indium-oxine and Abscess

Radiolabeled blood cells are widely used for both clinical and research studies. In vitro and in vivo studies have shown the tagging process does not significantly affect function. The labeling techniques and clinical uses of labeled leukocytes and platelets are reviewed.

Topics: Abscess; Blood Platelets; Cerebrovascular Disorders; Chromium Radioisotopes; Eosinophils; Fever of Unknown Origin; Graft Rejection; Humans; Hydroxyquinolines; Indium; Isotope Labeling; Leukocyte Count; Leukocytes; Lymphocytes; Organometallic Compounds; Oxyquinoline; Pulmonary Embolism; Radioisotopes; Radionuclide Imaging; Thrombophlebitis; Tropolone

Radionuclide techniques for localizing inflammatory processes had relied heavily upon 67Ga-citrate until McAfee and Thakur described the technique for the radiolabeling of leukocytes with 111In-oxine. Since their initial description in 1976 there has been continued development of the radiopharmaceutical, as well as clinical efficacy. At present 111In-labeled leukocytes continue to be handled as an investigational new drug but this has not greatly limited its clinical availability. Indium-111 leukocytes are the agent of choice for evaluation of patients with fever of unknown origin, osteomyelitis, and prosthetic graft infections; and preliminary data shows great promise in the area of detecting reoccurrence of inflammatory bowel disease. This article attempts to review currently accepted uses of 111In leukocytes as well as potential areas of application.

Topics: Abscess; Blood Vessel Prosthesis; Colitis, Ulcerative; Crohn Disease; Cytomegalovirus Infections; Enterocolitis, Pseudomembranous; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Indium; Infections; Inflammation; Leukocytes; Liver Abscess; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Pancreatic Diseases; Radionuclide Imaging

Topics: Abscess; Adult; Chromosome Aberrations; Female; Humans; Indium; Leukemia, Radiation-Induced; Lymphocytes; Male; Neoplasms, Radiation-Induced; Organometallic Compounds; Oxyquinoline; Radiation Genetics; Radioisotopes; Radionuclide Imaging; Risk

We have studied the clinical utility of indium 111 autologous leucocyte scintigraphy retrospectively in 45 patients presenting with suspected intra-abdominal sepsis. The sensitivity was 95% (21/22) and the specificity was 91% (21/23). Some 34 of the studies (17 positive and 17 negative) were considered helpful in furthering patient management (76%) and 8, unhelpful (18%). In 3, the study results were misleading and led to inappropriate treatment. Indium 111 scintigraphy, whether positive or negative, provides information in patients with suspected intra-abdominal sepsis upon which therapeutic decisions can be based.

Topics: Abdomen; Abscess; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Peritonitis; Radionuclide Imaging

The paper describes the authors experience relating to the use of indium-111-oxine scintigraphy as an aid to transrectal echography in the diagnosis of difficult anal fistulas. This method has proved useful in locating otherwise undetected accumulations and in controlling the outcome of operations with a "slow resolution" of the surgical wound. The marker showed a good level of resolution in that, as already shown in the case of chronic inflammatory diseases, marked leukocytes are prevalently located on the site of infection.

Topics: Abscess; Adult; Anus Diseases; Humans; Indium Radioisotopes; Male; Methods; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Rectal Fistula; Rectum; Time Factors; Ultrasonography

Topics: Abscess; Colitis, Ulcerative; Crohn Disease; Granulocytes; Humans; Organometallic Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

In three patients with fever of unknown etiology, an Indium-111-Oxine WBC (White blood cell) scan was performed, in order to detect occult sites of inflammation. An intra-abdominal abscess was located in two cases, while in the third the negative result of the scan directed the diagnosis to other systemic pathologies.

Topics: Abscess; Adenocarcinoma; Adult; Aged; Aged, 80 and over; Colonic Neoplasms; Connective Tissue Diseases; Female; Fever of Unknown Origin; Humans; Hydroxyquinolines; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Rectal Diseases

Gamma-camera imaging after injection of radiolabelled autologous leucocytes can be very helpful in the diagnosis, localization and further clinical treatment of inflammatory diseases. We present a technique allowing sterile separation of white blood cells and labelling with 99mTc-phytate or -oxine and with 111In-oxine, -oxine sulphate or -tropolone. The method is non-invasive and the radiation dose amounts to less than 80 mrad using 100 microCi 111Indium. The use of radiolabelled granulocytes is of particular diagnostic value in patients with septicaemia of unknown origin. Whole body scanning allows not only visualization of enhanced splenic uptake in septicaemia, but also localization of an inflammatory process. Preferential indications for a diagnostic approach using radiolabelled granulocytes are inflammatory abdominal processes which cannot easily be documented by means of other non-invasive techniques, such as inflammatory bowel disease (Crohn's diseases and ulcerative colitis), arthritic processes and abscesses of the liver and spleen, as well as subphrenic and retroperitoneal abscesses. Untreated osteomyelitis can be located with the help of labelled granulocytes, but in patients treated with antibiotics a false negative result is obtained in approximately 50% of cases for as yet unknown reasons, even in the presence of a still active osteomyelitic process.

