WBC Scan Research Articles

Extensive Paget??s Disease Demonstrated on ln-111 WBC Scanning

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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.

Kinetics of leukocyte sequestration in the lungs of acutely septic primates: A study using 111In-labeled autologous leukocytes

To further clarify the role of leukocytes in the pathogenesis of ARDS, we studied the localization and kinetics of leukocyte migration using 111In-labeled autologous white cell scans ( 111In wbc scans) in four primates made acutely septic with infusions of Escherichia coli. Whole body images were obtained with a gamma camera and were acquired on computer every 15 min beginning immediately after the E. coli infusion. Simultaneous measurements of C5a and peripheral blood leukocyte count were also obtained. Within 5 min of initiating sepsis, three major events occurred: complement activation as measured by the production of C5a, a profound fall in peripheral leukocyte count, and a significant increase in the sequestration of leukocytes in the lungs. The pulmonary sequestration reached a peak at 15 min with a mean of 152% of baseline activity. This sequestration consisted of a population that was predominantly neutrophils. Damage to the pulmonary capillary endothelium was demonstrated by an increase in extravascular lung water. The results support a role for neutrophils and complement as mediators in the pathogenesis of ARDS.

Vascular graft infection: The role of Indium scanning

Infection of a prosthetic graft is one of the most feared complications of vascular surgery. The difficulties of accurate, objective diagnosis are well recognised. We have used III Indium labelled white blood cell scans (InWBC) in two groups: 9 control patients who underwent uncomplicated aortic aneurysm surgery, and 23 patients with suspected graft sepsis. In the control group there was one positive scan in a patient with an inflammatory aneurysm. In the suspected sepsis group, 11 patients subsequently has proven graft sepsis. Nine were correctly predicted by Indium scanning. Ten of 12 patients who did not have proven graft sepsis had negative scans. There was a total of 5 inflammatory aneurysms in the control and suspected sepsis groups, of whom two had positive scans. False positive scans were not present in the early postoperative period i patients without inflammatory aneurysms. In our experience Indium labelled WBC scanning for suspected graft sepsis has a accuracy of 83% a negative predictive value of 83% and a positive predictive value of 82%. These results suggest that Indium white cell labelling techniques which do not involve substantial cross-labelling of platelets are the best objective methods of establishing the presence or absence of graft sepsis.

The complementary role of indium-111 labeled leukocyte imaging, ultrasonography and computed tomography in the evaluation of postoperative infection or abscess.

We report our experiences with the combined use of indium-111 labeled leukocyte imaging (In-III WBC scan.), computed tomography (CT) and ultrasonography (US) for evaluation of suspected postoperative infection or abscess, and discuss the complementary roles of these modalities. Postoperative abscesses or infections were diagnosed in 9 of 20 patients. All patients were correctly diagnosed by In-111 WBC imaging and 4 patients could not be diagnosed by US because of bowel gas. One false-positive CT examination and another artifact on CT images due to respiratory movements were obtained. The three modalities were found to be complementary: CT and US were efficient imaging methods for diagnosis and treatment of abscess. In-111 WBC imaging could estimate the activity of inflammation.

Evaluation of Tc-99m leukocyte scan in the diagnosis of acute appendicitis

A new 99mTc Microlite leukocyte scan was performed in 38 patients to assess its value in the diagnosis of acute appendicitis. Autologous leukocytes are labeled with 99mTc by inducing phagocytosis of 99mTc albumin microcolloid particles. The advantages of this test over the standard indium-111 scan include superior imaging capability, a marked reduction (>75%) in the radiation dose, and performance of the test including labeling, in less than 3 hr. Imaging is performed at 5–90 min postinjection of labeled cells. There were 19 male and 19 female patients with ages ranging from 10 to 80 years, in whom the diagnosis of appendicitis was indeterminate on clinical examination. Of the 13 of the 38 patients (34%) who came to surgery 12 had acute appendicitis. The WBC scan correctly identified 10 of the 12 cases of appendicitis. There were two false-negative studies. In the nonoperative group of 25 patients admitted for observation, 21 studies were reported as negative and four identified other sites of inflammation. All patients with a negative study have remained asymptomatic on follow-up. With a sensitivity of 83% ( 10 12 ) and a specificity of 100% ( 26 26 ) the 99mTc leukocyte scan provides a rapid and highly accurate method for diagnosis of appendicitis in this preliminary study of patients with equivocal clinical exams.

Unusual Presentation of a Large Infected Hemophiliac Pseudotumor in an Autologous lndium-111 WBC Scan

A false-negative In-111 WBC scan was obtained in a case of a large, infected hemophiliac pseudotumor. Following aspiration of the abscess, a positive scan was seen, demonstrating that In-111 WBC imaging occasionally may be misleading as a diagnostic tool.

Abdominal patterns of indium-111 labeled leukocyte imaging.

In-111 oxine WBC abdominal scanning is now a widely accepted technique for the detection of abdominal infectious processes. High sensitivity and specificity are achieved. In-111 labeled leukocyte accumulation, however, does not always suggest the diagnosis of abscess. Higher specificity could be obtained by the knowledge of the In-111 leukocyte distribution pattern in the abdomen in other pathologic states like inflammation of abdominal wounds, stoma; surgical complication without abscess formation; inflammatory or ischemic bowel disease; or swallowing leukocytes which subsequently are visualized in the intestinal lumen. One hundred fifty-two consecutive WBC scans performed over 18 months were reviewed and classified according to their pattern of uptake: 96 cases showed no abdominal uptake, and 56 had accumulation of leukocytes in the abdomen. Twenty-eight of these patients had proven abdominal abscess, and the remaining 26 were positive due to other causes. This report briefly discusses the distribution pattern of In-111 labeled leukocytes in the latter patients and compares the results obtained using different diagnostic criteria.

Indium 111 WBC Scan in Local and Systemic Fungal Infections

We describe two patients-one with a systemic fungal infection and one with a localized form-who had strikingly abnormal indium 111 leukocyte (WBC) scans. The patient with systemic disease had an abnormal WBC scan before lesions became clinically apparent.

Indium 111 WBC scan in local and systemic fungal infections

Indium 111 WBC scan in local and systemic fungal infections

Radiolabelled leucocytes: a new diagnostic tool in occult infection/inflammation.

Autologous white blood cells were labelled with Indium 111 (111In wbc) and reinjected into 18 children with suspected infection and 10 children with suspected inflammatory bowel disease aged 5 weeks to 15 years. In addition two immunosuppressed children with suspected infection received donor 111In wbc. Gamma camera images were obtained between one and four hours and 20 and 24 hours. Other appropriate investigations were also undertaken in these children. Of 18 positive 111In wbc scans 17 were true positive. There were 12 negative scans of which 9 were true negative and three were false negative. The overall results showed a sensitivity of 85%, a specificity of 90%, and an accuracy of 86%. Used appropriately this technique forms a valuable back up investigation.

Gallium Scan v Indium 111-Labeled Oxyquinoline WBC Scan

To the Editor. —We would like to comment on the article entitled The Gallium Scan: Problems and Misuse in Examination of Patients With Suspected Infection by Ebright et al published in the FebruaryArchives(1982;142:246-254). About the time they began their study, we stopped doing gallium citrate Ga 67 scans for precisely the reasons outlined in their article, namely, difficulty in interpretation and low specificity. Factors that contribute to the problem of specificity of67Ga include excretion of a substantial proportion of radioactivity through the colon and uptake in neoplasms and in healing wounds. Because of these problems, we have relied almost entirely on111In—labeled oxyquinoline WBC scans for detection of occult abscesses. This technique is not as simple to use as67Ga, since it requires separation of a polymorphonuclear-enriched fraction of the patient's blood (40 mL of venous blood is sufficient), labeling the cells with111

