Use Of Scintigraphy Research Articles

Usefulness of scintigraphy with [99mTc]Tc-DPD for the detection of transthyretin cardiac amyloidosis. Reference centre experience in an endemic area

Abstract Background Cardiac amyloidosis (CA) is an infiltrative disorder caused by protein deposition, being transthyretin amyloidosis (ATTR) and primary amyloidosis (AL) the most common forms of CA. ATTR can occur in a hereditary form (ATTRv) or wild-type (ATTRwt). Our area is endemic for ATTRv due to the Val30Met mutation. Purpose To analyse the usefulness of scintigraphy with [99mTc]Tc-DPD (DPD-CS) in an endemic area and its relationship with the diagnostic of CA. Methods We conduct a retrospective study (04/2013-12/2022) of DPD-CS performed for suspected/screening of CA. Our acquisition protocol consists of performing planar images after 3h p.i.(anterior, left anterior oblique and left lateral) +/- SPECT/CT. The assessment of myocardial uptake was evaluated using the Perugini scale (PS: 0-3), considering 2 and 3 as positive scans. DPD-CS results were classified based on the suspicion of CA, according to the 2021 ESC guidelines (we considered cardiomyopathy if: left ventricle hypertrophy ≥12 mm + ≥3 typical signs/symptoms), as well as according to their final diagnosis: ATTRv, asymptomatic carriers, ATTRwt, AL, AA and other non-amyloid (NA) causes. Clinical findings were correlated with the results of the DPD-CS. Results 509 DPD-CS were performed in 478 patients (median age:73 years [22-95], 62% men). Median follow-up: 4.17 years. 127/478 patients were classified with cardiomyopathy (131/509 DPD-CS) and 351/478 without cardiomyopathy (378/509 DPD-CS). 115/509 positive DPD-CS (PS-2: 17, PS-3: 98): 113 had cardiomyopathy (55 ATTRv, 60 ATTRwt) and 2 without cardiomyopathy (1 ATTRv, 1 asymptomatic carrier). These latter two patients developed cardiomyopathy during the follow-up. 394/509 negative DPD-CS (PS 0: 387, PS 1: 7): 18 with cardiomyopathy (1 ATTRv, 1 carrier, 3 AL and 13 NA) and 376 without cardiomyopathy (30 asymptomatic carriers, 88 ATTRv, 2 AA, 9 AL and 247 NA). One patient with cardiomyopathy and ATTRv had initial negative DPD-CS, but became positive DPD-CS on follow-up. All ATTRv without cardiomyopathy presented polyneuropathy. Final diagnoses (according to DPD-CS number): 143 ATTRv (140 Val30Met, 2 Val122Ile, 1 Glu495Gln), 32 carriers (29 Val30Met, 2 Val122Ile, 1 His51Asn), 61 ATTRwt,12 AL, 2 AA and 259 NA. The analysis obtained after correlating the results of the DPD-CS regarding the presence of cardiomyopathy was: sensitivity 86.25%, specificity 99.47%, PPV 98.26% and NPV 95.43%. Conclusion Our study reaffirms the usefulness of DPD-CS in the non-invasive diagnosis of transthyretin CA. DPD-CS has an additional value in endemic areas for the early detection of CA in asymptomatic patients.

Dexamethasone for the Treatment of Cardiac Al Amyloidosis: A Case Report and Literature Review

Background: Systemic immunoglobulin light chain (AL) amyloidosis is a condition characterised by the conversion of light chains (LCs) from their soluble states into highly organised fibrillar aggregates that deposit in tissues, resulting in progressive organ damage and dysfunction. While previously considered incurable, treatment strategies are emerging for cardiac amyloidosis, underscoring the importance of early diagnosis. Case Summary: We present the case of a 69-year-old male patient who was admitted with acute onset of dyspnea and diagnosed with heart failure. The diagnosis of cardiac amyloidosis was made on the basis of a discrepancy between the results of the electrocardiogram and the echocardiogram, a conclusion that was further substantiated by the use of scintigraphy and myelogram. Given the poor left ventricular fraction, the standard chemotherapy regimen was replaced with corticosteroid therapy, which led to a significant improvement within the first 48 hours, unfortunately reversible with rapid clinical deterioration followed by sudden death within a week. Conclusion: Our aim is to highlight that early administration of dexamethasone is associated with significant clinical improvement but a high mortality rate in patients with AL cardiac amyloidosis.

