technetium-tc-99m-sulfur-colloid and Infections

Topics: Bone Marrow; False Positive Reactions; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Muscular Diseases; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fusion; Technetium Tc 99m Sulfur Colloid

Persistent fever in a 60-yr-old man with polycystic kidney and liver diseases and bilateral hip prostheses was presented in this study. Multiple diagnostic tests failed to localize a source of infection. Subsequently, a combination of a 111In-oxine labeled WBC and 99mTc-sulfur colloid scans (and computer subtraction) demonstrated abnormally increased WBC activity in the left lobe of the liver, thus, diagnosis of an infected cyst (or cysts) was made. The patient responded to the treatment with antibiotics. This article discusses the clinical features of polycystic disease of the liver and kidneys. Infection in cysts are discussed as well as radiographic and scintigraphic investigations that can be used to diagnose and localize infection in a cyst.

Topics: Cysts; Fever; Hip Prosthesis; Humans; Indium Radioisotopes; Infections; Leukocytes; Liver Diseases; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Polycystic Kidney, Autosomal Dominant; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Several chelates are available for leukocyte labeling. Studies indicate that cells labeled with any of the chelates have a sensitivity for infection of 90% to 95% when imaged at 24 hours postinjection. The sensitivity of 111In-labeled leukocytes at earlier imaging times is more controversial. There has been concern about the utility of labeled leukocytes in musculoskeletal infection. Recent leukocyte studies show a high sensitivity for infected prostheses, even though these infections are often walled off and do not cause systemic symptoms. However, leukocytes frequently miss osteomyelitis of the spine for reasons that are not known. Although some investigators do not recommend the use of 111In-labeled leukocytes in chronic infections, we have found a high sensitivity for infections that are 2 or more weeks old. Autopsy studies from the preantibiotic era indicate that bacterial infections with common organisms have high levels of neutrophil infiltration for months. Labeled lymphocytes from mixed-cell preparations also may play a role in detecting these inflammatory sites. Questions have been raised about the effect of antibiotic therapy on leukocyte sensitivity. Antibiotics do not appear to have a significant effect on scan sensitivity. By reducing the number of bacteria at an inflammatory site, antibiotics reduce the amount of chemotactic inhibitors. In addition, some antibiotics have been shown to directly stimulate leukocyte chemotaxis. Other factors that can theoretically reduce leukocyte function, including hemodialysis, hyperalimentation, hyperglycemia, and steroids, do not appear to reduce labeled leukocyte sensitivity for infection. The specificity of leukocyte uptake is reduced in the gastrointestinal tract and lungs. In these sites, uptake correlates with infection or the true cause of the patients' fever in only 10% to 50% of cases.

Topics: Chronic Disease; Digestive System; Humans; Indium Radioisotopes; Infections; Leukocytes; Lung; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid; Tropolone

Forty-one possible cases of infected total knee prostheses studied with indium-111-labeled leukocyte scintigraphy were retrospectively reviewed. Twenty-four of the prostheses were studied with technetium-99m methylene diphosphonate bone scintigraphy and 19 with Tc-99m sulfur colloid marrow scintigraphy. Nine prostheses were infected, and 32 were uninfected. The accuracy of combined labeled leukocyte and sulfur colloid marrow imaging (95%) was higher than that of labeled leukocyte scintigraphy alone (78%), bone scintigraphy alone (74%), or combined labeled leukocyte and bone scintigraphy (75%). The authors conclude that combined labeled leukocyte and sulfur colloid imaging is an accurate method for diagnosis of infected knee prostheses. In this series, this technique was superior to labeled leukocyte and bone imaging, alone or in combination.

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Infections; Knee Prosthesis; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Indium-111-labeled leukocyte images of 92 cemented total-hip arthroplasties were correlated with final diagnoses. Prostheses were divided into four zones: head (including acetabulum), trochanter, shaft, and tip. The presence (or absence) and intensity of activity in each zone was noted, and compared to the corresponding contralateral zone. Though present in all 23 infected arthroplasties, periprosthetic activity was also present in 77% of uninfected arthroplasties, and was greater than the contralateral zone 51% of the time. When analyzed by zone, head zone activity was the best criterion for infection (87% sensitivity, 94% specificity, 92% accuracy). Fifty of the arthroplasties were studied with combined labeled leukocyte/sulfur colloid imaging. Using incongruence of images as the criterion for infection, the sensitivity, specificity, and accuracy of the study were 100%, 97%, and 98%, respectively. While variable periprosthetic activity makes labeled leukocyte imaging alone unreliable for diagnosing hip arthroplasty infection, the addition of sulfur colloid imaging results in a highly accurate diagnostic procedure.

Topics: Adult; Aged; Aged, 80 and over; Female; Hip Prosthesis; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A simultaneous dual isotope technique incorporating computer subtraction for the diagnosis of bone, joint, or soft-tissue infection using [67Ga]citrate and [99mTc]MDP or sulfur colloid is described. Comparison of this technique with visual congruence or noncongruence of the two radionuclide images in 41 patients shows that the two techniques have identical sensitivity (93%) and specificity (92%) but the computer technique gave additional information in 17% of all cases (44% of abnormals) concerning the anatomic location of the infective focus which aided in the subsequent surgical management of the patient.

Topics: Adolescent; Adult; Aged; Bone Diseases; Child; Child, Preschool; Computers; Connective Tissue Diseases; Diphosphonates; Female; Gallium Radioisotopes; Humans; Infections; Male; Middle Aged; Radionuclide Imaging; Subtraction Technique; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Bone Marrow; Humans; Infections; Intervertebral Disc; Male; Radionuclide Imaging; Spinal Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid