Intestinal accumulation of 111In-granulocytes in patients studied because of occult infection

111In-granulocyte scintigraphy was performed on 245 patients in whom a localized infection was suspected. In 123 patients scintigraphy was positive and of these 35 (28%) had intestinal accumulations of 111In-granulocytes. Specific local causes for the intestinal uptake of radioactivity were antibiotic associated colitis (eight patients), local pyogenic bowel infection (four patients), systemic disease (two patients), bowel necrosis (two patients), colonic cancer (one patient) and Stevens-Johnson's syndrome (one patient). Nonspecific mechanisms of bowel accumulation were desquamation of labelled granulocytes (12 patients) and bleeding (two patients). In three cases the mechanism of colonic accumulation of granulocytes was not revealed. These results show that unexpected accumulations of labelled granulocytes in the gut is not a rare phenomenon and is often due to clinically significant intestinal inflammation or other disease, especially in patients who do not have signs of respiratory, pancreatic or oesophageal inflammation causing desquamated granulocytes to accumulate in the gut.     

A comparative distribution study of 111In-labelled DTPA and TTHA monoclonal antibody conjugates in a choriocarcinoma xenograft model

Conjugates of the chelating agents DTPA and TTHA with a monoclonal anti-HCG were prepared. The tissue distribution of the ¹¹¹In-labelled conjugates and also ¹¹¹In-citrate was studied in mice bearing human choriocarcinoma xenografts. The antibody conjugates both gave high liver and spleen radionuclide accumulation. Elevated femur levels were observed for the TTHA conjugate and ¹¹¹In-citrate. Generally the DTPA conjugate showed the highest tumor/tissue ratios, although its tumor/blood ratio was lower than the other two materials. The results infer that the DTPA conjugate has the greatest utility as an imaging agent but that it would require a background subtraction technique.     

No difference in sensitivity for occult infection between tropolone- and oxine-labeled indium-111 leukocytes

There is considerable disagreement as to whether oxine or tropolone is the best labeling agent for indium leukocytes. We have previously looked at the sensitivity of oxine-labeled 111In leukocyte scans for occult infections and now present a similar group of patients imaged with tropolone-labeled 111In leukocytes. Thirty-four patients (38 studies) with possible occult infection were prospectively studied. Patients were imaged 1-4 hr after injection and again at 24 hr postinjection. The early tropolone images had a sensitivity of 53% while the delayed images at 24 hr had a sensitivity of 93%. Based on a previous study, oxine-labeled leukocyte scans have an early sensitivity of 33% and a delayed sensitivity (at 24 hr) of 95%. The differences in sensitivity between oxine and tropolone when imaged early and at 24 hr were not statistically significant. We conclude that there is no significant difference in the ability to detect infection between oxine- and tropolone-labeled leukocytes, both early at 1-4 hr, and on delayed imaging 24 hr after injection.     

Detection of deep venous thrombosis with indium 111-labelled monoclonal antibody against tissue plasminogen activator

The administration of a radiolabelled monoclonal antibody against tissue plasminogen activator allows detection of areas with increased fibrinolytic activity, i. e. those with an active thrombotic lesion. Eight patients with phlebographically verified deep venous thrombosis were examined. At the time of immunoscintigraphy study they were examined receiving anticoagulant therapy. Some 75–85 MBq indium 111-labelled antibody were injected, and scintigrams were obtained after 30 min and after 24 h. The precise site of the thrombus could not be visualized after 30 min due to high background activity, whereas after 24 h it was detectable in all patients. The thrombus/background ratios achieved are twice as high as those observed in a human antifibrin antibody study. These preliminary data suggest a high sensitivity of our t-PA-specific antibody for the detection of active deep venous thrombosis in man, and our antibody seems to offer theoretical advantages over both platelet and fibrin-specific antibodies.     