Gallium scan v indium 111-labeled oxyquinoline WBC scan

<h3>To the Editor.</h3> —We would like to comment on the article entitled "The Gallium Scan: Problems and Misuse in Examination of Patients With Suspected Infection" by Ebright et al published in the FebruaryArchives(1982;142:246-254). About the time they began their study, we stopped doing gallium citrate Ga 67 scans for precisely the reasons outlined in their article, namely, difficulty in interpretation and low specificity. Factors that contribute to the problem of specificity of⁶⁷Ga include excretion of a substantial proportion of radioactivity through the colon and uptake in neoplasms and in healing wounds. Because of these problems, we have relied almost entirely on¹¹¹In—labeled oxyquinoline WBC scans for detection of occult abscesses. This technique is not as simple to use as⁶⁷Ga, since it requires separation of a polymorphonuclear-enriched fraction of the patient's blood (40 mL of venous blood is sufficient), labeling the cells with¹¹¹

To the Editor.—-Reply

—Dr Silberstein points out that the low specificity of 67 Ga scans that we recently reported was caused, in large part, by nonspecific accumulation of 67 Ga in the GI tract. He further states that the specificity would have been improved had we obtained follow-up scans to see the radionuclide cleared from the intestine. Although we agree that specificity may have been improved had we obtained 72- and, possibly, 96-hour images, we hasten to make the following points: (1) other major medical centers are experiencing results similar to ours with 67 Ga (see the accompanying letter from Drs McDougall and Goodwin), and (2) the possibility of increasing specificity of 67 Ga scanning by obtaining 72- and 96-hour images is accompanied by a frequently unacceptable delay in providing meaningful results to the clinician. We, therefore, share Silberstein's as well as McDougall and Goodwin's interest in 111 In—labeled oxyquinoline WBC scans in

On a Possible Source of Error in the Diagnosis of Fungus in the Ear

<b>649</b> <h3><b>Objectives:</b></h3> Labeled white blood cell scintigraphy is used in various clinical conditions. When there is suspicion of an infectious process, especially for bacterial agents, it has high specificity. It can be used in several conditions such as fever of obscure or undetermined origin, osteomyelitis screening and, in cardiology, when there is suspicion of infective endocarditis (IE) associated with the prosthesis. In 2015 it was included in the assessment of suspected IE patient in the Guideline of the European Society of Cardiology (ESC) in 2015. Labeled white blood cell scintigraphy SPECT-CT (WBCS) has demonstrated to be able to reduce the rate of misdiagnosed cases of IE. Few studies are published in a real-world scenario because the technique is not broadly available. The goal of this study is to describe the use of WBCS in a series of consecutive patients in a reference cardiovascular hospital to evaluate the clinical impact in the diagnostic workup of suspected endocarditis. <h3><b>Methods:</b></h3> WBCS was performed at the nuclear medicine service of our institution from January 2015 to August 2017. The clinical indication, type of radiotracer employed, demographic aspects and scintigraphic findings were analyzed. Exams were performed using the in vivo labeling technique with antigranulocyte Besilesomab antibody or with the in vitro labeling of autologous leukocytes with ^99mTc-HMPAO. The scintigraphic images were performed on SPECT-CT equipment (Symbia T2). Experienced nuclear medicine physicians performed the interpretation of the scans. <h3><b>Results:</b></h3> A total of 138 WBCS were performed in this period, and the majority (108 patients) used the in vitro labeling of autologous leukocytes with HMPAO. Suspected infective endocarditis was responsible for 19% of the clinical indications. The mean age of the patients who underwent endocarditis WBCS was 70 years compared to patients with other indications that had a mean age of 66 years (p = 0.3). There was a predominance of males among patients with suspected endocarditis in relation to other indications (85% x 57%, p = 0.0001). Of the 26 exams requested for endocarditis, 13 (50%) were positive: 5 in prosthetic heart valves, 4 aortic endoprostheses, 2 in mechanical circulatory assist devices. In 2 other cases the examination showed the presence of a non-cardiovascular infectious focus: 1 pulmonary infection and another in the knee joint. Three patients with suspected infection of transcatheter aortic valve implant (TAVI) had negative labeled WBC scans that discarded the TAVI as the focus of infection. <h3><b>Conclusions:</b></h3> The use of WBCS has proved to be useful in the identification of IE in real-world complex cases such as valvular prostheses and vascular endoprostheses. WBCS use should be incorporated in the diagnostic workup of patients with suspected IE when conventional techniques do not yield conclusive results as is recommended by ESC Guideline.