technetium-tc-99m-exametazime and Inflammation

To develop the 'Stronger Towns Index': a deprivation index that took into account characteristics of areas encompassing towns that may be eligible for redevelopment funding and explore how this index was associated with self-rated health and migration within England between 2001 and 2011.. There were areas in the lowest deciles of Town Strength who did not receive funding. After multiple adjustment, LS members living in areas with higher deciles were significantly more likely (7% to 38%) to report good health than those in the lowest decile in 2001. Remaining in the same decile between 2001 and 2011 was associated with 7% lower odds of good self-rated health in 2011.. It is important to consider health in towns when allocating funding. Areas in the Midlands may have missed out on funding which might help mitigate poor health.. Ferritin levels <30µg/L were associated with unexplained infertility and might be screened in the future. Further studies with a focus on iron deficiency and iron treatment on women with unexplained infertility are warranted.. This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.. Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced.. Altogether, these findings clearly revealed the great potential of the in vitro biological activity of linseed extract as a safe source for combatting multidrug-resistant. In this work, the capture of carbon dioxide using a dense hollow fiber membrane was studied experimentally and theoretically. The factors affecting the flux and recovery of carbon dioxide were studied using a lab-scale system. Experiments were conducted using a mixture of methane and carbon dioxide to simulate natural gas. The effect of changing the CO. Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.. Thirty evaluable patients were enrolled. Median age was 60.5 years. Median follow-up for all patients was 17 months. Ten patients (33%) experienced grade ≥ 3 treatment-related adverse events, the most common being neutropenia and diarrhea; 50% required ≥ 1 dose reduction. The disease control rate was 90% (progressive disease: 10%, partial response: 23%, stable disease: 67%). There was zero treatment-related mortality. Twenty-two patients (73%, 90% CI 57-86; p = 0.008) completed all chemotherapy and surgery. Two patients (9%) who successfully underwent resection had minor postoperative complications. Median length of hospital stay was 4 days. Median RFS was 7.1 months. Median OS for the entire cohort was 24 months and was not reached in patients who underwent surgical resection.. Neoadjuvant treatment with gemcitabine, cisplatin, and nab-paclitaxel is feasible and safe prior to resection of intrahepatic cholangiocarcinoma and does not adversely impact perioperative outcomes.

Topics: Acetogenins; Acute Disease; Acute Kidney Injury; Administration, Intravenous; Aged; Albumins; Alcoholism; Aldehyde Dehydrogenase; Aldehyde Dehydrogenase, Mitochondrial; alpha-Glucosidases; Anemia; Animals; Anthozoa; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Bacterial; Antigens, Bacterial; Antihypertensive Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antioxidants; Apoptosis; Ascites; Asthma; Bacteria; beta-Lactamases; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Binding Sites; Biological Availability; Biomass; Borderline Personality Disorder; Brain; Brucella abortus; Brucella melitensis; Brucellosis; Calcium; Carbapenems; Case-Control Studies; Caseins; Cattle; CD8-Positive T-Lymphocytes; Ceftaroline; Cell Line; Cell Line, Tumor; Cell Physiological Phenomena; Cell Proliferation; Cephalosporins; Chemotherapy, Adjuvant; China; Chitin; Chlorella; Chlorophyll; Chlorophyll A; Chlorophyta; Cholangiocarcinoma; Cisplatin; Conotoxins; Contrast Media; Conus Snail; Cross-Sectional Studies; Cytokines; Decapodiformes; Deoxycytidine; Diagnostic and Statistical Manual of Mental Disorders; Dietary Fiber; Diterpenes; DNA Methylation; Dogs; Double-Blind Method; Drug Design; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Drug Screening Assays, Antitumor; Eicosapentaenoic Acid; Enzyme-Linked Immunosorbent Assay; Epidermis; Escherichia coli; Escherichia coli Infections; Extraintestinal Pathogenic Escherichia coli; Fatty Acids; Fatty Acids, Unsaturated; Fatty Acids, Volatile; Feasibility Studies; Feces; Female; Ferritins; Fluorodeoxyglucose F18; Gastrectomy; Gastrointestinal Microbiome; Gemcitabine; Glomerular Filtration Rate; Glucose; Glycerol; Granulocyte-Macrophage Colony-Stimulating Factor; HeLa Cells; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Hypoxia-Inducible Factor-Proline Dioxygenases; Immunoassay; Immunoglobulin G; India; Infant, Newborn; Infertility; Inflammation; Intensive Care Units; Iron; Iron Deficiencies; Kidney; Lacticaseibacillus rhamnosus; Laurencia; Leukocytes; Lipids; Liver Cirrhosis; Long Interspersed Nucleotide Elements; Longitudinal Studies; Male; Mesenchymal Stem Cells; Methicillin-Resistant Staphylococcus aureus; Mice; Microalgae; Microbial Sensitivity Tests; Microscopy; Middle Aged; Minerals; Molecular Conformation; Molecular Docking Simulation; Molecular Structure; Mycobacterium tuberculosis; Myeloid Cells; Myeloid-Derived Suppressor Cells; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Nephropidae; Nicotinic Antagonists; Nitrogen; Obesity; Oxaliplatin; Paclitaxel; Panax; Pancreatic Neoplasms; Pancreatitis; Personality; Personality Disorders; Personality Inventory; Photobioreactors; Plant Extracts; Plasmalogens; Plasmids; Polymorphism, Genetic; Polynesia; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prebiotics; Predictive Value of Tests; Prognosis; Prolyl-Hydroxylase Inhibitors; Rabbits; Radiopharmaceuticals; Rats; Rats, Wistar; Receptors, Nicotinic; Recombinant Proteins; Retrospective Studies; Rifampin; Risk Factors; RNA, Ribosomal, 16S; Salinity; Seaweed; Sensitivity and Specificity; Sepsis; Sesquiterpenes; Severity of Illness Index; Shock, Septic; Silicones; Single Photon Emission Computed Tomography Computed Tomography; Skin; Snails; Solubility; Solvents; Sputum; Staphylococcal Infections; Stomach Neoplasms; Stramenopiles; Structure-Activity Relationship; Technetium Tc 99m Exametazime; Technology; Terpenes; Tuberculosis; Tuberculosis, Multidrug-Resistant; Urinary Catheters; Urinary Tract Infections; Vascular Endothelial Growth Factor A; Virulence Factors; Water; Wound Healing

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

The spectrum of infectious diseases has changed over the last few years, hence the requirements for radionuclide imaging for the detection of infection are becoming more demanding so that, although gallium-67 and labelled leucocytes remain useful agents, there is currently great interest in the development of new agents especially able to target chronic, non-pyogenic inflammation. Agents can be classified according to the site at which the radiolabel is targeted: pre-endothelial (for example, labelled leucocytes), endothelial (for example, labelled anti-endothelial monoclonal antibodies) or post-endothelial (for example, fluorine-18-fluorodeoxyglucose (FDG)). 67Ga and labelled polyclonal human immunoglobulin (HIG) localize at inflammation initially as a result of increased endothelial permeability, followed by retention of the label through binding to local extravascular receptors. Labelled leucocytes are avidly taken up by acute pyogenic inflammatory foci but perform less well in chronic inflammation. Other indications for labelled leucocytes include bone infection and undiagnosed fever. Nevertheless, since many causes of the latter do not stimulate a neutrophilic infiltrate, a non-specific agent, such as 67Ga, FDG or HIG, may be preferable, especially in patients with no immediate significant medical history. Since endothelial E-selectin expression is closely correlated to lymphocyte migration, labelled anti-E-selectin monoclonal antibody may also have a potential role for imaging chronic inflammation.

Topics: Biomarkers; Fever of Unknown Origin; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Infections; Inflammation; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

111In or 99mTc-HMPAO labeled leukocyte scintigraphy has been shown to be useful in detection and diagnosis of infections and inflammatory lesions. Results from multiple retrospective series indicate that leukocyte scintigraphy achieves sensitivity and specificity of near 90% in abdominal abscess detection. 99mTc-HMPAO labeled leukocyte scintigraphy is now an accepted technique in the assessment of patients with inflammatory bowel disease and the diagnostic value of early 99mTc-HMPAO labeled leukocyte images has been discussed. It is known that 99mTc-HMPAO labeled leukocytes migrate to a large extent to the bone marrow. 99mTc-HMPAO labeled leukocytes may prove to be a practical agent for bone marrow imaging. In this report, definition, classification and pathological consideration of inflammation, and history, diagnostic efficacy and consideration for clinical application of inflammation scintigraphy are reviewed.

