Labeled Leukocyte Scintigraphy Research Articles

Rectal Crohn's disease on labeled leukocyte scintigraphy.

Radionuclide imaging with Tc-99m-labeled leukocytes showed increased uptake in the anal area, best seen with SPECT imaging. This was found to be secondary to rectal involvement in Crohn's disease.

Technetium Tc 99m hexamethyl propylene amine oxine leukocyte scintigraphy in patients with ulcerative colitis: correlation with clinical, biologic, endoscopic, and pathologic intensity, and local release of interleukin 8

Background: Technetium Tc 99m hexamethyl propylene amine oxine ( 99mTc-HMPAO) has been used to radiolabel leukocytes with promising results for its clinical use in inflammatory bowel disease. During active ulcerative colitis, colonoscopy is indicated to determine the extent and the intensity of the disease for proper management. The aim of this prospective study was to determine whether 99mTc-HMPAO–labeled leukocyte scintigraphy can give information similar to that obtained with colonoscopy during acute attacks of ulcerative colitis. Methods: Thirty-three consecutive patients with 50 acute episodes of ulcerative colitis underwent 99mTc-HMPAO scintigraphy and colonoscopy with biopsies. Scintigraphic determination of disease extent and intensity were compared with those obtained by colonoscopy with biopsies and clinico-biologic markers. Results: The scintigraphic index of disease intensity was correlated with endoscopic index, Truelove index, biologic markers, and local release of interleukin-8. The extent measured by scintigraphy was well correlated to the endoscopic and histologic extent. Conclusions: 99mTc-HMPAO scintigraphy accurately determines the extent and the intensity of acute ulcerative colitis lesions. This noninvasive method can specify the extent and the intensity of an acute attack in patients with previously known ulcerative colitis. (Gastrointest Endosc 1998;48:491-6.)

Infection of a left ventricular aneurysm and massive splenomegaly demonstrated by In-111-labeled leukocyte scintigraphy.

When septicemia has failed to resolve after appropriate antibiotic therapy, labeled leukocyte scintigraphy is often valuable to locate focal sites of infection. In this case, probable infection of a left ventricular aneurysm, the sequela of an old myocardial infarction, was demonstrated. Massive splenomegaly due to portal vein stenosis after prior orthotopic liver transplantation also was depicted. In previously reported cases of infected left ventricular aneurysms, there usually has been prior myocardial infarction. As in this case, associated mural thrombus and false aneurysms have been reported. Demonstration by labeled leukocyte scintigraphy has not been previously reported.

Reliability of technetium-99m-hexamethyl propylene amine oxime (99MTc-HMPAO) labelled leucocyte scintigraphy in clinical evaluation of inflammatory bowel disease (IBD)

Reliability of technetium-99m-hexamethyl propylene amine oxime (99MTc-HMPAO) labelled leucocyte scintigraphy in clinical evaluation of inflammatory bowel disease (IBD)

Early Cardioverter Defibrillator Infection: Value of Indium-111 Leukocyte Imaging

In the early postoperative period, it may be difficult to diagnose an infected implantable cardioverter-defibrillator system using anatomic imaging modalities such as computed tomography alone. We describe a case that illustrates the complementary physiologic role of indium-111–labeled leukocyte scintigraphy in identifying and defining the extent of early postoperative implantable cardioverter-defibrillator infection. (Ann Thorac Surg 1997;63:236–8)

In-111 labeled leukocyte scintigraphy of infected prosthesis with Candida parapsilosis in a patient without predisposing risk factors.

Candida infection after prosthetic arthroplasty is an extremely rare complication manifested by an indolent course and the suspicion of candida isolation as a culture contaminant, which make the diagnosis difficult. A knee prosthesis infected with candida palapsilosis in a 50-year-old woman without predisposing risk factors was clearly delineated by In-111 labeled leukocyte scintigraphy. With positive leukocyte scintigraphy, misinterpretation of the positive isolation of candida may be avoided and, thus, proper treatment may start at an early stage.

