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Erythrocyte radiolabelling: in vitro comparison of chromium, technetium, and indium in undamaged and heat damaged cells.

The stability of the commonly used red cell radio labels chromium-51, indium-(111 or 113m), and technetium-99m, within intact red cells and stroma and their distribution within the cell were compared in undamaged and heat damaged red cells in relation to the clinical use of heat damaged cells in the assessment of splenic function. Chromium-51 labelled haemoglobin both in undamaged and heat damaged cells; indium predominantly labelled haemoglobin in undamaged cells but labelled stroma in heat damaged cells, even when the cells were labelled before heating; technetium-99m predominantly labelled haemoglobin in undamaged cells but only labelled stroma in heat damaged cells if these were heated before labelling. Indium was more firmly bound by stroma prepared from heat damaged cells, and technetium-99m showed a high rate of elution both from cells and stroma, although this rate was lower for heat damaged cells.

Chromium Radioisotopes↗

Blood loss measured with indium-111-labeled red blood cells in dogs.

The authors describe a safe, simple, sensitive, and accurate technique of measuring moderate amounts of blood loss using erythrocytes labeled with indium-111. Donor red cells were labeled with indium-111 and tracer amounts infused into dogs. The magnitude of red cell loss was determined by the difference between two sequential volume measurements. The coefficient of variation of sequential measurements of the same red cell volume was 4.6 +/- 1%. The sensitivity of the technique, as determined by comparison of measured and estimated volumes, was 20.5 ml. The measured volume was related linearly to the calculated volume of red cells lost (r = 0.98). The authors recommend indium-111-labeled erythrocytes as a means of obtaining multiple measurements of small to moderate amounts of hemorrhage.

Animals↗

Indium-111-labeled leukocyte localization in hematomas: a pitfall in abscess detection.

Indium-111-labeled white-blood-cell scanning is a useful modality in abscess detection and has replaced gallium scanning in many institutions. Sensitivities of 72% to 90% and specificities of 90% to 100% have been reported. In searching for abscesses seven cases of indium-111-labeled leukocyte uptake were encountered in collections subsequently proved to be noninfected hematomas. Abundant red blood cells with few or no white blood cells, no bacteria, and a benign clinical course identified these noninfected hematomas. Five of the patients were being treated with hemodialysis and three were recent allograft recipients. The results indicate some limitation and nonspecificity in indium-111 scanning, despite its many benefits.

Abscess↗

Value of indium-111 granulocyte scintigraphy in the assessment of Crohn's disease of the small intestine: prospective investigation.

The present study was undertaken to determine the value of indium-111 granulocyte scintigraphy in Crohn's disease of the small bowel by comparing the results with those of radiology, endoscopy and surgery. Twenty-one patients with Crohn's disease of the small bowel, 9 patients with Crohn's disease of the colon, 1 patient with both localizations and 8 with ulcerative colitis were studied by indium-111 granulocyte scanning. Eighteen patients had evidence of active small intestinal disease based on clinical, radiologic, and/or endoscopic, and/or histopathological features. Thirteen of them had a true positive scan (sensitivity 72%), but accurate assessment of localization and extent of disease was often difficult. Five patients had a false negative scan and 4 a true negative. No false positive scans were found. The diagnostic accuracy was 77%. In contrast, from 18 patients with colonic disease, 16 had a true positive scan corresponding in localization and extent with standard investigations, 1 patient had a false negative scan (sensitivity 94%), and 1 a true negative (diagnostic accuracy 95%). This study also showed that 3-5 h scanning after injection of indium-111-labeled granulocytes is the optimal timing for this test. The patient's acceptability of this procedure was definitely superior to radiology and endoscopy. In conclusion, this technique has a definite place in evaluating localization and extent of active colonic disease, but it does not replace good small bowel radiology and should not be recommended in the routine diagnostic workup of Crohn's disease of the small intestine.

Adolescent↗

Failure of ticlopidine to inhibit deposition of indium-111-labeled platelets on Dacron prosthetic surfaces in humans.

