indium-oxine and Bacterial-Infections

To evaluate the usefulness of 111In-oxine-labelled platelet scan in the therapeutic management of prolonged febrile syndrome in dialysis patients with a non-functional renal allograft.. One hundred and fifty-eight patients (94 men, 64 women; mean age 44 +/- 9 years) were studied. Duration of fever was 42 days (range 7-112). A total of 68 % of the patients (107/158) were on low doses of corticosteroids (<10 mg/day). Platelet scans were performed 48 hours after reinjection of 111In-ixone-labelled platelets. A platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft by the cpm/pixel in a mirror background. A PUI > or = 1.5 was considered as threshold for immunological fever. The final diagnosis of immunological fever was established when it disappeared after transplantectomy, embolization or high doses of corticosteroid therapy. Fever of non-immunological origin was established when it disappeared after antibiotic therapy.. In 102/158 patients the fever was considered of immunological origin. In 56/158 patients the fever was considered of non immunological origin. Sensitivity and the specificity of the platelet scan was 80 % and 100 %, respectively. All those patients considered as having fever of immunological origin who had PUI <1.5 had been using corticosteroids during platelet scan.. 111In-labelled platelet scintigraphy is a useful technique in the therapeutic management of prolonged febrile syndrome in dialysis patients with non-functional renal allograft. The use of corticosteroids can reduce the sensitivity of 111In- labelled platelet scan.

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Bacterial Infections; Blood Platelets; Diagnosis, Differential; Embolization, Therapeutic; Female; Fever; Graft Rejection; Humans; Indium Radioisotopes; Kidney; Kidney Transplantation; Male; Middle Aged; Nephrectomy; Organometallic Compounds; Oxyquinoline; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Sensitivity and Specificity; Transplantation, Homologous

Technetium-99m-HM-PAO [( 99mTc]HM-PAO) leukocyte and indium-111-oxine (111In-oxine) leukocyte scanning were carried out simultaneously in 41 patients at 4 hr and 24 hr after reinjection to determine whether the 4-hr 99mTc scan could replace the 24-hr 111In scan for detecting intraabdominal sepsis. Abdominal infection was confirmed in 12 cases. The 4-hr 99Tc-leukocyte scan, the 4-hr 111In-leukocyte scan, and the 24-hr 111In-leukocyte scan yielded a sensitivity of 100%, 67%, and 100%, respectively, and a specificity of 62%, 90%, and 86%, respectively. The 24-hr 99mTc-leukocyte scan also produced a sensitivity of 100%, but it was falsely positive in all 29 cases without infection due to physiologic bowel uptake. False-positive 4-hr 99mTc-leukocyte scans were also produced by physiologic bowel uptake in seven cases all of whom had true-negative 4-hr and 24-hr 111In-leukocyte scans. Because of the high incidence of false-positive 4-hr [99mTc]HM-PAO leukocyte scans, it was concluded that they could not replace 24-hr 111In-leukocyte scans for detecting intraabdominal sepsis, and that serial 99mTc leukocyte scans starting earlier than 4 hr after reinjection must be evaluated.

Topics: Abdomen; Bacterial Infections; False Positive Reactions; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Bacterial sepsis, a significant complication of chronic hemodialysis, is generally the result of infection at the vascular access site. We retrospectively reviewed the utility of indium-111-(111In) labeled autologous leukocyte scintigraphy in 26 patients (30 scans) with synthetic vascular grafts, on chronic hemodialysis, in whom hemodialysis access site infection was a diagnostic consideration. Leukocyte scintigraphy correctly identified all fifteen access-site infections; there was one false-positive study, for an overall sensitivity and specificity of 100% and 93%, respectively. Of particular significance is the fact that in nine (60%) of the fifteen access-site infections, physical examination was normal. Our data indicate that 111In-labeled leukocyte scintigraphy is a useful procedure for the diagnosis of hemodialysis access-site infection, and it is especially valuable when physical examination of the access site is normal.

Topics: Adult; Bacterial Infections; Blood Vessel Prosthesis; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Polytetrafluoroethylene; Radionuclide Imaging; Renal Dialysis; Retrospective Studies

Technetium (99mTc) labelled, polyclonal human immunoglobulin (HIG) is a new agent that detects focal infection and inflammation. This new agent was compared in 40 patients with the accepted standard, namely 111In-oxine-labelled leucocytes. This comparison resulted in a sensitivity of 94% and a specificity of 96% for 99mTc-HIG when 111In-oxine leucocytes were defined as giving the true result. The new agent was shown to localize both sepsis and active inflammatory bowel disease (IBD). There was 100% concordance in the 16 patients with IBD who were imaged with both 99mTc-HIG and 111In-oxine leucocytes. Discordant results were obtained in one case of suspected osteomyelitis, which was false-positive on the 99mTc-HIG scan, and one case of pyrexia of unknown origin when the 99mTc-HIG was false-negative and the 111In-oxine leucocyte scan demonstrated accumulation of tracer in the caecum at 24 h post-injection. Normal distribution for 99mTc-HIG demonstrated activity in the kidneys and bladder and that 50% of the tracer is cleared through the kidneys during the first 24 h post-injection. There were no major or minor side-effects.