Chronic osteomyelitis: diagnosis with tech netium-99m-d,l-hexamethylpropylene amine oxime labelled leucocytes

To evaluate the diagnostic value of technetium-99m d, l-hexamethylpropylene amine oxime (HMPAO) labelled leucocytes in combination with a 99mTc-methylene diphosphonate (MDP) bone scan in the detection of chronic osteomyelitis, we retrospectively reviewed 55 patients. Prior to the 99mTc-d,l-HMPAO labelled leucocyte scan, all patients underwent a 99mTc-MDP bone scan. The correct diagnosis was confirmed by long-term clinical follow-up (n=29) or by bacteriological cultures (n=26). We found an overall sensitivity of 94%, a specificity of 91% and an accuracy of 92% for 99mTc-d,l-HMPAO labelled leucocyte scintigraphy in the diagnosis of chronic osteomyelitis. When the patients were divided into three groups according to the location of the infection, our study results showed a sensitivity and specificity for the central location (containing active bone marrow) of 94% and 100% respectively; for the peripheral location (hands and feet) both parameters were 100%, and for the middle location (all sites between the central and the peripheral location) the values were 92% and 81% respectively. Specificity and accuracy were significantly lower in the middle location than in the central and peripheral locations. The results of our study confirm that a 99mTc-d,l-HMPAO labelled leucocyte scan in combination with an 99mTc-MDP bone scan is a reliable way to diagnose chronic osteomyelitis, except for vertebral osteomyelitis.

Labelled leucocyte scintigraphy in inflammatory bowel disease: clinical applications.

<h3>Abstract</h3> Focal adhesions are important mechanosensitive structures, composed of transmembrane integrins, linking the extracellular matrix to the actomyosin cytoskeleton, via cytoplasmic proteins. Cellular adhesion to the extracellular matrix depends on the activation of integrins by intracellular mechanisms. Talin and kindlin are major activators of integrins that are recruited to the inner membrane and bind to β-integrin cytoplasmic tails. Many studies showed the importance of integrin activation and clustering and how the organization of extracellular ligands guides the nanoscale organization of adhesion complexes. However, the roles of talin and kindlin in this process are poorly understood. To determine the contribution of talin, kindlin, lipids and actomyosin in integrin clustering, we performed experiments using a biomimetic <i>in vitro</i> system, made of Giant Unilamellar Vesicles, containing transmembrane integrins, on which purified talin, kindlin, and actomyosin assemble. Here we first show that talin and kindlin individually have the ability to cluster integrins. When added together, talin and kindlin synergize to induce the formation of larger integrin clusters containing the three proteins. Comparison of protein density in the talin-integrin, kindlin-integrin, and talin-kindlin-integrin clusters reveals that kindlin increases talin and integrin density, whereas talin does not affect kindlin and integrin density. Finally, kindlin significantly enhances the segregation of talin-integrin clusters induced by actomyosin contractility, suggesting that it increases the coupling of these clusters to the actin cytoskeleton. Our study unambiguously demonstrates how kindlin and talin cooperate to induce integrin clustering, which is a major parameter for cell adhesion.

Colonic Localization Of Labeled Leukocytes In Critically III Patients

This study assesses the causes of colonic localization of labeled white blood cells (WBCs) in critically ill patients who had undergone leukocyte scintigraphy for suspected infection. Forty-two patients showed abdominal or pelvic WBC localization; 20 of these had a pattern of colonic localization, and some also showed a pattern of small bowel activity. Eight of the 20 patients had documented gastrointestinal bleeding. White blood cell scintigraphy in these eight patients showed a pattern of multifocal and/or regional bowel activity that changed in intensity and location from early (3-5-hour) to delayed (18-28-hour) images. In contrast, 5 of the 6 patients with documented pseudomembranous colitis (PMC) showed intense WBC localization involving most of the colon. In 3 of these 5 patients, early and delayed images were acquired and showed a relatively constant pattern of WBC localization. The sixth PMC patient had been treated with vancomycin before leukocyte scintigraphy and showed minimal distal small bowel activity on early images and only mild regional colonic activity on delayed images. As in the patients with gastrointestinal bleeding, the remaining six patients showed either focal or regional activity of variable intensity that changed over time. In critically ill patients, gastrointestinal bleeding and PMC accounted for 14 of the 20 patients in which labeled leukocyte scintigraphy exhibited colonic activity. A pattern of diffuse, intense colonic radiotracer activity which persists from early to delayed imaging strongly suggests the presence of PMC in this patient population.(ABSTRACT TRUNCATED AT 250 WORDS)