Topics: Bone Marrow Diseases; Contrast Media; Humans; Indium; Infections; Inflammation; Isotope Labeling; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Topics: Animals; Horse Diseases; Horses; Infections; Inflammation; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

99mTc-HMPAO-labelled white cell scanning is compared with other radionuclide techniques in this contribution. The sensitivity and specificity using both 111In and 99mTc-HMPAO-labelled leucocytes are comparably high. Both imaging methods are therefore suitable for imaging inflammation. However, images are available more quickly using 99mTc-HMPAO; their quality is superior and the radiation dose is lower. 111In is beneficial for chronic infections. 67Ga citrate is less specific for inflammation, since it also localizes in tumours, but it is useful in chronic infection. 99mTc nanocolloid has not been found suitable for imaging abdominal inflammation, but more so for bone and joint diseases. Comparisons of 99mTc-HMPAO leucocytes with 123I-labelled monoclonal antibodies show poorer results using the monoclonal antibody because of non-specific binding to plasma proteins. Visualization of lesions is generally poorer using 99mTC-HIG than 99mTc-HMPAO leucocytes and is less sensitive and specific. Few reports using 99mTc-labelled monoclonal antibodies are available. Early results are promising and more specific antibodies may be available in the future. Synthetic chemotactic peptides offer a novel approach to the detection of infection. However, at present the recommended method for imaging acute abdominal inflammation is 99mTc-HMPAO leucocytes.

Topics: Abdomen; Antibodies, Monoclonal; Diagnostic Techniques, Radioisotope; Gallium Radioisotopes; Humans; Immunoglobulins; Indium Radioisotopes; Inflammation; Inflammatory Bowel Diseases; Iodine Radioisotopes; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Topics: Antibodies, Monoclonal; Citrates; Citric Acid; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Inflammation; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To develop the 'Stronger Towns Index': a deprivation index that took into account characteristics of areas encompassing towns that may be eligible for redevelopment funding and explore how this index was associated with self-rated health and migration within England between 2001 and 2011.. There were areas in the lowest deciles of Town Strength who did not receive funding. After multiple adjustment, LS members living in areas with higher deciles were significantly more likely (7% to 38%) to report good health than those in the lowest decile in 2001. Remaining in the same decile between 2001 and 2011 was associated with 7% lower odds of good self-rated health in 2011.. It is important to consider health in towns when allocating funding. Areas in the Midlands may have missed out on funding which might help mitigate poor health.. Ferritin levels <30µg/L were associated with unexplained infertility and might be screened in the future. Further studies with a focus on iron deficiency and iron treatment on women with unexplained infertility are warranted.. This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.. Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced.. Altogether, these findings clearly revealed the great potential of the in vitro biological activity of linseed extract as a safe source for combatting multidrug-resistant. In this work, the capture of carbon dioxide using a dense hollow fiber membrane was studied experimentally and theoretically. The factors affecting the flux and recovery of carbon dioxide were studied using a lab-scale system. Experiments were conducted using a mixture of methane and carbon dioxide to simulate natural gas. The effect of changing the CO. Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.. Thirty evaluable patients were enrolled. Median age was 60.5 years. Median follow-up for all patients was 17 months. Ten patients (33%) experienced grade ≥ 3 treatment-related adverse events, the most common being neutropenia and diarrhea; 50% required ≥ 1 dose reduction. The disease control rate was 90% (progressive disease: 10%, partial response: 23%, stable disease: 67%). There was zero treatment-related mortality. Twenty-two patients (73%, 90% CI 57-86; p = 0.008) completed all chemotherapy and surgery. Two patients (9%) who successfully underwent resection had minor postoperative complications. Median length of hospital stay was 4 days. Median RFS was 7.1 months. Median OS for the entire cohort was 24 months and was not reached in patients who underwent surgical resection.. Neoadjuvant treatment with gemcitabine, cisplatin, and nab-paclitaxel is feasible and safe prior to resection of intrahepatic cholangiocarcinoma and does not adversely impact perioperative outcomes.

Topics: Acetogenins; Acute Disease; Acute Kidney Injury; Administration, Intravenous; Aged; Albumins; Alcoholism; Aldehyde Dehydrogenase; Aldehyde Dehydrogenase, Mitochondrial; alpha-Glucosidases; Anemia; Animals; Anthozoa; Anti-Bacterial Agents; Anti-Infective Agents; Antibodies, Bacterial; Antigens, Bacterial; Antihypertensive Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antioxidants; Apoptosis; Ascites; Asthma; Bacteria; beta-Lactamases; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Binding Sites; Biological Availability; Biomass; Borderline Personality Disorder; Brain; Brucella abortus; Brucella melitensis; Brucellosis; Calcium; Carbapenems; Case-Control Studies; Caseins; Cattle; CD8-Positive T-Lymphocytes; Ceftaroline; Cell Line; Cell Line, Tumor; Cell Physiological Phenomena; Cell Proliferation; Cephalosporins; Chemotherapy, Adjuvant; China; Chitin; Chlorella; Chlorophyll; Chlorophyll A; Chlorophyta; Cholangiocarcinoma; Cisplatin; Conotoxins; Contrast Media; Conus Snail; Cross-Sectional Studies; Cytokines; Decapodiformes; Deoxycytidine; Diagnostic and Statistical Manual of Mental Disorders; Dietary Fiber; Diterpenes; DNA Methylation; Dogs; Double-Blind Method; Drug Design; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Drug Screening Assays, Antitumor; Eicosapentaenoic Acid; Enzyme-Linked Immunosorbent Assay; Epidermis; Escherichia coli; Escherichia coli Infections; Extraintestinal Pathogenic Escherichia coli; Fatty Acids; Fatty Acids, Unsaturated; Fatty Acids, Volatile; Feasibility Studies; Feces; Female; Ferritins; Fluorodeoxyglucose F18; Gastrectomy; Gastrointestinal Microbiome; Gemcitabine; Glomerular Filtration Rate; Glucose; Glycerol; Granulocyte-Macrophage Colony-Stimulating Factor; HeLa Cells; Humans; Hypoxia-Inducible Factor 1, alpha Subunit; Hypoxia-Inducible Factor-Proline Dioxygenases; Immunoassay; Immunoglobulin G; India; Infant, Newborn; Infertility; Inflammation; Intensive Care Units; Iron; Iron Deficiencies; Kidney; Lacticaseibacillus rhamnosus; Laurencia; Leukocytes; Lipids; Liver Cirrhosis; Long Interspersed Nucleotide Elements; Longitudinal Studies; Male; Mesenchymal Stem Cells; Methicillin-Resistant Staphylococcus aureus; Mice; Microalgae; Microbial Sensitivity Tests; Microscopy; Middle Aged; Minerals; Molecular Conformation; Molecular Docking Simulation; Molecular Structure; Mycobacterium tuberculosis; Myeloid Cells; Myeloid-Derived Suppressor Cells; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Nephropidae; Nicotinic Antagonists; Nitrogen; Obesity; Oxaliplatin; Paclitaxel; Panax; Pancreatic Neoplasms; Pancreatitis; Personality; Personality Disorders; Personality Inventory; Photobioreactors; Plant Extracts; Plasmalogens; Plasmids; Polymorphism, Genetic; Polynesia; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prebiotics; Predictive Value of Tests; Prognosis; Prolyl-Hydroxylase Inhibitors; Rabbits; Radiopharmaceuticals; Rats; Rats, Wistar; Receptors, Nicotinic; Recombinant Proteins; Retrospective Studies; Rifampin; Risk Factors; RNA, Ribosomal, 16S; Salinity; Seaweed; Sensitivity and Specificity; Sepsis; Sesquiterpenes; Severity of Illness Index; Shock, Septic; Silicones; Single Photon Emission Computed Tomography Computed Tomography; Skin; Snails; Solubility; Solvents; Sputum; Staphylococcal Infections; Stomach Neoplasms; Stramenopiles; Structure-Activity Relationship; Technetium Tc 99m Exametazime; Technology; Terpenes; Tuberculosis; Tuberculosis, Multidrug-Resistant; Urinary Catheters; Urinary Tract Infections; Vascular Endothelial Growth Factor A; Virulence Factors; Water; Wound Healing