螺旋CT及重组技术对小肠Crohn病的诊断价值

目的：探讨小肠Crohn病的CT表现。方法：回顾性分析经病理证实的8例Crohn病的CT扫描及后处理图像,分析病变肠管的数量、部位、肠壁的厚度和增强后病变肠壁的强化及并发症（蜂窝组织炎、炎性肿块、脓肿和瘘管）。结果：CT及后处理图像均能显示小肠Crohn病的病变肠段,敏感度为100%,8例共显示27段炎症肠壁。小肠Crohn病的CT表现：增强后所有病变肠段肠壁均有强化,25个病变肠段（92%）肠壁增厚,病变累及第6组小肠（回肠远段）8例,累及第5组（回肠中段）、第4组（回肠近段）、第3组（空肠远段）和第2组小肠（空肠近段）者分别7例、3例、2例和2例,累及回盲部3例,广泛累及结肠2例,8例均同时累及2组及2组以上小肠并呈节段性分布。肠系膜血管改变5例（62%）,肠管周围蜂窝织炎3例,炎性肿块2例,腹腔脓肿形成1例,未见瘘管形成。结论：螺旋CT及后处理技术是诊断小肠Crohn病的一种敏感的检查方法,并可判断病变的活动性,对指导临床治疗具有重要意义。     

Autologous 111In-oxine-labeled granulocytes in Yersinia infections

Autologous ¹¹¹In-oxine-labeled granulocytes have proved to be valuable for the localization of inflammatory bowel diseases, especially Crohn's disease and ulcerative colitis. Other rare inflammatory bowel diseases also yield positive ¹¹¹In scans. One case of Yersinia infection of the terminal ileum (Yersinia enterocolitica) showing an accumulation of ¹¹¹In-oxine-labeled granulocytes 0.5, 4, and 24 h after the reinjection of the labeled cells is described. The 4-day fecal excretion of ¹¹¹In-oxine granulocytes showed a slight inflammatory activity of the terminal ileum. One negative scan is reported in a cotrimoxazoletreated patient with Yersinia infection.     

小儿肠重复畸形的影像学诊断

目的 提高对肠重复畸形的术前影像学认识及诊断水平。材料与方法 结合文献回顾性分析11例经手术和病理证实的肠重复畸形影像学表现、临床和病理特点。结果 11例肠重复畸形中,空肠2例,回肠8例,结肠1例,全部为囊肿型。其中,1例有细孔与回肠相通,同时有异位胃粘膜,1例囊肿穿孔,2例伴发炎症,与周围组织粘连。肠重复畸形9例位于系膜侧,2例位于系膜对侧。X线平片及钡餐见肠管受压移位,充盈钡剂的肠管勾划出肿块轮廓。超声示腹腔内囊性肿块,周围有蠕动的肠管包绕,其中1例并发感染,边缘模糊,壁厚。抗炎治疗后肿块缩小。CT扫描：低密度单房囊性肿块,壁较厚,增强扫描囊壁可强化。推移囊肿后位置可发生一定变化。结论 通过对多种影像学检查的综合分析并紧密结合临床,可提高肠重复畸形的术前诊断水平。     

Feasibility study of radioimmunoguided surgery of colorectal carcinomas using indium-111 CEA-specific monoclonal antibody

The study was undertaken to define the potential use of indium 111 carcinoembryonic antigen-specific antibody labelled [CEA F(ab)2] for the radioimmunodetection of colorectal carcinoma using an intraoperative hand-held gamma probe. The use of a linear radioactive source allowed optimization of physical characteristics. The best results regarding sensitivity and resolution were obtained using a 5-mm thick tungsten alloy collimator. A simulation study with a liver phantom (22 MBq or 0.6 mCi) was performed to determine the effect of side scatter as opposed to direct background and showed that it is possible to detect small radioactive targets (3.7 KBq or 0.1 Ci) 4 cm from the phantom. A clinical study performed with ten patients showed that tumours with good uptake of CEA-specific antibody could be detected with sufficient contrast in two patients when the probe was used. Results of a biodistribution study performed after tumour fragment or normal tissue countings in a well counter showed high tumour uptake (above 8 x 10^–3 injected dose/g) and tumour-to-normal tissue ratios (between 2.5 and 20) in five patients. Results with the probe showed markedly lower ratios. There was no correlation between absolute tumour uptake and the count rates of tumour measured intraoperatively. This can be attributed to the degradation of depth resolution resulting from the high energy photopeak of gamma-emitting¹¹¹In.     

