Keiko Imazeki

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-111 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.

Technetium-99m HMPAO labeled leukocytes in inflammation imaging

Technetium-99m-HMPAO (Tc-99m-HMPAO) labeled leukocyte imaging was carried out in 19 patients at 3–5 hr after reinjection. There were no side effects noted. Tc-99m leukocyte images showed gall bladder, colon, kidney, and urinary bladder activity in normal distribution as a result of excretion of the eluted Tc-99m complex. They yielded a sensitivity of 93%, a specificity of 100% and an accuracy of 95%. They were correctly positive in 14 out of 19 cases. But one false negative case was seen in a patient with pyonephrosis showing a lack of renal function with decreased renal blood flow. It was concluded that they have some advantages over In-111 leukocyte images, but we have to consider the fact that the ureteral obstruction or the lack of renal function with decreased renal blood flow may result in a false positive or a false negative case.

Fundamental study of 99mTc nanocolloids as an inflammatory imaging.

The biodistribution of nanometer-sized colloidal particles (nanocolloids, Solco-Basle Ltd.) was examined in six rabbits with turpentine-induced abscesses in the musculature of their hind legs. 99mTc labelled colloids with a mean particle size less than 100 nm were administered to each rabbit intravenously. The biodistribution of the tracer was studied with a gamma camera 1, 3, and 24 hours after injection. Prominent uptakes were demonstrated in the liver, spleen, bone marrow, kidneys, and urinary bladder. On the other hand, the abscess and surrounding inflammatory edema were depicted as unclearly margined faint hot spots. Subsequently, the rabbits were sacrificed and activity per gram tissues were counted with a well-type gamma counter. Although the results were almost in agreement with a gamma camera study, it was noticed the activity counts in the abscess were significantly higher than that of control muscles.