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Infection Imaging When the infection is well localized—that is, there are symptoms such as redness, swelling or heat— sophisticated testing is not required. For many infections, however, the symptoms are not nearly so well defined. These are generally referred to as "occult infections." Such infections may be seen in the post-operative period or in patients with impaired immune systems. In order to properly treat patients with these problems, a method for rapid diagnosis is necessary. Once the source of infection is located, appropriate treatment can be instituted. Inflamation foci blood flow vessels permeability migration of neutrophils to the site of infection deposit of transferrin 3-phase bone scan nanocoloide leucocyte scan Gallium sc. 67-Ga scintigraphy 67-Ga T1/2=78 h, g-emiter binds with transferrin in the serum, lactofferin in the leukocytes, ferrytin of macrophages, siderophores (low molecular weight compounds that facilitate iron uptake by microorganisms) of bacterias uptake: bones., liver, spleen, bowel, salivary glands, thymus, breasts Indications: chronic process, oportunistic infections, FUO, osteomyelitis overall accuracy is over 90% for infections - 60% for infections in the abdomen In patients who are HIV positive, gallium imaging may provide the first sign of dangerous lung infections Gallium is very accurate in finding bone infections Gallium scan showing uptake throughout the lungs in an HIV-positive patient with fever and an unknown source of infection. The findings indicated a diffuse pneumonia, not well seen on the x-ray. In vitro-labelled leukocyte scan 111-In-oxine, chinolinone (0,5 mCi) 99m-Tc-exametazime (HMPAO) (3-15 mCi) dyfusion to leukocyte bound with the nucleus and the mitochondrium necessity of leukocytes isolation from the patients aqusition after 1, 3, 24 h p.i., possibly SPECT Indications acute inflamatory process FUO abscessus of abdomen osteomyelitis Infection near endoprothesis inflamation of the bowel In vivo-labelled leukocyte scan - LeukoScan 99m-Tc-MOAB against nonspecific cross-reacting antigen (NCA-90) sensitivity 90% alergic reaction (HAMA) 40% indications: osteomyelitis, soft tissue infection, abscessus, vascular prothesis infection Policlonal IgG labelled with 111-In, 99m-Tc visualisation of any infection, inflamatory process, tumors sensitivity 92% the best quality of images after 2-3 days Nanocolloids human serum albumin Ø <80 nm passive transport through vessel wall aquisiton after 1 h uptake in the liver and th spleen TUMORS 67-Ga scintigraphy HD, NHL - residual mass after therapy, response to therapy, recurence Uptake in the lymph nodes: mediastinum, neck (60-70%) periaortal, spleen (30%) groin, thigh (10%) uptake corelates with activity of the disease Lung cancer Liver cancer (hepatoma) 99m-Tc-MIBI scintigraphy Mitochondrial uptake reflect P-gp expression (permeability glycoprotein) Indications: Parathyroid adenoma Gliomas Breast cancer Thyroid cancer Lung cancer Lymphomas