. We used PET/CT with F-18-FDG-labeled autologous leukocytes to detect infection in pancreatic or peripancreatic fluid collections in patients with AP. Methods: Forty-one patients (28 men and 13 women) who were 21-69 y old (mean +/- SD, 41 +/- 11.5) and had AP and radiologic evidence of a fluid collection in or around the pancreas were studied. Leukocytes were separated from the patient's venous blood, labeled with F-18-FDG, and reinjected intravenously; PET/CT images were acquired 2 h later. A final diagnosis of infection was based on microbiologic culture of fluid aspirated from the collection. Patients were treated with supportive care and antibiotics; percutaneous drainage or laparotomy was performed when indicated. Results: Blood glucose level, total leukocyte count, neutrophil count, and leukocyte labeling efficiency varied from 83 to 212 mg/100 mL (118 +/- 30), 4,600 to 24,200/mm(3) (11,648 +/- 5,376), 55% to 90% (73 +/- 10), and 31% to 97% (81 +/- 17), respectively. Increased tracer uptake in the fluid collection was seen in 12 of 41 patients; 10 had culture-proven infection and underwent percutaneous drainage, and aspiration was unsuccessful in 2. The scan results were negative for infection in 29 patients; 25 had fluid culture results that were negative for infection, and aspiration was unsuccessful in 4. The sensitivity, specificity, and accuracy of the scan were all 100% in 35 patients for whom fluid culture reports were available. Conclusion: PET/CT with F-18-FDG-labeled leukocytes is a noninvasive and reliable method for the diagnosis of infection in pancreatic or peripancreatic fluid collections in patients with AP.