The diagnosis of osteomyelitis is a challenge for diagnostic imaging. Nuclear medicine procedures including white blood cell imaging have been successfully used for the identification of bone infections. This multinational, phase III clinical study in 22 European centres was undertaken to compare anti-granulocyte imaging using the murine IgG antibody besilesomab (Scintimun) with (99m)Tc-labelled white blood cells in patients with peripheral osteomyelitis.. A total of 119 patients with suspected osteomyelitis of the peripheral skeleton received (99m)Tc-besilesomab and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells (WBCs) in random order 2-4 days apart. Planar images were acquired at 4 and 24 h after injection. All scintigraphic images were interpreted in an off-site blinded read by three experienced physicians specialized in nuclear medicine, followed by a fourth blinded reader for adjudication. In addition, clinical follow-up information was collected and a final diagnosis was provided by the investigators and an independent truth panel. Safety data including levels of human anti-mouse antibodies (HAMA) and vital signs were recorded.. The agreement in diagnosis across all three readers between Scintimun and (99m)Tc-HMPAO-labelled WBCs was 0.83 (lower limit of the 95% confidence interval 0.8). Using the final diagnosis of the local investigator as a reference, Scintimun had higher sensitivity than (99m)Tc-HMPAO-labelled WBCs (74.8 vs 59.0%) at slightly lower specificity (71.8 vs 79.5%, respectively). All parameters related to patient safety (laboratory data, vital signs) did not provide evidence of an elevated risk associated with the use of Scintimun except for two cases of transient hypotension. HAMA were detected in 16 of 116 patients after scan (13.8%).. Scintimun imaging is accurate, efficacious and safe in the diagnosis of peripheral bone infections and provides comparable information to (99m)Tc-HMPAO-labelled WBCs.

Topics: Adult; Animals; Chronic Disease; Female; Humans; Immunoglobulin G; Inflammation; Leukocytes; Mice; Middle Aged; Osteomyelitis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Vital Signs

An adult male rhesus macaque (

Topics: Animals; Brain; Inflammation; Leukocytes; Macaca mulatta; Male; Monkey Diseases; Osteomyelitis; Prostheses and Implants; Prosthesis-Related Infections; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Skull; Technetium Tc 99m Exametazime

Labeled leukocytes with 99mTc-HMPAO are routinely used for infection imaging. Although cell labeling with 99mTc-HMPAO represents an imaging probe to detect infection sites, the diagnostic efficiency of the probe is largely influenced by cell manipulation, multidisciplinary interventions (i.e., biologist, technicians) and available technology (i.e., SPECT, SPECT/CT). The aim of the study was to assess in vitro and in vivo accuracy of a comprehensive approach for quality assessment (QA) of all steps of the procedure.. Radiochemical purity (RCP), pH, labeling efficiency (LE) were measured in 320 procedures. White Cell Viability Factor (WVF) was determined in consecutive blood samples. Images (490 studies) were scored using a 5-point scale. Training program was evaluated using a Learning Questionnaire and a score system.. Pre/post-labelling WVF was 0.99% (max value 1%) in all blood samples. LE (mean value 72%) and RCP (>80% until 55 minutes) yielded considerably high values. The vast majority of images were scored as diagnostic by three independent observer (90% with score ≥4).. This method appears highly reproducible and easy to use in clinical routine for leukocyte labeling, especially when standardized training and total QA system are implemented.

Topics: Cell Survival; Chemotaxis, Leukocyte; Education, Pharmacy, Continuing; Humans; Infections; Inflammation; Isotope Labeling; Leukocytes; Quality Assurance, Health Care; Radiopharmaceuticals; Reproducibility of Results; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Female; Humans; Inflammation; Postoperative Complications; Radiopharmaceuticals; Surgical Mesh; Technetium Tc 99m Exametazime

Liposomes are phospholipid nanoparticles used for targeted drug delivery. This study aimed to determine whether intravenous liposomes accumulate in lamellar tissue during laminitis development in horses so as to assess their potential for targeted lamellar drug delivery. Polyethylene-glycol (PEG) coated liposomes were prepared according to the film hydration method and labelled using (99m)Tc-hexamethyl-propylene-amine-oxime. Six horses received 10 g/kg oligofructose via nasogastric tube to induce laminitis, and four control horses received water via nasogastric tube. All horses received 300 µmol (99m)Tc-PEG-liposomes (5.5 GBq) plus 5.5 µmol/kg PEG-liposomes by slow intravenous infusion. Scintigraphic imaging was performed at 0, 6 and 12 h post-infusion. Technetium-99m liposome uptake was measured in regions of interest over the hoof, fetlock and metacarpus. At the study end-point horses were euthanased, tissue samples collected and tissue liposome levels were calculated as the percentage of the injected dose of (99m)Tc-liposomes per kilogram of tissue. Data were analysed non-parametrically. All horses receiving oligofructose developed clinical and histological signs of laminitis. Technetium-99m liposome uptake in the hoof increased with time in laminitis horses (P = 0.04), but decreased with time in control horses (P = 0.01). Technetium-99m liposome levels in lamellar tissue from laminitis horses were 3.2-fold higher than controls (P = 0.02) and were also higher in laminitis vs. control skin, muscle, jejunum, colon, and kidney (P < 0.05). Liposomes accumulated in lamellar tissue during oligofructose-induced laminitis development and demonstrated potential for targeted lamellar drug delivery in acute laminitis. This study provides further evidence that lamellar inflammation occurs during laminitis development. Liposome accumulation also occurred in the skin, muscle, jejunum, colon and kidneys, suggesting systemic inflammation in this model.

Topics: Animals; Foot Diseases; Hoof and Claw; Horse Diseases; Horses; Inflammation; Liposomes; Male; Oligosaccharides; Polyethylene Glycols; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Topics: Asthma; Biomarkers; Case-Control Studies; Glutathione; Humans; Inflammation; Oxidation-Reduction; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

To evaluate inflammatory activity in patients with Crohn's disease (CD) using technetium-99m-hexamethylpropyleneamine oxime (99mTc-HMPAO) granulocyte scintigraphy.. Twenty patients (7 male and 13 female) with CD and five healthy volunteers were selected for 99mTc-HMPAO granulocyte scintigraphy. The Crohn's Disease Activity Index (CDAI), blood tests and C-reactive protein (CRP) of each patient were performed 7 d before the scintigraphic images. The leukocytes were labeled according to the International Society of Radiolabeled Blood Elements (ISORBE) consensus protocol and the scintigraphic images, including single photon emission computed tomography, were obtained 30 min and 2 h after injection of the radiolabeled leukocytes.. The labeling yield of the leukocytes with the lipophilic complex 99mTc-HMPAO was 55.0% +/- 10%. Six of the 20 patients (30%) presented congruent results for the three parameters investigated (CDAI, Scintigraphic Index and CRP). On the other hand, 14 patients (70%) did not show congruent results. There was no significant correlation between the indices analyzed according to the Spearman test (P > 0.05, n = 20).. The results suggest that 99mTc-HMPAO-labeled leukocyte scintigraphy could be important for determining inflammatory activity in CD even in the absence of clinical symptoms.

Topics: Adult; C-Reactive Protein; Case-Control Studies; Crohn Disease; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Exametazime

We describe here a protocol for labelling autologous white blood cells with (99m)Tc-HMPAO 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: Cell Separation; Chemotaxis, Leukocyte; Humans; Infections; Inflammation; Isotope Labeling; Leukocytes; Quality Control; Radiation Protection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tissue Distribution

To evaluate the ability of polymeric nanocapsules (NCs) radiolabeled with technetium-99m D,L-hexamethylpropyleneamine oxime (Tc-HMPAO) to identify inflammatory process in an experimental model.. NCs were prepared by interfacial deposition of preformed biodegradable polymer [poly (D,L-lactic acid) (PLA) and PLA-PEG (polyethyleneglycol)] followed by a solvent displacement. The size and homogeneity, and zeta potential of the NC preparations were determined in a Zetasizer by photon correlation spectroscopy and laser Doppler anemometry, respectively. The NCs radiolabeled with Tc-HMPAO were administered intravenously to Wistar male rats bearing a focal inflammation induced by subplantar injection of carrageenan in the right foot. At preestablished time intervals, the animals were anesthetized, tissues were removed and radioactivity was determined using an automatic scintillation apparatus.. The average diameter calculated by photon correlation spectroscopy varied from 216 to 323 nm. The biodistribution studies showed a greater uptake of the PEG surface-modified Tc-HMPAO-NC by the inflamed paws when compared with the respective controls. There was no significant difference in the uptake of conventional Tc-HMPAO-NC and of free Tc-HMPAO by inflamed and control paws. These results indicate that the PLA-PEG Tc-NC showed a higher uptake in inflammation compared with free complex and may be useful as a radiotracer to identify these foci.