Topics: Bacterial Infections; Female; Fever of Unknown Origin; Humans; Immunoglobulins; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging; Technetium

Four patients with the acquired immunodeficiency syndrome (AIDS) and fever were investigated using donor leucocyte scans. The lung/liver and lung/spleen uptake ratios in these patients were compared with the uptake ratios in donor leucocyte scans in seven neutropenic (non-AIDS) patients and five patients who had autologous leucocyte scans performed over the same time period. For all scans indium-111-oxime-labelled leucocytes were used, except for one AIDS patient in whom technetium-99m hexamethyl-propylene amine oxide (HMPAD)-labelled donor leucocytes were used. There were no adverse reactions to the donor cell infusions. Two patients had repeat studies 8 weeks apart (from different donors) without ill effect. There were no differences in the 111In uptake ratios between the three groups. There were three positive studies in the patients with AIDS, and these elucidated the cause of the pyrexia in all three. The negative case is more difficult to confirm, but the clinical course and the absence of focal disease on post-mortem have been taken to support the scan findings. There was no difference in the acceptability of the technique or the distribution of the labelled leucocytes between the AIDS and non-AIDS patients. Donor leucocyte imaging of patients with AIDS is probably more effective and considerably less hazardous for technical staff than autologous leucocyte methods. This study demonstrates that the technique can be applied successfully to patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Bacterial Infections; Blood Donors; Fever of Unknown Origin; Humans; Indium Radioisotopes; Isotope Labeling; Leukocytes; Middle Aged; Opportunistic Infections; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

Twelve patients with a clinical diagnosis of possible vascular graft infection have been studied over the last 3 years. All patients had their leucocytes labelled with indium-111 and gamma-camera imaging after 24 and 48 h. Subsequent management was according to established surgical techniques. Eight patients proved to have vascular graft infection and indium uptake was seen along the length of the graft in six. Two patients with open wound infections and synthetic grafts had localized uptake only on leucocyte scanning. Four patients, all of whom had negative scans were not thought to have infected grafts after further investigation using digital subtraction angiography and computed tomography scanning. These patients have been followed up for a median period of 19 months (range 5-25 months) and have remained symptom free. Initial experience with 111In-labelled leucocyte scanning has been encouraging, both in diagnosis and in planning the management of patients with graft infections.

Topics: Bacterial Infections; Blood Vessel Prosthesis; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

31 patients with suspected septic loosening of an endoprosthesis (hip endoprosthesis n = 30; knee endoprosthesis n = 1) were examined with leukocyte scans (10 MBq 111In-oxine: n = 22; 300 MBq 99mTc-HMPAO: n = 9). The results were compared with results of the bacterial growth (n = 22), the histology (n = 12) and of the bone scans (99mTc-MDP: n = 20) which were performed within 4 days. The sensitivity of the bone scan was 100%, the specificity 30% and the diagnostic accuracy regarding a septic loosening of the arthroplasty was 55%. For the leukocyte scans a comparable sensitivity of 100%, but a higher specificity (86%) and accuracy (91%) could be calculated. A false positive leukocyte scan could be observed in a periprosthetic granuloma, an ossifying periarthritis and in a patient with negative bacterial growth with the histological proof of an inflammation.

Topics: Adult; Aged; Bacterial Infections; Female; Hip Prosthesis; Humans; Indium Radioisotopes; Knee Prosthesis; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oximes; Oxyquinoline; Prosthesis Failure; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

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

Fifteen children underwent scintigraphy with indium 111 (111In)-labeled white blood cells (WBC) for the detection of a local suppuration. The procedure generally contributed to a correct diagnosis. False negative results were observed in 5 children, but in two of them positive foci were also present. The missed lesions were 2 liver abscesses, 1 lung abscess, foci of osteomyelitis and 1 pericarditis. Two cases of chronic granulomatous disease are presented in which increased leucocyte accumulation was not observed in proven instances of infection.

Topics: Adolescent; Bacterial Infections; Child; False Negative Reactions; Focal Infection; Granulomatous Disease, Chronic; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

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.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Child; Child, Preschool; Enteritis; Female; Granulocytes; Humans; Indium Radioisotopes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.

