Tc-99m Ciprofloxacin Research Articles

Chronic bacterial seminal vesiculitis as a potential disease entity in men with chronic prostatitis.

To investigate bacterial infection in the seminal vesicles by bacteriological examination and radionuclide imaging in men with chronic prostatitis. The study included 50 patients with chronic prostatitis who showed hot uptake in seminal vesicles on Tc-99m ciprofloxacin imaging and eight patients who did not show hot uptake. The evaluation included the National Institutes of Health Chronic Prostatitis Symptom Index and four-glass test. In all participants, transperineal aspiration of seminal vesicle fluid under the guidance of transrectal ultrasonography and bacteriological examination was carried out. Of the 50 patients who showed hot uptake in the seminal vesicles on the isotope study, microorganisms were isolated from the seminal vesicle fluid in 17 patients (positive predictive value, 34%). The most common causative organisms were Escherichia coli in 13 patients (26%), followed by coagulase-negative Staphylococcus species in two patients (4%), Enterococcus faecalis in one patient (2%) and Chlamydia trachomatis in one patient (2%). No microorganisms were isolated in the eight patients who did not show hot uptake in the seminal vesicles (negative predictive value, 100%). However, there were no significant differences in National Institutes of Health Chronic Prostatitis Symptom Index total scores and subscores between the study groups. Chronic bacterial seminal vesiculitis might simultaneously affect a considerable portion of patients with chronic prostatitis, although the clinical implication of the disease remains to be further investigated.

Study on the preparation and biological evaluation of 99mTc–gatifloxacin and 99mTc–cefepime complexes

The aim of this work is the development of new radiopharmaceuticals for imaging infection and inflammation in human. Gatifloxacin (fluoroquinolone derivative) and cefepime (cephalosporine derivative) are antibiotics used to treat bacterial infections were investigated to label with one of the most important radioactive isotopes (technetium-99m). The reaction parameters that affect the labeling yield such as substrate concentration, stannous chloride dihydrate concentration, pH of the reaction mixture, and reaction time were studied to optimize the labeling conditions. Maximum radiochemical yield of 99mTc–gatifloxacin (90 ± 1.8%) complex was obtained by using 50 μg SnCl2·2H2O and 2.5 mg gatifloxacin at pH 10 while 99mTc–cefepime was prepared at pH 8 with a maximum radiochemical yield of 98 ± 1.4% by adding 99mTc to 5 mg cefepime in the presence of 50 μg SnCl2·2H2O. Biological distribution of 99mTc–gatifloxacin and 99mTc–cefepime was carried out in experimentally induced infection rats, in the left thigh, using Escherichia coli. Both thighs of the rats were dissected and counted and the ratio of bacterial infected thigh/contralateral thigh was then evaluated. T/NT for both 99mTc–gatifloxacin and 99mTc–cefepime was found to be 4.5 ± 0.3 and 8.4 ± 0.1, respectively, which was higher than that of the commercially available 99mTc–ciprofloxacin. The abscess to normal muscle ratio indicated that 99mTc–cefepime could be used for infection imaging. Besides, in vitro studies showed that 99mTc–cefepime can differentiate between bacterial infection and sterile inflammation.

Synthesis and Biodistribution of a Novel 99mTcN Complex of Norfloxacin Dithiocarbamate as a Potential Agent for Bacterial Infection Imaging

