Diagnosis of upper-abdominal infections by In-111 labeled leukocytes with Tc-99m colloid subtraction technique

In 65 patients suspected of upper-abdominal inflammatory disease, indium-111 leukocyte scintigraphy was combined with a Tc-99m(Sn)colloid scan by computer-assisted subtraction. In 84% of these cases, a definite diagnosis would not have been possible without this method of subtraction. Accuracy was found to be 80%, sensitivity 93%, and specificity 59%. False-positive results were due either to noninfectious inflammatory lesions with accumulation of leukocytes or to some pitfalls in the subtraction technique itself.     

Scintigraphy with 99mTc-HMPAO labeled leukocytes in acute cholecystitis

99mTc-HMPAO labeled leukocyte scanning was performed on 38 patients with clinically suspected acute cholecystitis (AC) to evaluate its diagnostic value. The typical finding was an increasing accumulation of the tracer in the gallbladder wall in a 4 hour series of scintigrams. Leukocyte scan was positive in 16 of 17 patients with surgically and histologically confirmed AC. There were no false-positive findings. The sensitivity, specificity, and accuracy of scintigraphy were 94, 100, and 96%, respectively. In 2 patients with acute acalculous cholecystitis true-positive findings were observed. Scintigraphy with 99mTc-HMPAO labeled leukocytes is a valuable new imaging method in AC.     

Dosimetry of technetium-99m red blood cells labeled in vivo

Mean organ doses received from Tc-99m red blood cells labeled in vivo were calculated by the MIRD method using biodistribution data reported in the literature. The organ receiving the greatest dose was found to be the heart, followed closely by the bladder and stomach. Relatively high doses are also received by the blood, spleen, and lungs. Intermediate absorbed doses are received by the thyroid and kidneys, whereas organs with small blood concentrations and the remainder of the body receive the smallest doses. The major portion of the absorbed doses delivered to the stomach and the thyroid is due to the presence of free pertechnetate.     

Technetium-99m HMPAO labeled leukocytes in inflammation imaging

Technetium-99m-HMPAO (Tc-99m-HMPAO) labeled leukocyte imaging was carried out in 19 patients at 3–5 hr after reinjection. There were no side effects noted. Tc-99m leukocyte images showed gall bladder, colon, kidney, and urinary bladder activity in normal distribution as a result of excretion of the eluted Tc-99m complex. They yielded a sensitivity of 93%, a specificity of 100% and an accuracy of 95%. They were correctly positive in 14 out of 19 cases. But one false negative case was seen in a patient with pyonephrosis showing a lack of renal function with decreased renal blood flow. It was concluded that they have some advantages over In-111 leukocyte images, but we have to consider the fact that the ureteral obstruction or the lack of renal function with decreased renal blood flow may result in a false positive or a false negative case.     

Comparison of technetium-99m sulfur colloid and technetium-99m albumin colloid labeled solid meals for gastric emptying studies

A Tc-99m albumin colloid (Tc-AC) kit has been introduced as an alternative to Tc-99m sulfur colloid (Tc-SC) for liver-spleen imaging. Since there is no need for boiling, the use of Tc-AC reduces preparation time and manipulation. Tc-SC is one of the most commonly used radiopharmaceuticals for the labeling of solid-phase markers in gastric emptying studies. In vitro studies were performed to evaluate the labeling efficiency and stability in hydrochloric acid and in human gastric juice of intracellularly labeled chicken liver and scrambled eggs labeled with Tc-SC and Tc-AC. Gastric emptying studies also were performed on 20 healthy volunteers with both Tc-SC and Tc-AC labeled scrambled egg sandwiches. There was no significant difference between Tc-SC and Tc-AC in the labeling efficiency of chicken liver (98% +/- 1% for Tc-SC, 96% +/- 2% for Tc-AC) and scrambled eggs (92% +/- 2% for Tc-SC, 91% +/- 3% for Tc-AC). However, both Tc-SC and Tc-AC labeled scrambled eggs showed a lower stability than chicken liver, particularly in human gastric juice. Gastric emptying curves from both meals in 20 normal subjects were also similar, with a mean half-emptying time of 85 +/- 13 minutes and 87 +/- 16 minutes for the meals containing Tc-SC and Tc-AC respectively. Tc-AC is a reliable alternative to Tc-SC as a radiotracer for solid-phase gastric emptying studies.     

