INTERESTING IMAGE 67
Ga SPECT/CT in Diagnosis and Follow-up of Acute Bacterial Prostatitis Sin-Di Lee, MD,* Yu-Li Chiu, MD,*† and Nan-Jing Peng, MD*‡
Abstract: We report a case of 63-year-old man who had urinary tract infection with septic shock, Klebsiella pneumoniae bacteremia, and bacteriuria. 67Ga SPECT/CT showed hot uptake in prostate gland, and acute bacterial prostatitis was diagnosed. After antibiotic treatment, follow-up 67Ga SPECT/CT revealed much less uptake in the prostate gland, suggesting remission of prostatitis. Key Words: 67Ga, prostatitis, SPECT/CT (Clin Nucl Med 2015;40: 672–673) Received for publication July 22, 2014; revision accepted March 6, 2015. From the *Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung; †Department of Radiology, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung; and ‡School of Medicine, National Yang-Ming University, Taipei, Taiwan. Conflicts of interest sources of funding: none declared. Reprints: Sin-Di Lee, MD, Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, No 386, Tachung 1st Rd, Zuoying District, Kaohsiung 81362, Taiwan. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4008–0672 DOI: 10.1097/RLU.0000000000000811
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www.nuclearmed.com
REFERENCES 1. Pontari MA, Joyce GF, Wise M, et al. Prostatitis. J Urol. 2007;177:2050–2057. 2. Krieger JN, Lee SWH, Jeon J, et al. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008;31(Suppl 1):S85–S90. 3. Roberts RO, Lieber MM, Bostwick DG, et al. A review of clinical and pathological prostatitis syndromes. Urology. 1997;49:809–821. 4. Nagy V, Kubej D. Acute bacterial prostatitis in humans: current microbiological spectrum, sensitivity to antibiotics and clinical findings. Urol Int. 2012;89:445–450. 5. Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010;82:397–406. 6. Siroky MB, Moylan R, Austen G Jr, et al. Metastatic infection secondary to genitourinary tract sepsis. Am J Med. 1976;61:351–360. 7. Sullivan WT, Rosen PR, Weiland FL, et al. Prostatic uptake of Ga-67. Radiology. 1984;152:537. 8. Higashi TS, Hamana T, Takizawa K, et al. Using Ga-67 scintigraphy in prostatic abscess. Ann Nucl Med. 1995;9:89–92. 9. Bajaj SK, Seitz JP, Qing F. Diagnosis of acute bacterial prostatitis by Ga-67 scintigraphy and SPECT-CT. Clin Nucl Med. 2008;33:813–815. 10. Kim JH, Baek JH, Lee JS, et al. Diagnosis and follow-up of chronic bacterial prostatitis with recurrent urinary tract infection detected by 67Ga scintigraphy and SPECT/CT. Clin Nucl Med. 2013;38:904–907.
Clinical Nuclear Medicine • Volume 40, Number 8, August 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 8, August 2015
67
Ga SPECT/CT in Diagnosis and Follow-up of ABP
FIGURE 1. A 63-year-old man had urinary tract infection with septic shock, Klebsiella pneumoniae bacteremia, and bacteriuria. 67Ga scan was performed 1 day after IV injection of 111 MBq (3 mCi) 67Ga citrate. A, Whole-body planar image showed increased uptake over basal pelvic region (arrow), which was difficult to identify in the urinary bladder, prostate gland, or colon. B, SPECT/CT revealed focal hot uptake in the right lobe of the prostate gland (arrow), and acute bacterial prostatitis (ABP) was diagnosed. The patient received a 2-week IV antibiotic treatment and then switched to oral antibiotic treatment with minocycline for 2 months. C, Follow-up 67Ga SPECT/CT revealed much less uptake in the prostate gland (arrow), suggesting remission of ABP. Prostatitis is a common benign disorder of the prostate gland, and the prevalence seems to be in the 4% to 16% range.1 The National Institutes of Health classified prostatitis into 4 categories to improve its diagnosis and treatment, including category I ABP, category II chronic bacterial prostatitis, category III chronic prostatitis/chronic pelvic pain syndrome, and category IV asymptomatic inflammatory prostatitis.2 The most common pathogen is Escherichia coli, which is identified in 50% to 80% of infections.3,4 Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia, and Proteus species are isolated in 10% to 15%. The clinical diagnosis of ABP is based on history, physical examination, and laboratory studies. Urine and expressed prostatic secretions of the preprostatic and postprostatic massage may reveal pyuria and bacteriuria, but prostatic massage may be harmful and contraindicated in ABP.5 If there is a delay in diagnosis and antibiotic treatment, the complications are more likely to occur, such as bacteremia, epididymitis, chronic bacterial prostatitis, prostatic abscesses, and metastatic infection.6 67Ga has been used for decades in inflammation imaging of nuclear medicine. SPECT/CT helps to localize 67Ga uptake in prostate gland, which is difficult to be differentiated from physiological uptake in urinary bladder and anorectal region by whole-body planar image.7–10 This case points to the significance of functional and structural fused imaging in the evaluation of ABP. 67Ga SPECT/CT helps to localize prostatic uptake, and monitoring serial scans helps to assess disease progression or response to antibiotic treatment.
© 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
673
Ga SPECT/CT in Diagnosis and Follow-up of Acute Bacterial Prostatitis Sin-Di Lee, MD,* Yu-Li Chiu, MD,*† and Nan-Jing Peng, MD*‡
Abstract: We report a case of 63-year-old man who had urinary tract infection with septic shock, Klebsiella pneumoniae bacteremia, and bacteriuria. 67Ga SPECT/CT showed hot uptake in prostate gland, and acute bacterial prostatitis was diagnosed. After antibiotic treatment, follow-up 67Ga SPECT/CT revealed much less uptake in the prostate gland, suggesting remission of prostatitis. Key Words: 67Ga, prostatitis, SPECT/CT (Clin Nucl Med 2015;40: 672–673) Received for publication July 22, 2014; revision accepted March 6, 2015. From the *Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung; †Department of Radiology, Pingtung Branch of Kaohsiung Veterans General Hospital, Pingtung; and ‡School of Medicine, National Yang-Ming University, Taipei, Taiwan. Conflicts of interest sources of funding: none declared. Reprints: Sin-Di Lee, MD, Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, No 386, Tachung 1st Rd, Zuoying District, Kaohsiung 81362, Taiwan. E-mail: [email protected]. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/15/4008–0672 DOI: 10.1097/RLU.0000000000000811
672
www.nuclearmed.com
REFERENCES 1. Pontari MA, Joyce GF, Wise M, et al. Prostatitis. J Urol. 2007;177:2050–2057. 2. Krieger JN, Lee SWH, Jeon J, et al. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008;31(Suppl 1):S85–S90. 3. Roberts RO, Lieber MM, Bostwick DG, et al. A review of clinical and pathological prostatitis syndromes. Urology. 1997;49:809–821. 4. Nagy V, Kubej D. Acute bacterial prostatitis in humans: current microbiological spectrum, sensitivity to antibiotics and clinical findings. Urol Int. 2012;89:445–450. 5. Sharp VJ, Takacs EB, Powell CR. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010;82:397–406. 6. Siroky MB, Moylan R, Austen G Jr, et al. Metastatic infection secondary to genitourinary tract sepsis. Am J Med. 1976;61:351–360. 7. Sullivan WT, Rosen PR, Weiland FL, et al. Prostatic uptake of Ga-67. Radiology. 1984;152:537. 8. Higashi TS, Hamana T, Takizawa K, et al. Using Ga-67 scintigraphy in prostatic abscess. Ann Nucl Med. 1995;9:89–92. 9. Bajaj SK, Seitz JP, Qing F. Diagnosis of acute bacterial prostatitis by Ga-67 scintigraphy and SPECT-CT. Clin Nucl Med. 2008;33:813–815. 10. Kim JH, Baek JH, Lee JS, et al. Diagnosis and follow-up of chronic bacterial prostatitis with recurrent urinary tract infection detected by 67Ga scintigraphy and SPECT/CT. Clin Nucl Med. 2013;38:904–907.
Clinical Nuclear Medicine • Volume 40, Number 8, August 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Clinical Nuclear Medicine • Volume 40, Number 8, August 2015
67
Ga SPECT/CT in Diagnosis and Follow-up of ABP
FIGURE 1. A 63-year-old man had urinary tract infection with septic shock, Klebsiella pneumoniae bacteremia, and bacteriuria. 67Ga scan was performed 1 day after IV injection of 111 MBq (3 mCi) 67Ga citrate. A, Whole-body planar image showed increased uptake over basal pelvic region (arrow), which was difficult to identify in the urinary bladder, prostate gland, or colon. B, SPECT/CT revealed focal hot uptake in the right lobe of the prostate gland (arrow), and acute bacterial prostatitis (ABP) was diagnosed. The patient received a 2-week IV antibiotic treatment and then switched to oral antibiotic treatment with minocycline for 2 months. C, Follow-up 67Ga SPECT/CT revealed much less uptake in the prostate gland (arrow), suggesting remission of ABP. Prostatitis is a common benign disorder of the prostate gland, and the prevalence seems to be in the 4% to 16% range.1 The National Institutes of Health classified prostatitis into 4 categories to improve its diagnosis and treatment, including category I ABP, category II chronic bacterial prostatitis, category III chronic prostatitis/chronic pelvic pain syndrome, and category IV asymptomatic inflammatory prostatitis.2 The most common pathogen is Escherichia coli, which is identified in 50% to 80% of infections.3,4 Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia, and Proteus species are isolated in 10% to 15%. The clinical diagnosis of ABP is based on history, physical examination, and laboratory studies. Urine and expressed prostatic secretions of the preprostatic and postprostatic massage may reveal pyuria and bacteriuria, but prostatic massage may be harmful and contraindicated in ABP.5 If there is a delay in diagnosis and antibiotic treatment, the complications are more likely to occur, such as bacteremia, epididymitis, chronic bacterial prostatitis, prostatic abscesses, and metastatic infection.6 67Ga has been used for decades in inflammation imaging of nuclear medicine. SPECT/CT helps to localize 67Ga uptake in prostate gland, which is difficult to be differentiated from physiological uptake in urinary bladder and anorectal region by whole-body planar image.7–10 This case points to the significance of functional and structural fused imaging in the evaluation of ABP. 67Ga SPECT/CT helps to localize prostatic uptake, and monitoring serial scans helps to assess disease progression or response to antibiotic treatment.
© 2015 Wolters Kluwer Health, Inc. All rights reserved. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nuclearmed.com
673
