Tc-99m HMPAO ile işaretli lökosit sintigrafisi verileri ile sistemik inflamatuar markerların (NLR, PLR, SII) karşılaştırılması

Abstract

Amaç: Kanda dolaşan lökositlerin gama ışıması yapan radyoaktif maddeler ile işaretlenerek birikim gösterdiği alanların tespiti ile enfeksiyon ve inflamasyon görüntülemesi günümüzde sıklıkla kullanılmaktadır. Sistemik inflamasyonun değerlendirilmesinde nötrofil/lenfosit oranları (NLR),Platelet lenfosit oranı (PLR) kullanılmaktadır.Ancak bu iki enflamatuar marker nötrofil ve lenfosit sayılarını esas alarak bir değerlendirmeye olanak sağlar.Sistemik enflamatuar indeks adı verilen marker ise nötrofil, trombosit ve lenfosit sayılarını baz alarak bir değerlendirmeye olanak sağlayan yeni bir prognostik belirteçtir.Bu çalışmada amacımız Tc-99m HMPAO ile işaretli lökosit sintigrafisi bulguları ile NLR, PLR ve SII gibi sistemik inflamautar markerların ilişkisini araştırmaktı. Gereç ve yöntem: Çalışmamıza rutin klinik işleyiş içerisinde 2014-2020 yılları arasında vücudun herhangi bir bölgesinde enfeksiyon şüphesi nedeni ile Tc-99m HMPAO ile işaretli lökosit sintigrafisi tetkiki yapılan hastalar dahil edildi.SII = (trombosit sayısı × nötrofil sayısı)/lenfosit sayısı formülü ile hesaplanırken,NLR mutlak nötrofil sayısının lenfositlerin mutlak sayısına bölünmesi ile,PLR ise mutlak trombosit sayısının olarak lenfositlerin mutlak sayısına bölünmesi ile hesaplandı.Veriler SPSS 23.0 programı ile değerlendirildi. Bulgular: Çalışmamızda enfeksiyon görüntülemesi amacıyla işaretli lökosit sintigrafisi yapılmış 48 hasta yer almaktadır (38 erkek,10 kadın,ortalama yaş:59,1±13,5). Lökosit sintigrafisi ile SII ve PLR arasında istatistiksel olarak anlamlı ilişki varken, NLR ile arasında anlamlı ilişki bulunmadı.Lökosit sintigrafisi ile SII arasındaki ilişki değerlendirildiğinde sintigrafide enfeksiyon ile uyumlu olabilecek tutulum olan hastalarda SII ortalama 1615±1204 iken, olmayan hastalarda 1065±419 idi (p=0.033).Lökosit sintigrafisi ile PLR arasındaki ilişki değerlendirildiğinde sintigrafide enfeksiyon ile uyumlu olabilecek tutulum olan hastalarda PLR ortalama 191.03±98.80 iken,olmayan hastalarda 134.65±54.01 idi (p=0.016).Lökosit sintigrafisi ile NLR arasındaki ilişki değerlendirildiğinde sintigrafide enfeksiyon ile uyumlu olabilecek tutulum olan hastalarda NLR ortalama 4.80±1.85 iken,olmayan hastalarda 4.10±1.35 idi (p=0.181). Sonuç: İşaretli lökosit sintigrafisi ve sistemik inflamatuar markerlar karşılaştırıldığında sintigrafide enfeksiyon varlığı ile SII ve PLR arasıdaki istatistiksel olarak anlamlı bir ilişki bulunurken NLR ile ilişki istatistiksel olarak anlamlı değildi.

