Role of Gallium-67 scintigraphy in the evaluation of occult sepsis in the medical ICU

Abstract

Patients in intensive care units (ICUs) frequently have multiple infections or persistent fever despite management. The aim of this study was to evaluate the diagnostic contribution of gallium-67 scintigraphy in ICU patients with suspected occult sepsis. One hundred and seventeen patients (>18 years) who had undergone gallium-67 scintigraphy in the ICU of our medical center over a 3-year period were retrospectively reviewed and analyzed. Patients were categorized into Group 1 (n = 84), those with a known infectious source, but who still had persistent fever or sepsis despite antibiotic treatment or abscess drainage; or Group 2 (n = 33), those without an evident infectious source after clinical, physical, and imaging studies. Among the 117 patients, 19 (16.2%) had a new diagnosis. In Group 1, 12 patients (14%) had a new infection, including pneumonia (4 patients), bed sore infection (2 patients), pulmonary tuberculosis (2 patients), leg cellulitis (1 patient), psoas muscle abscess (1 patient), osteomyelitis (1 patient), and infective endocarditis (1 patient). In Group 2, seven patients (21.2%) had a new infectious source, including septic arthritis (3 patients), osteomyelitis (2 patients), neck abscess (1 patient), and cholecystitis (1 patient). Significant differences were not observed between patients with positive and negative findings on gallium-67 scintigraphy in characteristics, underlying diseases, laboratory data, and outcomes. Gallium-67 scintigraphy helped to detect new or additional infectious sites, particularly bone, joint, and soft tissues. However, differences in hospital stay and mortality were not observed between patients with positive and negative findings.

Potential Usefulness of FDG PET/CT in Patients with Sepsis of Unknown Origin

“…An important finding of the present report is that FDG PET/CT was able to identify occult foci of infection in 66% of the patients who had previously undergone an extensive diagnostic work-up with inconclusive data. Notably, a previous study conducted in our geographic area demonstrated that Ga-67 citrate scans were able to identify only 21% of such patients [24]. Interestingly, 25% of our study participants had their treatment modified after the localization of the infectious foci.…”

Biomedical Implementation of Liquid Metal Ink as Drawable ECG Electrode and Skin Circuit

“…Thus unless contacting the material in long terms or large doses, it is safe for normal use with small amount [12]. There are also other supports on gallium safety: gallium alloy has been used as restorative material in dentistry [13] and Ga-67 scintigraphy is an important body inside medical imaging method [14], [15]. And it is easy to remove the liquid metal by spraying medical alcohol solution, whose evaporation cools the material to solid form and much easier for separation with the substrates.…”

How to Avoid Nontherapeutic Laparotomy in Patients With Multiple Organ Failure of Unknown Origin. The Role of CT Scan Revisited

“…Beckmann's study reports that the majority of equipment-and organization-related incidents occur during the transfer from ICU to radiology or the operating theater for diagnostic testing. 24 Communication between ICU and sites of destination or origin is vital for reducing waiting time and therefore transport time. 25 Also, a preventive program applied by all care providers involved in transport of critically ill patients may be associated with a 20% absolute reduction of incidents.…”