Radioisotope diagnostics of endogenous ACTH-dependent hypercorticism: a review

INTRODUCTION: The literature review presents the possibilities of existing methods of radionuclide diagnosis of endogenous ACTH-dependent hypercorticism, which includes Itsenko-Cushing’s disease and ectopic ACTH syndrome. The similar clinical picture of these pathologies significantly complicates their differential diagnosis. Localization of corticotropinoma, especially in patients with persistent Cushing’s disease, and ectopic focus of ACTH hyperproduction also causes difficulties.OBJECTIVE: To analyze the available foreign and domestic literature to determine the possibilities of radionuclide imaging methods in the diagnosis of endogenous ACTH-dependent hypercorticism.MATERIALS AND METHODS: A search of scientifiс publications and clinical recommendations in the information and analytical systems PudMed and elibrary over the past twenty years, dedicated to the diagnosis of Itsenko-Cushing’s disease and ectopic ACTH syndrome using radioisotope diagnostic methods by keywords «Itsenko-Cushing’s disease», «ectopic ACTH syndrome», «radionuclide diagnostics», «scintigraphy», «SPECT», «PET».RESULTS: The presented review demonstrated the broad possibilities and prospects of using modern radioisotope imaging methods in the diagnosis of endogenous ACTH-dependent hypercorticism. Radionuclide imaging methods make it possible to conduct a study in the «whole body» mode, which makes it possible to detect not only the primary tumor focus, but also metastases in patients with ectopic ACTH syndrome in one study. In addition, the use of scintigraphy or positron emission tomography with labeled somatostatin analogues makes it possible to predict the effectiveness of treatment of formations producing adrenocorticotropic hormone with somatostatin analogues, which is important when planning antitumor therapy.CONCLUSION: The use of radioisotope diagnostic methods significantly increases the accuracy of topical diagnosis of a tumor focus, allows for an assessment of the prevalence of the tumor process and the selection of patients for antitumor therapy using somatostatin analogues.

P409 CARDIAC SYMPATHOMIMETIC RESPONSE IN PARKINSON‘S PATIENTS VS HEALTHY ADULTS

Abstract In recent works, it has been observed that cardiac sympathetic innervation contributes to the hemodynamic adaptations of the cardiovascular system, in relation to numerous needs. Orimo et al, through the use of scintigraphy with MIBG, showed in Parkinson‘s patients a marked reduction in myocardial uptake of MIBG corresponding to cardiac sympathomimetic denervation, in relation to the severity of the disease. The aim of this work was to evaluate the morpho–functional variations of the heart at a programmed sympathomimetic stimulus (dopamine test), both in healthy patients and in those suffering from Parkinson‘s disease. Materials and Methods At the University Cardiology “La Sapienza” of Rome, Pontine Polo, 10 patients affected by PD (age 56±5,5, of which 6 M and 4 W) and 10 healthy (54±6,4, of which 6M,4W)were tested in the absence of cardiovascular FR; all patients performed: blood chemistry, ECG, chest x–ray, Eco–TSA, tilt test, echocardio– Dopamine (2D–stress) and MIBG Scintigraphy. 2D–stress echocardiogradia was assessed by t–student of F.acc + EF + left and right diastolic times + GLS + Tapse + PAPS at 10, 20.30.40 µ dopa and their correlation (r–pearson) in the two groups. Discussion The observation of the data in the two groups of patients, in the absence of ongoing and remote cardiological pathology, showed a behavior of the values in the range both in basal conditions and during dopa stimulation. The comparison of the two groups both basal and during progressive dose stimulation that a statistical difference (P < 0.05) is observed on both systolic and diastolic function. The comparison in the two groups in the different stimulus phases showed a parallel growth behavior but with a different speed (Dp / Dv). There is no single explanation for these results: certainly the central role is played by the poor representation of post–ganglionic nerve endings as well as by the significant reduction of cardiac adrenergic receptors in Parkison. Conclusion The small number of patients and the data observed, stimulates researchers to continue the study, to better understand which pathophysiological mechanisms underlie these observations and verify the presence of an inverse relationship between PD and all those cardiological pathologies caused by catecholaminergic hyperstimulus.

