Harmon H. Davis

Indium‐III: a New Radionuclide Label for Studying Human Platelet Kinetics

Summary. Indium‐III, when complexed with 8‐hydroxyquinoline (oxine), has been employed as a radioactive platelet label for thrombus imaging in animals and man. The short half‐life (2.8 d) and high yield of gamma photons of 111In make it ideal for in vitro counting and external imaging. To evaluate its suitability for studies of platelet turnover in man, platelet kinetic studies were carried out on 10 healthy volunteers using 111In‐and 51Cr‐platelets concurrently. For 111In labelling, platelets were harvested by differential centrifugation from 43 ml of whole blood drawn into acid‐citrate dextrose (ACD) solution. The platelets were washed and suspended in a mixture of ACD and isotonic saline and then incubated with 111In‐oxine, rewashed, and suspended in plasma for reinfusion. 51Cr labelling was performed using standard methods. Mean labelling efficiency was 73% with 111In and 6.5% with 51Cr. In vitro studies demonstrated minimal release, elution, and reutilization of the 111In label. There was no significant difference in the aggregation response of 111In‐ and 51Cr‐platelets to ADP and collagen. The in vivo recovery of 111In‐platelets was approximately 50% greater than that of 51Cr‐platelets whereas the platelet life spans were similar. These results indicate that 111In labelled platelets may be useful for thrombokinetic studies in man. The new method offers the advantages of reduced blood requirements, higher labelling efficiency, and the ability to perform external imaging of platelet distribution in vivo.

Indium-111 platelet scintigraphy in cerebrovascular disease.

We obtained scintigraphic images of the neck from 100 patients with suspected cerebrovascular disease after injecting indium-111-labeled autologous platelets. One or more focuses of increased activity, implying local platelet accumulation, were seen along the course of the cervical carotid arteries in 52 patients. In 64 patients, there was a highly significant correlation between the results of scintigraphy and carotid arteriography (p = 10 6). There was no significant correlation between the scintigraphic findings and the previous or subsequent occurrence of transient ischemic attack or cerebral infarction in the carotid circulation. These data suggest that factors other than the simple formation of platelet thrombi in the cervical carotid arteries are of primary importance in the pathogenesis of stroke.

Posterior packs and the nasopulmonary reflex.

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow, and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies.

111Indium-labeled human alveolar macrophages and monocytes: Function and ultrastructure

Human alveolar macrophages and peripheral blood mononuclear cells were labelled with indium-111 (111In)-oxine in ethanol. The efficiency of labeling averaged 84% for macrophages and 74% for mononuclear cell preparations. Phagocytosis by macrophages, the release of colony stimulating factor activity (CSF) by macrophages, and chemotaxis by monocytes in response to human C5-derived chemotactic factor (C5fr) and formyl-methionyl-leucyl-phenylalanine (f-MLP), were indistinguishable between labeled and unlabeled cells. Microscopically, labeled cells looked similar to control cells. Radioautography demonstrated 111In throughout the labeled cells, but there was a disproportionately high quantity over nuclei. These findings add to the growing literature indicating that 111In labels cells efficiently and that cells can retain function after being labeled with 111In.

Ventilation imaging with Kr-81m

Sixty-five patients with suspected pulmonary embolism were studied prospectively with both Kr-81 m and Xe-133 ventilation imaging and Tc-99m MAA perfusion imaging. The krypton images, perfusion scintigrams and chest radiographs were read independently of the xenon images, perfusion scintigrams and chest radiographs by three observers. The studies of 53 patients were interpreted as normal or as indicative of a low or intermediate probability for pulmonary embolism with both gases. One study indicated intermediate probability with Xe-133 due to diffuse, severe xenon retention but low probability with Kr-81 m because of close ventilation-perfusion correspondence. The studies of 9 patients indicated a high probability of embolism with both gases, while those of two additional patients (one with emboli at angiography) indicated a high probability only with Kr-81m. While essential agreement between Xe-133 and Kr-81m ventilation imaging was found in most patients, the significant difference in interpretation in 2 of 11 patients with probable pulmonary embolism suggests that a controlled, prospective trial with pulmonary angiography is warranted before Kr-81m is employed for routine clinical use.