[124I]FIAU

Human dosimetry and infection imaging in patients with suspected prosthetic joint infection

Xiaoyan M. Zhang, Halle H. Zhang, Patrick McLeroth, Richard D. Berkowitz, Michael A. Mont, Michael G. Stabin, Barry A. Siegel, Abass Alavi, T. Marc Barnett, Jeffrey Gelb, Chantal Petit, John Spaltro, Steve Y. Cho, Martin Gilbert Pomper, James J. Conklin, Chetan Bettegowda, Saurabh Saha

Research output: Contribution to journalArticle

Abstract

Introduction: Fialuridine (FIAU) is a nucleoside analog that is a substrate for bacterial thymidine kinase (TK). Once phosphorylated by TK, [124I]FIAU becomes trapped within bacteria and can be detected with positron emission tomography/computed tomography (PET/CT). [124I]FIAU PET/CT has been shown to detect bacteria in patients with musculoskeletal bacterial infections. Accurate diagnosis of prosthetic joint infections (PJIs) has proven challenging because of the lack of a well-validated reference. In the current study, we assessed biodistribution and dosimetry of [124I]FIAU, and investigated whether [124I]FIAU PET/CT can diagnose PJIs with acceptable accuracy. Methods: To assess biodistribution and dosimetry, six subjects with suspected hip or knee PJI and six healthy subjects underwent serial PET/CT after being dosed with 74 MBq (2 mCi) [124I]FIAU intravenously (IV). Estimated radiation doses were calculated with the OLINDA/EXM software. To determine accuracy of [124I]FIAU, 22 subjects with suspected hip or knee PJI were scanned at 2-6 and 24-30 h post IV injection of 185 MBq (5 mCi) [124I]FIAU. Images were interpreted by a single reader blinded to clinical information. Representative cases were reviewed by 3 additional readers. The utility of [124I]FIAU to detect PJIs was assessed based on the correlation of the patient's infection status with imaging results as determined by an independent adjudication board (IAB). Results: The kidney, liver, spleen, and urinary bladder received the highest radiation doses of [124I]FIAU. The effective dose was 0.16 to 0.20 mSv/MBq and doses to most organs ranged from 0.11 to 0.76 mGy/MBq. PET image quality obtained from PJI patients was confounded by metal artifacts from the prostheses and pronounced FIAU uptake in muscle. Consequently, a correlation with infection status and imaging results could not be established. Conclusions: [124I]FIAU was well-tolerated in healthy volunteers and subjects with suspected PJI, and had acceptable dosimetry. However, the utility of [124I]FIAU for the clinical detection of PJIs is limited by poor image quality and low specificity.

Original languageEnglish (US)
Pages (from-to)273-279
Number of pages7
JournalNuclear Medicine and Biology
Volume43
Issue number5
DOIs
StatePublished - May 1 2016

Fingerprint

Joints
Infection
Healthy Volunteers
Thymidine Kinase
Knee Joint
fialuridine
Hip
Radiation
Bacteria
Nucleosides
Bacterial Infections
Artifacts
Prostheses and Implants
Urinary Bladder
Software
Spleen
Metals
Kidney
Muscles
Injections

Keywords

  • Diagnosis
  • FIAU
  • PET/CT
  • Prosthetic joint infection

ASJC Scopus subject areas

  • Cancer Research
  • Molecular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Zhang, X. M., Zhang, H. H., McLeroth, P., Berkowitz, R. D., Mont, M. A., Stabin, M. G., ... Saha, S. (2016). [124I]FIAU: Human dosimetry and infection imaging in patients with suspected prosthetic joint infection. Nuclear Medicine and Biology, 43(5), 273-279. https://doi.org/10.1016/j.nucmedbio.2016.01.004

[124I]FIAU : Human dosimetry and infection imaging in patients with suspected prosthetic joint infection. / Zhang, Xiaoyan M.; Zhang, Halle H.; McLeroth, Patrick; Berkowitz, Richard D.; Mont, Michael A.; Stabin, Michael G.; Siegel, Barry A.; Alavi, Abass; Barnett, T. Marc; Gelb, Jeffrey; Petit, Chantal; Spaltro, John; Cho, Steve Y.; Pomper, Martin Gilbert; Conklin, James J.; Bettegowda, Chetan; Saha, Saurabh.

