Infection and Inflammation

  • Carlo Buonomo
  • Annick D. Van den Abbeele


One of the most useful applications of pediatric nuclear medicine is the detection and localization of sites of infection. When referred to the nuclear medicine department with suspected infection in a specific organ, a child is usually best evaluated with a radiopharmaceutical that is normally taken up in that organ. Examples are the use of technetium-99m-methylene diphosphonate (99mTc -MDP) for the diagnosis of osteomyelitis and 99mTc -dimercap-tosuccinic acid (99mTc -DMSA) for the diagnosis of pyelonephritis. When a child referred with suspected infection does not have signs or symptoms that point to a specific organ or organ system, however, the choice of radiopharmaceuticals, and indeed the clinical utility of a nuclear medical evaluation, are less clear.


Chronic Granulomatous Disease Pneumocystis Carinii Pneumonia Febrile Child Prolonged Fever 67Ga Scintigraphy 
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  1. 1.
    Anstall HG, Coleman RE. Donor-leukocyte imaging in granulocytopenic patients with suspected abscesses: concise communication. J Nucl Med 1982; 23:319–321PubMedGoogle Scholar
  2. 2.
    Bekerman C, Hoffer P. Salivary gland uptake of 67Ga citrate following radiation therapy. J Nucl Med 1976;17:685–687PubMedGoogle Scholar
  3. 3.
    Bekerman C, Port R, Pang E, Moohr JW, Kranzler JK. Scintigraphic evaluation of childhood malignancies by 67Ga citrate. Radiology 1978; 127:719–725PubMedGoogle Scholar
  4. 4.
    Brewis EG. Undiagnosed fever. BMJ 1965; 1:107–109PubMedCrossRefGoogle Scholar
  5. 5.
    Buonomo C, Treves S. Gallium scanning in children with fever of unknown origin. Pediatr Radiol 1993;23:301–310CrossRefGoogle Scholar
  6. 6.
    Clausen J, Edeling CJ, Fogh J. 67Ga binding to human serum proteins and tumor components. Cancer Res 1974;34:1931–1937PubMedGoogle Scholar
  7. 7.
    Davies S, Garvie N. The role of indium-labelled-leukocyte imaging in pyrexia of unknown origin. Br J Radiol 1990;63:850–854PubMedCrossRefGoogle Scholar
  8. 8.
    De Jong G, van Dijk JP, van Eijk HG. The biology of transferrin. Clin Chim Acta 1990;190:1–46PubMedCrossRefGoogle Scholar
  9. 9.
    Dhawan V, Sziklas J, Spencer R. Localization of Ga-67 in inflammations in the absence of circulating polymorphonuclear leukocytes. J Nucl Med 1978; 19:292–294PubMedGoogle Scholar
  10. 10.
    Donahue DM, Leonard JL, Basmadsian GP, et al. Thymic gallium-67 localization in pediatric patients on chemotherapy. J Nucl Med 1981;22:1043–1048PubMedGoogle Scholar
  11. 11.
    Edeling C. Tumor visualization using 67Ga scintigraphy in children. Radiology 1978;127:727–731PubMedGoogle Scholar
  12. 12.
    Gainey M, McDougall I. Diagnosis of acute inflammatory conditions in children and adolescents using In-111-oxine white blood cells. Clin Nucl Med 1984;9:71–74PubMedCrossRefGoogle Scholar
  13. 13.
    Gelfand M, Thomas S, Kereiakes J. Absorbed radiation dose from routine imaging of the skeleton in children. Ann Radiol 1983;26:421–423PubMedGoogle Scholar
  14. 14.
    Gordon I, Vivian G. Radiolabelled leukocytes: a new diagnostic tool in occult infection/inflammation. Arch Dis Child 1984;59:62–66PubMedCrossRefGoogle Scholar
  15. 15.
    Haentjens M, Piepsz A, Schellfrederick E, Perlmutter-Kremer N, Frühling J. Limitations in the use of indium-111 oxine labeled leukocytes for the diagnosis of occult infection in children. Pediatr Radiol 1987;17:134–142CrossRefGoogle Scholar
  16. 16.
    Handmaker H, O’Mara R. Gallium imaging in pediatrics. J Nucl Med 1977;18:1057–1063PubMedGoogle Scholar
  17. 17.
    Hawker R, Hall C, Droic Z, Rhys-Evans P. Indium leukocyte imaging in true pyrexia of unknown origin. Eur J Nucl Med 1985;10:172–174PubMedCrossRefGoogle Scholar
  18. 18.
    Hibi S, Todo S, Imashuku S. Thymic localization of gallium-67 in pediatric patients with lymphoid and non-lymphoid tumors. J Nucl Med 1987;28:293–297PubMedGoogle Scholar
