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Research ArticleImaging

Novel Method to Detect and Characterize 18F-FDG Infiltration at the Injection Site: A Single-Institution Experience

Razi Muzaffar, Sarah A. Frye, Anna McMunn, Kelley Ryan, Ron Lattanze and Medhat M. Osman
Journal of Nuclear Medicine Technology December 2017, 45 (4) 267-271; DOI: https://doi.org/10.2967/jnmt.117.198408
Razi Muzaffar
1Division of Nuclear Medicine, Department of Radiology, Saint Louis University, St. Louis, Missouri
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Sarah A. Frye
2Doisy College of Health Sciences, Saint Louis University, St. Louis, Missouri
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Anna McMunn
3SSM Health Saint Louis University Hospital, St. Louis, Missouri; and
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Kelley Ryan
4Lucerno Dynamics, Cary, North Carolina
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Ron Lattanze
4Lucerno Dynamics, Cary, North Carolina
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Medhat M. Osman
1Division of Nuclear Medicine, Department of Radiology, Saint Louis University, St. Louis, Missouri
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  • FIGURE 1.
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    FIGURE 1.

    (Top) Sensors placed on injection arm and contralateral control arm. (Bottom) Lara device consists of 2 scintillation sensors, 2 pads, a reader, and a docking station.

  • FIGURE 2.
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    FIGURE 2.

    Time–activity curves from sensor recordings in 3 subjects. (Top) Example of ideal injection in right antecubital fossa. Sensor results drop immediately to reference arm level. (Middle) Example of moderate infiltration with injection in left wrist. Sensor results do not drop immediately to reference arm level. (Bottom) Example of severe infiltration with injection in right antecubital fossa. Sensor results never fall to reference arm level. Red line = reference arm level; red arrow = injection site; black line = sensor result; blue arrow = drop in sensor result.

Tables

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    TABLE 1

    Results for Each of the Initial 40 Patients

    Physician reportingSensor reporting
    Patient no.Infiltration present?Would SUV be affected?Infiltration present?Additional characterization?
    1NoYes, minorYes
    2NoNoNo
    3Site not in FOVYes, moderateYes
    4NoNoNo
    5Yes, minorNot likelyYes, minorNo
    6NoYes, minorYes
    7Yes, minorNot likelyYes, moderateYes
    8NoNoNo
    9Site not in FOVYes, minorYes
    10Yes, moderateNot likelyYes, moderateNo
    11NoNoNo
    12Site not in FOVNoYes
    13Yes, moderateNot likelyYes, minorYes
    14Yes, minorNot likelyYes, minorNo
    15Yes, significantVery likelyYes, significantNo
    16NoNoNo
    17Yes, moderateNot likelyYes, moderateNo
    18Site not in FOVNoYes
    19Yes, moderatePossibly likelyYes, moderateNo
    20Yes, minorNot likelyYes, minorNo
    21Yes, minorNot likelyYes, minorNo
    22NoNoNo
    23NoNoNo
    24NoNoNo
    25NoNoNo
    26*NoYes, minorYes
    27Yes, moderateNot likelyYes, minorYes
    28NoYes, minorYes
    29NoNoNo
    30NoNoNo
    31YesNot likelyYes, minorNo
    32NoNoNo
    33Yes, minorNot likelyYes, minorNo
    34Yes, minorNot likelyYes, minorNo
    35Yes, minorNot likelyYes, minorNo
    36NoNoNo
    37NoNoNo
    38NoNoNo
    39Yes, minorYes, minorYes
    40NoNoNo
    • ↵* Injection was in right forearm and within FOV; no injection problems were evident.

    • FOV = field of view.

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    TABLE 2

    Results Classified by Infiltration Extent Before Modifications Were Made

    Infiltration extentPhysician reportingSensor reportingReconciliation
    Minor916Sensor and physician reporting agreed on 8 minor infiltrations, but sensor classified 1 additional as out of the FOV; sensor found mild infiltration in 5 cases where physician found no infiltration and in 2 cases where physician found moderate infiltration
    Moderate55Sensor and physician reporting agreed on 3 moderate infiltrations; sensor found moderate infiltration in 1 case where physician found the injection site to be out of the FOV and in 1 case where physician found minor infiltration
    Significant11Sensor and physician reporting agreed on 1 significant infiltration
    Infiltration rate38%55%
    • FOV = field of view.

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    TABLE 3

    Results Classified by Infiltration Extent After Modifications Were Made

    Infiltration extentPhysician reportingSensor reportingReconciliation
    Minor132Of 13 infiltrations classified as minor on physician reporting, 12 were so minor that sensor did not count them, and sensor agreed that 1 was minor; 1 infiltration classified as moderate on physician reporting was classified as minor on sensor reporting
    Moderate32Of 3 infiltrations classified as moderate on physician reporting, sensor reporting agreed with two
    Significant10
    Infiltration rate25%6%
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Journal of Nuclear Medicine Technology: 45 (4)
Journal of Nuclear Medicine Technology
Vol. 45, Issue 4
December 1, 2017
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Novel Method to Detect and Characterize 18F-FDG Infiltration at the Injection Site: A Single-Institution Experience
Razi Muzaffar, Sarah A. Frye, Anna McMunn, Kelley Ryan, Ron Lattanze, Medhat M. Osman
Journal of Nuclear Medicine Technology Dec 2017, 45 (4) 267-271; DOI: 10.2967/jnmt.117.198408

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Novel Method to Detect and Characterize 18F-FDG Infiltration at the Injection Site: A Single-Institution Experience
Razi Muzaffar, Sarah A. Frye, Anna McMunn, Kelley Ryan, Ron Lattanze, Medhat M. Osman
Journal of Nuclear Medicine Technology Dec 2017, 45 (4) 267-271; DOI: 10.2967/jnmt.117.198408
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Keywords

  • 18F-FDG
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