In a randomized double-blind trial we sought to determine whether short-term therapy with ticlopidine (250 mg bid for 14 days) inhibited platelet deposition on Dacron aortic bifurcation grafts that had been in place a year or longer. A total of 10 men, 42 to 69 years old, underwent indium-111 platelet imaging during both placebo and drug phases of the trial at 24, 48, and 72 hr after the injection of labeled platelets. Platelet accumulation was quantitated by a graft/blood ratio that compared background-corrected activity of indium-111-labeled platelets in the graft with whole-blood activity of indium-111-labeled platelets. Additionally, blinded qualitative visual analysis of the unprocessed images was used to compare graft area activity with activity in adjacent native arteries. Ticlopidine significantly prolonged the template bleeding time from 5.3 +/- 0.5 to 17.1 +/- 3.1 min (+/- SEM) (p = .003). However, by quantitative analysis there was no significant reduction in platelet deposition in the graft during ticlopidine therapy compared with placebo at 24 hr (graft/blood ratio 2.3 +/- 0.4 vs 2.6 +/- 0.3), 48 hr (3.1 +/- 0.5 vs 3.2 +/- 0.4), or 72 hr (3.9 +/- 0.7 vs 4.0 +/- 0.6) after injection of labeled platelets. By visual analysis, nine patients had positive results for abnormal platelet deposition when on placebo that were unchanged when on ticlopidine. The tenth patient had an equivocal result for abnormal platelet deposition when on placebo and a negative result for abnormal platelet deposition when on ticlopidine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Noninvasive detection of rejection of transplanted hearts with indium-111-labeled lymphocytes.

To determine whether cardiac transplant rejection can be detected noninvasively with indium-111 (111In)-labeled lymphocytes, we studied 11 dogs with thoracic heterotopic cardiac transplants without immunosuppression and five dogs with transplants treated with cyclosporine (10 mg/kg/day) and prednisone (1 mg/kg/day). All were evaluated sequentially with gamma scintigraphy after administration of 150 to 350 muCi of autologous 111In-lymphocytes. Technetium-99m-labeled red blood cells (1 to 3 mCi) were used for correction of radioactivity in the blood pool attributable to circulating labeled lymphocytes. Lymphocyte infiltration was quantified as the ratio of indium in the myocardium of the transplant or native heart compared with that in blood (indium excess, IE). Results were correlated with mechanical and electrical activity of allografts and with histologic findings in sequential biopsy specimens. In untreated dogs (n = 11), IE was 15.5 +/- 7.0 (SD) in transplanted hearts undergoing rejection and 0.4 +/- 1.1 in native hearts on the day before animals were killed (p less than .01). In dogs treated with cyclosporine and prednisone (n = 5), IE was minimal in allografts during the course of immunosuppression (0.8 +/- 0.4) and increased to 22.9 +/- 11.1 after immunosuppression was stopped. Scintigraphic criteria of rejection (IE greater than 2 SD above that in native hearts) correlated with results of biopsies indicative of rejection and appeared before electrophysiologic or mechanical manifestations of dysfunction. Thus infiltration of labeled lymphocytes in allografts, indicative of rejection, is detectable noninvasively by gamma scintigraphy and provides a sensitive approach potentially applicable to clinical monitoring for early detection of rejection and guidance for titration of immunosuppressive measures.

Animals↗

Thrombophlebitis diagnosed on indium-111 labelled white cell scan.

A 64-year-old lady with type 2 diabetes and a non-resolving right foot ulcer, had an indium-111 labelled white cell scan (indium-111 WCS) to investigate the possibility of underlying osteitis. The scan suggested the possibility of infective thrombophlebitis. Unknown to the clinical team who requested the scan and the radiologist who performed it, the lady was admitted to hospital 2 days following the procedure with cellulitis and septic thrombophlebitis in the right leg. There is only one previous report in the literature of septic thrombophlebitis being diagnosed in this way. Perhaps indium-111 WCS has something to offer in the diagnosis of this condition and in determining those who require antibiotic treatment.

Female↗

Occult purulent pericarditis detected by indium-111 leukocyte imaging.

Leukocyte imaging with indium-111 is a relatively new technique which, to this point in time, has been discussed almost exclusively in the radiologic literature. Although this procedure has been used mainly to detect intra-abdominal infection, the thorax is routinely imaged along with the abdomen, and therefore detection of cardiac disease may be feasible. This case report is of a young woman after liver transplantation who developed occult purulent pericarditis initially detected by a leukocyte scan with indium-111. This case demonstrates that striking pericardial uptake on a whole-body indium-111 leukocyte scan can occur with purulent pericarditis, and it reemphasizes how insidiously purulent pericarditis may present in an immunosuppressed patient.

