[124I]FIAU: Human dosimetry and infection imaging in patients with suspected prosthetic joint infection

Xiaoyan M. Zhang, Halle H. Zhang, Patrick McLeroth, Richard D. Berkowitz, Michael A. Mont, Michael G. Stabin, Barry A. Siegel, Abass Alavi, T. Marc Barnett, Jeffrey Gelb, Chantal Petit, John Spaltro, Steve Y. Cho, Martin G. Pomper, James J. Conklin, Chetan Bettegowda, Saurabh Saha

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


Introduction: Fialuridine (FIAU) is a nucleoside analog that is a substrate for bacterial thymidine kinase (TK). Once phosphorylated by TK, [124I]FIAU becomes trapped within bacteria and can be detected with positron emission tomography/computed tomography (PET/CT). [124I]FIAU PET/CT has been shown to detect bacteria in patients with musculoskeletal bacterial infections. Accurate diagnosis of prosthetic joint infections (PJIs) has proven challenging because of the lack of a well-validated reference. In the current study, we assessed biodistribution and dosimetry of [124I]FIAU, and investigated whether [124I]FIAU PET/CT can diagnose PJIs with acceptable accuracy. Methods: To assess biodistribution and dosimetry, six subjects with suspected hip or knee PJI and six healthy subjects underwent serial PET/CT after being dosed with 74 MBq (2 mCi) [124I]FIAU intravenously (IV). Estimated radiation doses were calculated with the OLINDA/EXM software. To determine accuracy of [124I]FIAU, 22 subjects with suspected hip or knee PJI were scanned at 2-6 and 24-30 h post IV injection of 185 MBq (5 mCi) [124I]FIAU. Images were interpreted by a single reader blinded to clinical information. Representative cases were reviewed by 3 additional readers. The utility of [124I]FIAU to detect PJIs was assessed based on the correlation of the patient's infection status with imaging results as determined by an independent adjudication board (IAB). Results: The kidney, liver, spleen, and urinary bladder received the highest radiation doses of [124I]FIAU. The effective dose was 0.16 to 0.20 mSv/MBq and doses to most organs ranged from 0.11 to 0.76 mGy/MBq. PET image quality obtained from PJI patients was confounded by metal artifacts from the prostheses and pronounced FIAU uptake in muscle. Consequently, a correlation with infection status and imaging results could not be established. Conclusions: [124I]FIAU was well-tolerated in healthy volunteers and subjects with suspected PJI, and had acceptable dosimetry. However, the utility of [124I]FIAU for the clinical detection of PJIs is limited by poor image quality and low specificity.

Original languageEnglish (US)
Pages (from-to)273-279
Number of pages7
JournalNuclear Medicine and Biology
Issue number5
StatePublished - May 1 2016


  • Diagnosis
  • FIAU
  • PET/CT
  • Prosthetic joint infection

ASJC Scopus subject areas

  • Molecular Medicine
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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