indium-oxine and Inflammation

There were many studies for diagnosis of localization and activity of thrombi and inflammation using indium-111-oxine labeled platelet (In-plt) and leucocyte scintigraphy (In-WBC), respectively. The study using these techniques is decreasing recently, because other diagnostic modarities have been developed and the techniques of these scintigraphy are complicated. However, because these scintigraphy are noninvasive, it is expected that these are widely applied to the clinical diagnosis and follow up. 1. Platelet scintigraphy can visualized thrombi and distinguish the activation of platelet aggregation. There were many reports and reviews. I reviewed recent studies in cardiovascular diseases and our cases. 2. Leucocyte scintigraphy (In-WBC) is usually used for the detection of inflammation. Furthermore, it is possible that In-WBC can detect inflammation of the arteriosclerotic lesion of the aortic wall. I introduced our studies of In-WBC in aortic aneurysma and aortic dissection. The In-WBC maybe useful for detection of inflammation of the aortic aneurysma and evaluation of prognosis of aortic dissection.

Topics: Aortic Aneurysm; Aortic Dissection; Blood Platelets; Cardiovascular Diseases; Humans; Inflammation; Leukocytes; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Radiopharmaceuticals; Thrombosis

Investigators have used various techniques and radionuclides such as 51Cr and 32P-diisofluorophosphate to label blood cells and to study cell survival. Early studies also used these radionuclides to label human leucocytes for cell survival by in-vitro counting. But external imaging could not be done with these agents. Starting with the use of the gamma-emitting radionuclide (111)In-oxine for in-vitro labelling of phagocytic leucocytes, external imaging became possible. This method was the basis of visualisation of cell distribution within the body. Because an abscess consists primarily of leucocytes, leucocytes labelled with (111)In localise within the abscess and are detectable by imaging. Nowadays other radiopharmaceuticals with other underlying uptake mechanisms are also used to detect inflammatory or infectious foci in patients. Nuclear medicine can be most useful in patients with fever of unknown origin, where a focus has to be defined, or in patients where a lesion is known by clinical symptoms or by a radiological imaging and the differentiation between infection and other pathologies has to be made.

Topics: Fever of Unknown Origin; Fluorine Radioisotopes; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Inflammation; Leukocytes; Nuclear Medicine; Organometallic Compounds; Oxyquinoline; Radioimmunodetection; Radiopharmaceuticals; Technetium Tc 99m Exametazime

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

We describe here a protocol for labelling autologous white blood cells with (111)In-oxine based on previously published consensus papers and guidelines. This protocol includes quality control and safety procedures and is in accordance with current European Union regulations and International Atomic Energy Agency recommendations.

Topics: Adult; Cell Separation; Chemotaxis, Leukocyte; Child, Preschool; Humans; Indium Radioisotopes; Infections; Inflammation; Isotope Labeling; Leukocytes; Organometallic Compounds; Oxyquinoline; Radiation Protection; Radionuclide Imaging; Radiopharmaceuticals; Tissue Distribution

Topics: Communicable Diseases; Humans; Indium Radioisotopes; Inflammation; Leukocytes; Organometallic Compounds; Oxyquinoline; Practice Guidelines as Topic; Quality Assurance, Health Care; Tomography, Emission-Computed, Single-Photon