Topics: Abscess; Aged; Bacterial Infections; Diagnosis, Differential; Female; Granulocytes; Humans; Hydroxyquinolines; Indium Radioisotopes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oxyquinoline; Peritonitis; Phagocytosis; Radionuclide Imaging; Subphrenic Abscess; Surgical Wound Infection; Technetium

The authors describe the limited role of non-invasive imaging procedures in the differential diagnosis of splenic abscess versus infarction. Sonography and computed tomography often do not offer any characteristic findings in these splenic disorders. A case is reported as an example. By means of 111 In-labelled leukocyte and gallium-67-scintigraphy exclusion of acute inflammatory processes can be performed with great certainty, and unnecessary surgical interventions can thus be avoided.

Topics: Abscess; Diagnosis, Differential; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Splenic Diseases; Splenic Infarction

Indium-111 leukocyte scanning has evolved into a practical and highly accurate method for the identification of infectious and inflammatory processes. The most commonly used agent for labeling leukocytes has been [111In]oxine. We have investigated a newer agent, 2-mercaptopyridine-N-oxide (Merc) at our institution which unlike oxine, allows us to label leukocytes in plasma, using a simple kit procedure. Of the 92 consecutive patients referred for detection or localization of an infectious process, autologous leukocytes of 55 patients were labeled with [111In]Merc, while those of the remaining 37 patients were labeled with [111In]oxine. The sensitivities for Merc and oxine procedures were 87% and 92%, respectively, while the respective specificities were 100% and 92%. We conclude that the [111In]Merc-labeled leukocytes are equally effective as [111In]oxine-labeled leukocytes in detecting infectious processes. The use of [111In]Merc is advantageous over [111In]oxine for white blood cell labeling because of its easier preparation.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Female; Humans; Hydroxyquinolines; Indium; Isotope Labeling; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pyridines; Radioisotopes; Radionuclide Imaging; Statistics as Topic; Thiones

99mTc-hexamethylpropylene amine oxime d,l diastereoisomer (HM-PAO), developed as a diffusible brain imaging agent, labels leukocyte suspensions in saline with an efficiency of 80% using 1-200 micrograms quantities. In dogs, the recovery and survival of reinjected cells in the bloodstream resemble those of 111In-oxine labeled cells at least for several hours. Images in control animals at 18 h show the spleen, liver, marrow, and bladder, minimal pulmonary activity and some gastrointestinal activity. Induced E. coli abscesses and joint inflammatory lesions in dogs are shown on 18 h images. This complex appears promising as an agent for abscess detection in humans. However, strict quality control of this agent is necessary, and it must be used immediately after the 99mTc complex is formed for labeling cells.

Topics: Abscess; Animals; Dogs; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tissue Distribution

We report our experiences with the combined use of indium-111 labeled leukocyte imaging (In-III WBC scan.), computed tomography (CT) and ultrasonography (US) for evaluation of suspected postoperative infection or abscess, and discuss the complementary roles of these modalities. Postoperative abscesses or infections were diagnosed in 9 of 20 patients. All patients were correctly diagnosed by In-111 WBC imaging and 4 patients could not be diagnosed by US because of bowel gas. One false-positive CT examination and another artifact on CT images due to respiratory movements were obtained. The three modalities were found to be complementary: CT and US were efficient imaging methods for diagnosis and treatment of abscess. In-111 WBC imaging could estimate the activity of inflammation.

Topics: Abscess; Adult; Aged; Aged, 80 and over; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Postoperative Complications; Radionuclide Imaging; Tomography, X-Ray Computed; Ultrasonography

In-111 oxine WBC abdominal scanning is now a widely accepted technique for the detection of abdominal infectious processes. High sensitivity and specificity are achieved. In-111 labeled leukocyte accumulation, however, does not always suggest the diagnosis of abscess. Higher specificity could be obtained by the knowledge of the In-111 leukocyte distribution pattern in the abdomen in other pathologic states like inflammation of abdominal wounds, stoma; surgical complication without abscess formation; inflammatory or ischemic bowel disease; or swallowing leukocytes which subsequently are visualized in the intestinal lumen. One hundred fifty-two consecutive WBC scans performed over 18 months were reviewed and classified according to their pattern of uptake: 96 cases showed no abdominal uptake, and 56 had accumulation of leukocytes in the abdomen. Twenty-eight of these patients had proven abdominal abscess, and the remaining 26 were positive due to other causes. This report briefly discusses the distribution pattern of In-111 labeled leukocytes in the latter patients and compares the results obtained using different diagnostic criteria.

