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.

中文翻译：

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[124I] FIAU PET / CT对肌肉骨骼和肺部细菌感染的评估。

目的：

在细菌感染评估中，影像学是有限的。原位细菌的直接成像有望用于无创诊断。我们调查了细菌胸苷激酶抑制剂（[ ¹²⁴ I] FIAU）成像肺和肌肉骨骼感染的能力。

方法：

前瞻性纳入了33例患者：疑似肌肉骨骼感染16例，疑似肺部感染14例，已知类风湿关节炎但未感染3例。31例患者接受了[ ¹²⁴ I] FIAU PET / CT和28例接受了[ ¹⁸ F] FDG PET / CT的成像。病历由经验丰富的临床医生进行了传染病亚专业培训，经过审查后确定为阳性，模棱两可或阴性。

结果：

估计[ ¹²⁴ I] FIAU PET / CT对感染的敏感性，特异性，阳性预测值，阴性预测值和准确性分别为7.7％至25.0％，0.0％，50％，0.0％和20.0％肌肉骨骼感染的发生率分别为71.4％和100.0％，51.7％至72.7％，0.0％至50.0％，100.0％和57.1％至78.6％，无法计算。对于[ ¹⁸ F] FDG PET / CT，肌肉骨骼感染的参数分别为75.0％至92.3％，0.0％，23.1％至92.3％，0.0％和21.4％至85.7％，不可估量为100.0％，0.0％ ，肺部感染分别为0.0％至18.2％，无法计算和0.0％至18.2％。

结论：

大量临床表现模棱两可的患者无法就[ ¹²⁴ I] FIAU的诊断功效做出明确的结论。未来需要使用微生物学来严格定义患者的感染情况，并需要针对图像质量进行优化的PET放射性示踪剂。