A 62 year old woman with history of lumbar and right femur instrumentation has persistent fevers.
She undergoes the following imaging exam:
There is linear radiotracer uptake in the left abdomen. The rotating SPECT MIP images are depicted below:
Fused SPECT and contrast-enhanced CT images:
This is a patient with infectious colitis. The SPECT/CT shows Indium-111 WBC uptake in the descending colon, with wall thickening in the descending and sigmoid colon.
Normal distribution of Indium-111 labeled white cells at 24 hours is highest activity seen in the spleen, followed by liver and bone marrow. No normal intestinal activity is seen. The tracer is not normally cleared by biliary, gastrointestinal or urinary routes.
An important differential consideration for this case is colon malignancy, because of the associated inflammatory cell infiltration seen with cancer. (This inflammation has been proposed to contribute to FDG uptake in some types of cancer.) However in this case, a subsequent biopsy demonstrated inflammatory changes without malignancy.
Ziessman HA, O’Malley JP, Thrall JH, eds. Nuclear Medicine, the Requisites, 4th ed. Philadelphia: Elsevier, 2014.