Topics: Abdomen; Abscess; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

Topics: Abdomen; Abscess; Cecal Neoplasms; False Positive Reactions; Female; Humans; Indium; Leukocytes; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

An island of bone marrow surrounded by the glue used in securing a hip prosthesis accumulated In-111 leukocytes in a patient being imaged for hip pain. This was shown to be normal marrow uptake of labeled cells and not an abscess by performing bone marrow imaging. The appearance of the leukocyte and bone marrow scans of the area were identical.

Topics: Abscess; Aged; Bone Marrow; Diagnosis, Differential; Female; Hip Prosthesis; Humans; Indium; Leukocytes; Organometallic Compounds; Oxyquinoline; Prosthesis Failure; Radionuclide Imaging

Indium-111-oxine saline-labeled "mixed" leukocyte (n = 16) and "pure" granulocyte (n = 66) scans were prospectively performed as "three-phase" white blood cell (WBC) scans (imaging: 30 min, 4 hr, and 24 hr after reinjection of the cells) in 82 patients suspected of having abdominal or retroperitoneal abscesses or inflammatory lesions. Inflammation was verified histologically, endoscopically, radiologically or by autopsy in 51 and excluded in 31 patients. Sensitivity, specificity, and diagnostic accuracy of the 30-min scan (90%, 56%, 72%) were statistically significantly lower than the 4-hr scan (96%, 97%, 98%). Of the 24-hr scan sensitivity, specificity, and diagnostic accuracy were only 84%, 98%, and 89% because many patients with chronic inflammatory bowel diseases had excreted a portion of intestinal 111In activity by 24 hr. The overall sensitivity, specificity, and accuracy of the "three-phase" WBC scan were 98%, 97%, and 98%, respectively. Only one female patient showed a false-positive scan with granulocyte uptake in an ulcerating adenocarcinoma of the colon. The 4-hr scan or the three-phase study are recommended because of their high sensitivity, specificity, and excellent diagnostic accuracy (98%). The 30-min scan is less specific (56%); the 24-hr scan less sensitive (84%). The three-phase study additionally allows the differentiation between inflammatory bowel diseases and abscesses because it allows observation of granulocyte kinetics for 24 hr.

Topics: Abdomen; Abscess; Adult; Aged; Crohn Disease; Diagnosis, Differential; Female; Granulocytes; Humans; Indium; Inflammation; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Time Factors

Topics: Abdomen; Abscess; Bone Diseases; Enterocolitis; Humans; Hydroxyquinolines; Indium; Neutrophils; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging

A case of artifactual multifocal lung activity presumably due to emboli of In-111 labeled leukocytes is described. These may have been caused by infusion through an intravenous line containing glucose, or by a minute amount of blood clotted in the needle. When administration through an existing intravenous line is necessary, flushing with saline before and after cell infusion is recommended to avoid this potential pitfall. A fresh needle also should be used for each venipuncture attempt.

Topics: Abscess; Aged; Aged, 80 and over; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Kidney Diseases; Leukocytes; Lung; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

Topics: Abdomen; Abscess; Animals; Cell Separation; Humans; Hydroxyquinolines; Indium; Lethal Dose 50; Leukocytes; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Rats; Tissue Distribution; Tropolone

Topics: Abdomen; Abscess; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Postoperative Complications; Radionuclide Imaging

Leukocyte suspensions labeled with In-111 oxine or tropolone were administered intravenously to 150 patients for the detection of suspected foci of bacterial infection by gamma camera imaging. The results were correlated with other imaging modalities, and clinical, laboratory, and surgical findings after a minimum follow-up period of six months. Twenty-five of 29 foci of bacterial infection were demonstrated on the leukocyte-labeled images (sensitivity of detection = 86%). Three of the four missed lesions were chronic active osteomyelitis. The specificity of detection proved difficult to define, varying with different criteria for a false positive diagnosis. In every region of the body, a variety of lesions other than foci of bacterial infection produced positive uptake of the labeled leukocytes. An intense focal uptake was uncommon in lesions other than abscesses and hematomas. It was concluded that imaging with labeled leukocytes is valuable for demonstrating sites of infection in conjunction with other diagnostic methods. Detectable leukocytic infiltration, however, may occur in inflammatory lesions of any cause and in some noninflammatory states as well.