Achieving a (⁹⁹m)Tc-labeled fluoroquinolone derivative as a single photon emission computed tomography (SPECT) tracer is considered to be of great interest. The norfloxacin dithiocarbamate (NFXDTC) was synthesized and radiolabeled with a [(⁹⁹m)TcN]²(+) intermediate to form the (⁹⁹m)TcN-NFXDTC complex in high yield. The radiochemical purity of (⁹⁹m)TcN-NFXDTC was over 90%, as measured by thin layer chromatography (TLC) and high performance liquid chromatography (HPLC), without any notable decomposition at room temperature over a period of 6 h. The partition coefficient and electrophoresis results indicated that (⁹⁹m)TcN-NFXDTC was lipophilic and neutral. The bacterial binding assay studies showed tht (⁹⁹m)TcN-NFXDTC had a good binding affinity. Biodistribution results in bacterial infected mice showed that (⁹⁹m)TcN-NFXDTC had a higher uptake at the sites of infection and better abscess/blood and abscess/muscle ratios than those of (⁹⁹m)Tc-ciprofloxacin and (⁹⁹m)TcN-CPFXDTC (CPFXDTC = ciprofloxacin dithiocarbamate). The biodistribution results of (⁹⁹m)TcN-NFXDTC in bacterially infected mice and in mice with turpentine-induced abscesses indicated that (⁹⁹m)TcN-NFXDTC was suited to be a bacteria-specific infection imaging agent. Single photon emission computed tomography (SPECT) image studies showed there was a visible accumulation in infection sites, suggesting that it would be a promising candidate for bacterial infection imaging.

Synthesis and biological distribution of 99mTc–norfloxacin complex, a novel agent for detecting sites of infection

The optimization of the radiolabeling yield of ciprofloxacin analogous, norfloxacin, with technetium-99m (99mTc) was described. Dependence of the labeling yield of 99mTc–norfloxacin complex on the concentration of norfloxacin, SnCl2·2H2O content, pH of the reaction mixture and reaction time was studied. Norfloxacin was labeled with 99mTc at pH 3 with a labeling yield of 95.4% by using 5 mg norfloxacin, 50 μg SnCl2·2H2O and 30 min reaction time. The formed 99mTc–norfloxacin complex was stable for a time up to 3 h. Biological distribution of 99mTc–norfloxacin complex was investigated in experimentally induced inflammation rats using Staphylococcus aureus (bacterial infection model) and heat killed Staphylococcus aureus and turpentine oil (sterile inflammation model). In case of bacterial infection, the T/NT value for 99mTc–norfloxacin complex was found to be 6.9 ± 0.4 which was higher than that of the commercially available 99mTc–ciprofloxacin under the same experimental condition.

Tc-99m Ciprofloxacin SPECT of Pulmonary Tuberculosis

Tc-99m ciprofloxacin is available for imaging infection. However, there has been no study on employing single photon emission computed tomography (SPECT) with using Tc-99m ciprofloxacin to image active pulmonary tuberculosis. Therefore, we conducted this study to assess the efficacy of Tc-99m ciprofloxacin SPECT for imaging active pulmonary tuberculosis. Twenty-one participants were enrolled in this prospective study. They were divided into two groups according to the clinical and radiological assessment. Group one (Gr. 1) consisted of five normal volunteers and six patients with inactive pulmonary tuberculosis. Group two (Gr. 2) consisted of ten patients with active pulmonary tuberculosis. SPECT was performed 3 h after injecting 555MBq (15mCi) of Tc-99m ciprofloxacin. The findings of Tc-99m ciprofloxacin SPECT were interpreted by a nuclear medicine specialist and then the results were analyzed according to the patients' clinical and radiological classifications. The results of Tc-99m ciprofloxacin SPECT were as follows: eight true-positive cases, ten true-negative cases, one false-positive case and two false-negative cases. The sensitivity and specificity was 80.0% and 90.9%, respectively. The positive predictive value was 88.9% and the negative predictive value was 83.3%. Tc-99m ciprofloxacin SPECT is feasible for imaging active pulmonary tuberculosis. It is a useful nuclear-imaging method for discriminating between the active and inactive tuberculosis states in patients with a past medical history of pulmonary tuberculosis.