Enostosis-Like Lesion in Thoroughbred Horse

Background: Enostosis like lesions are characterized by areas of intramedullary sclerosis affecting the long bones and their presence in any cases may be not associated with lameness. It has a migratory characteristic and, therefore there is the occurrence of lameness at different sites from the initial lesion. Its etiology is speculative and has been attributed to intraosseous increased pressure, of Havers’ canals compression, stimulation of unmyelinated fibers and circulating platelet aggregates. Diagnosis is made through nuclear scintigraphy and associated with radiographic examination. This paper aims to report a clinical case on the use of scintigraphy for the reference diagnosis of enostosis-type injury and treatment through surgical bone decompression.Case: A 2-year-old thoroughbred mare, weighing 483 kg, with a history of acute lameness of the left pelvic limb associated with the no previous signs of trauma and no noteworthy changes in radiographic and ultrasound images, was referred to the Horse Center Veterinary Clinic. In the examination of the locomotor system, the animal presented a 2/5 degree lameness in a straight line, with accentuated exacerbation of the same after flexion of the left femoro-tibio-patellar joint. In addition, presented a reduction in the caudal phase of the stride and croup asymmetry associated with mild myopenia. The findings of the scintigraphic exam characterized by intense focal area of hyperconcentration of medullary radiopharmaceutical in the proximal third of the right third metatarsal, and multiple areas of hyperconcentration in the aspect proximal to the distal third of the left tibia. In the radiographic images, multifocal radiopaque regions that coincided with the areas of radiopharmaceutical hyperconcentration were observed. The initial treatment was based on rest, use of non-steroidal antiinflammatory drugs and acetylsalicylic acid. In the 60 days’ later evaluation of the first exam, the patient returned to the clinic presenting 4/5 degree lameness and with an unsatisfactory evolution. Therefore, surgical bone decompression was performed on the left radius through intramedullary perforations with a 3.5 mm drill in the lesion sites. Approximately 30 days after the surgical procedure, the animal returned to the clinic complaining of acute 2/5 degree lameness of the left pelvic limb. The patient was removed from his race career and destined for amateur jumping events where he is currently doing the same without presenting a clinical complaint of persistent lameness.Discussion: The presence of focal areas of radiopharmaceutical hyperconcentration in several bones of a limb, not just in the same lame limb, makes it even more difficult to understand this pathology. The intensity of radiopharmaceutical uptake evident in scintigraphy exams is related to the degree of lameness. Severe lameness is associated with intense radiopharmaceutical concentration indicating an acute stage of the disease, as well as a decrease in radiopharmaceutical concentration in follow-up exams, demonstrating an improvement in the degree of lameness. In the present clinical case described, there was a decrease in the radiopharmaceutical concentration in the right radius, but in the left radius, the limb in which spinal cord decompression was performed, it was still possible to observe radiopharmaceutical hyperconcentration. This was possibly due to an inflammatory bone process caused by surgical decompression. The literature suggests a favorable prognosis for the return to athletic function, with clinical resolution after following a period of rest and administration of non-steroidal anti-inflammatory drugs. The patient in the described clinical case returned to sports activities with a reduced athletic performance requirement, replacing running events with basic and amateur jumping events. Keywords: lameness, intramedullary sclerosis, bone, equine.Título: Enostose múltipla em equino puro sangue de corridaDescritores: claudicação, esclerose intramedular, osso, equino.

Cardiac Scintigraphy and Screening for Transthyretin Cardiac Amyloidosis: Caveat Emptor.

Cardiac Scintigraphy and Screening for Transthyretin Cardiac Amyloidosis: Caveat Emptor.

