Reumatología Clínica (English Edition) Reumatología Clínica (English Edition)
Reumatol Clin 2017;13:178-9 - Vol. 13 Num.3 DOI: 10.1016/j.reumae.2016.02.010
Images in Clinical Rheumatology
Hybrid SPECT/CT using 3D reconstruction with 99mTc-HMPAO-labeled leukocytes in the diagnosis of an infectious process of unknown origin in foot
SPECT/TC con leucocitos autólogos marcados con 99mTc-HMPAO y reconstrucción 3D híbrida en el diagnóstico de proceso infeccioso no filiado en pie
Juan José Martín-Marcuartu, , Víctor Manuel Pachón-Garrudo, Jose Antonio Lojo-Ramírez, Rosario García-Jiménez
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Received 01 February 2016, Accepted 20 February 2016

The patient was a 45-year-old man with nothing remarkable in his medical records, who presented with a 6-month history of pain and swelling in the dorsum of right foot (Fig. 1D) with purulent exudate between 4th and 5th toes. Cultures had repeatedly been negative, and he did not improve with intensive antibiotic therapy. The radiological images were not conclusive, and he came to our department to undergo scintigraphy1 with 99mTc-hexamethylpropyleneamine oxime (HMPAO)-labeled leukocytes (Fig. 1A and B). There was an increased uptake of the tracer in the fourth metatarsal 3h after injection of the radiotracer.2 The study was completed with the acquisition of a single photon emission computed tomography/computed tomography and 3D reconstruction (3D SPECT/CT) which made it possible to locate the infectious process in soft tissue of the dorsum of the foot. It was related to a foreign body in the distal third of the fourth metatarsal (Fig. 1C), unknown until then. After its surgical removal, the patient's improvement was excellent in a few weeks.

Fig. 1.
(0.13MB).

Single photon emission computed tomography/computed tomography (SPECT/CT) after the intravenous administration of autologous leukocytes labeled with 20mCi of 99mTc-hexamethylpropyleneamine oxime (HMPAO). Hybrid SPECT/CT image (A) and SPECT image (B) showing the increased uptake in the fourth metatarsal of right foot. 3D reconstruction with bone window (C) that enables the correlation of the scintigraphic findings with the presence of a foreign body (arrow), that can be discerned by the impression it leaves on the surface of the skin (D).

Informative Message

The hybrid SPECT/CT image with 99mTc-HMPAO-labeled autologous leukocytes and 3D reconstruction is a highly accurate tool for the noninvasive diagnosis of infectious processes associated with invisible foreign bodies using morphological imaging techniques.

Ethical DisclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of Interest

The authors declare they have no conflicts of interest.

References
1
A.W. Glaudemans,E.F. de Vries,L.E. Vermeulen,R.H. Slart,R.A. Dierckx,A. Signore
A large retrospective single-centre study to define the best image acquisition protocols and interpretation criteria for white blood cell scintigraphy with 99mTc-HMPAO-labelled leucocytes in musculoskeletal infections
Eur J Nucl Med Mol Imaging, 40 (2013), pp. 1760-1769 http://dx.doi.org/10.1007/s00259-013-2481-0
2
P.A. Erba,A.W. Glaudemans,N.C. Veltman,M. Sollini,M. Pacilio,F. Galli
Image acquisition and interpretation criteria for 99mTc-HMPAO-labelled white blood cell scintigraphy: results of a multicentre study
Eur J Nucl Med Mol Imaging, 41 (2014), pp. 615-623 http://dx.doi.org/10.1007/s00259-013-2631-4

Please cite this article as: Martín-Marcuartu JJ, Pachón-Garrudo VM, Lojo-Ramírez JA, García-Jiménez R. SPECT/TC con leucocitos autólogos marcados con 99mTc-HMPAO y reconstrucción 3D híbrida en el diagnóstico de proceso infeccioso no filiado en pie. Reumatol Clin. 2017;13:178–179.

Corresponding author. (Juan José Martín-Marcuartu jjmarcuartu@gmail.com)
Copyright © 2016. Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología
Reumatol Clin 2017;13:178-9 - Vol. 13 Num.3 DOI: 10.1016/j.reumae.2016.02.010