scholarly journals White Blood Cell Scintigraphy for Fracture-Related Infection: Is Semiquantitative Analysis of Equivocal Scans Accurate?

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2227
Author(s):  
Paul Bosch ◽  
Frank F.A. IJpma ◽  
Geertje A.M. Govaert ◽  
Inge H.F. Reininga ◽  
Jean-Paul P.M. de Vries ◽  
...  
Keyword(s):  
Blood Cell ◽  
Diagnostic Accuracy ◽  
White Blood Cell ◽  
Clinical Decision Making ◽  
False Negative ◽  
Nuclear Imaging ◽  
Semiquantitative Analysis ◽  
Discriminative Ability ◽  
Suspected Infection ◽  
R Ratio

Purpose: White blood cell (WBC) scintigraphy is considered the gold-standard nuclear imaging technique for diagnosing fracture-related infection (FRI). Correct interpretation of WBC scans in FRI is important since a false positive or false negative diagnosis has major consequences for the patient in terms of clinical decision-making. The European Association of Nuclear Medicine (EANM) guideline for correct analysis and interpretation of WBC scans recommends semiquantitative analysis of visually equivocal scans. Therefore, this study aims to assess the diagnostic accuracy of semiquantitative analysis of visually equivocal WBC scans for diagnosing FRI. Methods: A retrospective single-center study was performed in consecutive patients who received WBC scintigraphy in the diagnostic work-up for FRI between February 2012 and January 2017. All the visually equivocal scans were analysed using semiquantitative analysis by comparing leukocyte uptake in the manually selected suspected infection focus with the contralateral bone marrow (L/R ratio). Cut-off points for a ‘positive’ scan result of >0%, >10% and >20% leukocyte increase between the early and late scans were used in separate analyses. The discriminative ability was quantified by calculating the sensitivity, specificity and diagnostic accuracy. Results: In total, 153 WBC scans were eligible for inclusion. After visual assessment of all the scans, 28 visually equivocal scans were included. Dichotomization of the ratios using the cut-off of >0% resulted in a sensitivity of 30%, a specificity of 45% and a diagnostic accuracy of 40%. The >10% cut-off point resulted in a sensitivity of 18%, a specificity of 82% and a diagnostic accuracy of 66%. The >20% cut-off point resulted in a sensitivity of 0%, a specificity of 89% and a diagnostic accuracy of 67%. Conclusion: Semiquantitative analysis of visually equivocal WBC scans is insufficient for correctly diagnosing FRI.

Extended combined 99mTc-white blood cell and bone imaging improves the diagnostic accuracy in the detection of hip replacement infections

2001 ◽  
Vol 28 (3) ◽  
pp. 288-293 ◽  
Author(s):  
Martti J. Larikka ◽  
Aapo K. Ahonen ◽  
Juhani A. Junila ◽  
Onni Niemelä ◽  
Martti M. Hämäläinen ◽  
...  
Keyword(s):  
Blood Cell ◽  
Diagnostic Accuracy ◽  
White Blood Cell ◽  
Hip Replacement ◽  
Bone Imaging

The Use of Tagged White Blood Cell Scans to Diagnose Appendicitis in Pregnant Patients

2006 ◽  
Vol 72 (10) ◽  
pp. 894-896 ◽  
Author(s):  
David Stewart ◽  
Nina Grewal ◽  
Rosa Choi ◽  
Kenneth Waxman
Keyword(s):  
Blood Cell ◽  
Radiation Exposure ◽  
White Blood Cell ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
Fetal Loss ◽  
Ct Scans ◽  
Positive Rate ◽  
In Pregnancy

A prompt and accurate diagnosis of appendicitis in pregnant patients is important in avoiding premature labor and fetal loss. Computed tomography (CT) scans are accurate, but fetal radiation exposure is high. Ultrasound avoids radiation exposure, but is less accurate as the uterus enlarges. A third option involves the use of technetium-99 tagged white blood cell scans (TWBCS), which have less than 5 per cent of the fetal radiation exposure of CT scans. However, in pregnancy, the value of TWBCS has not been studied. Therefore, a retrospective review of all patients who were pregnant and underwent a nuclear medicine study as part of their evaluation was performed. Thirteen patients were identified from 1999 through 2005. Before receiving a TWBCS, each patient had an indeterminate physical examination and an ultrasound or CT. Patients with negative TWBCS were admitted and observed clinically. There was no relationship between the results of TWBCS and the presence of appendicitis (P = 0.538). The sensitivity of the TWBCS was 50 per cent, whereas the specificity was 73 per cent. TWBCS had a false-positive rate of 27 per cent and a false-negative rate of 50 per cent, and its positive predictive value was 25 per cent. The data suggest that TWBCS in pregnancy is not reliable in evaluating for appendicitis.

Diagnostic performance of the noninvasive prenatal FetoGnost RhD assay for the prediction of the fetal RhD blood group status

2021 ◽  
Author(s):  
Tobias J. Legler ◽  
Sandra Lührig ◽  
Irina Korschineck ◽  
Dieter Schwartz
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Clinical Decision Making ◽  
False Negative ◽  
Clinical Decision ◽  
Multiple Pregnancies ◽  
Group Status ◽  
Test Kit ◽  
Existing Data

Abstract Purpose: To evaluate the diagnostic accuracy of a commercially available test kit for noninvasive prenatal determination of the fetal RhD status (NIPT-RhD) with a focus on early gestation and multiple pregnancies. Methods: The FetoGnost RhD assay (Ingenetix, Vienna, Austria) is routinely applied for clinical decision making either in woman with anti-D alloimmunization or in order to target the application of routine antenatal anti-D prophylaxis (RAADP) to women with a RhD positive fetus. Based on existing data in the laboratory information system the newborn’s serological RhD status was compared with NIPT RhD results. Results: Since 2009 NIPT RhD was performed in 2,968 pregnant women between week 5+6 and 40+0 of gestation (median 12+6) and conclusive results were obtained in 2,888 (97.30%) cases. Diagnostic accuracy was calculated from those 2244 (77.70%) cases with the newborn’s serological RhD status reported. The sensitivity of the FetoGnost RhD assay was 99.93% (95% CI 99.61% - 99.99%) and the specificity was 99.61% (95% CI 98.86% - 99.87%). No false positive or false negative NIPT RhD result was observed in 203 multiple pregnancies. Conclusion: NIPT RhD results are reliable when obtained with FetoGnost RhD assay. Targeted routine anti-D-prophylaxis can start as early as 11+0 weeks of gestation in singleton and multiple pregnancies.

scholarly journals A Vignette-Based Survey to Assess Clinical Decision Making Regarding Antibiotic Use and Hospitalization of Patients with Probable Aseptic Meningitis

2012 ◽  
Vol 23 (3) ◽  
pp. 125-129
Author(s):  
Glenn Patriquin ◽  
Jill Hatchette ◽  
Kevin Forward
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Baseline Scenario ◽  
Blood Cell Count ◽  
Laboratory Findings

BACKGROUND: The many etiologies of meningitis influence disease severity – most viral causes are self-limiting, while bacterial etiologies require antibiotics and hospitalization. Aided by laboratory findings, the physician judges whether to admit and empirically treat the patient (presuming a bacterial cause), or to treat supportively as if it were viral.OBJECTIVE: To determine factors that lead infectious disease specialists to admit and treat in cases of suspected meningitis.METHODS: A clinical vignette describing a typical case of viral meningitis in the emergency department was presented to clinicians. They were asked to indicate on a Likert scale the likelihood of administering empirical antibiotics and admitting the patient from the vignette and for eight subsequent scenarios (with varied case features). The process was repeated in the context of an inpatient following initial observation and/or treatment.RESULTS: Participants were unlikely to admit or to administer antibiotics in the baseline scenario, but a low Glasgow Coma Score or a high cerebrospinal fluid (CSF) white blood cell count with a high neutrophil percentage led to empirical treatment and admission. These factors were less influential after a negative bacterial CSF culture. These same clinical variables led to maintaining treatment and hospitalization of the inpatient.CONCLUSIONS: Most participants chose not to admit or treat the patient in the baseline vignette. Confusion and CSF white blood cell count (and neutrophil predominance) were the main influences in determining treatment and hospitalization. A large range of response scores was likely due to differing regional practices or to different levels of experience.

scholarly journals Clinical Utility of Indium 111–Labeled White Blood Cell Scintigraphy for Evaluation of Suspected Infection

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Sarah S. Lewis ◽  
Gary M. Cox ◽  
Jason E. Stout
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Vascular Access ◽  
Clinical Utility ◽  
Imaging Modality ◽  
Unknown Origin ◽  
Annual Number ◽  
Suspected Infection ◽  
Tertiary Referral Center ◽  
Indium 111

Background.  We sought to characterize the clinical utility of indium 111 (111In)–labeled white blood cell (WBC) scans by indication, to identify patient populations who might benefit most from this imaging modality. Methods.  Medical records for all patients who underwent 111In-labeled WBC scans at our tertiary referral center from 2005 to 2011 were reviewed. Scan indication, results, and final diagnosis were assessed independently by 2 infectious disease physicians. Reviewers also categorized the clinical utility of each scan as helpful vs not helpful with diagnosis and/or management according to prespecified criteria. Cases for which clinical utility could not be determined were excluded from the utility assessment. Results.  One hundred thirty-seven scans were included in this analysis; clinical utility could be determined in 132 (96%) cases. The annual number of scans decreased throughout the study period, from 26 in 2005 to 13 in 2011. Forty-one (30%) scans were positive, and 85 (62%) patients were ultimately determined to have an infection. Of the evaluable scans, 63 (48%) scans were deemed clinically useful. Clinical utility varied by scan indication: 111In-labeled WBC scans were more helpful for indications of osteomyelitis (35/50, 70% useful) or vascular access infection (10/15, 67% useful), and less helpful for evaluation of fever of unknown origin (12/35, 34% useful). Conclusions.  111In-labeled WBC scans were useful for patient care less than half of the time at our center. Targeted ordering of these scans for indications in which they have greater utility, such as suspected osteomyelitis and vascular access infections, may optimize test utilization.

Inadequacy of Temperature and White Blood Cell Count in Predicting Bacteremia in Patients with Suspected Infection

2012 ◽  
Vol 42 (3) ◽  
pp. 254-259 ◽  
Author(s):  
Todd A. Seigel ◽  
Michael N. Cocchi ◽  
Justin Salciccioli ◽  
Nathan I. Shapiro ◽  
Michael Howell ◽  
...  
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Blood Cell Count ◽  
Suspected Infection

scholarly journals Diagnostic accuracy of CSF cell index and corrected CSF white blood cell count in healthcare-associated ventriculitis and meningitis after intracranial hemorrhage

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S304-S304
Author(s):  
Helena Jenkinson ◽  
Onaizah Habib ◽  
Lucrecia Salazar ◽  
Rodrigo Hasbun
Keyword(s):  
Blood Cell ◽  
Diagnostic Accuracy ◽  
Intracranial Hemorrhage ◽  
White Blood Cell ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Cell Index ◽  
Csf Lactate ◽  
Wbc Count ◽  
Healthcare Associated

Abstract Background The diagnosis of healthcare-associated meningitis and ventriculitis (HCAMV) in patients with intracranial hemorrhage (ICH) is challenging. The purpose of this study was to evaluate the diagnostic accuracy of routine cerebrospinal fluid (CSF) studies including a cell index and a corrected white blood cell (WBC) count. Methods Case control study of adult patients with the diagnosis of ICH and HCAMV at a large tertiary care hospital in Houston, Texas from 2003 to 2016. Cases were defined as patients with ICH and HCAMV as documented by a positive CSF culture. Controls were selected as patients with ICH without evidence of HCAMV, no previous antibiotic therapy and a negative CSF culture. Cases and controls were matched 1:2 by age, Glasgow Coma Scale (GCS) and Apache II scores. Cell index was calculated using the following formula: (CSF leukocytes / CSF erythrocytes) / (blood leukocytes / blood erythrocytes). Corrected WBC count was calculated using the following formula: CSF leukocytes - (CSF erythrocytes/1,000). Area under the curve of receiver operating characteristic (AUC-ROC) and 95% confidence interval (CI) for CSF cell index greater than or equal to absolute value of 1, corrected CSF WBC count greater than 5 K/uL, CSF lactate greater than 4 mmol/L, and CSF glucose less than 40 mmol/L, respectively, were calculated in order to determine the accuracy of these studies. Results A total of 120 patients with ICH were included in this study; 40 patients had proven HCAMV whereas 80 patients had ICH with no evidence of HCAMV. Matching of cases and controls by age, GCS, and Apache II score was appropriate (p>0.05). The AUC-ROC values for CSF cell index, corrected CSF WBC count, CSF lactate, and CSF glucose were all low at 0.609 (95% CI = 0.449–0.768), 0.731 (95% CI = 0.589–0.872), 0.719 (95% CI = 0.573–0.864), and 0.609 (95% CI = 0.449–0.768), respectively. Conclusion This study demonstrated poor accuracy of CSF cell index, corrected CSF WBC count, CSF lactate, and CSF glucose in diagnosis of HCAMV after ICH. Disclosures R. Hasbun, Biomeriaux: Consultant, Consulting fee. Biofire: Speaker’s Bureau, Speaker honorarium. Merck: Speaker’s Bureau, Speaker honorarium. Pfizer: Speaker’s Bureau, Speaker honorarium. Medicine’s Co: Speaker’s Bureau, Speaker honorarium.

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