Synthesis and biological evaluation of a novel 99mTc(CO)3 complex of ciprofloxacin dithiocarbamate as a potential agent to target infection

The ciprofloxacin dithiocarbamate (CPFXDTC) was radiolabeled with [99mTc(CO)3(H2O)3]+ intermediate to form the 99mTc(CO)3–CPFXDTC complex in high yield. The 99mTc(CO)3–CPFXDTC complex was characterized by HPLC and its stability in serum was studied. Its partition coefficient indicated that it was a lipophilic complex. The bacterial binding efficiency of 99mTc(CO)3–CPFXDTC was almost the same as that of 99mTcN–CPFXDTC, and was higher than that of 99mTc–ciprofloxacin. Biodistribution results in induced infection mice showed 99mTc(CO)3–CPFXDTC had higher uptake at the sites of infection and better abscess/blood and abscess/muscle ratios than those of 99mTc–ciprofloxacin and 99mTcN–CPFXDTC. Single photon emission computed tomography (SPECT) static imaging study in infected rabbits demonstrated the uptake in the left thigh infection lesion was observable, while no accumulation in the right thigh muscle was found. These results suggested 99mTc(CO)3–CPFXDTC would be a promising candidate for further evaluation as infection imaging agent.

Diagnosis of Mandibular Osteomyelitis in Probable Coexisting Tumor Recurrence: Role of Tc-99m Ciprofloxacin Imaging

We demonstrate the use of Tc-99m ciprofloxacin imaging in a follow-up case of squamous cell carcinoma of the tongue post hemi-mandibulectomy with clinical suspicion of local recurrence of osteomyelitis. On Tc-99m ciprofloxacin scan, we observed a focus of sharply increasing radiotracer concentration in the left side of the mandible after 24 hours, indicating active bacterial infection. Histopathologic analysis revealed no evidence of local recurrence, whereas the culture examination showed bacterial growth sensitive to ciprofloxacin. A follow-up Tc-99m ciprofloxacin scan after debridement and 8 weeks of antibiotic treatment showed no focus of tracer concentration in the region of the mandible.

Tc-99m Ciprofloxacin Scans for Detection of Tubercular Bone Infection

Tc-99m MDP and Tc-99m ciprofloxacin scans were performed in 14 patients with suspected tubercular bone disease and in 2 cases of nontubercular bone infection. In 5 patients the findings were true negative. There were no false positives and 1 was false negative. The sensitivity, specificity, and positive predictive value were found to be 93, 71, and 87.5%, respectively, for detection of bone tubercular lesions. However, the test does not distinguish TB osteomyelitis from other types of osteomyelitis. Delayed 24 hour scans were found useful to differentiate between inflammatory and infective lesions. The aim of this study was to evaluate the usefulness of the Tc-99m ciprofloxacin scan as a means to detect tubercular bone disease.

Tc-99m ciprofloxacin imaging in acute cholecystitis

To evaluate the efficacy of a new nuclear imaging Infecton (Tc-99m ciprofloxacin) for the diagnosis of acute cholecystitis. Sixteen patients thought to have acute cholecystitis were included in this study. The diagnosis of acute cholecystitis was made based on clinical symptoms and ultrasonographic and pathologic findings. The 16 patients were composed of 12 acute and 4 chronic cholecystitis patients. Twelve patients with acute cholecystitis were image-positive, including one false-positive. Four patients with chronic cholecystitis were image-negative, of whom three were true-negative. This nuclear imaging had a sensitivity of 91.7%, a specificity of 75%, a positive-predictive value of 91.7%, and a negative-predictive value of 75%. Tc-99m ciprofloxacin imaging is easy to perform and applicable for the diagnosis of acute cholecystitis.

Imaging in Acute Pyogenic Spondylitis

A 51-year-old woman who was receiving 7.5 mg prednisone daily for sarcoidosis presented with low backache on the right side, fever, and chills 2 weeks after dental surgery. Examination revealed lower lumbar tenderness andrestricted movement. Blood cultures grew Streptococcus viridans but echocardiography failed repeatedly to demonstrate any evidence of infective endocarditis. Skeletal scintigraphy, including a pinhole image, revealed abnormal uptake in L5. Computed tomography (CT) showed a lytic lesion in the body of L5 and Tc-99m ciprofloxacin (Infecton) imaging demonstrated increased uptake in the lower lumbar region on the right. After several weeks of antibiotic therapy, the patient became afebrile and pain-free.

