technetium-tc-99m-exametazime and Bacterial-Infections

The diagnosis of abdominal infections and inflammations often presents considerable difficulty, and various imaging techniques may be required to localize them accurately. At present, radiolabelled leucocytes offer the most widely accepted radionuclide method for imaging inflammation. Because of the many advantages of technetium-99m (99mTc) over indium-111 (111In), 99mTc-HMPAO-leucocyte scintigraphy is preferred for the investigation of acute abdominal sepsis and inflammatory bowel disease, and 111In-leucocyte scintigraphy for more chronic infections and renal sepsis. The 99mTc-HMPAO-labelled leucocytes technique is highly accurate within the first few hours postinjection, and is therefore useful also in acutely ill patients. It is sensitive in detecting abdominal abscesses in all locations except the liver and spleen. By whole body imaging, unsuspected sites and types of infection can be found. 99mTc-HMPAO-leucocyte scan is valuable also in the investigation of acute cholecystitis in problematic situations in which ultrasound is known to give misleading results, especially in acute acalculous cholecystitis. In inflammatory bowel disease it can reliably assess disease activity, but a normal scintigraphy does not exclude mild inflammation. Leucocyte scan is useful also in suspected acute appendicitis, acute diverticulitis, pelvic inflammatory disease, aortic graft infection, etc. But infection and inflammation cannot reliably be differentiated, which may cause misinterpretations in the early postoperative period. Radionuclide techniques have an important role to play in the investigation of abdominal sepsis if the nuclear medicine department can offer instant investigations when the clinical problem is acute.

Topics: Abdomen; Abdominal Abscess; Antibodies, Monoclonal; Bacterial Infections; Gallium Radioisotopes; Humans; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sepsis; Technetium Tc 99m Exametazime

The purpose of this study was to compare the utility of 99mTc labelled ciprofloxacin (Infecton) imaging with the 99mTc white blood cell and three-phase bone imaging procedures for identifying hip prosthesis infection. We studied 30 symptomatic patients in whom infection was confirmed in eight and excluded in 22 cases based on clinical and microbiological findings. 99mTc ciprofloxacin images were obtained at 1, 4 and 24 h after the injection of the tracer, and the data were compared to those obtained from 99mTc leukocyte and three-phase bone imaging. The 99mTc ciprofloxacin imaging correctly identified all true infections. In 13 (59%) of the non-infected patients, non-specific uptake of 99mTc ciprofloxacin was found in the 1-h and 4-h images, which disappeared, however, in the 24-h images. When the early and late 99mTc ciprofloxacin images were compared, the specificity was found to improve from 41% to 95%, positive predictive value from 38% to 89%, and the diagnostic accuracy from 57% to 97%. The accuracy of the conventional 99mTc leukocyte imaging was 90%. Dynamic bone imaging also yielded abnormal findings in all the infected patients although also in 23% of the non-infected patients. Current data indicate that 99mTc ciprofloxacin is a useful method for confirming hip prosthesis infection. The diagnostic efficiency of this method is improved when the imaging time is extended to 24 h post-injection of the tracer.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone and Bones; Ciprofloxacin; False Positive Reactions; Female; Hip; Hip Prosthesis; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Single-Blind Method; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

The differential diagnosis between complex regional pain syndrome (CRPS) and postoperative infection is sometimes difficult. We discuss such a case following surgical release of a trigger finger. Because of lack of an accurate diagnosis, the patient was subjected to more and more costly investigations and was operated one more (and unnecessary) time. As white blood cell scintigraphy ((99m)technetium hexamethylpropyleneamineoxime leukocyte [(99m)Tc HMPAO leu]) proved negative, it allowed us to identify with high specificity, a non infectious cause for the problem, and to stop over-investigation and inflation of the costs of treatment. However, the use of white blood cell scintigraphy should remain exceptional, because of its complexity and expense.

