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Nucl Med Biol. 2016 May;43(5):273-9. doi: 10.1016/j.nucmedbio.2016.01.004. Epub 2016 Feb 2.

[(124)I]FIAU: Human dosimetry and infection imaging in patients with suspected prosthetic joint infection.

Author information

1
BioMed Valley Discoveries Inc., Kansas City, Missouri. Electronic address: mzhang@biomed-valley.com.
2
BioMed Valley Discoveries Inc., Kansas City, Missouri.
3
Covance, Princeton, New Jersey.
4
Phoenix Clinical Research, Tamarac, Florida.
5
The Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, Maryland.
6
Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee.
7
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
8
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
9
Mission Hospital, Ashville, North Carolina.
10
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
11
Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland.
12
ICON Medical Imaging, Warrington, Pennsylvania.
13
Department of Neurology, The Johns Hopkins Medical Institutes, Baltimore, Maryland.
14
BioMed Valley Discoveries Inc., Kansas City, Missouri. Electronic address: ssaha@biomed-valley.com.

Abstract

INTRODUCTION:

Fialuridine (FIAU) is a nucleoside analog that is a substrate for bacterial thymidine kinase (TK). Once phosphorylated by TK, [(124)I]FIAU becomes trapped within bacteria and can be detected with positron emission tomography/computed tomography (PET/CT). [(124)I]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 [(124)I]FIAU, and investigated whether [(124)I]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 74MBq (2mCi) [(124)I]FIAU intravenously (IV). Estimated radiation doses were calculated with the OLINDA/EXM software. To determine accuracy of [(124)I]FIAU, 22 subjects with suspected hip or knee PJI were scanned at 2-6 and 24-30h post IV injection of 185MBq (5mCi) [(124)I]FIAU. Images were interpreted by a single reader blinded to clinical information. Representative cases were reviewed by 3 additional readers. The utility of [(124)I]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 [(124)I]FIAU. The effective dose was 0.16 to 0.20mSv/MBq and doses to most organs ranged from 0.11 to 0.76mGy/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:

[(124)I]FIAU was well-tolerated in healthy volunteers and subjects with suspected PJI, and had acceptable dosimetry. However, the utility of [(124)I]FIAU for the clinical detection of PJIs is limited by poor image quality and low specificity.

KEYWORDS:

Diagnosis; FIAU; PET/CT; Prosthetic joint infection

PMID:
27150029
DOI:
10.1016/j.nucmedbio.2016.01.004
[Indexed for MEDLINE]
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