Topics: Abdomen; Abscess; Adult; Aged; Bacterial Infections; False Positive Reactions; Female; Humans; Indium; Joint Diseases; Leukocytes; Male; Middle Aged; Mouth Diseases; Neoplasms; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Pelvis; Radioisotopes; Radionuclide Imaging; Respiratory Tract Infections; Sinusitis; Tropolone

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.

Topics: Abscess; Adult; Cycloheptanes; False Negative Reactions; Female; Humans; Hydroxyquinolines; Indium; Infections; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Prospective Studies; Radioisotopes; Radionuclide Imaging; Surgical Wound Infection; Time Factors; Tropolone

Topics: Abdomen; Abscess; Aged; Humans; Hydroxyquinolines; Indium; Male; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Technetium

Topics: Abdomen; Abscess; Adult; Chemotaxis, Leukocyte; Diagnosis, Differential; Female; Hematoma; Humans; Indium; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

A 61-year-old white female with ulcerative carcinoma of the sigmoid exhibited an abscess-like pattern on a white blood cell scan using 111In-oxine-labeled 'pure' granulocytes. Constant 111In activity could be seen in the tumor 0.5, 3, and 20 h after the reinjection of the labeled cells. The absence of an abscess was proven by surgery and histological investigation.

Topics: Abdomen; Abscess; Adenocarcinoma; Diagnosis, Differential; Female; Granulocytes; Humans; Hydroxyquinolines; Indium; Middle Aged; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging; Sigmoid Neoplasms; Time Factors

The present paper compares scintigraphy using leucocytes labelled with 111 indium oxine sulphate with conventional 99Tc pyrophosphate scintigraphy for the investigation of inflammatory processes in the region of the jaw bones. It also tries to establish whether progress can be made in the field of differential diagnosis using a combination of these two methods of investigation. It is shown that conventional scintigraphy using 99Tc pyrophosphate represents an approved method of investigation, whereas scintigraphy using autologous leucocytes does not as yet fulfil the expectations that have been placed in it.

Topics: Abscess; Bone Cysts; Diphosphates; Granulocytes; Humans; Hydroxyquinolines; Indium; Jaw Diseases; Maxillary Sinus; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Sinusitis; Technetium; Technetium Tc 99m Pyrophosphate

In-111 oxine labeled white cells were used to diagnose acute inflammatory conditions in 42 children and adolescents, aged 6 weeks to 19 years. In 43 scans where a clinical correlation could be made, the test had a sensitivity of 81% and a specificity of 94%. There were no adverse reactions. For children the dose of In-111 recommended is 10-12 mu Ci/kg body weight to a maximum of 500 mu Ci.

Topics: Abscess; Acute Disease; Adolescent; Adult; Arthritis, Infectious; Child; Child, Preschool; False Negative Reactions; Female; Humans; Hydroxyquinolines; Indium; Infant; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Radiation Dosage; Radioisotopes; Radionuclide Imaging

The accuracy and usefulness of indium-111 oxine-labeled autologous leukocyte scans in the management of infectious complications of colon and rectal surgery and of inflammatory diseases of the colon have been studied by review of the records of all patients undergoing such scans at Morristown Memorial Hospital during the first six months such scans were performed there. A total of 20 scans was performed on 18 patients. Twelve scans were performed on 11 patients being treated for diseases of the colon and rectum. Of these 12 scans, one was normal, four demonstrated intra-abdominal abscesses, three demonstrated wound infections (two abdominal, one perineal), one was positive for granulomatous colitis, one for pseudomembranous colitis, one for chronic diverticulitis, and one for enterocutaneous fistula. One allergic reaction to the labeled leukocytes occurred. Comparisons with other corroborative localizing diagnostic tests were made. Subsequent treatment was reviewed. Analysis of these cases indicates that the majority of all scans were performed to evaluate complications of colorectal surgery or inflammatory diseases of the colon and that these scans were highly accurate. In all instances where appropriate, delineation of a lesion in the colorectal cases was followed by corrective treatment.

Topics: Abdomen; Abscess; Colitis; Colonic Diseases; Humans; Hydroxyquinolines; Indium; Leukocytes; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging; Rectal Diseases; Surgical Wound Dehiscence; Surgical Wound Infection

Topics: Abscess; Adult; Aged; Enterocolitis, Pseudomembranous; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Organometallic Compounds; Oxyquinoline; Peritoneal Diseases; Radioisotopes; Radionuclide Imaging

Topics: Abscess; Diagnostic Errors; Humans; Hydroxyquinolines; Indium; Inflammation; Leukocytes; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

Topics: Abdomen; Abscess; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Retrospective Studies; Ultrasonography