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Imaging with 18F-FDG–labeled leukocytes identified infection in acute pancreatitis
In patients with acute pancreatitis, the use of PET/CT scanning with 18F-fluorodeoxyglucose-labeled leukocytes is a valuable tool for detecting infection in fluid collections, according to recent findings.
“Documenting infection of pancreatic necrosis/pancreatic or peripancreatic fluid collections is one of the key questions in managing such patients. So far only fine needle aspiration under radiological guidance could establish that with limitations of invasive procedure and, at times, insufficient amount of aspirate,” researcher Anish Bhattacharya, MD, of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, said in a press release. “The present study, for the first time, gives evidence of a non-invasive investigation that can answer the question of infected pancreatic fluid collections.”
Bhattacharya and colleagues evaluated 41 patients aged 21 to 69 years. All participants exhibited acute pancreatitis and fluid collection in the peripancreatic area, as evidenced by imaging results. The researchers separated autologous leukocytes from the patient’s venous blood, labeled them with 18F- fluorodeoxyglucose (18F-FDG), and reinjected the leukocytes. The patients underwent PET/CT imaging 2 hours later.
Microbiologic culture of aspirated fluid was used to make final infection diagnoses. Patients with infection underwent regimens of supportive care and antibiotics, or when needed, percutaneous drainage or laparotomy.
The researchers found that the blood glucose levels varied from 83 mg/100 mL to 212 mg/100 mL; total leukocyte counts varied from 4,600 mm3 to 24,200 mm3; neutrophil counts ranged from 55% to 90%; and leukocyte labeling efficiency varied from 31% to 97%.
In 12 of the 41 patients, increased tracer uptake was identified in the fluid collections. Aspiration was unsuccessful in two patients; 10 of these patients had culture-confirmed infection, for which percutaneous drainage was performed.
A total of 29 patients had negative scan results for infection; 25 of these patients had fluid culture-confirmed negative results. Aspiration was unsuccessful in four patients. In the 35 patients for whom fluid culture reports were available, the sensitivity, specificity and accuracy of the scan were 100%.
“This research uses a new technique to diagnose infection occurring in patients with pancreatic fluid collections,” Bhattacharya said in the press release. “The patient is spared empirical antibiotic therapy or radiological intervention followed by time-consuming microbiological work-up.”
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