  19. 19.
    Higashi T, Kobayashi M, Wakao H, Jinbu Y. The relationship between 67Ga accumulation and ATP metabolism in tumor cells in vitro. Eur J Nucl Med 1989;15:152–156PubMedCrossRefGoogle Scholar
  20. 20.
    Hilson AJW, Maisey MN. Gallium-67 scanning in pyrexia of unknown origin. BMJ 1979;4:1330–1331CrossRefGoogle Scholar
  21. 21.
    Hoffer P. Gallium: mechanisms. J Nucl Med 1980; 21:282–285PubMedGoogle Scholar
  22. 22.
    Johnson P, Berdon W, Baker D, Fawwaz RA. Thymic uptake of gallium-67 citrate in a healthy four year old boy. Pediatr Radiol 1978;7:243–244PubMedCrossRefGoogle Scholar
  23. 23.
    Kapala G, Chusid M, Sty J. Ga-67 chest imaging: chronic granulomatous disease. Clin Nucl Med 1983; 6:623Google Scholar
  24. 24.
    Kaplan WD. Gallium tumor imaging. Postgrad Radiol 1984;4:145–173Google Scholar
  25. 25.
    Korsvik H, Piccolello M, Keller M. CT scanning for evaluation of pediatric cancer patients with fever and neutropenia [abstract]. Presented to the Society for Pediatric Radiology, Seattle, 1993Google Scholar
  26. 26.
    Kramer EL, Sanger JJ. Detection of thoracic infections by nuclear medicine techniques in the acquired immunodeficiency syndrome. Radiol Clin North Am 1984;27:1067–1076Google Scholar
  27. 27.
    Larson EB, Featherstone HJ, Petersdorf RG. Fever of undetermined origin: diagnosis and follow-up of 105 cases, 1970–1980. Medicine (Baltimore) 1982; 61:269–292Google Scholar
  28. 28.
    Lohr JA, Hendley JD. Prolonged fever of unknown origin. Clin Pediatr 1977;16:768–773CrossRefGoogle Scholar
  29. 29.
    Lorin MI, Feigin RD. Fever without localizing signs and fever of unknown origin. In Feigin RD, Cherry JD (eds): Pediatric Infectious Disease. Philadelphia: Saunders, 1987:1050–1061Google Scholar
  30. 30.
    MacSweeney J, Peters A, Lavender J. Indium-labelled leukocyte scanning in pyrexia of unknown origin. Clin Radiol 1990;42:414–417PubMedCrossRefGoogle Scholar
  31. 31.
    McClung HJ. Prolonged fever of unknown origin in children. Am J Dis Child 1972;124:544–550PubMedGoogle Scholar
  32. 32.
    McNeil B, Sanders R, Alderson P, et al. A prospective study of computed tomography, ultrasound and gallium imaging in patients with fever. Radiology 1981;139:647–653PubMedGoogle Scholar
  33. 33.
    Papanicolau N, Curnutte J, Nathan D, Treves S. Gallium-67 scintigraphy in children with chronic granulomatous disease. Pediatr Radiol 1983; 13:137–140CrossRefGoogle Scholar
  34. 34.
    Peters AM, Danpure HJ, Osman S, et al. Clinical experience with 99mTc -hexamethylpropyleneamine-oxime for labelling leukocytes and imaging inflammation. Lancet 1986;2:946–949PubMedCrossRefGoogle Scholar
  35. 35.
    Petersdorf RG, Beeson PB. Fever of unexplained origin: report of 100 cases. Medicine (Baltimore) 1961; 40:1–30CrossRefGoogle Scholar
  36. 36.
    Pitt J. Lymphocytic interstitial pneumonia. Pediatr Clin North Am 1991;38:89–95PubMedGoogle Scholar
  37. 37.
    Pizzo P, Lovejoy FH, Smith DH. Prolonged fever in children: review of 100 cases. Pediatrics 1975; 55:468–473PubMedGoogle Scholar
  38. 38.
    Pizzo PA, Robichaud KS, Wesley R, Commens JR. Fever in the pediatric and young adult patient with cancer. Medicine (Baltimore) 1982;61:153–165Google Scholar
  39. 39.
    Raijmakers PG, Groeneveld AB, Den Hollander W, Teule GJ. Transport of 67Ga and 111In across a membrane: role of plasma binding and concentration gradients. NuclMed Commun 1992;13:349–356CrossRefGoogle Scholar
  40. 40.
    Reynolds JH, Graham D, Smith FW. Imaging inflammation with 99mTc HMPAO labelled leucocytes. Clin Radiol 1990;42:195–198PubMedCrossRefGoogle Scholar
  41. 41.
    Richman S, Levenson S, Bunn P, et al. 67Ga accumulation in pulmonary lesions associated with bleomycin toxicity. Cancer 1975;36:1966–1969PubMedCrossRefGoogle Scholar
  42. 42.