Temporal Trends of Wild-type Attr Amyloidosis in the Transthyretin Amyloidosis Outcomes Survey

Introduction Wild-type transthyretin amyloidosis (ATTRwt) is an infiltrative cardiomyopathy (CM) underdiagnosed in older adults. The Transthyretin Amyloidosis Outcomes Survey (THAOS) is an ongoing, global, observational survey of patients with inherited (ATTRv) and ATTRwt amyloidosis, and asymptomatic gene carriers. Temporal trends in ATTRwt diagnosis were explored in this analysis. Hypothesis ATTRwt CM diagnosis has trended up since introducing scintigraphy. Methods Demographic and diagnostic data of CM patients enrolled in THAOS up to the 06January2020 data cut-off were analyzed. Diagnosis frequency between ATTRwt and ATTRv with cardiac phenotype (p.Val142Ile, p.Leu131Met, p.Thr60Ala, p.Ile88Leu), and ATTRwt diagnostic modality, were compared by year. Results A total of 1,069 ATTRwt patients (94.6% male) from 15 countries were identified. Symptoms were reported at a mean (SD) age of 68.8 (11.1) years and diagnosis made at 76.1 (7.1) years. Median (Q1, Q3) time to diagnosis from symptom onset was 4.7 (1.0, 10.9) years. ATTRwt diagnoses increased from single digits to >100 per year, whereas ATTRv with cardiac phenotype increased after 2007 then plateaued after 2011 (Panel A). ATTRwt diagnosis with biopsies increased and peaked in 2014 with a subsequent decline, compared to an increase in diagnosis with scintigraphy since 2012 (Panel B). Conclusions In the last decade, ATTRwt CM amyloidosis diagnoses increased with a concomitant shift from using biopsy to scintigraphy. Despite rising use of scintigraphy, half of the patients experienced diagnosis delays of >4.7 years.

Evaluation of recurrence of musculoskeletal tumors with thallium-201 scintigraphy plus SPECT/CT in pediatric population.

Imaging studies, particularly simple and contrast-enhanced tomography, constitute the first diagnostic approach to detect recurrence of musculoskeletal tumors. The aim of the present retrospective study was to demonstrate the usefulness of scintigraphy plus SPECT/CT (single photon emission computed tomography) with thallium-201 (201Tl) in the evaluation of malignant musculoskeletal tumors with suspicion of recurrence or metastatic disease. Eight weeks after the last therapy, 72 scintigraphy and SPECT/CT studies were performed to assess regional recurrence and metastatic disease in 42 patients with different types of malignant musculoskeletal tumors, such as osteosarcoma, Ewing's sarcoma, rhabdomyosarcoma, retinoblastoma, synovial sarcoma, and Wilms tumor at the Hospital Infantil de México Federico Gómez. The positive predictive value (PPV) and the confidence interval of the scintigraphy and SPECT/CT were calculated when compared with the results of the histopathological analysis and the clinical and radiological follow-up for the identification of recurrence. Scintigraphy was abnormal in 30 (71.4%) of the 42 patients; 33 lesions (30 patients) were detected by scintigraphy and 25 lesions (21 patients) by chest X-ray and tomography of two regions. The SPECT/CT was performed on 30 patients, where 12 lesions were detected in addition to the planar scintigraphy. Scintigraphy showed a PPV of 82%; SPECT/CT, 100%. 201Tl-scintigraphy can be considered as an adequate study to identify the sites of tumor viability with a high degree of diagnostic certainty combined with the SPECT/CT technique.

Myocardial perfusion scintigraphy in the diagnostics of takotsubo syndrome

We analyzed the publications about single-photon emission computed tomography in the diagnostics of takotsubo syndrome; the dynamics of testing data are presented on a clinical example. Single-photon emission computed tomography can be used to evaluate perfusion parameters for exclusion of myocardial infarction in uncertain cases. In segments with impaired contractile function, it is possible to detect normal or reduced perfusion. During the acute phase there is a reduced accumulation of radiopharmaceuticals in myocardial segments with impaired function, which coincides with the regional distribution of neuronal activity. Pathological changes may persist for several months, and use of scintigraphy with a radiopharmaceutical may help in cases when the diagnosis was not well-timed established. The method of myocardial scintigraphy in ECG-synchronized tomography allows to simultaneously assess the perfusion and the function of the left ventricle and differentiate such disorder as takotsubo syndrome.