Topics: Animals; Inflammation; Isotope Labeling; Male; Nanocapsules; Rats; Rats, Wistar; Technetium Tc 99m Exametazime; Tissue Distribution

To investigate the biodistribution and the ability of stealth pH-sensitive liposomes radiolabelled with 99mTc to identify inflammatory regions in a rat focal inflammation model.. Preformed glutathione-containing stealth pH-sensitive liposomes were labelled with 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO). The 99mTc-HMPAO radiolabelled stealth pH-sensitive liposomes (99mTc-SpHL) were administered intravenously in Wistar male rats with inflammation induced by injection subplantar of carrageenan in the right foot. At pre-established time intervals the animals were anaesthetized and tissues were removed and analysed for 99mTc content using an automatic scintillation apparatus. Scintigraphic imaging was also performed after 2, 4 and 8 h of intravenous injection of 99mTc-SpHL.. The 99mTc-SpHL was significantly taken up by the spleen (19.21+/-2.98%ID/g at 30 min post-injection). Low radioactivity levels were found in the liver, lungs, and kidney. Moreover, the 99mTc-SpHL uptake was significantly higher in the inflamed foot when compared to the respective control (0.386+/-0.059 and 0.215+/-0.018%ID/g at 2 h post-injection, respectively). As early as 30 min after administration of 99mTc-SpHL, the focus of inflammation could be visualized scintigraphically. The value of the inflammatory and non-inflammatory site radioactivity counting ratio was greater than 5.. This result indicates that the 99mTc-SpHL presents a high tropism for inflammatory regions and may be useful as a radiopharmaceutical to identify these foci.

Topics: Animals; Drug Carriers; Hydrogen-Ion Concentration; Inflammation; Liposomes; Male; Metabolic Clearance Rate; Organ Specificity; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Wistar; Technetium Tc 99m Exametazime; Tissue Distribution

The case of an 11-year-old boy with recurrent abdominal pain is presented. Physiological findings were found normal during a clinical investigation, as well as many laboratory tests, ultrasonography and CT of abdomen. Only a high level of sedimentation rate and the focus of increased activity in the sacral region on scintigraphy using 99mTc-HMPAO (hexamethypropyleneaminooxime) labelled leukocytes were found. The other findings on bone scintigraphy, X-ray and MRI led to a deflection of the correct diagnosis. The real culprit proved to be an ingested foreign body (a piece of a wooden skewer) that the patient failed to reveal.

Topics: Abdomen; Abdominal Pain; Child; Diagnosis, Differential; Foreign Bodies; Humans; Inflammation; Leukocytes; Magnetic Resonance Imaging; Male; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography

We studied the in vivo fate of CD8(+) lymphocytes, of naive (CD8(+)CD45RC(bright)) or memory (CD8(+)CD45RC(dim)) phenotype, injected in syngeneic rats, after their sorting and labeling with [(99m)Tc] HM-PAO. By using the scintigrafic method we showed that memory CD8(+) lymphocytes were able to recirculate into liver and lungs. The same method was also successfully used to in vivo study the homing of total blood lymphocytes obtained from inflamed rats.

Topics: Animals; Inflammation; Lymphocytes; Male; Metabolic Clearance Rate; Organ Specificity; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Inbred F344; Rats, Inbred Strains; Technetium Tc 99m Exametazime; Tissue Distribution

Pulmonary vascular endothelium damage in 34 patients with systemic lupus erythematosus (SLE) was measured by technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan. The degree of damage was represented as lung/liver uptake (L/L) ratio. The patients were divided into two subgroups according to the following criteria: (a) clinical features, separated as stable or flare stage and (b) chest X-ray findings separated as positive or negative results. Meanwhile, quantitative gallium-67 citrate (Ga-67) lung scan was performed as Ga-67 uptake index (GUI) to evaluate the severity of inflammation in the SLE lungs. The results show (a) no significant statistical differences in the degree of pulmonary vascular endothelium damage (the L/L ratio on Tc-99m HMPAO lung scan) between the two subgroups according to clinical features or chest X-ray findings and (b) no good correlation between the degree of pulmonary vascular endothelium damage and lung inflammation (GUI on Ga-67 lung scan). In conclusion, the change in pulmonary vascular endothelium damage in SLE may be unrelated to the clinical presentation or chest X-ray findings, and its degree is not related to the severity of pulmonary inflammation.

Topics: Adult; Citrates; Endothelium, Vascular; Female; Gallium; Humans; Inflammation; Lung; Lung Diseases; Lupus Erythematosus, Systemic; Male; Radionuclide Imaging; Radiopharmaceuticals; Respiratory Function Tests; Severity of Illness Index; Technetium Tc 99m Exametazime; Vascular Diseases

The results of the survey carried out in our country during the present year on the nuclear medicine studies in infectious and inflammatory studies during 1999 are presented. They survey was sent to 89 centers with a nuclear medicine service, 45 of which were publicly owned and 44 of which were privately owned. A total of 32 centers (36%) replied to the survey. 51.1% (23 out of 45) of the public hospitals responded but only a 20.5% (9 out of 44) of the private ones did.A total of 70.92% (4,344) out of the 6,125 explorations were carried out to discard and infectious process and 29.07% (1,781) to discard inflammation. The most frequent indication was to discard infections resulting from bone prostheses (2,099 explorations accounting for 48.31% of the total infectious process), followed by bone infection or osteomyelitis (965 explorations, 22.21% of the total). Within the osteomyelitis cases, acute processes motivated the most frequent requests (60.31% of all osteomyelitis cases). Assessment of the scope and localization of the intestinal inflammatory disease was the most frequent request in the inflammation group. Concerning the radiopharmaceuticals used, 99mTc HMAPO or 111I marked-leukocytes were ranked first, these accounting for 47% of the cases. Gallium, used in 44% of all cases, was the second most frequently used, even though it continues to be the more commonly used radiopharmaceuticals for infectious processes.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Drug Utilization; Fever of Unknown Origin; Gallium Radioisotopes; Health Care Surveys; Hospitals, Public; Humans; Infections; Inflammation; Intestinal Diseases; Iodine Radioisotopes; Leukocytes; Nuclear Medicine; Osteomyelitis; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Spain; Technetium Tc 99m Exametazime

(99m)Tc-HMPAO (Ceretec) labelling of leucocytes is used clinically for the detection of inflammatory processes in the body. This study investigated the mechanisms by which (99m)Tc-HMPAO is taken up by eosinophils and neutrophils. Blood cells were labelled with (99m)Tc-HMPAO and the cells separated by means of their densities in Percoll gradients. For other purposes, eosinophils and neutrophils were purified by means of the MACS system and, after labelling these pure cellular preparations, the cells were ultrasonicated and the organelles separated on sucrose density gradients by means of ultracentrifugation. Organelles were characterized by their morphology on electron microscopy. Granulocytes were stimulated to secrete their granule constituents by means of exposure to complement-coated particles. ECP (eosinophil cationic protein) and MPO (myeloperoxidase) were measured using specific immunoassays. The uptake of (99m)Tc-HMPAO was 15--25-fold higher in eosinophils than in other leucocytes. (99m)Tc-HMPAO was predominantly stored in the secretory granules of eosinophils and released from the eosinophil, upon activation, together with ECP. A second storage compartment was a very light density organelle of unknown nature. These results indicated that, among leucocytes, (99m)Tc-HMPAO is preferentially taken up by eosinophils and stored in the secretory granules, which has to be taken into consideration when evaluating images based on this technique. Our findings suggest that (99m)Tc-HMPAO (Ceretec) may be used as a tool to follow eosinophil turnover and activity in disease.