DSA对肠血管发育不良的诊断价值

目的 探讨数字减影血管造影（DSA）对肠血管发育不良的诊断价值。资料与方法 对9例经临床手术病理证实的肠血管发育不良的DSA资料作一回顾性分析。结果 综合分析DSA表现，可归纳为如下几种：（1）局部畸形血管闭伴引流静脉；（2）从肠系膜缘侧至对侧缘走行的直小血管增粗、迂曲；（3）病变血管增多、增粗、聚集；（4）动静脉瘘和动脉期静脉早显；（5）对比剂补溢。结论 DSA对肠血管发育不良的诊断具有重要意义。     

Decreased sensitivity of early imaging with In-111 oxine-labeled leukocytes in detection of occult infection: concise communication

Imaging with leukocytes labeled with indium-111 oxine is a sensitive technique for detecting sites of occult infection. Traditionally, imaging is performed 24 hr after injection. We undertook a prospective study of 35 patients (40 studies) with possible occult infection to see whether a 24-hr delay in imaging is really necessary. Patients were imaged at 1-4 hr and again at 24 hr after injection. The early images had a sensitivity of only 33%, compared with 95% for the 24-hr images. Of the seven studies that were positive on both early and delayed images, 71% had more intense uptake at 24 hr. There were no false-positive early images. We conclude that imaging 1-4 hr after injection with In-111 oxine-labeled leukocytes has a low sensitivity for detecting occult infection. However, a positive early image is specific for a site of infection.     

Intestinal transit studied with radiopaque markers in patients with multiple sclerosis]

The patients affected with multiple sclerosis (MS) often complain of constipation. This symptom is little tolerated by the patient; its etiology is still unknown. MS patients often have their movements impaired by disease progress, so that they have to sit down for a long time, or else they exhibit severe problems walking or moving. MS patients also present low intraabdominal pressure during voluntary contraction of abdominal wall muscles. In these patients, the authors suggest to study intestinal transit time by means of radiopaque markers. To this purpose, the radiological follow-up contributes to the setting of colorectal MS dysfunctions by daily controls of the progress of per os radiopaque markers, focusing on colonic transit time and temporary deposit areas. The results show high incidence of anorectal constipation. Thus, the examination can be considered a useful tool in the study of MS dysfunctions and an effective alternative to anorectal manometry.     

Pulmonary uptake in indium-111 leukocyte imaging: clinical significance in patients with suspected occult infections

A retrospective review was undertaken to evaluate the frequency and significance of pulmonary activity noted on 306 indium-111 leukocyte studies involving 232 patients with suspected occult infections. Forty-eight studies showed pulmonary activity in one of two patterns of uptake, focal or diffuse. Fourteen of 27 studies (52%) with focal uptake and two of 21 studies (10%) with diffuse uptake were associated with infectious processes. Lung uptake of indium-111-labeled leukocytes was a poor predictor of pulmonary infection in patients studied for occult infection, although the focal pattern was more likely than the diffuse pattern to be associated with infection.     

MRI在肠梗阻病因诊断中的应用价值

目的 评价MRI在肠梗阻病因诊断中的应用价值. 资料与方法 应用MRI对临床拟诊为肠梗阻的39例患者进行检查,分析梗阻病因,并与手术或随访结果 对照. 结果 39例中有36例经手术证实,其中肿瘤所致梗阻25例,粪石、胆石梗阻4例,肠粘连4例,乙状结肠扭转3例.MRI术前定性诊断准确35例,1例小肠肿瘤误诊为炎症.梗阻部位在小肠者11例,在结肠者25例,MRI定位与手术一致.3例未手术者MRI诊断为粘连性肠梗阻,经保守治疗后缓解.MRI定性与定位诊断符合率分别为97%和100%. 结论 MRI可以较为准确地诊断肠梗阻病因及其梗阻部位,为临床制订治疗方案提供重要信息.     

Prognostic relevance of pancreatic uptake of technetium-99m labelled human polyclonal immunoglobulins in patients with type 1 diabetes

Insulin-dependent type 1 diabetes (IDDM) is caused by the autoimmune destruction of insulin-producing beta cells. Approximately 10%–20% of patients may benefit from adjuvant immunotherapy upon diagnosis of the disease in order to protect residual beta-cell function. It has been suggested that this subgroup of patients differs from others by virtue of the presence of residual pancreatic inflammation and beta-cell function. In this study we have investigated to what extent technetium-99m-labelled human polyclonal immunoglobulins (^99mTc-HIG) accumulate in the pancreas of IDDM patients at the time of diagnosis and 1 year thereafter, with a view to ascertaining whether HIG scintigraphy is useful for the identification of IDDM patients with residual pancreatic inflammation. Patients with recent-onset IDDM (n=15) were investigated at the time of diagnosis and 1 year later, and ten age- and sex-matched normal subjects were also studied. Gamma camera imaging and target to background ratio, analysed blind by three independent readers, were used to quantify the radioactivity in the pancreatic region and findings were correlated with metabolic, immunological and clinical parameters. Seven out of 15 newly diagnosed IDDM patients showed a significant accumulation of radiolabelled HIG in the pancreas (pancreas/bone ratio higher than the mean +2SD of normal subjects). One year after diagnosis, pancreatic accumulation of HIG was still detectable in most IDDM patients who were positive at the time of diagnosis. Six out of seven patients with positive scintigraphy had a partial clinical remission. These results indicate that HIG scintigraphy at the time of onset of diabetes identifies a subset of patients with residual beta-cell function who may benefit from adjuvant immunotherapy. Received 1 November 1997 and in revised form 21 January 1998     

