indium-oxine and Brain-Abscess

The differential diagnosis of intracerebral enhancing lesions on contrast computed tomography includes tumors, abscesses, and cerebrovascular accidents. Particularly important is the differentiation between tumor and abscess. While In-111 labeled leukocyte imaging is an accurate test for identification of foci of infection in general, the role of this procedure in the evaluation of the intracranial lesion is not well established. We undertook a retrospective review of 16 patients with contrast enhancing intracerebral lesions identified on computed tomography, who were also studied with labeled leukocyte imaging. Final diagnoses were: abscess (n = 2), primary brain tumor (n = 6), metastasis (n = 4), dermoid cyst (n = 1), and cerebral infarct (n = 3). There were two positive labeled leukocyte studies; both were cerebral abscesses. No labeled leukocyte activity was identified in any of the tumors or infarcts. We conclude that In-111 labeled leukocyte imaging is an accurate method of differentiating infectious from noninfectious causes of intracerebral lesions identified on computed tomography.

Topics: Adult; Aged; Aged, 80 and over; Brain Abscess; Brain Diseases; Brain Neoplasms; Cerebral Infarction; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Retrospective Studies; Tomography, X-Ray Computed

111-indium-labelled leukocyte scintigraphy used for testing inflammatory intracranial lesion delimitation in differential diagnosis, shows reliable results in 80% of the cases, whereas 10% demonstrate false-positive as well as false-negative results. Loss of time is caused by the 24 h waiting period for measurement, and because of supply problems. Due to these drawbacks, this method is of only limited help to the neurosurgeon in quickly finding safe pointers for determining the time of operation if inflammatory intracranial lesions are suspected. Hence, this method requires to be improved upon, or a new one should be developed.

Topics: Adult; Aged; Brain Abscess; Female; Humans; Leukocytes; Male; Meningitis; Middle Aged; Organometallic Compounds; Oxyquinoline; Tomography, Emission-Computed, Single-Photon

CT scanning and scintigraphy with 111Indium-oxide-labelled white blood cells were used to study 32 cases of intracerebral cystic lesions. The results and the criteria of positivity used to lower the false positive rate are discussed. A new criterion, designed to assess the time course of the scintiscan and so reduce still further the frequency of false positives is put forward.

Topics: Adolescent; Adult; Aged; Brain Abscess; Brain Diseases; Chemotaxis, Leukocyte; Cysts; Diagnosis, Differential; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Retrospective Studies; Tomography, X-Ray Computed

Sixteen patients with intracerebral mass lesions where computed tomography (CT) was not fully conclusive with respect to the differential diagnosis between brain tumor and abscess were examined with leukocyte brain scintigraphy (LBS). Autologous leukocytes were labeled with indium-111 oxinate and were reinjected intravenously; registration with a gamma camera was performed after 24 and 48 hours. In 10 of 11 patients with the final diagnosis of a brain tumor, no accumulation of radiolabeled leukocytes could be detected in the brain. In 4 of 5 patients with the final diagnosis of brain abscess, scintigraphy showed a pronounced increase of focal activity corresponding to the lesion demonstrated with CT. The reasons for the one false-positive and the one false-negative result are discussed, and it is concluded that LBS (a) can be used to detect intracranial infection and (b) may be a useful diagnostic tool for distinguishing between brain abscess and brain tumor.

Topics: Adult; Aged; Brain Abscess; Brain Neoplasms; Diagnosis, Differential; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging; Time Factors

A case of acute tentorial subdural hematoma detected by In-111 leukocyte scintigraphy and confirmed by CT brain scan is herein described. White blood cells are an integral part of the blood pool and labeled white cells freely leave the intravascular space in case of active bleeding. Acute hemorrhage and hematoma can thus be a cause of a false-positive study.

Topics: Aged; Brain Abscess; False Positive Reactions; Hematoma, Subdural; Humans; Hydroxyquinolines; Indium; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Radioisotopes; Radionuclide Imaging