Topics: Blood Proteins; Eosinophil Granule Proteins; Eosinophils; Humans; Inflammation; Isotope Labeling; Neutrophils; Organelles; Peroxidase; Ribonucleases; Secretory Vesicles; Technetium Tc 99m Exametazime; Time Factors

In order to evaluate the importance of 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) leukocyte scintigraphy in the diagnosis of bone infection, we retrospectively reviewed 324 patients. Abnormal findings were seen in 221 patients. In the other 103 cases acute pathological inflammation could be ruled out. The patients with pathological findings were divided into four groups according to the location of the infection. This method showed the localizations of skeletal disorders and its differences to other diagnostic imaging modalities. The underlying abnormalities causing the inflammation were determined. In conclusion, 99mTc-HMPAO leukocyte scintigraphy is still a very sensitive method for either whole body screening or local detection of acute or exacerbated chronic osteomyelitis. The advantages of this method over other diagnostic imaging methods are shown.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Bone Diseases, Infectious; Chronic Disease; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Exametazime; Wounds and Injuries

Polyethyleneglycol (PEG) liposomes have been shown to be excellent vehicles for scintigraphic imaging of infection and inflammation in various experimental models. In this article we report on a series of patients with possible infectious and inflammatory disease in whom the performance of 99mTc-PEG liposomes was evaluated. The results of 99mTc-PEG liposome scintigraphy were directly compared with those of 111In-immunoglobulin G (IgG) scintigraphy.. Thirty-five patients (22 men, 13 women; mean age, 51 y; range, 20-76 y), suspected of having infectious or inflammatory disease, received 740 MBq 99mTc-PEG liposomes intravenously. Imaging was performed at 4 and 24 h after injection. Patients received 75 MBq 111In-IgG 24 h after administration of the liposomes. The scintigraphic results were compared and verified by culture, biopsy, surgery, and follow-up of at least 6 mo.. Of the 16 proven infections and inflammations, 15 were detected by 99mTc-PEG liposome scintigraphy: soft-tissue infection (n = 3), septic arthritis (n = 3), autoimmune polyarthritis (n = 2), infected hip prosthesis (n = 1), infected osteosynthesis (n = 1), spondylodiscitis (n = 1), infected aortic prosthesis (n = 1), colitis (n = 1), abdominal abscess (n = 1), and pneumonia (n = 1). 99mTc-PEG liposome and 111In-IgG scintigraphy both missed 1 case of endocarditis. In addition, an 111In-IgG scan of a patient with mild soft-tissue infection was false-negative. Concordantly false-positive scans were recorded from 2 patients, both with uninfected pseudarthrosis and focal signs of sterile inflammation. During liposomal administration, 1 patient experienced flushing and chest tightness, which rapidly disappeared after lowering the infusion rate. No other adverse events were observed.. This clinical evaluation of 99mTc-PEG liposomes shows that focal infection and inflammation can be adequately imaged with this new agent. The performance of 99mTc-PEG liposomes is at least as effective as that of 111In-IgG. With the simple and safe preparation and the physical and logistic advantages of a 99mTc label, 99mTc-PEG liposomes could be an attractive agent for infection or inflammation imaging.

Topics: Female; Focal Infection; Humans; Immunoglobulin G; Indium Radioisotopes; Inflammation; Leukocytes; Liposomes; Male; Middle Aged; Polyethylene Glycols; Prospective Studies; Radioimmunodetection; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Two abscesses were shown on CT in a 72-year-old man: one in the left hip and one in the left pelvic region that resulted from a motor vehicle collision that occurred 8 months earlier. Bone scintigraphy showed increased uptake in the left hip area. On Tc-99m HMPAO leukocyte imaging, the hip area appeared to be photopenic, and the abscess of the left pelvis was not identified. Incidental uptake in the left lung base appeared to be an active acute inflammatory process as evidenced by an infiltrating lesion in the left lower lung on a chest radiograph. Because leukocyte scintigraphy cannot detect the presence of a chronic inflammatory process in the absence of acute inflammatory cells, the patient's abscesses in the left hip and the left pelvis did not localize Tc-99m HMPAO-labeled neutrophils. The cold lesion in the left hip area was most likely caused by the lesion in the reticuloendothelial system (bone marrow); the unidentifiable pelvic lesion was related to the area(s) outside the reticuloendothelial system. In interpreting a labeled leukocyte image, clinicians should be alert to the stage (chronic or acute) and location (regardless of whether in the reticuloendothelial system) of infectious lesion(s). In this patient, a wide spectrum of manifestations was evident on leukocyte scintigraphy.

Topics: Abscess; Aged; Enterococcus faecalis; Gram-Positive Bacterial Infections; Hip; Humans; Inflammation; Leukocytes; Lung Diseases; Male; Neutrophils; Pelvis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, X-Ray Computed

We evaluated the sensitivity and specificity of Technetium-99m (99mTc)-white blood cell (WBC) for identifying terminal ileum inflammation in children with Crohn's disease (CD). In 40 children, total colonoscopy was done within a few days of a 99mTc-WBC scan carried out to evaluate the inflammation in children with CD. In 38 patients the intensity and the location of inflammation shown on the 99mTc-WBC scan of the colon were similar to the biopsy result of the colonoscopy. The sensitivity of the 99mTc-WBC scan was 97% in assessing colonic inflammation compared with colonoscopy. The 99mTc-WBC scan allowed evaluation of inflammation in the terminal ileum in 21 patients in whom the endoscopist did not cannulate the terminal ileum. Of the 19 patients in whom the terminal ileum was visualized endoscopically (14) or surgically (5), the 99mTc-WBC scan findings showed a similar degree of inflammation in 17. The 99mTc-WBC scan was abnormal in 10 of these 21 children in whom the gastroenterologist did not reach the terminal ileum. In these children with no ileoscopy the results of the 99mTc-WBC scan were consistent with the laboratory values, the gastroenterologist's clinical assessment and with long-term clinical follow-up. Finally, the 99mTc-WBC scan of 83 controls did not reveal any false-positive findings in the terminal ileum (colonoscopy result available in 30 controls). When total colonoscopy or ileoscopy is not performed or when contrast radiography is negative or unable to differentiate CD from lymphoid nodular hyperplasia, scintigraphy can demonstrate the presence of ileitis and/or colitis.

Topics: Adolescent; Child; Colon; Colonoscopy; Crohn Disease; Female; Humans; Indium Radioisotopes; Inflammation; Intestinal Obstruction; Leukocytes; Male; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Communicable Diseases; Humans; Inflammation; Inflammatory Bowel Diseases; Leukocytes; Practice Guidelines as Topic; Quality Assurance, Health Care; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We aimed to determine the activity of Crohn's Disease (CD) and Ulcerative Colitis (UC) with this radiotracer and to compare it with the normal clinical indexes. 32 patients with CD (19 women) and 18 with UC (13 women) were studied and a sequential abdominal 99mTc-HMPAO-label leukocyte scintigraphy was performed after evaluating the activity clinical scales indexes (Harvey's for CD and Lictiger for UC). Quantification was performed to obtain intestinal activity indexes in regards to intestinal uptake with background, bone marrow, liver and spleen, comparing them with the clinical indexes. In CD, all scintigraphic indexes showed a significant correlation (p < 0.001) with clinical activity. The best results were obtained with gut/background (r: 0.73) and gut/bone marrow (r: 0.72). In UC, we obtain a lower correlation between clinical and scintigraphic indexes. Significant correlations (p < 0.05) were only found with the gut/background (r: 0.52) and gut/bone marrow growth indexes (r: 0.58). The others showed no correlation. In conclusion, IBD activity estimated with 99mTc-WBC and scintigraphy indexes showed moderate correlation with clinical scales. However, the information of the scintigraphy was very useful in the management of these patients.

Topics: Adult; Aged; Colitis, Ulcerative; Crohn Disease; Evaluation Studies as Topic; Female; Humans; Inflammation; Intestines; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Liposomes encapsulating both glutathione and deferoxamine were labeled with 99mTc-HMPAO and 111In-oxine at the same time. These dual radiolabeled liposomes were intravenously injected in rats with S. aureus infection in thigh. The target-to-background ratio (T/BG) increased from 2.9 at 2 h to 4.4 at 8 h in 99mTc images. In 111In images, T/BG of 5.5 at 8 h increased to 10.5 by 48 h. The 24-h spleen uptake of 111In- and 99mTc-liposomes was 24.14%ID and 8.91%ID. In femur, 99mTc-liposomes remained at approximately 10.5%ID, but 111In-liposomes increased from approximately 11%ID at 4 h to approximately 25.5%ID at 24 h. The simultaneous presence of 99mTc and 111In in the liposomes resulted in good early (2-8 h) as well as delayed (24-48 h) images delineating the infection site.

