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Review
. 2017 Feb 3;4(1):ofx011.
doi: 10.1093/ofid/ofx011. eCollection 2017 Winter.

Using Nuclear Medicine Imaging Wisely in Diagnosing Infectious Diseases

Andrea Censullo  1 , Tara Vijayan  2
Affiliations
Review

Using Nuclear Medicine Imaging Wisely in Diagnosing Infectious Diseases

Andrea Censullo et al. Open Forum Infect Dis. .

Abstract

In recent years, there has been an increasing emphasis on efficient and accurate diagnostic testing, exemplified by the American Board of Internal Medicine's "Choosing Wisely" campaign. Nuclear imaging studies can provide early and accurate diagnoses of many infectious disease syndromes, particularly in complex cases where the differential remains broad. This review paper offers clinicians a rational, evidence-based guide to approaching nuclear medicine tests, using an example case of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia in a patient with multiple potential sources. Fluorodeoxyglucose-positron emission tomography (FDG-PET) with computed tomography (CT) and sulfur colloid imaging with tagged white blood cell (WBC) scanning offer the most promise in facilitating rapid and accurate diagnoses of endovascular graft infections, vertebral osteomyelitis (V-OM), diabetic foot infections, and prosthetic joint infections (PJIs). However, radiologists at different institutions may have varying degrees of expertise with these modalities. Regardless, infectious disease consultants would benefit from knowing what nuclear medicine tests to order when considering patients with complex infectious disease syndromes.

Keywords: fever of unknown origin; nuclear medicine imaging; osteomyelitis; prosthetic joint infection; vascular graft infection.

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Figures

Figure 1.
Figure 1.
99mTc-hydroxymethylene diphosphonate bone SPECT scan of patient with osteomyslitis of fifth lumbar vertebra (arrows). This research was original published in JNMT. Martin Gotthardt et al. J. Nucl. Med. Technol. 2013; 41:157–69. ©by the Society of Nuclear Medicine and Molecular Imaging, Inc.
Figure 2.
Figure 2.
18F-FDG PET/CT scan of patient with provend Escherichia coli infection of vascular graft. This research was original published in JNMT. Martin Gotthardt et al. J. Nucl. Med. Technol. 2013; 41:157–69. ©by the Society of Nuclear Medicine and Molecular Imaging, Inc.
Figure 3.
Figure 3.
Radiation exposure of various imaging modalitites (computed tomography [CT] vs nuclear medicine). CTA, CT angiography; F-FDG-PET, fluorodeoxyglucose-positron emission tomography; PE, pulmonary embolism; WBC, white blood cells.
See this image and copyright information in PMC

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