OP-37 - Usefulness of Scintigraphy to Predict Coronary Stenting in Cabg Patients

Objective: Myocardial perfusion imaging (MPI) has also been useful for the risk stratification of patients with previous coronary artery bypass grafting (CABG). Whether myocardial tissue damage evaluated by myocardial perfusion SPECT (MPS) has an association with clinical decision making for coronary stenting in CABG patients is unclear. The purpose of this study was to elucidate the clinical significance of severity of myocardial tissue damage (SMTD) for the prediction of coronary stenting in patients with CABG.

Usefulness of Scintigraphy to Evaluate Adrenal Tumors

Usefulness of Scintigraphy to Evaluate Adrenal Tumors

Usefulness of Scintigraphy to Evaluate Adrenal Tumors

Usefulness of Scintigraphy to Evaluate Adrenal Tumors

Comparison of scintigraphy and ultrasound imaging in patients with primary, secondary and tertiary hyperparathyroidism - own experience.

BackgroundThe imaging techniques most commonly used in the diagnosis of hyperparathyroidisms are ultrasound and scintigraphy. The diagnostic algorithms vary, depending mainly on the population, and experience of physicians.AimAim of the present research was to determine the usefulness of parathyroid scintigraphy and ultrasonography in patients diagnosed for hyperparathyroidism in own material.Material and methodIn the present research, 96 operated patients with documented primary, secondary and tertiary hyperparathyroidism were retrospectively analyzed. All patients underwent a 99mTc hexakis-2-methoxyisobutylisonitrile scintigraphy of the neck with the use of subtraction and two-phase examinations. Ultrasonography of the neck was performed in all the patients in B mode 2D presentation. A total number of 172 parathyroid glands were analyzed.ResultsThe sensitivity and specificity of scintigraphy was 68% and 60%, respectively. The sensitivity of ultrasound was 49% and specificity 85%. Both techniques allowed visualization of 76 parathyroid glands. Ultrasound revealed 19 glands that were not visible in scintigraphy. Scintigraphy showed 76 parathyroid glands that were not visualized on ultrasound. Having combined the results of scintigraphy and ultrasound, the sensitivity of 76% and specificity of 50% were obtained. Considering the ability to locate the parathyroid glands in both techniques as a positive result, the sensitivity decreased to 37% and specificity rose to 95%.ConclusionsScintigraphy showed greater sensitivity than ultrasound in the localization of enlarged parathyroid glands. Ultrasound, in turn, was characterized by a higher specificity. The combined use of scintigraphy and ultrasonography allowed to obtain the specificity of 95%. In the light of obtained results, scintigraphy and ultrasonography are complementary and should be used together.

Nuclear Molecular and Theranostic Imaging for Differentiated Thyroid Cancer.

Traditional nuclear medicine is rapidly being transformed by the evolving concepts in molecular imaging and theranostics. The utility of new approaches in differentiated thyroid cancer (DTC) diagnostics and therapy has not been fully appreciated. The clinical information, relevant to disease management and patient care, obtained by scintigraphy is still being underestimated. There has been a trend towards moving away from the use of radioactive iodine (RAI) imaging in the management of the disease. This paradigm shift is supported by the 2015 American Thyroid Association Guidelines (1). A more systematic and comprehensive understanding of disease pathophysiology and imaging methodologies is needed for optimal utilization of different imaging modalities in the management of DTC. There have been significant developments in radiotracer and imaging technology, clinically proven to contribute to the understanding of tumor biology and the clinical assessment of patients with DTC. The research and development in the field continues to evolve, with expected emergence of many novel diagnostic and therapeutic techniques. The role for nuclear imaging applications will continue to evolve and be reconfigured in the changing paradigm. This article aims to review the clinical uses and controversies surrounding the use of scintigraphy, and the information it can provide in assisting in the management and treatment of DTC.