    Richman S, Levenson S, Jones A, Johnston G. Radionuclide studies in Hodgkin’s disease and lymphomas. Semin NuclMed 1975;5:103–118CrossRefGoogle Scholar
  43. 43.
    Rubin R, Fischman A, Callahan R, et al. 111-Inlabeled nonspecific immunoglobulin scanning in the detection of focal infection. N Engl J Med 1989;321:935–940PubMedCrossRefGoogle Scholar
  44. 44.
    Rubin R, Young L, Hansen P, et al. Specific and nonspecific imaging of localized Fisher immunotype 1 Pseudomonas aeruginosa infection with radiolabeled monoclonal antibody. J Nucl Med 1988;29:651–656PubMedGoogle Scholar
  45. 45.
    Saverymuttu SH, Peters AM, O’Brien C, et al. Indium-111 labeled autologous leukocyte scanning in gastrointestinal graft-versus-host disease (GVHD). Dig Dis Sci 1986;31:829–832PubMedCrossRefGoogle Scholar
  46. 46.
    Schell-Frederick E, Fruhling J, Van der Auwera P, Van Laethem Y, Klastersky J. 111Indium-oxine-labeled leukocytes in the diagnosis of localized infection in patients with neoplastic disease. Cancer 1984; 54:817–824PubMedCrossRefGoogle Scholar
  47. 47.
    Schiff R, Kabat L, Kamani N. Gallium scanning in lymphoid interstitial pneumonitis of children with AIDS. J Nucl Med 1987;28:1915–1919PubMedGoogle Scholar
  48. 48.
    Sfakianakis G, Al-Sheikh W, Heal A, et al. Comparison of scintigraphy with In- 111 leukocytes and Ga-67 in the diagnosis of occult sepsis. J Nucl Med 1982;23:618–626PubMedGoogle Scholar
  49. 49.
    Sickles E, Greene W, Wernick P. Clinical presentation of infection in granulocytopenic patients. Arch InternMed 1975;135:715–719CrossRefGoogle Scholar
  50. 50.
    Staab EV, McCartney WH. Role of gallium-67 in inflammatory disease. Semin Nucl Med 1978; 8:219–234PubMedCrossRefGoogle Scholar
  51. 51.
    Steele RW, Jones SM, Lowe BA, Glasier CM. Usefulness of scanning procedures for diagnosis of fever of unknown origin in children. J Pediatr 1991;119:526–530PubMedCrossRefGoogle Scholar
  52. 52.
    Stricof D, Glazer G, Amendola M. Chronic granulomatous disease: value of newer imaging modalities. Pediatr Radiol 1984;14:328–331PubMedCrossRefGoogle Scholar
  53. 53.
    Suga K, Nakagi K, Kuramitsu T, et al. The role of gallium-67 imaging in the detection of foci in recent cases of fever of unknown origin. Ann Nucl Med 1991;5:35–10PubMedCrossRefGoogle Scholar
  54. 54.
    Syrjala M, Valtonen V, Liewendahl K, Myllyla G. Diagnostic significance of indium-111 granulocyte scintigraphy in febrile patients. J Nucl Med 1987;28:155–160PubMedGoogle Scholar
  55. 55.
    Thakur ML, Coleman RE, Welch MJ. Indium-111-labeled leukocytes for the localization of abscesses: preparation, analysis, tissue distribution, and comparison with gallium-67 citrate in dogs. J Lab Clin Med 1977;89:217–228PubMedGoogle Scholar
  56. 56.
    Tsuchiya Y, Nakao A, Komatsu T, Yamamoto M, Shimokata K. Relationship between gallium-67 citrate scanning and transferrin receptor expression in lung diseases. Chest 1992;102:530–534PubMedCrossRefGoogle Scholar
  57. 57.
    Weber DA, Eckerman KF, Dillman LT, Ryman JC, MIRD Committee. MIRD: Radionuclide Data and Decay Schemes. New York: Society of Nuclear Medicine, 1989Google Scholar
  58. 58.
    Williamson S, Williamson M, Seibert J, Latture T, Mart S. Indium-111-white blood cell scanning in the pediatric population. Pediatr Radiol 1986; 16:493–197PubMedCrossRefGoogle Scholar
  59. 59.
    Woolfenden J, Carrasquillo JA, Larson SM, et al. Acquired immunodeficiency syndrome: Ga-67 citrate imaging. Radiology 1987;162:383–387PubMedGoogle Scholar
  60. 60.
    Zuckier L, Ongseng F, Goldfarb C. Lymphocytic interstitial pneumonitis: a cause of pulmonary gallium-67 uptake in a child with acquired immunodeficiency syndrome. J Nucl Med 1988;29:707–711PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Carlo Buonomo
  • Annick D. Van den Abbeele

There are no affiliations available

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