We compared 125I-labelled recombinant human interleukin-8 (125I-IL-8) with 111In-labelled human leukocytes (111In-WBC) and 67Ga-citrate for scintigraphic depiction of acute sterile inflammatory lesions in rats. Radioiodination of IL-8 was catalysed by chloramine-T, and human leukocytes were radiolabelled with 111In-oxine. Inflammatory lesions were induced in male rats by subcutaneous injection of 2% carrageenan suspension into their left hindlimbs. Twenty-four hours later, each rat received 1.8-3.7 MBq (50-100 microCi) of a single agent by intravenous injection. Sequential whole-body scintigrams were obtained between 0 and 96 h post-injection. Activities in the lesion-bearing and control hindlimbs were expressed as regional percent injected activity corrected for physical decay (%IA) by reference to concurrently imaged standards, and for 125I-IL-8 by direct tissue counting at necropsy as well. 125I-IL-8 displayed appropriate electrophoretic mobility, retained chemotactic and high-affinity receptor-binding activity in vitro, and exhibited exponentially decreasing activity in most tissues beginning shortly after intravenous injection. Scintigrams showed asymmetrically increased activity in the lesion-bearing hindlimb for all three agents. By scintigraphy, 125I-IL-8 activity in the lesion-bearing hindlimb reached a zenith 1-3 h post-injection at 4.8 +/- 0.5 %IA and decreased exponentially thereafter, with little change in lesioned-to-control limb ratios (mean L/C = 3.0 +/- 0.7) over the imaging period. By direct tissue counting, abscess-associated mean IL-8 activity per gram of tissue increased to four times that of adjacent muscle and nearly seven times that of contralateral muscle by 24 h post-injection. Lesion-bearing hindlimb 111In-WBC activity also rose rapidly, reaching 4.2 +/- 0.6 %IA by scintigraphy at 3 h and an eventual plateau (maximum of 4.5 +/- 0.4 %IA) by 24 h. 67Ga scintigraphic activity in the lesion-bearing hindlimb peaked briefly at 3-6 h post-injection (9.2 +/- 0.5 %IA) and subsequently declined to a constant level of about 7.5 %IA. However, L/C for 111In-WBC and for 67Ga-citrate each averaged only 1.5 +/- 0.3 over the imaging period, compared with a mean L/C of 1.2 +/- 0.2 for a blood pool radiotracer. We conclude that 125I-IL-8 is rapidly and selectively concentrated in regions of acute inflammation, presumably by high-affinity binding to IL-8 receptors on neutrophils within the inflammatory focus. Radioiodinated IL-8 offers an attractiv

Topics: Animals; Carrageenan; Citrates; Female; Gallium; Gallium Radioisotopes; Humans; Indium Radioisotopes; Inflammation; Interleukin-8; Iodine Radioisotopes; Leukocyte Transfusion; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Rats; Rats, Sprague-Dawley; Recombinant Proteins; Tissue Distribution; Tomography, Emission-Computed; Transplantation, Heterologous

Indium-111 oxine labelled leucocyte (111In oxine leucocyte) scintigraphy is the test of choice in detecting occult infection and localising focal inflammation. 111In oxine labelling is technically difficult and expensive and leucocyte labelling with technetium-99m stannous colloid (99mTc Sn colloid) has been considered to be an alternative. Leucocytes from 40 cases referred for investigation of occult infection or localisation of inflammation were simultaneously labelled with 111In oxine and 99mTc Sn colloid with dual isotope acquisition performed at 1, 3 and 24 h. Twenty-four hour 99mTc Sn colloid scans were corrected for 111In downscatter. Each case was independently interpreted by two experienced observers. Twenty-one patients demonstrated positive 111In oxine leucocyte scans. Using 111In oxine leucocyte scans as the gold standard, 99mTc Sn colloid leucocyte scanning had an overall sensitivity of 86% and a specificity of 95%. Clinical follow-up verified that three patients had false negative 99mTc Sn colloid leucocyte scans and one patient had a false positive. Further clinical evaluation of 99mTc Sn colloid labelled leucocytes is required before they can become a reliable replacement for 111In oxine leucocytes.