Topics: Animals; Chelating Agents; Deferoxamine; Glutathione; Image Processing, Computer-Assisted; Indium Radioisotopes; Infections; Inflammation; Liposomes; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Staphylococcal Infections; Technetium Tc 99m Exametazime; Tissue Distribution

Leukocyte scintigraphy has been used as a standard diagnostic procedure for the detection of inflammation in vivo. In this study, we developed a method of labelling purified lymphocytes with technetium99m-hexamethyl propyleneamine oxime (Tc99m-HMPAO) without significantly impairing their function. This was confirmed by measurements of in vitro lymphocyte adhesion and migration and of both necrotic and apoptotic cell death. The results of the in vitro control studies indicate that the dysfunction of leukocytes caused by Tc99m-HMPAO labelling can be minimized by using a gentle labelling method and low Tc99m activity. Because lymphocytes have been thought to participate specifically in the pathogenesis of inflammatory bowel disease (IBD), we compared scintigraphies obtained with Tc99m-HMPAO-labelled purified lymphocytes and mixed leukocytes in colitis patients. We found that a lower number of Tc99m-HMPAO-labelled peripheral blood lymphocytes accumulated in the inflamed colon during the first 4 h than labelled mixed leukocytes. The results are likely to reflect the dissimilar kinetics of lymphocyte traffic compared with granulocytes in IBD. We do not recommend the use of Tc99m-HMPAO-labelled purified lymphocytes as a diagnostic tool in chronic colitis. However, the in vitro data indicate that Tc99m-HMPAO-labelled lymphocytes may be suitable for studying short term lymphocyte recirculation and lymphocyte kinetics in other types of inflammation.

Topics: Adolescent; Adult; Apoptosis; Cell Adhesion; Cell Survival; Colitis, Ulcerative; Crohn Disease; Endothelium, Vascular; Female; Humans; Inflammation; Isotope Labeling; Lymphocytes; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Adult; Child, Preschool; Humans; Infections; Inflammation; Leukocytes; Organotechnetium Compounds; Oximes; Radiation Dosage; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The performance of 99mTc Stealth liposomes was investigated in various rat models.. Preformed polyethyleneglycol-containing liposomes with encapsulated reduced glutathione, were radiolabeled using the lipophilic 99mTc-HMPAO. The labeled liposomes were intravenously administered to rats with focal S. aureus or E. coli infection, or turpentine-induced inflammation. For comparison, Tc-99m-nanocolloid- and 99mTc-labeled nonspecific IgG were tested. In rats with Pneumocystis carinii pneumonia (PCP), Tc-99m-liposomes were directly compared to In-111 labeled nonspecific IgG.. Technetium-99m-liposomes accumulated in the infectious and inflammatory muscle foci over 24 hr (0.59% injected dose per gram tissue (%ID/g) for S. aureus; 1.18 %ID/g for turpentine). Abscess-to-muscle ratios increased to values as high as 24.0, 41.7 and 44.5 for the respective models at 24 hr postinjection. Technetium-99m-liposomes visualized the foci as early as 1 hr postinjection. Technetium-99m-IgG visualized S. aureus infection, but abscess-to-muscle ratios and abscess uptake at the later time points were significantly lower. Technetium-99m-nanocolloid failed to visualize any of the muscle foci. In PCP however, 99mTc-liposomes did not show preferential localization in the infection. The control agent 111In-IgG showed a significant, two-fold increase in lung uptake.. Technetium-99m-Stealth liposomes preferentially accumulated in abscesses, leading to very high target-to-nontarget ratios. This property appears to be related to a process based on uptake of long-circulating particles. In a specific type of infection, i.c. PCP, 99mTc-liposomes did not accumulate in diseased lung tissue, thus mimicking the in vivo behavior of labeled leukocytes.

Topics: Abscess; Animals; Escherichia coli Infections; Female; Immunoglobulin G; Indium Radioisotopes; Inflammation; Liposomes; Male; Organotechnetium Compounds; Oximes; Pneumonia, Pneumocystis; Radioimmunodetection; Rats; Rats, Sprague-Dawley; Rats, Wistar; Staphylococcal Infections; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Exametazime; Tissue Distribution

99Tcm-hexamethylpropyleneamine oxime (99Tcm-HMPAO) is presently recognized as an effective radiopharmaceutical for in vitro white blood cell (WBC) labelling in addition to its widespread utility in cerebral blood flow imaging. While performing clinical studies in patients with a wide range of inflammatory diseases, the effect of the ligand and stannous ion quantity on the labelling efficiency (LE) of WBC was examined. A mean LE of 64 +/- 7% (n = 29) was achieved when the whole HMPAO kit was used for labelling. The LEs were 78 +/- 5% (n = 43), 83 +/- 3% (n = 37) and 85 +/- 5% (n = 18) when one-half, one-third and one-fifth of the lyophilized kit was used, respectively. This is in agreement with the reports of Sampson et al. and Lang et al., suggesting that the optimal formulation of the 99Tcm-HMPAO is a faction of the whole kit. Accordingly, fractionation of a freshly prepared 99Tcm-HMPAO kit into five parts for a high-efficiency WBC labelling is proposed, encouraging the more widespread use of 99Tcm-HMPAO in WBC labelling.

Topics: Evaluation Studies as Topic; Humans; In Vitro Techniques; Inflammation; Leukocytes; Methods; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

To compare air enema radiology with a leukocyte scintigraphy technique using technetium-99m-hexamethyl propylene amine oxime-labelled leukocytes for imaging colonic inflammation in ulcerative colitis.. Prospective study in a University hospital. One radiologist and one nuclear physician independently graded the degree of inflammation in six colon segments per patient using radiographs and leukocyte scans.. Twenty consecutive patients with symptoms of active ulcerative colitis requiring corticosteroids, inflammation on rigid sigmoidoscopy and a positive leukocyte scan above the rectum.. Using air enema radiology, inflammation above the rectum was observed in 17 of the 20 patients. Eleven patients had the same extent of disease with both imaging techniques (total n = 5; extensive n = 3; distal n = 3). Seven patients had more widespread colitis using leukocyte scintigraphy. In the remaining two patients with extensive inflammation at scintigraphy, air enema films showed total colitis. When the colon was subdivided into six different segments, prediction of the presence of inflammation in individual segments was 0.88 for air enema radiology compared with leukocyte scintigraphy and 0.60 for the prediction of absence of inflammation. All segments with an irregular mucosal contour or ulceration on air enema films had intense inflammation at scintigraphy.. In patients with active ulcerative colitis, air enema radiology underestimates the extent of inflammation because this investigation shows secondary patho-anatomical changes, while leukocyte scintigraphy visualizes the acute cellular infiltrate. In patients with more severe inflammation, there is excellent agreement between the two methods.

Topics: Adolescent; Adult; Colitis, Ulcerative; Colon; Enema; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Pneumoradiography; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

A 19-year-old woman with active Crohn's disease under immunosuppressive therapy underwent scintigraphy with 99mTc-anti-NCA-95 antigranulocyte antibodies in order to determine the extent of inflammation. It turned out to be falsely negative whereas a 99mTc-HMPAO-labelled leukocyte scan revealed a marked terminal ileitis and pancolitis. It is assumed that immunosuppressive therapy was the main reason for the falsely negative antibody scan, possibly affecting the red bone marrow where most of the antibodies bind to granulocytes. Peripheral leukocytes labelled in vitro do not seem to be subject to these hypothetical effects on red bone marrow.