Topics: Bacterial Infections; Diagnosis, Differential; Female; Hand; Humans; Leukocytes; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Sensitivity and Specificity; Surgical Wound Infection; Technetium Tc 99m Exametazime; Thumb

The aim of this study was to evaluate, retrospectively, the diagnostic value of Tc hexamethylpropylene amine oxime (99mTc-HMPAO) labelled autologous leucocytes for the preferred septic localizations of the infection of the endoprosthesis. We retrospectively reviewed 67 patients with implanted endoprostheses. Diagnosis was found in 42/67 patients. In 25/67 patients we were able to negate an acute pathological process of infection of the endoprosthesis. Our patients were divided into three groups according to the type of endoprosthesis (hip joint, knee joint, shoulder joint). The localizations of the endoprosthesis disorders are shown. The preferred localizations of the acute infection of the hip endoprosthesis are the regio intertrochanterica and the middle part of the shaft of the prosthesis. The preferred localization of the acute infection of the knee endoprosthesis is the proximal shaft of the tibia. The preferred localization of the acute infection of the shoulder endoprosthesis is the distal end of the prosthesis in the proximal humerus. It is hoped that the knowledge of these preferred localizations of infection of endoprosthesis will help patients and doctors in diagnosis and treatment in the future.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bacterial Infections; Female; Hip Prosthesis; Humans; Joint Prosthesis; Knee Prosthesis; Leukocytes; Male; Middle Aged; Osteomyelitis; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Shoulder Joint; Technetium Tc 99m Exametazime

99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections.. Fifty-six sites with suspected bone or joint infection were examined with 99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370-400 MBq infecton or 185-200 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies.. There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With 99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients.. Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone and Bones; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Female; Humans; Infant; Joint Diseases; Joints; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Prospective Studies; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Exametazime

Our purpose was to investigate cerebral blood flow disturbances in patients with bacterial and viral meningoencephalitis.. Forty-two patients with acute bacterial and viral meningoencephalitis and 14 control subjects were studied using 99mTc-hexamethylpropyleneamine oxime (HMPAO) single-photon emission computed tomography (SPECT). SPECT images were evaluated semiquantitatively. The results were compared with clinical severity of the meningoencephalitis assessed at the time of the SPECT study with the Hunt and Hess scale, with separately recorded focal clinical signs, and with the Glasgow outcome scale (GOS) after 3 weeks.. Count density values were significantly reduced in patients with bacterial meningoencephalitis as compared with the control subjects. Inhomogeneous tracer accumulation assessed by asymmetry indexes was significantly greater in patients than in the control group. With increasing Hunt and Hess scores, the count density values decreased and the asymmetry indexes increased. Patients with a poor outcome (GOS 1 to 3) had significantly higher asymmetry indexes and lower CDV values than did patients with a good outcome.. Global and focal alterations of cerebral perfusion are frequent in bacterial and viral meningoencephalitis and correlate with acute clinical state.

Topics: Adult; Bacterial Infections; Cerebrovascular Circulation; Female; Humans; Male; Meningoencephalitis; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Virus Diseases

Topics: Adult; Bacterial Infections; Foot Diseases; Humans; Leukocytes; Lymph Nodes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

To evaluate the applicability of Tc-99m HMPAO leukocyte scintigraphy in the assessment of focal infections in children, we retrospectively analyzed 26 studies performed between 1988 and 1992. All patients (n = 25, age range 1 month-15 years) were severely ill and suspected to have invasive bacterial infection. In each case, whole body scintigraphy was performed 2-4 hours after injection of autologous labeled leukocytes. There were 8 true positive and 14 true negative cases; specificity was 88% and sensitivity 80%. The two false negative findings were observed in patients on immunosuppressive therapy; both had fungal infections. In one case, atypical non-specific bowel accumulation of the tracer was falsely interpreted as an abscess. The other false positive finding was hip accumulation in a patient who later turned out to have Mucha-Haberman disease; transient synovitis may explain the finding. Of the eight true positive cases, six had an invasive infection focus and two had an aseptic inflammatory process. Tc-99m HMPAO leukocyte scintigraphy is a valuable method in the assessment of focal inflammation in children, including infants.