Keywords

• Lökosit sintigrafisi
• Enfeksiyon
• SII
• NLR
• PLR
• sistemik immün inflamasyon indeksi

Comparison of 99mTc-HMPAO-labeled leukocyte scintigraphy findings with systemic inflammatory markers

Abstract

Aims: Technetium-99m-hexamethylpropylene amine oxime (99mTc-HMPAO) labeled leukocyte scintigraphy is frequently used for infection imaging. The systemic immune-inflammation index is a new marker. In this study, we aim to investigate the relationship between 99mTc-HMPAO-labeled leukocyte scintigraphy findings and systemic inflammatory markers such as Neutrophil/lymphocyte ratios (NLR) and Platelet lymphocyte ratio (PLR) and systemic immune-inflammation index (SII). Methods: Patients who underwent 99mTc-HMPAO-labeled leukocyte scintigraphy between 2014 and 2020 due to suspected infection such as diabetic foot infection or prosthesis infection vs. in any part of the body were included in our study. In addition, a negative control group consisting of 19 normal subjects who had no leukocyte scintigraphy and had hemogram examination was added to the study. Cases with findings consistent with infection in labeled leukocyte scintigraphy and infectious symptoms in this area of involvement in the clinical examination were considered as the positive group. The data were evaluated with the SPSS 23.0 program. Results: Our study included 36 patients (28 males,8 females, mean age: 59.7). The mean SII was 1526±787 x109 cells/L in patients with positive findings in leukocyte scintigraphy that might be compatible with infection, while it was 1025 ± 370 x109 cells/L in patients who did not (p=0.017). The mean PLR was 183.95±68.30 in patients with positive findings in leukocyte scintigraphy that might be compatible with infection, while it was 145.81±58.30 in patients who did not (p=0.102). The mean NLR was 4.82±1.91 in patients with positive findings on leukocyte scintigraphy that might be compatible with infection, while it was 4.15±1.40 in patients who did not (p=0.181). While the negative control group and the patients who were considered positive in leukocyte scintigraphy were compared; a statistically significant difference was found between SII, NLR and PLR values. When the relationship between SII was evaluated, the mean SII was 1526±787 x109 cells/L in patients with involvement that may be compatible with infection in leukocyte scintigraphy, while it was 762±224 x109 cells/L in the negative control group (p<0.05). While the relationship between PLR was evaluated, the mean PLR was 183.95±68.30 in patients with involvement that might be compatible with infection in leukocyte scintigraphy, while it was 100.67±26.18 in the negative control group (p<0.05). When the relationship between NLR was evaluated, the mean NLR was 4.82±1.91 in patients with involvement that might be compatible with infection in leukocyte scintigraphy, while it was 3.11±0.85 in the negative control group (p<0.05). Conclusion: When labeled leukocyte scintigraphy and systemic inflammatory markers were compared, there was a statistically significant relationship between the presence of infection in scintigraphy and SII, but the relationship with NLR and PLR were not statistically significant. When the negative control group and the patients who were considered positive in leukocyte scintigraphy were compared; a statistically significant difference was found between SII, NLR and PLR values. For this reason, we think that SII, NLR and PLR may be useful markers for diagnosis confirmation in centers that can’t perform radiolabeled infection imaging.

Keywords

• Leukocyte scintigraphy
• Infection
• SII
• NLR
• PLR
• Systemic immune-inflammation index

References

1. Ziessman HA, O’Malley JP, Thrall JH. (2013). Nuclear medicine: the requisites e-book. Elsevier Health Sciences.
2. Signore A, Jamar F, Israel O, Buscombe J, Martin-Comin J, Lazzeri E. Clinical indications, image acquisition and data interpretation for white blood cells and anti-granulocyte monoclonal antibody scintigraphy: an EANM procedural guideline. Eur J Nucl Med Mol Imaging. 2018;45(10):1816-1831. doi:10.1007/s00259-018-4052-x
3. Love C, Marwin SE, Tomas MB, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med. 2004;45(11):1864-1871.
4. Palestro CJ. Radionuclide imaging of osteomyelitis. Semin Nucl Med. 2015;45(1):32-46. doi:10.1053/j.semnuclmed.2014.07.005
5. Datz FL. Indium-111-labeled leukocytes for the detection of infection: current status. Semin Nucl Med. 1994;24(2):92-109.
6. Yaylali O. The role of molecular imaging methods in orthopedic prosthetic infections/Ortopedik protez enfeksiyonlarinda molekuler görüntüleme yöntemlerinin rolü. Nuclear Medicine Seminars. Vol. 2. No. 2. Galenos Yayinevi Tic. Ltd., 2016.
7. Velasco Á, Rodríguez-Revuelta J, Olié E, et al. Neutrophil-to-lymphocyte ratio: a potential new peripheral biomarker of suicidal behavior. Eur Psychiatry. 2020;63(1):e14. doi:10.1192/j.eurpsy.2019.20
8. Sun H, Que J, Peng Y, et al. The neutrophil-lymphocyte ratio: a promising predictor of mortality in coronary care unit patients - a cohort study. Int Immunopharmacol. 2019;74:105692. doi:10.1016/j.intimp.2019.105692