Adult↗

Effective treatment of bone metastases from a neuroendocrine tumour of the pancreas with high activities of Indium-111-pentetreotide.

OBJECTIVE: To evaluate therapy with high doses of (111)Indium pentetreotide in a patient with bone metastases from a carcinoid of the pancreas. CASE REPORT: A 55-Year-old male presented in November 1990 with stomach ache with dorsal irradiation. Ultrasonography and computed tomography (CT-) scans of the abdomen revealed a tumour of the tail of the pancreas and liver metastases. Histological examination revealed a neuroendocrine tumour. Surgery and polychemotherapy were initiated and after seven cycles a tumour regression of 30% was achieved. During follow-up multiple metastases were seen upon bone scintigraphy for which treatment with high doses Indium-111-octreotide was initiated. MATERIALS AND METHODS: The patient underwent eight cycles, with one cycle every 5 weeks. Each treatment consisted of an i.v. injection of 6 GBq Indium-111-pentetreotide. Comparing the results of the first and the last post-treatment scintigraphy, a regression of the number and intensity of uptake in the lesions was found. Bone scintigraphy showed a regression of the skeletal lesions as well, while X-ray, CT-scan and chromogranin-A levels showed stable disease. CONCLUSION: Results from the treatment of our patient indicate that the use of high dose radiolabelled somatostatin analogues could be of significant use, even in the case of bone metastases. To our knowledge, this is the first report describing therapeutic effects on bone metastases from a neuroendocrine tumour.

Bone Neoplasms↗

Preliminary studies on the indium slide immunoassay for estimation of human chorionic gonadotropin and antihuman chorionic gonadotropin antibody.

Human chorionic gonadotropin (hCG) is synthesized and secreted as early as 170 hr after fertilization and has been used as an index for pregnancy. Neutralization of hCG with a beta-subunit hCG vaccine(s) has been proposed as a contraceptive technique. To monitor the duration of effectiveness of the vaccine, it will be necessary to monitor the anti-hCG antibodies, especially those responsible for inhibiting the hCG bioactivity. We report a simple, rapid technique using an indium slide immunoassay for the qualitative estimation of hCG and to monitor a bioeffective anti-hCG antibody. The sensitivity of the indium slide assay to measure hCG ranged from 1 microgram/ml to 1 ng/ml, depending on the format of the assay. The indium slide assay also detected anti-hCG antibodies generated against a specific determinant on hCG recognized by a neutralizing monoclonal antibody (P3W80) in women immunized with a contraceptive vaccine.

Antibodies↗

Indium-111 octreotide uptake in the surgical scar.

Indium-111 octreotide uptake has been reported in various somatostatin receptor positive tumors, granulomas and autoimmune diseases in which activated leucocytes may play a role, subcutaneous cavernous hemangioma and angiofibroma. We present Indium-111 octreotide uptake in a surgical abdominal scar tissue 1.5 and 6 months after surgery in a patient who had been treated for recurrent carcinoid tumor in the rectosigmoid junction. Indium-111 octreotide uptake in a surgical scar may be related to the binding to somatostatin receptors in the activated lymphocytes and fibroblasts that is previously reported.

Carcinoid Tumor↗

Indium-113m perfusion study and the nonfunctioning thyroid nodule.

Indium-113m eluate has been used to study the perfusion of 12 patients with solitary thyroid nodules that appeared "cold" in the 131I and 99mTc image studies. Seven patients with colloid nodules showed no perfusion and the remaining five (three adenomas and two carcinomas) showed good perfusion with indium. Histologic confirmation was obtained in all cases. Indium-113m perfusion study may be useful in differentiating colloid nodules from either adenomas or carcinomas.

Adenoma↗

Indium light source for curing composite resins.

There is an existing problem of cumulative hazardous effect of violet and near ultra-violet light which is produced by standard polymerisation units. Another restrict is shallow depth of cure, particularly of darker composite shades in premolar and molar region. Searching for better light source we used indium resonance lines from several indium high pressure lamps and tested curing effect on three different composite resins. The overall results are better with the lamp in which two strong resonance lines of indium are present, rather than with a lamp with just one strong resonance line. The improvements in lamp design are necessary to overcome conventional polymerisation lamps.