Technetium-99m hexamethyl-propyleneamine-oxime–labeled leukocyte scintigraphy in inflammatory bowel disease in children

Technetium Tc 99m–labeled hexamethyl-propyleneamine-oxime (Tc-HMPAO) scintigraphy has been evaluated in adults with inflammatory bowel diseases and has shown promising ability to define intensity and extent of disease. To evaluate the method's utility in children, we studied 27 pediatric patients-23 with inflammatory bowel diseases and 4 control subjects without abdominal inflammation. Autologous leukocytes labeled with Tc-HMPAO were reinjected into each patient and serial scans were obtained up to 4 hours later. None of the control subjects had any uptake of Tc-HMPAO by the bowel. Disease localization as defined by the scan correlated well with that visualized in surgical specimens from five patients, at endoscopy in three patients, with barium studies of two patients, and with computed tomography scanning of the abdomen in one patient. A "scan score" was calculated by comparing uptake of tracer in five bowel segments with iliac crest bone marrow activity. Scan score correlated much better with clinical disease activity (correlation coefficient = 0.62) than did the erythrocyte sedimentation rate (correlation coefficient = 0.24). Scintigraphy with Tc-HMPAO appears to be useful in evaluation of disease localization and intensity in children with inflammatory bowel disease. (J PEDIATR 1994;125:213-7)

Technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy in ulcerative colitis and Crohn's disease

Technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy (LS) was performed on 45 occasions in 30 patients with ulcerative colitis and on 53 occasions in 34 patients with Crohn's disease. Serial images were taken following re-injection of the labelled leucocytes. The segmental extent of the inflammation and the grade of the leucocyte uptake were calculated, and compared with the laboratory results and colonoscopy findings. The sensitivity and specificity of LS proved higher in ulcerative colitis (87% and 93%) than in Crohn's disease (53% and 89% in cases with large intestine involvement, and 82% and 100% in cases with small intestine involvement). The activity of the process determined by LS correlates with the alpha 2-globulin level (r = 0.47), fibrinogen level (r = 0.50), fS iron level (r = -0.57), sedimentation (r = 0.44), leucocyte count (r = 0.38), platelet count (r = 0.34) and Best index (r = 0.31) in ulcerative colitis, but not in Crohn's disease.

Infected Knee Prosthesis

Studies have shown the usefulness of labeled leukocyte scintigraphy as a specific tracer to detect inflammatory-infectious conditions in orthopedic surgery. The authors submit the case of a 69-year-old woman who had a total left knee prosthesis implanted 2 months earlier. At the time of exploration, the patient complained of knee pain and local clinical signs of soft tissue infection adjacent to the surgical scar. A fistulous orifice on the front of the leg, immediately below the knee, with abundant suppuration was observed.

Ln-111 Labeled Leukocyte Imaging in a Case of Pseudogout

In-111 labeled leukocyte scintigraphy was performed on a 90-year-old woman who had a fever and left lower extremity pain for 3 days. Leukocyte images demonstrated abnormal activity in the left knee and ankle. Aspiration of the left knee joint yielded cloudy yellow fluid with a leukocyte count of 30,000 per mm3 (75% polymorphonuclear leukocytes, 1% lymphocytes, and 24% monocytes). Cultures of the aspirate were reported as no growth. Microscopic examination of the aspirate revealed the presence of rod-shaped crystals of calcium pyrophosphate dihydrate, confirming the diagnosis of calcium pyrophosphate deposition disease, also known as pseudogout. The acute arthritis of pseudogout stimulates an intense leukocyte response; therefore, labeled leukocyte images performed on patients suspected of having this condition must be interpreted cautiously because scintigraphically it may not be possible to distinguish pseudogout from septic arthritis.

Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging.

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.

Role of ln-111 Labeled Leukocyte Scintigraphy in the Diagnosis of Intracerebral Lesions

The differential diagnosis of intracerebral enhancing lesions on contrast computed tomography includes tumors, abscesses, and cerebrovascular accidents. Particularly important is the differentiation between tumor and abscess. While In-111 labeled leukocyte imaging is an accurate test for identification of foci of infection in general, the role of this procedure in the evaluation of the intracranial lesion is not well established. We undertook a retrospective review of 16 patients with contrast enhancing intracerebral lesions identified on computed tomography, who were also studied with labeled leukocyte imaging. Final diagnoses were: abscess (n = 2), primary brain tumor (n = 6), metastasis (n = 4), dermoid cyst (n = 1), and cerebral infarct (n = 3). There were two positive labeled leukocyte studies; both were cerebral abscesses. No labeled leukocyte activity was identified in any of the tumors or infarcts. We conclude that In-111 labeled leukocyte imaging is an accurate method of differentiating infectious from noninfectious causes of intracerebral lesions identified on computed tomography.

Appearance of Fibrous Dysplasia on ln-111 Labeled Leukocyte Scintigraphy

Appearance of Fibrous Dysplasia on ln-111 Labeled Leukocyte Scintigraphy

Indium labelled leucocyte scintigraphy in occult infection: A comparison with ultrasound and computed tomography

A review of five year's experience of the use of 111Indium labelled leucocyte scintigraphy (111In WBC) in the investigation of suspected sepsis is presented. The results of 257 111In WBC scans for which a definitive diagnosis was subsequently established were available for analysis. The findings are compared with those of ultrasound (130 cases) and computed tomography (82 cases) and the final clinical outcome. The sensitivity and specificity of the 111In WBC for the series were 97% and 91% respectively. The major cause of the false positive 111In WBC results was activity within the bowel not due to infection. Thrombus within the inferior vena cava caused a false positive 111In WBC result: this is previously undescribed. There were a large number of incorrect ultrasound results, particularly with abdominal and pelvic abscesses, pyelonephritis, peritonitis and non-infected fluid collections, showing that a negative ultrasound cannot exclude infection. The relative merits of the three modalities are discussed, emphasizing that more than one technique may be required to establish a diagnosis.

Ln-111 Labeled Leukocyte Scintigraphy in a Case of Multifocal Candidiasis

The value of indium-111 labeled leukocyte scintigraphy for the diagnosis of infection in the general population is well documented; there is less information available on its role in the evaluation of the immunocompromised patient. In this study, leukocyte scintigraphy was performed on a 31-year-old immunocompromised woman who had a possible intra-abdominal abscess. No abscess was detected, but intense oral, esophageal, gastric, and vaginal uptake was observed. Candida infection was histologically confirmed at all four sites.

111 In‐oxine labelled leukocyte scintigraphy in the detection and localization of active inflammation and sepsis

We report an analysis of the results obtained in our first 100 studies with indium-111-oxine labelled leukocyte scintigraphy, a diagnostic technique which has recently become available for clinical evaluation within Australia. We used this technique to assess patients with suspected sepsis or inflammation after other commonly used investigations had failed to confirm a diagnosis. Four patient subgroups were evaluated: fever of unknown origin; suspected abdominal or postoperative sepsis; suspected active inflammatory bowel disease; and suspected sepsis or inflammation of bones or joints. The course of all patients was followed for at least three months to establish the accuracy of the technique. The leukocyte labelling procedure took 90 min and imaging was carried out typically 3-6, 24 and occasionally 48 h after reinjection of the labelled autologous leukocytes. In one patient labelling of leukocytes was unsuccessful. In the remaining 99 studies the overall sensitivity of leukocyte scintigraphy was 88% (36 of 41 patients with a proved inflammatory or infective disease focus had positive scan findings); and the specificity was 95% (55 of 58 cases with no proved disease focus had normal scan findings). This series supports the use of this method as the imaging procedure of choice in nuclear medicine for the evaluation of suspected acute sepsis (symptoms less than four weeks' duration), of inflammatory bowel disease and of suspected infections involving appendicular bones which contain no active bone marrow. It is also a useful secondary scintigraphic procedure, after gallium-67-citrate scintigraphy, in patients with suspected infective disorders of more than four weeks' duration.