Topics: Adult; Antibodies, Monoclonal; Crohn Disease; False Negative Reactions; Female; Granulocytes; Humans; Inflammation; Leukocytes; Leukocytosis; Organotechnetium Compounds; Oximes; Radiography; Radioimmunodetection; Technetium Tc 99m Exametazime

Patients with acute lower abdominal pain remain a diagnostic challenge. Although acute appendicitis is the most common surgical disorder, its accurate and timely diagnosis can be difficult. Historically, females of childbearing age are the most difficult patient group in whom to make the diagnosis of acute appendicitis; they have reported negative laparotomy rates ranging from 30 to 50 percent. Tc-99 hexamethylpropyleneamineoxide (HMPAO) labeled leukocyte scan has previously been shown to be very accurate in the detection of acute appendicitis.. One year ago, a blinded study using Tc-99 HMPAO labeled leukocyte scan was reported for the detection of acute appendicitis. That study consisted of 27 patients who presented with abdominal pain. The present report is a follow-up study of 37 additional patients in whom the Tc-99 HMPAO leukocyte scan was used to diagnose or discount acute appendicitis.. Twenty-seven patients had histologically proved acute appendicitis. Twenty-three of these were correctly diagnosed using the leukocyte scan, for a sensitivity rate of 85 percent. The overall specificity rate was 93 percent, with an overall accuracy rate of 89 percent. Thirty-one of 64 patients were females of reproductive age and represented 56 percent of all patients in the study with appendicitis. In this group, the Tc-99 HMPAO leukocyte scan had a sensitivity rate of 87 percent, specificity rate of 92 percent, and an overall accuracy rate of 89 percent. The Tc-99 HMPAO leukocyte scan also proved to be valuable in the diagnosis of other intra-abdominal inflammatory conditions. Eight scans interpreted as negative for acute appendicitis were positive for other conditions, including five that were positive for diverticulitis, one for a tumor, one for a tubo-ovarian abscess, and one for a small intestinal infarction.. The Tc-99 HMPAO leukocyte scan is a highly accurate, diagnostic, and minimally invasive test of use in patients with abdominal pain of unclear cause, in which the differential diagnosis includes acute appendicitis. It is of particular value in females of childbearing age, in whom the cause of lower abdominal pain is unclear.

Topics: Abdominal Pain; Acute Disease; Adult; Appendicitis; Diagnosis, Differential; Diverticulitis; Female; Follow-Up Studies; Humans; Inflammation; Leukocytes; Male; Organotechnetium Compounds; Oximes; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Single-Blind Method; Technetium Tc 99m Exametazime; Ultrasonography

To evaluate the usefulness of 99mTc-HMPAO-labeled leukocytes and 99mTc-labeled polyclonal human immunoglobulin G (Technescan HIG) in the diagnosis of focal purulent disease, 31 comparative scintigraphies were done in 30 patients with known or strongly suspected focal infection. Focal purulent disease was the final diagnosis in 19 patients. Technetium-99m-labeled leukocytes showed 16 true-positive, no false-positive, 11 true-negative and 3 false-negative findings. The corresponding figures for 99mTc-labeled HIG were 11, 2, 9 and 8. The sensitivity and specificity of imaging with labeled leukocytes were 84% and 100%, respectively, and with labeled HIG, 58% and 82%, respectively. The overall accuracy of the leukocyte scan was significantly better than that of the HIG scan (90% versus 67%, p < 0.001). Thus, if focal infection is suspected, scintigraphy with 99mTc-labeled leukocytes is the preferable method. No cases exhibited a better imaging result with 99mTc-HIG scintigraphy than with 99mTc-labeled leukocytes.

Topics: Female; Focal Infection; Humans; Immunoglobulin G; Inflammation; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Prospective Studies; Radioimmunodetection; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Thirty-seven children (11 girls, 26 boys; aged 2.8 +/- 2.2 years) with Kawasaki disease (KD) were included in the study. The biventricular functions were evaluated by equilibrium multigated blood pooling ventriculography (EMBPV) and the severity of carditis was decided by Tc-hexamethylpropyleneamine oxime (HMPAO) labelled white blood cell (WBC) heart scans (Tc-WBC). The results showed that 43% (16/37) of the KD cases with the severe carditis by Tc-WBC had the worst left ventricular ejection fraction (LVEF) (55.4 +/- 15.6%) and right ventricular ejection fraction (RVEF) (43.7 +/- 12.2%) by EMBPV; 24% (9/37) of the cases with the mild carditis had the best LVEF (63.5% +/- 8.2%) and RVEF (53.7% +/- 11.2%); the remaining 32% (12/37) had moderately severe carditis and biventricular function (LVEF: 58.2 +/- 17.2% and RVEF: 46.9 +/- 19.5%). Because Tc-WBC cannot only detect the severity of carditis but also predict impairment of ventricular function accurately, the choice of Tc-WBC should be preferable for KD-a common inflammatory cardiovascular disease in children.

Topics: Child; Child, Preschool; Female; Gated Blood-Pool Imaging; Heart Diseases; Humans; Infant; Inflammation; Leukocytes; Male; Mucocutaneous Lymph Node Syndrome; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Ventricular Function

Myocardial imaging with 99Tcm-hexamethylpropylene amineoxime (HMPAO)-labelled white blood cells (Tc-WBC) was used to detect carditis and differentiate rheumatic fever (RF) and inactive rheumatic heart disease (IRHD). Ten cases of RF and 15 cases of IRHD were studied, and the results revealed 60% (6/10) of the cases of RF with carditis, but none of the cases (0/15) of IRHD with carditis. There was significant difference (P less than 0.05, by Fisher's test) between RF and IRHD. In our preliminary conclusion, Tc-WBC heart scanning may be a noninvasive method for evaluating the existence of carditis in cases of RHD and in the differentiation of RF and IRHD.

Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Female; Heart Diseases; Humans; Inflammation; Leukocytes; Male; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Rheumatic Fever; Rheumatic Heart Disease; Technetium Tc 99m Exametazime

The possible contribution of an inflammatory component in osteoarthritis was investigated. There was no correlation between the percentage uptakes of 99Tcm-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells and 99Tcm-methylene diphosphonate (MDP) and between the former and pain scores. A significant correlation was found between the percentage uptake of 99Tcm-MDP and pain scores (0.002 > P > 0.01). In osteoarthritis, 99Tcm-HMPAO-labelled white cell imaging may or may not show a positive localization in the synovial membrane. Positive white cell localization appears to be limited to the area that corresponds to the radiological evidence of the condition and the positive uptake of the skeletal imaging agent.

Topics: Adult; Aged; Cell Movement; Female; Humans; Inflammation; Knee Joint; Leukocytes; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Osteoarthritis; Oximes; Pain; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Due to their spontaneous accumulation in inflamed or infected areas, blood phagocytes are potent drug vectors with specific targeting. Drug like molecule loading was obtained by use of cell electropermeabilization in which the impermeability of their plasma membrane is transiently impaired. Electrical conditions were used which allow electroloading of a drug like molecule (propidium iodide) in 70% of leukocytes in a whole blood sample while preserving in vitro functional properties. Slow release of entrapped hydrophilic molecules was observed with a half lifetime longer than 4 hours at 4 degrees C and at 37 degrees C. With an in vivo assay, using a rat model of inflammation, we showed that, as for non-pulsed cells, pulsed neutrophils accumulate 10 times more in an inflamed area than they do in control areas. Phagocyte electropermeabilization is therefore a very efficient way of drug targeting. Accumulation of electropulsed neutrophils in an area of inflammation gives targeted release of the electroloaded drug.

Topics: Animals; Chemotaxis, Leukocyte; Inflammation; Kinetics; Male; Neutrophils; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium Tc 99m Exametazime; Time Factors

A simplified and efficient procedure for 99mTc-HMPAO-labelling of leukocytes is described. For this purpose, the pH and concentration of the 99mTc-HMPAO preparation was modified. Leukocytes were isolated from a 20 mL mixture of patient blood, 5 mL ACD and 0.8 mL methylcellulose after 1 h sedimentation of erythrocytes and centrifugation (at 400 g) of the obtained plasma layer. Simultaneously, 99mTc-HMPAO was prepared (one single-dose kit for two patients) by adding 2.2 mL 99mTc-generator eluate and, after 10 min, 0.3 mL of phosphate buffer to lower the pH to 7. The isolated WBCs were then labelled by the addition of 1-1.2 mL of 99mTc-HMPAO solution and incubated for 20 min. The unbound tracer was then discarded, the labelled WBC washed and finally resuspended in autologous cell-free plasma. Leukocytes labelled by this procedure were used for scintigraphic localization of inflammatory lesions and abscesses in the gastro-intestinal tract. The labelling efficiency was 60 +/- 9%, with a separation yield of 55 +/- 11%.

Topics: Abscess; Humans; Hydrogen-Ion Concentration; Inflammation; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Topics: Antibodies, Monoclonal; Humans; Indium Radioisotopes; Inflammation; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sternum; Surgical Wound Infection; Technetium; Technetium Tc 99m Exametazime

Topics: Humans; Indium Radioisotopes; Inflammation; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; 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

A radionuclide imaging with Tc-99m HMPAO labeled leukocyte was performed in order to determine its clinical usefulness in inflammatory disease. The mixed leukocyte isolated from 40 ml of whole blood containing 5 ml of acid citrate dextrose A and 7 ml of 6% hydroxyethyl starch was incubated with 370 MBq (10 mCi) of Tc-99m HMPAO at 37 degrees C for 30 minutes. Because the labeling efficiency of Tc-99m HMPAO labeled leukocyte was 60.2 +/- 6.3%, the procedure of washing Tc-99m, leukocyte with 5 ml of physiological saline was necessary before intravenous injection, in order to remove the unlabeled Tc-99m HMPAO. The recoveries of Tc-99m leukocyte in the blood after intravenous injection were 41.1 +/- 6.7% at 5 minutes, 33.4 +/- 2.1% at 30 minutes, and 27.2 +/- 3.4% at 2 hours after injection. Moreover, the labeled leukocyte was not stained with trypan blue. Therefore, the biological activity of the Tc-99m leukocyte was maintained as that of In-111 oxine labeled leukocyte. In the 39 patients with clinical suspicion of inflammatory disease including 15 patients with acute and chronic infectious disease where both Tc-99m leukocyte and Ga-67 citrate imagings were performed, the sensitivity, specificity and accuracy for infectious disease were 47%, 100% and 79% with Tc-99m leukocyte, and 67%, 79% and 74% with Ga-67 citrate. These results suggest that Tc-99m HMPAO labeled leukocyte imaging is promising for evaluating inflammatory disease because of the much higher specificity, the ready availability of Tc-99m HMPAO, the good image quality, and the lower radiation dose to the patient.

Topics: Gallium Radioisotopes; Humans; Inflammation; Leukocytes; Organotechnetium Compounds; Oximes; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Topics: Abdomen; Abscess; Humans; Infections; Inflammation; Leukocytes; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Labelling leucocytes with 99Tcm using hexamethylpropyleneamine oxime (HMPAO) utilizes the advantages of technetium over indium in imaging inflammation. A retrospective study has been performed on 43 consecutive patients imaged with 99Tcm HMPAO labelled leucocytes in order to assess the reliability of the technique. Particular attention was paid to the different handling characteristics of the 99Tcm HMPAO labelled cells compared with those labelled with indium. It was found that 99Tcm HMPAO labelled leucocytes gave an overall accuracy of 93.2%, a sensitivity of 92.8%, a specificity of 93.3% and a positive predictive value of 86%. 99Tcm HMPAO labelled leucocyte scanning provides a reliable method of imaging inflammation, though errors in interpretation may occur due to the hepato-biliary excretion of activity that occurs with this technique.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Crohn Disease; Humans; Inflammation; Leukocytes; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Pelvis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime

Forty-three patients with suspected benign, inflammatory, or infectious diseases were imaged with [99mTc]HM-PAO-labeled leukocytes and [67Ga]citrate. Technetium-99m leukocytes showed 22 true-positive, no false-positive, 19 true-negative, and two false-negative findings and [67Ga]citrate 23, 7, 12 and 1, respectively. The sensitivity, specificity, and accuracy values with 99mTc leukocytes were 92%, 100%, and 95%, and with [67Ga]citrate 96%, 63%, and 81%. Technetium-99m leukocyte scintigraphy has a promising future in comparison with [67Ga]citrate because of the ready availability of [99mTc]HM-PAO, the good image quality, more rapid results (within few hours), and the lower radiation exposure to the patient with 99mTc leukocytes. The usefulness of 99mTc leukocytes in chronic osteomyelitis needs further evaluation.

Topics: Abdomen; Abscess; Adult; Aged; Blood Vessel Prosthesis; Bone Neoplasms; Citrates; Citric Acid; Female; Hip Prosthesis; Humans; Ilium; Infections; Inflammation; Leukocytes; Lymphoma; Male; Middle Aged; Organometallic Compounds; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

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

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

Leukocytes labeled with technetium-99m hexamethylpropyleneamine oxime (HMPAO) were used in 100 patients: 32 with suspected inflammatory bowel disease, 17 with fever of unknown origin, 21 with suspected abdominal sepsis, 20 with suspected bone sepsis, seven with bronchiectasis, and three with recent myocardial infarction. The distribution of activity in patients subsequently shown not to have inflammatory bowel disease was similar to that previously described for indium-111-labeled leukocytes. However, in this study, activity was also seen in the kidneys and bladder and occasionally the gallbladder on both early (1-3 hours) and late (24 hours) views, and in the colon in late views. Migration of Tc-99m-labeled granulocytes was seen in inflammatory disease as early as 30 minutes after injection, while normal bowel activity was not seen before 4 hours. The sensitivity of Tc99m-labeled leukocytes in the detection of inflammation was 100%, the specificity was 95%.

Topics: Colitis; Crohn Disease; Fever of Unknown Origin; Humans; Inflammation; Leukocytes; Organometallic Compounds; Osteitis; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

The lipophilic complex, 99Tcm-hexamethylpropyleneamine oxime (HMPAO) is an efficient leucocyte label, and labels granulocytes with more stability than mononuclear leucocytes. The recovery of 99Tcm-HMPAO granulocytes, expressed as the percentage of injected granulocyte-associated activity circulating as granulocyte-associated activity 40-45 min after injection, was 37% (S.E. 3%), similar to the recovery of 111In-labelled granulocytes isolated and labelled in plasma using tropolone. The T1/2 of 99Tcm-HMPAO labelled granulocytes in blood was 4.4 h (S.E. 0.4 h), less than that of 111In-labelled granulocytes, although when a correction was made for 99Tcm elution, it was 6.4 h. The initial biodistribution of 99Tcm-labelled leucocytes was similar to 111In-labelled granulocytes, with a rapid initial lung transit, prominent splenic activity, bone marrow activity and minimal hepatic activity, although, unlike 111In, 99Tcm activity was also seen in urine, occasionally in the gallbladder, and, from about 4 h, consistently in the colon. Bone marrow activity was particularly prominent with 99Tcm. About 6% of 99Tcm was excreted in the faeces up to 48 h after injection, and about 17% in urine up to 24 h. The time-activity curves of reticuloendothelial activity up to 24 h were broadly similar for the two labelled cell preparations, and the differences that were observed can be explained on the basis of a higher rate of 99Tcm elution. Clinical information given by the two agents was similar in 27 of 30 patients who received both. Of the three who gave different information, one received 111In-labelled granulocytes which were considered to be functionally suboptimal and two, with inflammatory bowel disease, showed different distributions of abnormal bowel activity. We conclude that with respect to granulocyte kinetics and clinical data, 99Tcm-HMPAO labelled leucocytes are comparable with 111In-tropolonate labelled granulocytes.

Topics: Colitis, Ulcerative; Crohn Disease; Cycloheptanes; Female; Granulocytes; Humans; Indium Radioisotopes; Inflammation; Leukocytes; Male; Organometallic Compounds; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime; Tissue Distribution; Tropolone

Topics: Adult; Aged; Female; Gastrointestinal Diseases; Humans; Inflammation; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

20 patients were studied with 99mTcHMPAO labelled leucocytes for detection of inflammation. 14 patients had positive uptake. 6 patients were examined also with 67Ga-citrate and 5 with 99mTc-nanocolloid. The 99mTc-HMPAO images were superior to other methods. Abscesses, osteitis, inflammatory bowel disease and graft infection were positive. Abscesses were positive at 30 min images and became more positive at 4 h. The 99mTc-HMPAO labelled leucocyte scan can be used also to follow up healing of inflammation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Gallium Radioisotopes; Humans; Inflammation; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Hexamethylpropylene-amineoxime (HMPAO) forms a lipid-soluble neutral complex with 99mTc which is rapidly incorporated into leucocytes in vitro. In six patients with suspected or known inflammatory disease, a "mixed" leucocyte suspension isolated from 85 ml blood anticoagulated with acid-citrate-dextrose was labelled by 99mTc-HMPAO with a mean efficiency of 47% (SE2%), of which 78% (3) was taken up by granulocytes. Activity eluted more rapidly from other cell types in vitro than from granulocytes, which remained firmly labelled. Mean initial biodistribution of the label and granulocyte recovery in blood of 32% (8) at 30-40 min showed that the granulocytes were not significantly activated during labelling. All six patients were positive for inflammatory disease, as early as 30 min in five patients and at 3 h in the sixth; they all remained positive at 20-24 h. Four patients also received 111In-labelled "pure" granulocytes. In terms of detail, the 99mTc images were comparable or superior to the 111In images.

Topics: Adult; Granulocytes; Humans; Indium; Inflammation; Intestinal Diseases; Isotope Labeling; Middle Aged; Oximes; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime