indium-oxine and Inflammatory-Bowel-Diseases

Radiolabelled leucocytes migrate rapidly to sites of acute inflammation. The simplest technique for imaging intestinal inflammation involves radiolabelling patients' mixed while cells ex vivo with either 99mTc or 111In which are then reinjected. However, further purification of mixed white cells to granulocytes is needed for optimal results using 111In. Owing to the simpler labelling procedure, availability, image quality and dosimetry, 99mTc-HMPAO has gained favour for the investigation of acute inflammation including inflammatory bowel disease. Because of its longer half life. 111In is more suited to the imaging of chronic inflammation such as osteomyelitis. Attempts to radiolabel granulocytes in vivo using monoclonal anti-granulocyte antibodies have been largely unsuccessful to date, and this approach remains a challenge for the future.

Topics: Cell Separation; Granulocytes; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Monocytes; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Antibodies, Monoclonal; Humans; Indium Radioisotopes; Infections; Inflammatory Bowel Diseases; Iodine Radioisotopes; Leukocytes; Organometallic Compounds; Oxyquinoline; Predictive Value of Tests; Radionuclide Imaging; Technetium; Tissue Distribution

The increasing knowledge of the molecular basis of leukocyte trafficking results in the development of novel anti-inflammatory strategies for inflammatory bowel disease (IBD). For optimal evaluation of therapy efficacy, information about inflammatory activity in bowel segments or lymphocyte recirculation and kinetics in the follow-up of experimental treatment for IBD is needed. The aim of this study was to evaluate a non-invasive scintigraphic technique, able to assess lymphocyte trafficking in a trinitrobenzene sulfonic acid (TNBS) induced mouse colitis model of IBD.. TNBS sensitized and non-sensitized murine total splenocytes were labeled in vitro with 111In-oxine and injected into either control or TNBS colitis BALB/c mice. Biodistribution and specific radioactive uptake, representing transferred cells, were determined by serial dedicated animal planar scintigraphy and pinhole SPECT of the abdomen 4, 24 and 48h post injection of labeled cells. In addition, the severity of inflammation was determined by histological scoring.. Migration of 111In labeled splenocytes to the colon increased in time and was maximal at 48h after administration. The highest specific radioactive uptake ratio in the colon after 48h was observed in mice with TNBS colitis that received TNBS sensitized lymphocytes. Histological scoring confirmed the presence of colitis in the TNBS treated groups.. Homing of TNBS-sensitized lymphocytes can be assessed in vivo by means of dedicated animal pinhole SPECT. Generally, this technique enables serial measurement of specific cell trafficking with potential of in vivo evaluation of novel anti-inflammatory strategies in inflammatory bowel disease.

Topics: Animals; Cell Movement; Colitis; Colon; Disease Models, Animal; Female; Inflammatory Bowel Diseases; Lymphocytes; Mice; Mice, Inbred BALB C; Organometallic Compounds; Oxyquinoline; Radiopharmaceuticals; Receptors, Lymphocyte Homing; Tissue Distribution; Tomography, Emission-Computed, Single-Photon; Trinitrobenzenesulfonic Acid

Topics: Adult; Child; Humans; Inflammatory Bowel Diseases; Leukocytes; Organometallic Compounds; Oxyquinoline; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Topics: Adult; Child; Humans; Inflammatory Bowel Diseases; Leukocytes; Organometallic Compounds; Oxyquinoline; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Forty-seven patients, 29 with chronic inflammatory bowel disease (IBD) and 18 with presumed irritable bowel syndrome, including one with uncomplicated diverticular disease, were studied with simultaneous technetium-99m hexamethylpropylene amine oxime and indium-111 oxine labelled leucocyte scans performed at 1, 3 and 24 h. Twenty-seven patients with IBD had active disease as judged by clinical and laboratory criteria and all of these had positive scans with both agents. No false positive studies were obtained. The 1-h 99mTc-HMPAO WBC scans showed the same distribution to disease as the 3-h 111-In WBC scans, with no difference in intensity (P < 0.92); they showed more extensive disease (P < 0.02) and more intense uptake (P < 0.001) than did the 1-h 111-In scans. The 3-h 99mTc-HMPAO WBC scans showed more extensive disease (P < 0.002), with greater intensity (P < 0.0005), than did the 3-h 111In WBC scans. Physiological bowel activity on 3-h 99mTc-HMPAO WBC scans was present in 12 patients but was faint and did not interfere with assessment of disease extent and activity. It is concluded that in terms of isotope availability, radiation dosimetry and image quality, 99mTc-HMPAO is the agent of choice in detecting active IBD, with localization of disease possible at 1-h after re-injection and optimal resolution and definition of disease extent at 3 h. A negative scan reliably excludes active disease.

Topics: Adult; Colonic Diseases, Functional; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Intestines; Leukocytes; Male; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Thirty-three patients suspected of suffering from inflammatory bowel disease were studied. Autologous leucocytes were labelled with indium 111 oxine and re-injected simultaneously with 0.3-0.5 mg of technetium 99m granulocyte-specific monoclonal antibody BW 250/183. Two scans were obtained, the early scan 3-4 h postinjection (p.i.) and the late scan 18-24 h p.i. Using the endoscopy study as standard, the diagnostic accuracy of both agents was determined. Sensitivity, specificity and accuracy of 111In scans was 88.8%, 100.0% and 93.7% at 4 h and 94.7%, 100.0% and 96.9% at 24 h, respectively. Concerning the results using antibodies, the values were 61.1%, 100.0% and 78.1% at 4 h and 78.9%, 92.8% and 84.8% at 24 h, respectively. Segmental analysis showed concordance in 89.3% and 93.3% of the cases at 4 and 24 h, respectively. Though less sensitive and less accurate than scanning employing indium 111 leucocytes, BW 250/183 granulocyte-specific scintigraphy can be used for inflammatory bowel disease diagnosis and localization.

Topics: Adult; Evaluation Studies as Topic; Female; Humans; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Organometallic Compounds; Oxyquinoline; Predictive Value of Tests; Radioimmunodetection; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m

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

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Colon; Female; Humans; Ileum; Indium Radioisotopes; Inflammatory Bowel Diseases; Leukocytes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Adult; Antibodies, Monoclonal; Antigen-Antibody Reactions; Female; Granulocytes; Humans; Indium Radioisotopes; Infections; Inflammatory Bowel Diseases; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tissue Distribution

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