Fast diagnosis of abdominal infections and inflammations with technetium-99m-HMPAO labeled leukocytes

The diagnostic value of early 99mTc-HMPAO-leukocyte images (2 min, 0.5 hr, 2 hr and 4 hr) was studied in 87 prospectively performed investigations in 80 patients with a suspicion of abdominal inflammation or infection. Sensitivity, specificity and accuracy were 74%, 85% and 77% in the 2-min scans, 88%, 81% and 86% in the 0.5-hr scans, 95%, 85% and 92% in the 2-hr scans, and 96%, 92% and 95% in the 4-hr scans. Nonspecific bowel accumulation was seen in 7% of patients at 2 hr and in 28% at 4 hr but was easily distinguishable from pathologic activity. The uptake in early images represents an active accumulation of granulocytes at the site of inflammation rather than nonspecific blood-pool activity judged by results of 99mTc-HMPAO-RBC imaging. We found that imaging within 2 hr from injection has a high diagnostic value, and that the activity accumulates in areas of infection and inflammation faster than in the intestinal background.     

Septic Haemophilus influenzae polyarthritis demonstrated best with Tc-99m HMPAO labeled leukocytes

A 5-year-old girl with fever and tenderness in her left wrist and right ankle was hospitalized. Bone scanning and Tc-99m labeled leukocyte imaging showed increased uptake in these joints and also in her left knee. These radionuclide methods helped determine the diagnosis and were superior to plain radiography and CT scanning. Uptake was greater on leukocyte imaging than it was on the bone scan. The patient had infectious polyarthritis caused by Haemophilus influenzae, which is a very rare cause of acute polyarthritis in children older than 2 years. The patient fully recovered with antibiotic therapy, and no surgical procedure was needed.     

Tc-99m labeled leukocytes in imaging of patients with suspected acute abdominal inflammation

One hundred patients with suspected acute abdominal inflammation were imaged at 0.5, 2-3, 4-6, and 24 hours after the administration of Tc-99m HMPAO labeled autologous leukocytes. Scan findings were retrospectively compared with final diagnosis, serum C-reactive protein (CRP), and antibiotic treatment. Clinical findings were confirmed with surgery, barium enema, or sigmoidoscopy in 61 patients, and diagnosis was based only on clinical findings in 13 patients. In 26 patients, symptoms subsided before a final diagnosis was made. Tc-99m leukocyte images were positive in 45 of the 61 patients with a confirmed diagnosis, including all patients with acute cholecystitis (N = 4) and inflammatory bowel disease (N = 8). They were also positive in nineteen out of 25 patients who had acute colonic diverticulitis and in 6 out of 7 who had intra-abdominal abscesses. Abnormal activity was found in patients with colonic carcinoma, small bowel infarction, and acute appendicitis. Abnormal activity was visualized in 0.5-hour images in all but one of the positive cases. With the exception of two postoperative cases, malignant lymphoma, and a liver abscess, a CRP level of greater than 75 mg/L was associated with positive image findings. Antibiotic treatment did not affect imaging findings. Imaging with Tc-99m labeled leukocytes appears to be valuable for detecting and localizing abdominal inflammation, and three-phase imaging during the first 4-6 hours is recommended. In some cases, 24-hour images may be useful for distinguishing small bowel from large bowel inflammation.     

Dosimetry at the cellular level of Kupffer cells after technetium-99m-sulphur colloid injection.

The radiation dose to Kupffer cells was estimated at the cellular level after intravenous injection of 99mTc labeled sulphur colloids in rats. The results were then compared with those obtained using macroscopic dosimetry. From the microscopy appearance observed using a "track" microautoradiographic method (MAR), it was shown that only 0.2% of the Kupffer cells were actually involved in the pinocytosis of radioactive colloids. For each electronic emission from 99mTc (Auger and internal conversion), the fraction of the emitted energy actually absorbed within the Kupffer cell was calculated using the values provided by Berger. About 15% of the total energy emitted by electrons was absorbed in 0.2% of the Kupffer cells. If these results are extrapolated to humans, the dose absorbed by the labeled cells can be estimated to be between 0.5 and 0.9 Gy/MBq. This represents about 15,000 times the average electron dose to the liver as estimated from macrodosimetric methods. In cases such as this one where an important distribution heterogeneity is expected, dosimetric estimations at a cellular level may be particularly useful.     

Imaging of abdominal infection using 99m Tc stannous fluoride colloid labelled leukocytes

Radiolabelling of leukocytes using labelled phagocytosed technetium-99m (99mTc) colloidal radiopharmaceuticals has been reported as a method for imaging infection. This in vivo study compares the use of leukocytes labelled using 99mTc stannous fluoride colloid with leukocytes labelled using indium-111 (111In) oxinate. A total of 26 patients (10 male, 16 female; mean age 52 years, range 23-88 years) referred for the investigation of possible infection were studied using both leukocyte labelling methods simultaneously. Images were acquired 4h and 24h after re-injection of the labelled cells. The images were evaluated qualitatively by two nuclear medicine physicians. The results show a high degree of concordance between the techniques: 11 of the 28 images showed a focus of leukocyte accumulation with both techniques at 24h, and 13 out of 28 showed a normal appearance at 24h with both methods. In four cases the results were discordant; the 99mTc stannous fluoride colloid labelled leukocytes gave a false positive appearance at 24h in three patients and a false negative in one. In conclusion, colloid labelling of leukocytes offers a sensitive method for the detection of infective foci coupled with the high resolution imaging offered by 99mTc. It has the advantage over other in vitro labelling methods of being a simpler, non-labour-intensive procedure employing whole blood, and its use should be considered by departments that have limited facilities for in vitro leukocyte labelling.     

Polymorphonuclear leukocytes labeled with technetium-99m HMPAO. A potential bone marrow imaging agent

A case of multifocal avascular necrosis of the bone complicating systemic lupus erythematosis is presented in which the extent of involvement was incidentally identified by Tc-99m HMPAO leukocyte imaging. Leukocytes labeled with Tc-99m HMPAO may be an excellent bone marrow imaging agent.     

Hepatobiliary scintigraphy with 99Tcm-HIDA and 99Tcm-sulphur colloid

The results of a study comparing the ability of ⁹⁹Tc^m-sulphur colloid and ⁹⁹Tc^m-HIDA to demonstrate circumscribed defects and obstruction of the biliary flow to the intestines are reported. As regards focal liver diseases, colloid scintigraphy (SC) had a nosographic sensitivity and specificity of 0.87 and 0.85, respectively. The corresponding figures for the HIDA scintigraphy were 0.40 and 0.92. The sensitivities are significantly different. Concerning the diagnosis of extrahepatic obstruction, sulphur colloid scintigraphy had a nosographic sensitivity and specificity of 0.31 and 0.94. The corresponding figures for HIDA scintigraphy were 0.69 and 0.84. These sensitivities are significantly different too. The most frequent cause of false results was a pattern of hepatocellular disease in sulphur colloid scans in patients with a longstanding biliary obstruction. The second most frequent error was due to circumscribed defects in SC as well as in HIDA scans in patients with obstructive diseases and a high value of serum bilirubin. A third source of error was the pattern of an obstruction in HIDA scans in patients with focal diseases. The significance of the star pattern the sulphur colloid scan in patients with obstruction is stressed, as the significance of this pattern not has been evaluated previously. It is concluded that the two different scintigraphic methods are complementary tools in the examination of patients with liver diseases     

In vivo kinetics of canine leukocytes labeled with technetium-99m HM-PAO and indium-111 tropolonate

Two weeks after the introduction of osteomyelitis in three dogs, autologous leukocytes were dual-labeled with both [99mTc]HM-PAO and [111In]tropolonate, and reinjected. Blood sampling and imaging were then performed. Two weeks later, the same dogs received simultaneous injections of singly-labeled [99mTc]WBC and [111In]WBC for comparison. For both studies, blood samples were drawn over 6 hr to determine the respective blood clearance half-time (TB) and % recovery (%R0) of cell-bound radioactivity. There were no significant differences in the average TB results of the 99mTc and 111In groups, either within or between the dual- and singly-labeled studies. The %R0 of singly-labeled [99mTc]WBC was about half that of the other groups (p less than 0.01); however, this difference was attributed to the dissimilar radiochemical purity of the [99mTc]HM-PAO reagents. Region of interest analysis of the 6 and 24 hr images revealed no significant differences between either cell label in the relative or absolute in vivo uptake at known sites of osteomyelitis, noninfected surgery, and normal bone marrow.     

In vitro evaluation of canine leukocytes radiolabeled in whole blood with (99m)Tc stannous colloid

INTRODUCTION: Technetium-99m stannous colloid ((99m)TcSnC)-labeled leukocytes are used to investigate a variety of inflammatory diseases in human medicine. The present study investigates the in vitro behavior of canine leukocytes labeled in whole blood with (99m)TcSnC. METHODS: Blood samples from 10 healthy dogs were labeled with (99m)TcSnC using a standard procedure. The distribution of radioactivity among blood components (plasma, leukocyte layers and erythrocytes) was measured following separation of the radiolabeled samples across Histopaque density gradients. Phagocytic function of labeled and unlabeled leukocytes was estimated using zymosan particles. Labeling retention by leukocytes was determined at 1, 3, 4 and 7 h postlabeling. RESULTS: The mean+/-standard error percentage of radioactivity associated with plasma, erythrocyte and leukocyte fractions was 2.0+/-0.21%, 55.5+/-0.60% and 42.5+/-0.54%, respectively (the last comprising 70.2+/-0.83% in polymorphonuclear leukocytes and 29.8+/-0.83% in mononuclear leukocytes). Labeled canine leukocytes had a phagocytic activity of 91.3+/-0.28% (control, 91.7+/-0.26%). The radiolabeled canine leukocytes retained 94.1+/-0.30% of radioactivity at 7 h postlabeling. CONCLUSIONS: Radiolabeling of canine leukocytes in whole blood with (99m)TcSnC has minor adverse effect on their phagocytic function. The radiolabeled canine leukocytes retained a large percentage of radioactivity for at least 7 h postlabeling.     

Localization of inflammation with 111In IgG and 99Tcm albumin colloid labelled leukocytes in a rabbit model

Localization of inflammation with two recently described radiotracers, 111In-labelled polyclonal IgG and 99Tcm albumin colloid labelled leukocytes (Tc-WBC), was studied. Accumulation of activity was compared with 111In-labelled leukocytes (In-WBC) using 131I human serum albumin as a control. Ratios of activity in a chemically induced abscess in the thigh of rabbits compared with normal muscle tissue were measured. The results showed that all agents localize in inflammation but Tc-WBC consistently localizes to a greater degree than the other agents. At 2 h the inflammed-to-normal ratios for Tc-WBC were 4, IgG 2.1, albumin 1.9 and In-WBC 1.7. The pattern of the ratios remained similar over the 18 h period of the study. The short time in which leukocytes can be labelled and the quality of the images obtained suggest that Tc-WBC imaging is the method of choice for this model.