The Relationship between Inflammation or Bacterial Infection according to the Traditional 4-glass Tests or Tc-99m Ciprofloxacin Imaging and the Scores of the National Institute of Health-Chronic Prostatitis Symptom Index in Men with Chronic Prostatitis

Purpose: We wanted to determine whether inflammation and bacterial infection, as tested for by the traditional 4-glass test or Tc-99m ciprofloxacin imaging, correlate with the symptom severity in men with chronic prostatitis. Materials and Methods: The study included 256 patients with symptoms of prostatitis. The Korean version of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was used to measure the symptoms of each patient. To diagnose bacterial infection, four-glass tests were performed that included culture for general bacteria, Mycoplasma hominis and Ureaplasma urealyticum, and polymerase chain reaction was performed for Chlamydia trachomatis. The patients with established uropathogens localized to the expressed prostatic secretion or the voided urine 3 were classified as having chronic bacterial prostatitis (CBP). To further localize the infection, the single photon emission computerized tomography images were obtained 3 hours after intravenous injection of Tc-99m ciprofloxacin. Associations between the symptoms and the inflammation and infection were evaluated. Results: Based on the 4-glass tests, the patients were classified as CBP (n=16) or as chronic pelvis pain syndrome (CCPS) (the inflammatory type, n=94; non-inflammatory type, n=146). The CBP patients had a higher pain score than did the CPPS patients and there were no significant differences in the subscores for voiding symptoms and the quality of life between the groups. No significant differences were found in the total score or the subscores of the NIH-CPSI based on the presence or location of infection on the Tc-99m ciprofloxacin imaging. Conclusions: These findings suggest that bacterial infection, not inflammation, as determined by traditional laboratory tests contribute to the symptoms, especially pain, in men with chronic prostatitis. (Korean J Urol 2006; 47:870-875)

Comparison of the Efficacy of Transperineal Intraprostatic Injection and Oral Administration of Fluoroquinolone in Men with Chronic Bacterial Prostatitis-Seminal Vesiculitis

Purpose: Although oral antibiotic therapy remains the most common treatment modality for chronic bacterial prostatitis (CBP), it is known to have problems, such as potential adverse effects and the development of bacterial resistance. We compared the effects of oral and local injection therapies, with fluoroquinolones, in patients diagnosed as having chronic bacterial prostatitis/seminal vesiculitis, from Tc-99m ciprofloxacin imaging. Materials and Methods: The study randomly included 79 patients with symptom of prostatitis, who also showed hot uptake in the prostate or seminal vesicle on Tc-99m ciprofloxacin imaging. A total of 53 patients received oral antibiotics for 3 months. In 26 patients, a local injection of ciprofloxacin into the prostate and/or seminal vesicle was performed via the transperineal route, with transrectal ultrasonography guidance. Fourglass tests and Tc-99m ciprofloxacin imaging were performed, and the patients were asked to complete National institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaires at the baseline and 3 months after the initiation of therapy. Results: The total score or subscores from the NIH-CPSI and bacteriological study after treatment was significantly decreased in both groups compared to that before treatment. The complete cure rate, based on the Tc-99m ciprofloxacin imaging findings, was significantly higher in the local injection (23.1%) than the oral therapy group (16.9%, p<0.024). In the local injection group, 15 men (57.7%) showed transient hematuria and/or bloody ejaculation, but without any serious side effects. Conclusions: A transperineal lesional injection of fluoroquinolone will be a valuable therapeutic alternative in men with chronic bacterial prostatitis/ seminal vesiculitis; although a long term outcome study will be required. (Korean J Urol 2006;47:1185-1190) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Technetium-99m Ciprofloxacin Imaging in the Diagnosis of Postsurgical Bony Infection and Evaluation of the Response to Antibiotic Therapy: A Case Report