Scintigraphy for detecting tumour necrosis factor-α on the skin of patients with psoriatic arthritis

Objective: This study assessed the use of scintigraphy and magnetic resonance imaging (MRI) in identifying the presence and amount of tumour necrosis factor-α (TNF-α) in the joint or skin of patients with psoriatic arthritis, to guide the course of treatment more efficiently.Method: We compared the results of scintigraphy and MRI in two patients with psoriatic arthritis who underwent technetium-99m (99mTc)-anti-TNF-α scintigraphy, and MRI 5 days later.Results: Greater uptake of 99mTc-anti-TNF-α was observed in the left wrist and right second metacarpal in patient 1, and in the left ulnocarpal joint and distal interphalangeal joint of the left first metacarpal in patient 2. These results correlated with the MRI findings.Conclusions: 99mTc-anti-TNF-α scintigraphy may recognize the molecule involved in the inflammatory process. This may provide crucial information to help physicians make decisions about which drugs to use based on biological evidence, and which are cost-effective and appropriate for the treatment of choice. To the best of our knowledge, this is the first time that TNF-α has been shown in the skin of a patient using diagnostic imaging methods.

Vascular evaluation after cervical hip fractures in children: a case series of eight children examined by scintigraphy after surgery for cervical hip fracture and evaluated for development of secondary radiological changes.

Femoral neck fractures in children and young adults are rare, but have a high risk of avascular necrosis (AVN) and subsequent gradual collapse of the femoral head. In 2006, we initiated the use of scintigraphy for the diagnosis of vascular impairment after a cervical fracture in children. In the present retrospective case study, we evaluated the effect of the remaining postoperative circulation in the femoral head after fracture in terms of the development of AVN and secondary degenerative changes of the hip joint. Eight children, four girls and four boys [mean age 11.5 years (7-16)], had been operated for a cervical or a basocervical hip fracture between 2006 and 2012. The femoral head circulation was evaluated postoperatively with scintigraphy and all children had been followed radiographically for a minimum of 1 year. The Ficat classification was used to stage the AVN and the Stulberg classification was used to stage the sphericity of the femoral head at follow-up. In two patients, the femoral head had normal circulation postoperatively and they also had normal radiographs at follow-up. In two patients, the entire femoral head was avascular postoperatively and at follow-up, one patient had normal radiographs and one had both subchondral sclerosis and flattening. These two patients had been treated with bisphosphonates and prolonged non-weight-bearing. Four patients had postoperatively retained circulation in parts of the femoral head. Three of these four patients had normal radiographs at follow-up. Evaluation of the remaining circulation after surgery may help to predict the outcome and guide the postoperative regime in children with a femoral neck fracture.

Validez de la gammagrafía ósea de sacroilíacas para el diagnóstico de sacroiliítis en una cohorte colombiana de pacientes con espondiloartritis (SpA)

IntroductionRadiological identification of sacroiliitis is essential in the diagnosis of spondyloarthritis. Nuclear Magnetic Resonance has helped to optimize its early detection, leading to improved treatment and a better prognosis for patients. The problem with NMR is that it is expensive and there is limited access to it. For this reason cheaper studies such pelvis x-rays and scintigraphy used more often than nuclear magnetic resonance in clinical practice. ObjectiveTo determine the usefulness of scintigraphy in diagnosing sacroiliitis. MethodsThe sensitivity, specificity, positive predictive value, negative predictive value of Bone Scintigraphy were analyzed for the diagnosis of sacroiliitis in a Colombian patient cohort with Spondyloarthritis using nuclear magnetic resonance as the gold standard. ResultsA total of 55 patients were analyzed, 43.6% females and 53.3% males, with a mean disease duration of 9.1± years. The mean age of onset of symptoms was 31± years. Undifferentiated spondyloarthritis was the most frequent pathology (60.5%), and mixed pattern was the most common (58.2%). The scintigraphy performance compared to NMR was, sensitivity: 15% (95% CI; 0.04–0.25), specificity: 81% (95% CI; 0.72–0.9), positive predictive value: 32% (95% CI; 0.11–0.52), and negative predictive value: 62% (95% CI; 0.52–0.72). ConclusionsScintigraphy has variable sensitivity but a low specificity, positive predictive value, and negative predictive value, for sacroiliitis detection, thus it can be said that it is not useful in the diagnosis of spondyloarthritis.

