indium-oxine and Bone-Diseases

We report an analysis of the results obtained in our first 100 studies with indium-111-oxine labelled leukocyte scintigraphy, a diagnostic technique which has recently become available for clinical evaluation within Australia. We used this technique to assess patients with suspected sepsis or inflammation after other commonly used investigations had failed to confirm a diagnosis. Four patient subgroups were evaluated: fever of unknown origin; suspected abdominal or postoperative sepsis; suspected active inflammatory bowel disease; and suspected sepsis or inflammation of bones or joints. The course of all patients was followed for at least three months to establish the accuracy of the technique. The leukocyte labelling procedure took 90 min and imaging was carried out typically 3-6, 24 and occasionally 48 h after reinjection of the labelled autologous leukocytes. In one patient labelling of leukocytes was unsuccessful. In the remaining 99 studies the overall sensitivity of leukocyte scintigraphy was 88% (36 of 41 patients with a proved inflammatory or infective disease focus had positive scan findings); and the specificity was 95% (55 of 58 cases with no proved disease focus had normal scan findings). This series supports the use of this method as the imaging procedure of choice in nuclear medicine for the evaluation of suspected acute sepsis (symptoms less than four weeks' duration), of inflammatory bowel disease and of suspected infections involving appendicular bones which contain no active bone marrow. It is also a useful secondary scintigraphic procedure, after gallium-67-citrate scintigraphy, in patients with suspected infective disorders of more than four weeks' duration.

Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Female; Humans; Indium Radioisotopes; Infections; Inflammation; Inflammatory Bowel Diseases; Joint Diseases; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

Although photon deficient defects on bone scan have received a great deal of interest, such defects in bones on Indium-111 (111In) leukocyte imaging have not been as well recognized. We therefore undertook a retrospective review to determine the frequency and significance of such "cold" defects on 111In-labeled leukocyte imaging. Three hundred thirty-two scans on 290 patients were reviewed and 40 cases of decreased activity involving bone were found, for an incidence of 12%. The causes of the defects were: fracture (eight), nontraumatic avascular necrosis (eight), solid tumor (six), prostheses and other orthopedic hardware (four), advanced age (four), radiation (three), leukemia (two), osteomyelitis (two), myelofibrosis (one), postlaminectomy (one), and idiopathic (one). To determine the frequency of cold defects in osteomyelitis, all 15 cases of osteomyelitis in this series were reviewed and 12 showed increased activity, two were cold, and one was normoactive. Thus, 14% of cases of osteomyelitis presented as cold defects. We conclude that cold bone defects do occur on 111In-labeled leukocyte scans and that the causes of such defects are similar to those reported for bone and bone marrow scanning.

Topics: Bone and Bones; Bone Diseases; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging; Retrospective Studies

Indium-111-labeled leukocyte scans were performed on 39 patients with suspected musculoskeletal infections to assess the usefulness of this study in detecting bone and joint infections. Results of these scans, as well as results of technetium-99m bone scans, were correlated with the patients' final diagnoses. The indium scan had an overall sensitivity of 77%, a specificity of 69%, and an accuracy of 72%. In 10 patients with a duration of symptoms of six weeks or less, the sensitivity was 100% and the specificity was 75%. In 29 patients with symptoms of greater than six weeks, the sensitivity and specificity were lower at 50% and 71% respectively. Technetium-99m bone scans were performed on 23 patients; sensitivity for infection was 100% while specificity was 60%. Our results suggest that the indium-111 leukocyte scan is a useful adjunct in the diagnosis of acute musculoskeletal infections, but may be inconclusive in chronic infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Child; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Muscular Diseases; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging

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

A method for the concentration of leucocytes from blood and labelling of the separated cells with 111-Indium oxine is described. This method guaranteed a good preparation. On average there were 64.8% of leucocytes from the blood in the concentrate. The yield of the labelling averaged 93%. Seventy-two patients from various departments were examined to test the clinical application of the labelled leucocytes in the diagnosis of inflammatory diseases. The results obtained led to the formulation of six indications for the appropriate application of leucocyte scanning in everyday clinical routine.

Topics: Adolescent; Adult; Aged; Bone Diseases; Brain Diseases; Child; Humans; Hydroxyquinolines; Indium; Inflammation; Isotope Labeling; Leukocytes; Middle Aged; Neuromuscular Diseases; Organometallic Compounds; Oxyquinoline; Radiation Dosage; Radioisotopes; Radionuclide Imaging; Urologic Diseases

A new nuclear scanning technique was found more specific for bone, joint, and soft tissue infections than any previously described scanning technique. The leukocyte scan, whereby a patient's own cells are labeled with a radioactive tagging agent (111In oxine), can distinguish an active infectious process from other pain-inducing conditions. Ninety-seven 111In labeled autologous leukocyte scans were performed in 88 patients. The findings in 17 of 40 patients scanned for possible acute osteomyelitis, six of nine for suspected septic arthritis, and six for possible soft tissue infections, were positive. Subsequent clinical courses verified the infectious nature of these processes in all patients. Patients who had chronic osteomyelitis (14), bony metastases (four patients), heterotopic ossification (three), and degenerative arthritis (two) demonstrated negative findings. Of the seven patients scanned for acute long-bone fractures, one demonstrated positive findings. Nine scans demonstrated positive findings without determined causes. The leukocyte scan is a useful addition to the diagnostic tools of the orthopedic surgeon.

Topics: Adult; Aged; Bone Diseases; Bone Neoplasms; Female; Fractures, Bone; Humans; Indium; Infections; Isotope Labeling; Joint Diseases; Leukocytes; Male; Middle Aged; Neoplasm Metastasis; Organometallic Compounds; Ossification, Heterotopic; Oxyquinoline; Radioisotopes; Radionuclide Imaging