The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants. We present a case report of a patient with undiagnosed and unrelenting pain in the lower third of the left leg, which had persisted for 6 months. A novel scintigraphy, which was developed in-house using a 99mTC ciprofloxacin single vial kit, was used for diagnosing the active bacterial infection. A 99mTC methylene diphosphonate bone scan was also performed to locate precisely the site of the lesion. Gradually increasing concentrations of both the radiotracers confirmed the presence of active bacterial infection in the distal third of the left tibia. Follow-up scanning after antibiotic therapy showed the disappearance of the pooling of 99mTC ciprofloxacin, indicating a good response. Therefore, 99mTC ciprofloxacin has good diagnostic and prognostic applications in deep-seated covert skeletal microbial infections. However, the persistence of a focal concentration detected by the 99mTC methylene diphosphonate scan was attributed to the inflammatory and not the infective pathology.

99MTC‐CIPROFLOXACIN IN IMAGING OF CLINICAL INFECTIONS IN CAMELIDS AND A GOAT

(99M)Tc-ciprofloxacin was used to image five adult camelids and a juvenile goat with clinical and/or radiographic signs of infection. (99m)Tc-ciprofloxacin (range 10-33 MBq/kg) was injected intravenously and a series of 2-min static images were acquired at 1- and 4-h postinjection. At 24-h postinjection, 5-min static images were acquired. Only the skull or abdomen was imaged in the adults; the whole body was imaged in the goat. The quality of the 1-, 4-, and 24-h studies was evaluated subjectively. Normal and abnormal areas of (99m)Tc-ciprofloxacin uptake were recorded and subjectively graded as mild, moderate or intense. Image quality was best 4-h postinjection. Twenty-four-hour images were poor because of insufficient radioactivity. (99m)Tc-ciprofloxacin imaging resulted in true positive or true negative scans in four of six animals. Two false-negative studies occurred. Intense (99m)Tc-cirofloxacin activity was seen in the lungs and urinary bladder, moderate/intense activity in the kidneys, and mild activity in the physes/epiphyses, liver and intermittently in the gastrointestinal tract. The normal distribution of (99m)Tc-ciprofloxacin in camelids/small ruminants differed from people. Further studies to determine the sensitivity and specificity of infection detection using (99m)Tc-ciprofloxacin in animals are warranted.

Comparative scintigraphic study of 99mTc ciprofloxacin pharmacokinetics after intravenous and lymphotropic administration in experimental pulmonary suppuration

Intravenously injected 99mTc ciprofloxacin is rapidly accumulated and washed from the septic focus. Lymphotropic injections provide targeted and long-lasting effect of the antibiotic. After injection into the interspinous ligament the drug slowly enters the inflammation area (by-passing the urinary organs and liver), where it is maximally accumulated only after 24 h, which allows to reduce the number of injections and the total dose of the antibiotic.

Imaging Seminal Vesiculitis with Tc-99m Ciprofloxacin

The authors describe Tc-99m ciprofloxacin SPECT imaging and corresponding magnetic resonance images (MRIs) of a patient with a prostatitis syndrome, in whom seminal vesiculitis was finally diagnosed. Tc-99m ciprofloxacin imaging can detect areas of active bacterial infection. It is difficult to accurately classify patients with a prostatitis syndrome, because valid diagnostic tests are rare and the treatment is often empirical. Visualization of acute seminal vesiculitis in patients with a prostatitis syndrome, made possible with Tc-99m ciprofloxacin imaging, should improve diagnostic accuracy.

Renal abscess: filling in with Tc-99m ciprofloxacin of defects seen on Tc-99m DMSA SPECT.