Musculoskeletal Scintigraphy of the Equine Athlete

Nuclear scintigraphic examination of equine athletes has a potentially important role in the diagnosis of lameness or poor performance, but increased radiopharmaceutical uptake (IRU) is not necessarily synonymous with pain causing lameness. Nuclear scintigraphy is highly sensitive to changes in bone turnover that may be induced by loading and knowledge of normal patterns of RU is crucial for accurate diagnosis. Blood pool images can be useful for identification of some soft tissue injuries, although acute bone injuries may also have intense IRU in blood pool images. Some muscle injuries may be associated with IRU in bone phase images. The use of scintigraphy together with other diagnostic imaging modalities has helped us to better understand the mechanisms of some musculoskeletal injuries. In immature racehorses, stress-related bone injury is a common finding and may be multifocal, whereas in mature sport horses, a very different spectrum of injuries may be identified. False-negative results are common with some injuries.

Use of scintigraphy in the current diagnosis of thyroid diseases

Use of scintigraphy in the current diagnosis of thyroid diseases

Comment on Grippaudo et al.: Radiolabelled white blood cell scintigraphy in the work-up of dermal filler complications

Dear Sir, I read with great interest the recent article by Grippaudo et al. [1]. The authors evaluated the role of WBC scintigraphy in the diagnosis and follow-up of patients with suspected soft tissue infection caused by dermal fillers in the face. They concluded that scintigraphy with radiolabelled WBC was found to be the most accurate method for diagnosing infection in patients with long-term dermal filler complications, particularly using qualitative analysis of single photon emission computed tomography (SPECT) images. I think infection should be classified as an acute or subacute complication related to dermal fillers. Rather, foreign body granuloma is a delayed or long-term dermal filler complication [2, 3]. Therefore, it is reasonable to say that infection can be accompanied by a granulomatous reaction. Although accurate diagnosis has been made using scintigraphy with radiolabelled WBC, this novel method cannot affect the treatment modality. Clinically, once physicians suspect filler-related infection, they should commence adequate culture followed by appropriate antibiotic therapy [4, 5]. In my opinion, it would be more practical if clinicians could exclude soft tissue tumour in the cases of foreign body granuloma by use of scintigraphy with radiolabelled WBC. Diagnosis of dermal filler-related infection with such a novel method is less cost-effective. In addition, depending on such a novel method for follow-up of patients with suspected soft tissue infection caused by dermal fillers cannot be justified in all cases. I think scintigraphy with radiolabelled WBC only reveals inflammatory reactions without providing additional information about the injected materials or otherwise while incurring additional costs to the patients. Due to its cost-effectiveness, surgeons have ceased to conduct a routine diagnostic imaging study once clinical diagnoses are confirmed. In my opinion, clinical challenges originate not from an insufficient diagnostic method but mainly from the difficulty in obtaining an accurate history. Above all, accurate diagnosis based on clinical suspicion is the most important to define treatment [4]. However, as dermal filler injections have become widespread and subsequent infection/inflammation or granuloma have increased, I agree with Grippaudo et al. that physicians treating these complicated conditions should be familiar with the novel diagnostic method [1]. With various dermal fillers, attempts to rejuvenate the aging hands also have recently gained popularity [5]. I suggest that further study with complications of hand rejuvenation can also be of great interest to many clinicians with the novel method introduced by the authors. To the best of our knowledge, the article by Grippaudo et al. is the first study to introduce scintigraphy with radiolabelled WBC for the diagnosis and follow-up of injected filler complications. This issue itself has special merit to many surgeons as well as other physicians treating this complicated condition and further studies with granulomatous lesions caused by dermal filler are warranted.