In: Nuclear Medicine and Biology, Vol. 43, No. 5, 01.05.2016, p. 273-279.

Research output: Contribution to journalArticle

Zhang, XM, Zhang, HH, McLeroth, P, Berkowitz, RD, Mont, MA, Stabin, MG, Siegel, BA, Alavi, A, Barnett, TM, Gelb, J, Petit, C, Spaltro, J, Cho, SY, Pomper, MG, Conklin, JJ, Bettegowda, C & Saha, S 2016, '[124I]FIAU: Human dosimetry and infection imaging in patients with suspected prosthetic joint infection', Nuclear Medicine and Biology, vol. 43, no. 5, pp. 273-279. https://doi.org/10.1016/j.nucmedbio.2016.01.004
Zhang, Xiaoyan M. ; Zhang, Halle H. ; McLeroth, Patrick ; Berkowitz, Richard D. ; Mont, Michael A. ; Stabin, Michael G. ; Siegel, Barry A. ; Alavi, Abass ; Barnett, T. Marc ; Gelb, Jeffrey ; Petit, Chantal ; Spaltro, John ; Cho, Steve Y. ; Pomper, Martin Gilbert ; Conklin, James J. ; Bettegowda, Chetan ; Saha, Saurabh. / [124I]FIAU : Human dosimetry and infection imaging in patients with suspected prosthetic joint infection. In: Nuclear Medicine and Biology. 2016 ; Vol. 43, No. 5. pp. 273-279.
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abstract = "Introduction: Fialuridine (FIAU) is a nucleoside analog that is a substrate for bacterial thymidine kinase (TK). Once phosphorylated by TK, [124I]FIAU becomes trapped within bacteria and can be detected with positron emission tomography/computed tomography (PET/CT). [124I]FIAU PET/CT has been shown to detect bacteria in patients with musculoskeletal bacterial infections. Accurate diagnosis of prosthetic joint infections (PJIs) has proven challenging because of the lack of a well-validated reference. In the current study, we assessed biodistribution and dosimetry of [124I]FIAU, and investigated whether [124I]FIAU PET/CT can diagnose PJIs with acceptable accuracy. Methods: To assess biodistribution and dosimetry, six subjects with suspected hip or knee PJI and six healthy subjects underwent serial PET/CT after being dosed with 74 MBq (2 mCi) [124I]FIAU intravenously (IV). Estimated radiation doses were calculated with the OLINDA/EXM software. To determine accuracy of [124I]FIAU, 22 subjects with suspected hip or knee PJI were scanned at 2-6 and 24-30 h post IV injection of 185 MBq (5 mCi) [124I]FIAU. Images were interpreted by a single reader blinded to clinical information. Representative cases were reviewed by 3 additional readers. The utility of [124I]FIAU to detect PJIs was assessed based on the correlation of the patient's infection status with imaging results as determined by an independent adjudication board (IAB). Results: The kidney, liver, spleen, and urinary bladder received the highest radiation doses of [124I]FIAU. The effective dose was 0.16 to 0.20 mSv/MBq and doses to most organs ranged from 0.11 to 0.76 mGy/MBq. PET image quality obtained from PJI patients was confounded by metal artifacts from the prostheses and pronounced FIAU uptake in muscle. Consequently, a correlation with infection status and imaging results could not be established. Conclusions: [124I]FIAU was well-tolerated in healthy volunteers and subjects with suspected PJI, and had acceptable dosimetry. However, the utility of [124I]FIAU for the clinical detection of PJIs is limited by poor image quality and low specificity.",
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T1 - [124I]FIAU

T2 - Human dosimetry and infection imaging in patients with suspected prosthetic joint infection

AU - Zhang, Xiaoyan M.

AU - Zhang, Halle H.

AU - McLeroth, Patrick

AU - Berkowitz, Richard D.

AU - Mont, Michael A.

AU - Stabin, Michael G.

AU - Siegel, Barry A.

AU - Alavi, Abass

AU - Barnett, T. Marc

AU - Gelb, Jeffrey

AU - Petit, Chantal

AU - Spaltro, John

AU - Cho, Steve Y.

AU - Pomper, Martin Gilbert

AU - Conklin, James J.

AU - Bettegowda, Chetan

AU - Saha, Saurabh

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Introduction: Fialuridine (FIAU) is a nucleoside analog that is a substrate for bacterial thymidine kinase (TK). Once phosphorylated by TK, [124I]FIAU becomes trapped within bacteria and can be detected with positron emission tomography/computed tomography (PET/CT). [124I]FIAU PET/CT has been shown to detect bacteria in patients with musculoskeletal bacterial infections. Accurate diagnosis of prosthetic joint infections (PJIs) has proven challenging because of the lack of a well-validated reference. In the current study, we assessed biodistribution and dosimetry of [124I]FIAU, and investigated whether [124I]FIAU PET/CT can diagnose PJIs with acceptable accuracy. Methods: To assess biodistribution and dosimetry, six subjects with suspected hip or knee PJI and six healthy subjects underwent serial PET/CT after being dosed with 74 MBq (2 mCi) [124I]FIAU intravenously (IV). Estimated radiation doses were calculated with the OLINDA/EXM software. To determine accuracy of [124I]FIAU, 22 subjects with suspected hip or knee PJI were scanned at 2-6 and 24-30 h post IV injection of 185 MBq (5 mCi) [124I]FIAU. Images were interpreted by a single reader blinded to clinical information. Representative cases were reviewed by 3 additional readers. The utility of [124I]FIAU to detect PJIs was assessed based on the correlation of the patient's infection status with imaging results as determined by an independent adjudication board (IAB). Results: The kidney, liver, spleen, and urinary bladder received the highest radiation doses of [124I]FIAU. The effective dose was 0.16 to 0.20 mSv/MBq and doses to most organs ranged from 0.11 to 0.76 mGy/MBq. PET image quality obtained from PJI patients was confounded by metal artifacts from the prostheses and pronounced FIAU uptake in muscle. Consequently, a correlation with infection status and imaging results could not be established. Conclusions: [124I]FIAU was well-tolerated in healthy volunteers and subjects with suspected PJI, and had acceptable dosimetry. However, the utility of [124I]FIAU for the clinical detection of PJIs is limited by poor image quality and low specificity.

AB - Introduction: Fialuridine (FIAU) is a nucleoside analog that is a substrate for bacterial thymidine kinase (TK). Once phosphorylated by TK, [124I]FIAU becomes trapped within bacteria and can be detected with positron emission tomography/computed tomography (PET/CT). [124I]FIAU PET/CT has been shown to detect bacteria in patients with musculoskeletal bacterial infections. Accurate diagnosis of prosthetic joint infections (PJIs) has proven challenging because of the lack of a well-validated reference. In the current study, we assessed biodistribution and dosimetry of [124I]FIAU, and investigated whether [124I]FIAU PET/CT can diagnose PJIs with acceptable accuracy. Methods: To assess biodistribution and dosimetry, six subjects with suspected hip or knee PJI and six healthy subjects underwent serial PET/CT after being dosed with 74 MBq (2 mCi) [124I]FIAU intravenously (IV). Estimated radiation doses were calculated with the OLINDA/EXM software. To determine accuracy of [124I]FIAU, 22 subjects with suspected hip or knee PJI were scanned at 2-6 and 24-30 h post IV injection of 185 MBq (5 mCi) [124I]FIAU. Images were interpreted by a single reader blinded to clinical information. Representative cases were reviewed by 3 additional readers. The utility of [124I]FIAU to detect PJIs was assessed based on the correlation of the patient's infection status with imaging results as determined by an independent adjudication board (IAB). Results: The kidney, liver, spleen, and urinary bladder received the highest radiation doses of [124I]FIAU. The effective dose was 0.16 to 0.20 mSv/MBq and doses to most organs ranged from 0.11 to 0.76 mGy/MBq. PET image quality obtained from PJI patients was confounded by metal artifacts from the prostheses and pronounced FIAU uptake in muscle. Consequently, a correlation with infection status and imaging results could not be established. Conclusions: [124I]FIAU was well-tolerated in healthy volunteers and subjects with suspected PJI, and had acceptable dosimetry. However, the utility of [124I]FIAU for the clinical detection of PJIs is limited by poor image quality and low specificity.

KW - Diagnosis

KW - FIAU

KW - PET/CT

KW - Prosthetic joint infection

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