Tc-99m DMSA SPECT and Tc-99m ciprofloxacin SPECT images were sequentially acquired (time span, 3 days) in a 21-year-old woman with clinical signs of an upper urinary tract infection, an inflammatory syndrome, and urine cultures positive for Escherichia coli. The patient had an undocumented history of pyelonephritis a few years earlier. A wedge-shaped defect seen in the lateral cortex of the left kidney on Tc-99m DMSA SPECT was filled in on the Tc-99m ciprofloxacin scan. These findings were in favor of an acute inflammatory process and not of a new episode of pyelonephritis or a structural abnormality. Contrast-enhanced computed tomography (CT) revealed the presence of an abscess at this site. To our knowledge, no such case of cold-hot kidney lesions on sequential Tc-99m DMSA and ciprofloxacin SPECT studies has been reported.

Imaging bacterial infection with 99mTc-ciprofloxacin (Infecton)

Aims: The diagnosis of deep seated bacterial infections, such as intra-abdominal abscesses, endocarditis, and osteomyelitis, can be difficult and delayed, thereby compromising effective treatment. This study assessed the efficacy of...

Tc-99m ciprofloxacin in clinically selected patients suspected for peripherial osteomyelitis, spondylodiscitis and fever of unknown origin: preliminary results

Retrospective evaluation of Tc-99m ciprofloxacin (infection) scintigraphy consecutively performed in a series of patients clinically suspected for peripheral osteomyelitis (OM), spondylodiscitis (SD) and fever of unknown origin (FUO). A total of 20 patients clinically suspected for OM (n = 12), SD (n = 3) and FUO (n = 5) were included in our retrospective analysis. The additional criterion was a positive 3-phase bone scan for OM, or a 2-phase bone scan in case of SD. Planar whole body scans and static acquisitions were performed 1 and 4 h after application of 370 MBq Tc-99m ciprofloxacin. In 10 patients with suspected OM, additional immunoscintigraphy using Tc-99m labelled monoclonal antibodies (Mab BW 250/183) was performed and the correlation of infection to bloodpool and antigranulocyte scintigraphy was analysed. OM: Bacterial infection was confirmed in 8 of 15 lesions. Infection demonstrated true positive (TP) results in 7 of 8, true negative (TN) results in 2 of 7, false positive (FP) results in 5 of 7 patients and one false negative (FN) result. A strong correlation could be demonstrated between T/NT ratios of infection and bloodpool Tc-99m medronate imaging (r = 0.84, 0.88) and between infection and BW 250/183 (r = 0.92, 0.90). Using a threshold of 2.0 for T/NT ratio, only TP results could be observed whereas a T/NT in the range of 1.0-2.0 could not discriminate between septic and aseptic inflammation. Concordant results with Mab BW 250/183 could only be observed in 5 of 10 patients (4 TP, 1 TN) by showing 4 FP and 1 FN lesions with IF. Non-specific uptake of infection can be observed in a variety of clinical situations with moderate uptake, by showing a strong correlation with blood-pool imaging. Nevertheless, intense uptake may be specific for septic inflammation.

Demonstration of Spinal Osteomyelitis With Ga-67 Citrate, Tc-99m MDP, and Tc-99m Ciprofloxacin With Provisionally Negative Results on MRI

A 65-year-old woman was hospitalized with pyrexia and lumbar back pain. Radiographs of her lumbar spine and MRI were performed on the day of admission and the results were considered normal. Five days after admission, a Tc-99m MDP bone scan was performed and showed nonspecific increased uptake at L2-L3. Planar and SPECT Ga-67 citrate scintigraphy showed increased tracer uptake at L2-L3. MRI confirmed osteomyelitis at this site. A Tc-99m ciprofloxacin scan was performed and also showed infection at L2-L3. Group B Streptococcus grew in blood cultures from the patient, who improved clinically after a prolonged course of antibiotics.