Topics: Adolescent; Bacterial Infections; Child; Child, Preschool; Female; Focal Infection; Humans; Infant; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Thirty-five patients with suspected chronic osteomyelitis related to an orthopaedic device had 50 99Tcm-HMPAO-labelled leucocyte scans (LS). The scan appearances were compared with the bacteriological or clinical results and gave a sensitivity and specificity of HMPAO-LS of 83 and 100%, respectively. Bacteriological examination is often inaccurate in the diagnosis of osteomyelitis and therefore we assessed the clinical utility of HMPAO-LS. When the clinical, biological and radiological data were clearly suggestive of osteomyelitis (16/50) LS was unhelpful or even misleading when falsely negative (3/16). When the clinical, biological and radiological data were poorly suggestive of osteomyelitis (20/50) or conflicting (14/50) LS was misleading in only one patient (false negative). It is concluded that HMPAO-LS should only be performed to assist in the diagnosis of chronic osteomyelitis when there is no preexisting strong suspicion based on clinical, biological and radiological signs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Chronic Disease; Female; France; Humans; Joint Prosthesis; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Orthopedic Equipment; Orthopedic Fixation Devices; Osteomyelitis; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Technetium-99m-HMPAO (Tc-99m-HMPAO) labeled leukocyte imaging was carried out in 19 patients at 3-5 hr after reinjection. There were no side effects noted. Tc-99m leukocyte images showed gall bladder, colon, kidney, and urinary bladder activity in normal distribution as a result of excretion of the eluted Tc-99m complex. They yielded a sensitivity of 93%, a specificity of 100% and an accuracy of 95%. They were correctly positive in 14 out of 19 cases. But one false negative case was seen in a patient with pyonephrosis showing a lack of renal function with decreased renal blood flow. It was concluded that they have some advantages over In-111 leukocyte images, but we have to consider the fact that the ureteral obstruction or the lack of renal function with decreased renal blood flow may result in a false positive or a false negative case.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Technetium-99m-HMPAO labeled leukocytes demonstrated chronic femoro-femoral prosthetic vascular graft infection several times during an 18-mo period in a 77-yr-old man. The intensity and distribution of the uptake in the graft were fluctuating in different imaging occasions possibly indicating the strength and location of the infection. Gallium-67-citrate imaging showed negative results twice. The reason for negative 67Ga results remained obscure. The infected graft was removed and the patient did well 5 mo postoperatively.

Topics: Aged; Bacterial Infections; Blood Vessel Prosthesis; Chronic Disease; Enterobacteriaceae Infections; Humans; Leukocytes; Male; Organotechnetium Compounds; Oximes; Peptostreptococcus; Radionuclide Imaging; Technetium Tc 99m Exametazime

Technetium-99m-HM-PAO [( 99mTc]HM-PAO) leukocyte and indium-111-oxine (111In-oxine) leukocyte scanning were carried out simultaneously in 41 patients at 4 hr and 24 hr after reinjection to determine whether the 4-hr 99mTc scan could replace the 24-hr 111In scan for detecting intraabdominal sepsis. Abdominal infection was confirmed in 12 cases. The 4-hr 99Tc-leukocyte scan, the 4-hr 111In-leukocyte scan, and the 24-hr 111In-leukocyte scan yielded a sensitivity of 100%, 67%, and 100%, respectively, and a specificity of 62%, 90%, and 86%, respectively. The 24-hr 99mTc-leukocyte scan also produced a sensitivity of 100%, but it was falsely positive in all 29 cases without infection due to physiologic bowel uptake. False-positive 4-hr 99mTc-leukocyte scans were also produced by physiologic bowel uptake in seven cases all of whom had true-negative 4-hr and 24-hr 111In-leukocyte scans. Because of the high incidence of false-positive 4-hr [99mTc]HM-PAO leukocyte scans, it was concluded that they could not replace 24-hr 111In-leukocyte scans for detecting intraabdominal sepsis, and that serial 99mTc leukocyte scans starting earlier than 4 hr after reinjection must be evaluated.

