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To what extent does prior antimicrobial therapy affect the diagnostic performance of radiolabeled leukocyte

Katarzyna Holcman1,2, Paweł Rubiś3, Bogdan Ćmiel4

  • 1Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202, Krakow, Poland. katarzyna.holcman@gmail.com.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|July 12, 2022
PubMed
Abstract

Insights

Prior antibiotic use can interfere with technetium-99m-HMPAO-SPECT/CT imaging for infective endocarditis. Patients receiving antibiotics are more likely to have false-negative imaging results, impacting diagnosis.

Area of Science:

  • Nuclear Medicine
  • Radiopharmacology
  • Infectious Diseases

Background:

  • Infective endocarditis (IE) diagnosis relies on imaging techniques.
  • Technetium-99m-hexamethylpropyleneamine oxime-labeled leukocytes single-photon emission tomography-computed tomography (99mTc-HMPAO-SPECT/CT) is a hybrid imaging modality used in IE.
  • The impact of prior antimicrobial therapy on 99mTc-HMPAO-SPECT/CT performance in IE is not fully understood.

Purpose of the Study:

  • To evaluate the interference of antimicrobial therapy with 99mTc-HMPAO-SPECT/CT in patients with suspected infective endocarditis.
  • To determine how prior antibiotic administration affects the diagnostic accuracy of 99mTc-HMPAO-SPECT/CT.

Main Methods:

  • Prospective, single-center study of 205 adult patients with suspected IE from 2015-2019.
  • All patients underwent 99mTc-HMPAO-SPECT/CT.
  • Patients were categorized into two groups: those who received antimicrobial therapy within 30 days prior to imaging (n=96) and those who did not (n=109).

Main Results:

  • Patients who received prior antimicrobial therapy showed significantly higher positive predictive values (91.89% vs. 60.00%) and lower negative predictive values (77.97% vs. 90.54%) compared to untreated patients.
  • Antimicrobial therapy was associated with a higher likelihood of false-negative 99mTc-HMPAO-SPECT/CT results (OR, 4.63).
  • The risk of false-negative results was particularly elevated with intravenous, definite, and combination antibiotic regimens.

Conclusions:

  • Prior antibiotic administration significantly affects the diagnostic performance of 99mTc-HMPAO-SPECT/CT in infective endocarditis.
  • Antimicrobial therapy can lead to false-negative imaging findings, especially with specific antibiotic administration methods.
  • Clinicians should consider the influence of prior antibiotic treatment when interpreting 99mTc-HMPAO-SPECT/CT results in IE patients.
Keywords:
InfectionSPECThybrid imaging

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