Topics: Colloids; Evaluation Studies as Topic; Female; Focal Infection; Humans; Indium Radioisotopes; Inflammation; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Technetium Compounds; Time Factors; Tin; Tin Compounds

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

The in vitro and in vivo behaviour of 99Tcm-HMPAO (hexamethylpropyleneamineoxime) (n = 12) and 111In-oxine (n = 11) labelled granulocytes, isolated by density-gradient centrifugation (Metrizamide/plasma gradients), was compared in patients with suspected inflammatory diseases. The in vitro elution of both labels and the viability of the labelled cells (99Tcm, 98.5%; 111In, 96.5%) was comparable but the labelling efficiency was different (99Tcm, 44 +/- 13%; 111In, 72.5 +/- 5.5%). In vivo, the lung (t1/2 max: 7.7 min), liver and spleen perfusion patterns were nearly identical; the image quality for detail in 99Tcm scans was superior to 111In images. The blood disappearance curves of 99Tcm and 111In were comparable. In the small number of patients examined all infections could be diagnosed correctly, without false-positive or false-negative results. Disadvantageous is the renal excretion of 99Tcm complexes (3+% over 20 h) with kidney and bladder activity from the beginning of the study. The biliary excretion in half of the patients (n = 6) with unspecific positive small and large bowel visualization and the late intestinal excretion also render the diagnosis more difficult. The recommended best imaging times for abdominal and retroperitoneal inflammations are 30 min to 2 h after injection. Late scans in septic prosthetic joints have disproportionate long acquisition times. As a potential cell labelling compound, 99Tcm-HMPAO has a promising future in comparison to 111In scans because of the good availability of 99Tcm, the image quality and the lower radiation exposure to the patient when lower activities for the early diagnosis of abdominal inflammatory diseases are reinjected.

Topics: Colitis, Ulcerative; Crohn Disease; Female; Granulocytes; Humans; Hydroxyquinolines; Indium Radioisotopes; Inflammation; Isotope Labeling; Joint Diseases; Lung Diseases; Male; Organometallic Compounds; Oximes; Oxyquinoline; Polycystic Kidney Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

The uptake of indium-111 labelled neutrophils was examined in 30 patients with acute myocardial infarction by planar imaging and single photon emission computed tomography. The time from venepuncture to reinjection of the autologous labelled neutrophils was less than 2.5 hours and imaging was carried out 24 hours later. Twenty three patients had a positive uptake of neutrophils in the myocardium and imaging was improved by single photon emission computed tomography. There was a significant difference between the intervals from the onset of chest pain to injection of labelled neutrophils between patients with positive and negative images; early reinjection was more likely to produce a positive image. Indeed, all nine patients reinjected within 18 hours of the onset of symptoms had positive images. The results suggest that the stimulus for activation and migration of neutrophils is transient; this is an important factor if neutrophil release products play a role in cell damage after coronary occlusion.

Topics: Acute Disease; Acute-Phase Reaction; Female; Heart; Humans; Hydroxyquinolines; Indium; Inflammation; Liver; Male; Middle Aged; Myocardial Infarction; Neutrophils; Organometallic Compounds; Oxyquinoline; Radioisotopes; Spleen; Tomography, Emission-Computed

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

Autologous lymphocytes were labeled with In-111 oxine in 26 patients with chronic inflammatory disease. Whole body gamma camera scans were performed at 24 and 48 hours post injection. Activity was normally seen in spleen, liver, bone marrow, and cervical and inguinal lymph nodes; any activity outside there areas was considered abnormal. Five out of 11 patients with proven or suspected chronic osteomyelitis had positive scans. Four out of five patients with chronic arthritic diseases had positive scans. Also, three patients had bladder uptake suggesting bladder inflammation on a chronic basis.

Topics: Adult; Aged; Chronic Disease; Humans; Hydroxyquinolines; Indium; Inflammation; Lymphocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Time Factors; Whole-Body Counting

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

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

Topics: Aged; Diagnosis, Differential; Humans; Hydroxyquinolines; Indium; Inflammation; Ketones; Leukocytes; Organometallic Compounds; Oxyquinoline; Pentanones; Radioisotopes; Radionuclide Imaging

Topics: Humans; Indium; Inflammation; Leukocytes; Organometallic Compounds; Oxyquinoline; Radiography; Radioisotopes