Topics: Abdomen; Bacterial Infections; False Positive Reactions; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Four patients with the acquired immunodeficiency syndrome (AIDS) and fever were investigated using donor leucocyte scans. The lung/liver and lung/spleen uptake ratios in these patients were compared with the uptake ratios in donor leucocyte scans in seven neutropenic (non-AIDS) patients and five patients who had autologous leucocyte scans performed over the same time period. For all scans indium-111-oxime-labelled leucocytes were used, except for one AIDS patient in whom technetium-99m hexamethyl-propylene amine oxide (HMPAD)-labelled donor leucocytes were used. There were no adverse reactions to the donor cell infusions. Two patients had repeat studies 8 weeks apart (from different donors) without ill effect. There were no differences in the 111In uptake ratios between the three groups. There were three positive studies in the patients with AIDS, and these elucidated the cause of the pyrexia in all three. The negative case is more difficult to confirm, but the clinical course and the absence of focal disease on post-mortem have been taken to support the scan findings. There was no difference in the acceptability of the technique or the distribution of the labelled leucocytes between the AIDS and non-AIDS patients. Donor leucocyte imaging of patients with AIDS is probably more effective and considerably less hazardous for technical staff than autologous leucocyte methods. This study demonstrates that the technique can be applied successfully to patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Bacterial Infections; Blood Donors; Fever of Unknown Origin; Humans; Indium Radioisotopes; Isotope Labeling; Leukocytes; Middle Aged; Opportunistic Infections; Organometallic Compounds; Organotechnetium Compounds; Oximes; Oxyquinoline; Radionuclide Imaging; Technetium Tc 99m Exametazime

Early and accurate detection of prosthetic arterial graft infection is important because this serious complication of vascular surgery carries high morbidity and mortality rates. This report describes the use of a new method of isotopic imaging to detect graft infection using 99mTc-hexametazime-labelled leucocytes. Seventeen patients with potentially infected arterial grafts were imaged in addition to routine investigations but were managed according to our normal surgical practice. 99mTc-imaging was positive in eight patients with proven graft infection and falsely positive in one patient with a groin haematoma (89 per cent specificity). There were no false negatives (100 per cent sensitivity) after an average follow-up of 6 months (range 3-9 months). This technique has proved a reliable and rapid method of confirming graft infection.

Topics: Aged; Bacterial Infections; Blood Vessel Prosthesis; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Polyethylene Terephthalates; Polytetrafluoroethylene; Postoperative Complications; Radionuclide Imaging; Reoperation; Technetium Tc 99m Exametazime; Time Factors

Topics: Arthritis, Infectious; Bacterial Infections; Focal Infection; Humans; Immunoglobulin G; Indium Radioisotopes; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

31 patients with suspected septic loosening of an endoprosthesis (hip endoprosthesis n = 30; knee endoprosthesis n = 1) were examined with leukocyte scans (10 MBq 111In-oxine: n = 22; 300 MBq 99mTc-HMPAO: n = 9). The results were compared with results of the bacterial growth (n = 22), the histology (n = 12) and of the bone scans (99mTc-MDP: n = 20) which were performed within 4 days. The sensitivity of the bone scan was 100%, the specificity 30% and the diagnostic accuracy regarding a septic loosening of the arthroplasty was 55%. For the leukocyte scans a comparable sensitivity of 100%, but a higher specificity (86%) and accuracy (91%) could be calculated. A false positive leukocyte scan could be observed in a periprosthetic granuloma, an ossifying periarthritis and in a patient with negative bacterial growth with the histological proof of an inflammation.

Topics: Adult; Aged; Bacterial Infections; Female; Hip Prosthesis; Humans; Indium Radioisotopes; Knee Prosthesis; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oximes; Oxyquinoline; Prosthesis Failure; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

The functional integrity of white blood cells labeled with [99mTc]d,1-HM-PAO containing variable amounts of the ligand or of the 99mTc activity was evaluated by enzymatic tests and by measuring random migration, chemotaxis, phagocytosis, killing, and adhesion. The ultrastructure of labeled cells was studied by electron microscopy. The tracer dose and the HM-PAO concentration did not significantly affect phagocytosis and killing. The results of the other tests remained normal. A maximum labeling efficiency of 80% was reached by incubating the granulocytes for 20 min with 10-20 mCi of [99mTc]d,1-HM-PAO containing 50 micrograms of the ligand in 1 ml of saline. There was only a slow washout of 20% of activity from the labeled cells in 24 hr. The ultrastructure was not influenced by the labeling technique. Proven infection sites of 17 orthopedic patients were clearly visualized. After a short transient lung uptake, there was a clear spleen and moderate liver uptake with early bladder and late prominent colon visualization. Because of the lower cost, favorable radiation dose and more suitable tracer characteristics, this technique is a promising alternative for 111In labeling of white blood cells.

Topics: Bacterial Infections; Cell Adhesion; Chemotaxis, Leukocyte; Evaluation Studies as Topic; Granulocytes; Humans; In Vitro Techniques; Isotope Labeling; Microscopy, Electron; Organotechnetium Compounds; Oximes; Phagocytosis; Radionuclide Imaging; Technetium Tc 99m Exametazime

70 patients with confirmed (23 patients) or suspected (47 patients) bacterial infection in the skeleton following diseases, injuries or operations in orthopedic surgery were investigated using Tc-99m-HMPAO leucocyte scintigraphy in order to evaluate the accuracy of this procedure. Infections could be detected correctly in 37 of 70 patients (right positives) while 28 patients had negative scans corresponding to the clinical course (right negatives). One false negative finding was observed. Five patients with clinically suspected infection had a focal uptake in the WBC-scan and were not operated subsequently. They range as false positive results, although they belong to a special group (Infection: Yes-Operation: No [IYON]-group). In the assessment of the Tc-99m-HMPAO-WBC-scan there was a senstivity of 97.1%, specificity of 82.9% and an overall accuracy of 90%. The method is suitable for detection of early and late infection as well as chronic or hematogenous osteomyelitis in the locomotor system. This means an important contribution in diagnosis of infection determining further operative or conservative treatment.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Child; Female; Follow-Up Studies; Fracture Fixation, Internal; Hip Prosthesis; Humans; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Surgical Wound Infection; Technetium Tc 99m Exametazime

Thirteen patients with a suspicion of bacterial infection or inflammatory disease were studied with 99Tcm-HMPAO-labelled leucocytes (99Tcm-WBC) and 123I-labelled monoclonal antibodies against granulocytes (123I-MoAb-gc) within 5 days of the first study. Images were obtained at 30-40 min, 3-5 and 20-24 h. The quality of 99Tcm-WBC images was superior to that of the 123I-MoAb-gc. Eight cases were negative with both agents. Six inflammatory or infectious sites in five patients were clearly positive with 99Tcm-WBC even at 30 min, becoming moderately or strongly positive at 3-5 h but only three of them were weakly positive with 123I-MoAb-gc. One cause of the poor result with 123I-MoAb-gc may be the quite low activity in granulocytes and high plasma activity. We cannot recommend 123I-MoAb-gc as a primary imaging agent for inflammatory or infectious diseases for which 99Tcm-WBC seems very useful.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Bacterial Infections; Female; Granulocytes; Humans; Inflammation; Iodine Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime