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FDG PET/CT of Infection: Should It Replace Labeled Leukocyte Scintigraphy of Inpatients?
Elizabeth H Dibble1, Don C Yoo1, Grayson L Baird1,2
1Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903.
Insights
FDG PET/CT imaging is more sensitive and equally specific for diagnosing inpatient infections compared to labeled leukocyte scintigraphy. This advanced imaging technique also proved more helpful to clinicians and offered significant cost savings.
Area of Science:
- Nuclear Medicine
- Diagnostic Imaging
- Radiopharmaceuticals
Background:
- Inpatient infections require accurate and timely diagnosis.
- Labeled leukocyte scintigraphy and FDG PET/CT are imaging modalities used to detect infection.
- Comparing the diagnostic performance and clinical utility of these techniques is crucial.
Purpose of the Study:
- To compare the sensitivity, specificity, and clinical helpfulness of FDG PET/CT versus labeled leukocyte scintigraphy.
- To evaluate changes in the utilization and radiopharmaceutical costs of these imaging techniques over time.
Main Methods:
- Retrospective analysis of inpatient studies for suspected infection from 2009 to 2017.
- Comparison of sensitivity and specificity using a mixed generalized linear model.
- Assessment of yearly test volumes and radiopharmaceutical costs.
Main Results:
- FDG PET/CT demonstrated higher sensitivity (89.7%) than labeled leukocyte scintigraphy (66.7%) (p=0.0485).
- Specificity was comparable between FDG PET/CT (73.3%) and labeled leukocyte scintigraphy (76.9%) (p=0.8050).
- FDG PET/CT was 4.6 times more likely to be helpful to referring clinicians (p=0.0412), with increasing utilization and decreasing costs.
Conclusions:
- FDG PET/CT is a more sensitive and equally specific imaging modality for identifying infection sources in inpatients.
- FDG PET/CT offers greater clinical utility and cost-effectiveness compared to labeled leukocyte scintigraphy.
- The shift towards FDG PET/CT reflects advancements in diagnostic imaging for infectious diseases.
Abstract:
OBJECTIVE. The purpose of this study was to compare the sensitivity, specificity, and helpfulness to referring clinicians of labeled leukocyte scintigraphy versus FDG PET/CT in inpatients with suspected infection. MATERIALS AND METHODS. In this retrospective study, labeled leukocyte scintigraphy and FDG PET/CT examinations performed from 2009 to 2017 for suspected infection in inpatients were identified. Sensitivity, specificity, and helpfulness of PET/CT versus labeled leukocyte scintigraphy were calculated by means of a mixed generalized linear model. Number of yearly tests and radiopharmaceutical costs were also assessed. RESULTS. Fifty-seven patients (30 men, 27 women; median age, 65 years; range, 21-91 years) underwent whole-body labeled leukocyte scintigraphy. Forty-two patients (30 male patients, 12 female patients; median age, 62.5 years; range, 12-91 years) underwent PET/CT for suspected infection. Labeled leukocyte scintigraphy was 66.7% sensitive, whereas the sensitivity of PET/CT was 89.7% (p = 0.0485). The higher sensitivity of PET/CT did not come at a cost to specificity, which was 73.3% as opposed to 76.9% for labeled leukocyte scintigraphy (p = 0.8050). The odds of a positive study being helpful increased 4.6-fold for PET/CT versus labeled leukocyte scintigraphy (p = 0.0412). From 2009 to 2011, 33 labeled leukocyte scintigraphic examinations were performed versus two PET/CT examinations; and from 2012 to 2014, 16 labeled leukocyte scintigraphic versus 22 PET/CT examinations; from 2015 to 2017, eight labeled leukocyte scintigraphic versus 18 PET/CT examinations. The cost of labeled leukocytes increased between 2009 and 2017, but that of FDG decreased. By 2017, a labeled leukocyte radiopharmaceutical dose was approximately 10 times the cost of an FDG dose. CONCLUSION. PET/CT was more sensitive than and as specific as labeled leukocyte scintigraphy for identifying a source of infection in inpatients, and it was more helpful to referring clinicians. Use of PET/CT increased over time and was associated with substantial savings in radiopharmaceutical cost.
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