肠道菌群失调与结直肠癌的相关研究进展

人体肠道微生物组与许多健康因素有关,但研究之间的差异限制了它们之间效应的探索。本文综述了肠道菌群失调与结直肠癌的发病机制之间的关系,讨论了调节肠道菌群用以防治结直肠癌的可行性,为结直肠癌的预防诊断及治疗打开新思路。     

肠梗阻的CT诊断

目的 探讨CT对肠梗阻诊断价值。材料与方法 68例肠梗阻,42例手术治疗,26例胃肠减压保守抗炎治疗。68例均作CT检查和立位腹部平片,其中6例作钡剂灌肠检查。结果 （1）68例立位腹部平片,其中62例典型阶梯状气液平面,6例肠管少量积气,未见液平面;（2）6例CT检查后作钡剂灌肠检查,4例肿瘤,2例肿瘤合并肠套叠;（3）68例CT检查示机械性梗阻56例,麻痹性肠梗阻12例。结论 CT可确定或除外肠梗阻,同时在判断是否绞窄性肠梗阻或麻痹性肠梗阻的诊断中起着重要的作用。CT对肠梗阻诊断定位准确,病因诊断也能显示,为临床提供可靠诊断依据,但有时在定性诊断中有一定的局限性,需要结合病史及其他检查。     

Differences in tumour and normal tissue concentrations of iodine- and indium-labelled monoclonal antibody.

The poor imaging characteristics of ¹³¹I have resulted in the use of alternative radionuclides for radiolabelling monoclonal antibodies. Clinical imaging studies have shown that, in addition to the more suitable energy of emission of ¹¹¹In over ¹³¹I for gamma camera detection, the ¹¹¹In-labelled antibody appears to clear from the blood-stream at a faster rate than that of ¹³¹I-labelled antibody, resulting in greater tumour-to-background image contrast.However, measurements of the activity in blood samples from patients demonstrate that both ¹³¹I- and ¹¹¹In-labelled anitbodies clear from the circulation at similar rates. This discrepancy is probably due to the different biological fates of the two radionuclides and warrants further scientific study.     

婴儿肠旋转不良影像学检查的探讨

目的:探讨婴儿肠旋转不良影像学检查的价值.方法:回顾性分析41例经手术证实的婴儿肠旋转不良患者的病例资料.所有病例均摄腹部平片,16例行钡剂灌肠,18例行钡餐检查.结果:腹部平片显示十二指肠部分性梗阻32例,双泡征13例,小肠低位梗阻并腹腔积液3例,未见明显异常3例.钡剂灌肠显示阑尾位于右上腹10例,右中腹1例,左上腹4例,1例位置正常;与手术中记录的阑尾位置比较,诊断符合率较低(28.6%,4/14).钡餐检查显示十二指肠水平段及其近端扩张、梗阻,扩张远端呈鼠尾状改变6例,其中2例显示为完全性梗阻;十二指肠空肠曲位置异常11例;十二指肠螺旋型下降13例;空肠位于右侧腹9例,位置正常1例.结论:在肠旋转不良影像学检查中,腹部平片能提供肠道气体的异常信息,可作为本病的首诊检查方法;钡剂灌肠虽然可显示阑尾位置异常,但诊断准确性低,胃肠钡餐检查可显示十二指肠的位置和形态,是确诊本病的较好影像学方法.     

Indium-111 leukocyte accumulation in intramuscular injection sites

We report four cases of indium-111 leukocyte concentration in previous intramuscular injection sites. Three patterns were observed: (1) small, discrete, and round; (2) linear; (3) irregular and large. The scintigraphic appearance did not necessarily correlate with the number of injections that the patient had received.