9. Bilen MA, Martini DJ, Liu Y, et al. The prognostic and predictive impact of inflammatory biomarkers in patients who have advanced-stage cancer treated with immunotherapy. Cancer. 2019;125(1):127-134. doi:10.1002/cncr.31778
10. Hu J, Zhou W, Zhou Z, Han J, Dong W. Elevated neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict post-stroke depression with acute ischemic stroke. Exp Ther Med. 2020;19(4):2497-2504. doi:10.3892/etm.2020.8514
11. Huang G, Chen H, Wang Q, et al. High platelet-to-lymphocyte ratio are associated with post-stroke depression. J Affect Disord. 2019;246:105-111. doi:10.1016/j.jad.2018.12.012
12. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222. doi:10.1158/1078-0432.CCR-14-0442
13. Tong YS, Tan J, Zhou XL, Song YQ, Song YJ. Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med. 2017;15(1):221. doi:10.1186/s12967-017-1326-1
14. Govaert GAM, Bosch P, IJpma FFA, et al. High diagnostic accuracy of white blood cell scintigraphy for fracture related infections: Results of a large retrospective single-center study. Injury. 2018;49(6):1085-1090. doi:10.1016/j.injury.2018.03.018
15. Granados U, Fuster D, Soriano A, et al. Cribado mediante angiogammagrafía previo a la realización de gammagrafía con leucocitos (99m)Tc-HMPAO en el diagnóstico de infección de prótesis articulares [Screening with angiographic images prior to (99m)Tc-HMPAO labelled leukocyte scintigraphy in the diagnosis of periprosthetic infection]. Rev Esp Med Nucl Imagen Mol. 2015;34(4):219-224. doi:10.1016/j.remn.2014.10.003
16. Şener K, Çakır A, Kılavuz H, Altuğ E, Güven R. Diagnostic value of systemic immune inflammation index in acute appendicitis. Rev Assoc Med Bras (1992). 2023;69(2):291-296. doi:10.1590/1806-9282.20221003
17. Ozer Balin S, Ozcan EC, Uğur K. A New Inflammatory Marker of Clinical and Diagnostic Importance in Diabetic Foot Infection: Systemic Immune-Inflammation Index [published online ahead of print, 2022 Oct 11]. Int J Low Extrem Wounds. 2022;15347346221130817. doi:10.1177/15347346221130817
18. Wang RH, Wen WX, Jiang ZP, et al. The clinical value of neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR) and systemic inflammation response index (SIRI) for predicting the occurrence and severity of pneumonia in patients with intracerebral hemorrhage. Front Immunol. 2023;14:1115031. Published 2023 Feb 13. doi:10.3389/fimmu.2023.1115031
19. Carpio-Orantes LD, García-Méndez S, Hernández-Hernández SN. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and systemic immune-inflammation index in patients with COVID-19-associated pneumonia. Índices neutrófilo/linfocito, plaqueta/linfocito e inmunidad/inflamación sistémica en pacientes con neumonía por COVID-19. Gac Med Mex. 2020;156(6):527-531. doi:10.24875/GMM.M21000480
20. Asik Z. The Role of the NLR and PLR in urinary tract infection. Clin Lab. 2021;67(10):10.7754/Clin.Lab.2021.210133. doi:10.7754/Clin.Lab.2021.210133
21. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. doi:10.1016/j.intimp.2020.106504