title: Utility of the indium 111-labeled human immunoglobulin G scan for the detection of focal vascular graft infection.
abstract: The ability to diagnose and localize vascular graft infections has been a major challenge. Recent studies in animal models and humans with focal bacterial infection have shown that radiolabeled, polyclonal, human immunoglobulin G accumulates at the site of inflammation and can serve as the basis for an imaging technique. This study investigated this new technique for the diagnosis and localization of vascular graft infections. Twenty-five patients with suspected vascular infections involving grafts (22), atherosclerotic aneurysms (2), and subclavian vein thrombophlebitis (1) were studied. Gamma camera images of the suspected area were obtained between 5 and 48 hours after intravenous administration of 1.5 to 2.0 mCi (56 to 74 mBq) of indium 111-labeled, human, polyclonal immunoglobulin G. Scan results were interpreted without clinical information about the patient and were subsequently correlated with surgical findings, other imaging modalities, and/or clinical follow-up. In 10 of 10 patients found to have positive scan results, localized infections were confirmed at the involved sites. In 14 of 15 patients whose scan results were interpreted as negative, no vascular infections were identified at follow-up. The patient with false-negative results and recurrent bacteremia from an aortoduodenal fistula was found to have a negative scan outcome at a time when his disease was quiescent. These data suggest that nonspecific, human, indium 111-labeled immunoglobulin G scanning can be a useful noninvasive means of localizing vascular infections.
authors.affiliation: Vascular Surgery Unit, Massachusetts General Hospital, Boston 02114.
authors.forename: G M
authors.initials: GM
authors.lastname: LaMuraglia
authors.forename: A J
authors.initials: AJ
authors.lastname: Fischman
authors.forename: H W
authors.initials: HW
authors.lastname: Strauss
authors.forename: F
authors.initials: F
authors.lastname: Keech
authors.forename: R
authors.initials: R
authors.lastname: Wilkinson
authors.forename: R J
authors.initials: RJ
authors.lastname: Callahan
authors.forename: B A
authors.initials: BA
authors.lastname: Khaw
authors.forename: R H
authors.initials: RH
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D005490:Focal Infection / Q000000981:diagnostic imaging*; D006801:Humans; D007074:Immunoglobulin G; D007205:Indium Radioisotopes; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging*; D013212:Staphylococcus epidermidis; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging*
chemical_list: D007074:Immunoglobulin G; D007205:Indium Radioisotopes