Composite Resins↗

Value of indium-111-labeled leukocytes scintigraphy in patients after arterial reconstructive surgery.

The study was performed to evaluate the diagnostic value of Indium-111-leukocytes scintigraphy in arterial prosthetic infection. Scintigrams were performed in 19 patients in two groups. Group A consisted of 11 patients, where ten days after uncomplicated graft implantation, an Indium-111-scintigraphy was performed. Group B consisted of 8 patients, where we suspected an infected arterial graft. In group A we had one false-positive scan and in group B one false-negative scan. This gives an accuracy of 89%, a sensitivity of 87% and a specificity of 90%. These results indicate that Indium-111-leukocytes scintigraphy is a favourable test to detect a vascular graft infection.

Aorta↗

Detection of musculoskeletal infection with the indium-III leukocyte scan.

Indium-111-labeled leukocyte scans were performed on 39 patients with suspected musculoskeletal infections to assess the usefulness of this study in detecting bone and joint infections. Results of these scans, as well as results of technetium-99m bone scans, were correlated with the patients' final diagnoses. The indium scan had an overall sensitivity of 77%, a specificity of 69%, and an accuracy of 72%. In 10 patients with a duration of symptoms of six weeks or less, the sensitivity was 100% and the specificity was 75%. In 29 patients with symptoms of greater than six weeks, the sensitivity and specificity were lower at 50% and 71% respectively. Technetium-99m bone scans were performed on 23 patients; sensitivity for infection was 100% while specificity was 60%. Our results suggest that the indium-111 leukocyte scan is a useful adjunct in the diagnosis of acute musculoskeletal infections, but may be inconclusive in chronic infections.

Adolescent↗

Clinical imaging with indium 111 oxine-labeled leukocyte scan: review and case report.

The clinical use and mechanisms of action of technetium 99m pyrophosphate, gallium 67 citrate, and indium 111 oxine have been presented. The diagnosis of osteomyelitis in the lower extremity can often be made on the basis of clinical, laboratory, and conventional radiographic evaluations. In the case report of diabetic osteolysis, initial evaluations revealed osteomyelitis. The use of scanning involving leukocytes labeled with technetium and indium 111 oxine lessened the possibilities of an osseous infection. Studies show the sensitivity, specificity, and accuracy of scans using leukocytes labeled with indium 111 oxine to be superior to those of any other form of nucleotide imaging, but further clinical research is needed.

Adult↗

Potential use of indium-111-labeled polymorphonuclear leukocytes for the detection of lung microvascular injury.

The early stages of microvascular injury are often difficult to detect due to the lack of a suitable marker to assess such an injury. We utilized the well known phenomenon of polymorphonuclear leukocyte (PMN) migration to the microvascular bed as a result of acute inflammatory reactions originating from the damaged cells. A radiotracer technique was developed, employing indium-111-labeled PMN for the detection of microvascular injury induced by hyperoxia. New Zealand white rabbits exposed to either 100% oxygen or air for various intervals of time were injected with indium-111-tropolone or oxine-labeled PMNs. Influx of radioactive PMN into the lung was detected in 72 hr/oxygen-exposed animals using gamma scintigraphic technique. Analysis of dry/wet ratios and histological examinations of the lung biopsies indicated noncardiogenic edema formation at this stage. Mortality was 50% beyond 96 hr/oxygen exposure. Our study thus provided a means to detect early microvascular injury during 72 hr/oxygen-exposure, which was not detectable by any other noninvasive techniques. The use of indium-111-labeled PMN thus appears to be a potentially important tool for the clinical assessment of lung microvascular injury.

Animals↗

False positive indium-111 white blood cell scan in a closed clavicle fracture.

Aggressive treatment of the multiply injured patient often requires early fixation of many fractures, some of which may be open. Often, patients develop postoperative fevers requiring a thorough workup to rule out infection. Recently, indium-111 white blood cell (WBC) imaging has become a valuable adjunct in the diagnosis of acute infection. The patient described had a simple, closed clavicle fracture with markedly increased activity on an indium-111 WBC scan obtained for fever workup. This subsequently proved to be a normal, healing, noninfected fracture by other diagnostic techniques. Noninfected, simple closed fractures should be added to the list of causes for a false-positive indium-111 WBC scan.

Adult↗