Topics: Adult; Aged; Bacterial Infections; False Negative Reactions; False Positive Reactions; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Preoperative Care; Radionuclide Imaging; Technetium Tc 99m Medronate

Recent animal and human studies have suggested that positive indium 111-labeled leukocyte scans may help establish the diagnosis of vascular graft infection; however, there is little information available about the predictive value of both positive and negative leukocyte scans in larger groups of patients. In this study 31 indium 111 leukocyte scans were performed prior to definitive treatment in 21 patients with suspected vascular graft infections. Patients with more than one leukocyte scan performed had either anatomically distinct sites of infection or rescanning of a potentially infected site after definitive treatment. Scans were performed according to the method of Baker et al., attaching 500 muCi of indium 111 to leukocytes with imaging 24 hours later. All patients with positive scans underwent surgical exploration of the area of leukocyte accumulation, with documentation of purulence and culture of the graft. Patients with negative scans were treated as if scan results were indeterminate and underwent surgical exploration for usual clinical indications; if no exploration was performed, the patient was followed up closely for at least 1 year. Twelve of 12 positive scans showed purulence or culture evidence of infection with three different organisms; in 15 instances of negative scans, two operations were performed with one infection noted, whereas no patient without surgery has had a graft infection at 10 months follow-up. In addition to localizing graft infections, two scans demonstrated a nonvascular site of infection. Positive scans also helped determine the extent of infection along the graft, allowing better planning of the surgical procedure. These results indicate that indium 111-labeled leukocyte scans help document and localize prosthetic vascular graft infections.

Topics: Aged; Bacterial Infections; Blood Vessel Prosthesis; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Polyethylene Terephthalates; Polytetrafluoroethylene; Radioisotopes; Radionuclide Imaging; Reoperation; Surgical Wound Infection

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

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.

Topics: Adult; Aged; Bacterial Infections; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Hydroxyquinolines; Indium; Isotope Labeling; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging; Subphrenic Abscess; Time Factors

The radiopharmaceuticals gallium-67 and indium-111 labelled leucocytes have been compared in 15 patients with a painful joint prosthesis in an attempt to identify those patients with periprosthetic infection. Gallium-67 images were abnormal in five out of six patients with periprosthetic infection and normal in seven out of nine without evidence of infection. Indium-111 leucocyte images were abnormal in three out of six patients with infection and normal in all nine patients without infection. Indium-111 labelled leucocyte imaging is technically more difficult to perform than gallium-67 imaging. This, combined with the higher sensitivity of gallium-67 imaging for infection around a prosthetic joint, leads us to conclude that gallium-67 imaging is superior to indium-111 leucocyte imaging in identifying infection as a cause of a painful prosthetic joint.

Topics: Adult; Aged; Bacterial Infections; Female; Gallium Radioisotopes; Hip Prosthesis; Humans; Hydroxyquinolines; Indium; Joint Prosthesis; Knee Prosthesis; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pain, Postoperative; Pelvis; Postoperative Complications; Radioisotopes; Radionuclide Imaging

One hundred twenty-nine 111In-oxine-labeled leukocyte scintiscans have been performed in 117 patients with cancer in order to diagnose localized infectious disease. Of the 115 contributive scans, 40 were in patients with localizing signs, whereas in 75 fever of unknown origin constituted the indication for this examination. The overall specificity of the method was 95.4%, the overall sensitivity 86%, and the global accuracy 91.3%. In 10 cases with localizing signs, the 111In-oxine granulocyte scintigram allowed exclusion of the diagnosis of infection, whereas in 17 instances without localizing signs, a focal infectious process was demonstrated. Heterologous donor leukocytes were used successfully in five instances. With the exception of accumulation of label at the site of an osteolytic metastasis in one case, no uptake was observed in primary or secondary tumors. It is concluded that 111In-oxine-labeled leukocytes constitute a valuable tool in the diagnosis and localization of infection in patients with malignant disease.

Topics: Bacterial Infections; Bone Neoplasms; Diagnosis, Differential; False Negative Reactions; Female; Humans; Hydroxyquinolines; Indium; Leukemia, Lymphoid; Leukocytes; Liver Neoplasms; Lymphoma; Neoplasms; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging; Rectal Neoplasms; Uterine Cervical Neoplasms

Early and accurate diagnosis of infected prosthetic arterial grafts is difficult, despite the application of diverse diagnostic modalities. Delay in making the diagnosis is largely responsible for the high amputation and mortality rates associated with this complication. In nine patients with suspected graft infections, indium-111 white blood cell scanning was useful and accurate. Graft infection was proved in five cases and ruled out in three. One false-positive scan was due to a sigmoid diverticular abscess overlying the graft. Indium-111 white blood cell scans may improve the accuracy of diagnosing infected prosthetic grafts, which may result in better limb and patient salvage rates.

Topics: Adult; Aged; Aorta; Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm; Bacterial Infections; Blood Vessel Prosthesis; Female; Humans; Indium; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Postoperative Complications; Radioisotopes; Radionuclide Imaging