indium-oxine and Pneumonia

The objective of this study was to characterize, and determine the significance of, pulmonary activity on labelled leukocyte images. This retrospective review included 137 immunocompetent patients who had undergone 111In labelled autologous leukocyte chest imaging and chest X-ray within 7 days. Pulmonary activity was classified as normal, focally increased, or diffusely increased. Images were correlated with chest X-rays and final diagnoses. One hundred and twelve patients (82%) had normal pulmonary activity. Seventy-six had normal chest X-rays; none had pulmonary infection. Thirty-six patients had chest X-ray abnormalities; only one had pulmonary infection. Twenty-five patients had abnormal pulmonary activity. In 13 patients it was segmental or lobar in distribution. The chest X-ray was abnormal in 12: pneumonia (11) and cystic fibrosis (one). The chest X-ray was normal in one patient with pneumonia. Two patients with non-segmental pulmonary activity did not have pulmonary infection. The chest X-ray was abnormal in one (pulmonary edema) and normal in one (sepsis). Ten patients had diffuse pulmonary activity. Chest X-ray was abnormal in two patients: adult respiratory distress syndrome (ARDS) (one) and drug toxicity (one). No patient with diffuse pulmonary activity had pulmonary infection. In summary, negative labelled leukocyte imaging excludes pulmonary infection with a high degree of certainty (the negative predictive value was 99% in this series), and can exclude pneumonia as the cause of a chest X-ray abnormality. Focal pulmonary activity strongly suggests pneumonia, while diffuse pulmonary activity is unlikely to indicate infection.

Topics: Aged; Aged, 80 and over; Child; Female; Humans; Indium Radioisotopes; Leukocytes; Lung; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pneumonia; Radiography; Radionuclide Imaging; Respiratory Tract Infections; Retrospective Studies; Whole-Body Counting

Indium-111-labeled-leukocyte scintigraphy was performed on three febrile patients, two of whom had no signs or symptoms referable to the respiratory tract. The third patient had dyspnea on exertion, unchanged over two months. Their past histories were remarkable in that all three had recently undergone chemotherapy for malignancy (2 lymphoma, 1 malignant thymoma). Diffuse pulmonary uptake of labeled leukocytes was observed in all three individuals. As a direct result of leukocyte imaging, all three underwent fiberoptic bronchoscopy and transbronchial biopsy. The final diagnosis in each of these patients was drug-induced pneumonitis, which responded to treatment with corticosteroids. This entity should be added to the group of conditions, both infectious and noninfectious, that cause diffuse pulmonary uptake on labeled leukocyte images. Moreover, in the appropriate clinical setting, even in the absence of pulmonary signs or symptoms, diffuse pulmonary uptake of labeled leukocytes should alert the physician to the possibility of drug-induced pneumonitis.

Topics: Aged; Antineoplastic Agents; Humans; Leukocytes; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pneumonia; Radionuclide Imaging; Thymoma

One hundred sixty-two white-blood-cell scans were retrospectively reviewed to determine the sensitivity and specificity of the test for pulmonary and pleural infection. All scans were performed 18-24 hr after injection of indium-111 oxine-labeled autologous or donor cells. Pulmonary activity was graded on a scale of 0-4: 0 = equal to soft tissue; 1 = greater than soft tissue but less than rib; 2 = equal or greater than rib but less than liver; 3 = equal or greater than liver but less than spleen; 4 = equal to spleen. Activity was also characterized as being focal or diffuse. The white-blood-cell scan findings were correlated with the clinical diagnosis on the basis of physical examination, laboratory results, chest radiographs, clinical course, and pathologic studies when available. As pulmonary activity increased from grade 1 to 4, sensitivity declined from 93% to 14% and specificity increased from 64% to 100%. The sensitivity and specificity of focal uptake were 31% and 89% vs 62% and 74% for diffuse pulmonary activity. Making a distinction between focal and diffuse activity did not improve the specificity of low grades of pulmonary activity. The white-blood-cell scan can be very sensitive or very specific for pulmonary or pleural infection, depending on the criteria selected for a positive scan.

Topics: Adolescent; Adult; Aged; Empyema; Female; Humans; Hydroxyquinolines; Indium; Leukocytes; Lung; Lung Diseases; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Pleural Diseases; Pneumonia; Radionuclide Imaging; Respiratory Tract Infections