Indium 111–Labeled Leukocyte Scintigraphy in Evaluating Head and Neck Infections

Abstract

This retrospective study looked at the role of indium 111-labeled white blood cell (111In WBC) scintigraphy in head and neck infections. The efficacy of 111In WBCs was compared to gallium 67 citrate (67Ga) and technetium Tc99m methylene diphosphonate (99mTc MDP) scintigraphy in detecting and monitoring the resolution of infection. For 22 active infections, the sensitivities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 94%, 56%, and 86%, respectively, and the specificities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 100%, 43%, and 0%, respectively. For 8 successfully treated infections, all seven 111In WBC studies became negative after therapy, in as short an interval as 1 month. In contrast, all seven 99mTc MDP images remained positive for as long as 6 months after therapy. The seven 67Ga studies had variable results, with four (57%) remaining positive, including two (28%) positive at 6 months after therapy. These results suggest that 111In WBC scintigraphy should be the initial radionuclide imaging tool in detecting active head and neck infections because of its greater accuracy, and its ability to revert to normal much sooner than 67Ga or 99mTc MDP scintigraphs when applied to a subset of patients with resolved infections.

Evaluation of temporal and facial osteomyelitis by simultaneous In‐WBC/Tc‐99m‐MDP bone SPECT scintigraphy and computed tomography scan

“…The Ga‐67 scan has been used to evaluate the resolution of established osteomyelitis. Ga‐67 scans, however, often take up to 6 months to return to normal after successful treatment of osteomyelitis 24 . Ga‐67 scans were not obtained in our patients, so comparisons could not be made.…”

“…Epstein et al 24 recently reported planar In‐WBC scintigraphy as a useful technique for diagnosis and monitoring of osteomyelitis. However, false‐negative and false‐positive In‐WBC scans have been reported in low‐grade or chronic infections, at sites with extensive bone marrow (such as the vertebral column), or in immunosuppressed patients, inpatients after long‐term intravenous antibiotic therapy, and inpatients with diabetic microangiopathy 22‐29 . By combining SPECT Tc‐99m‐MDP bone with In‐WBC SPECT scintigraphy, many of the problems inherent with planar In‐WBC scintigraphy can be avoided.…”

“…21 ' 22' 24 Indium-ill-labeled leukocyte (In-WBC) planar scintigraphy has been reported to give better results for the detection of osteomyelitis than either planar or tomographic Ga-67 and/or Tc-99m-MDP scintigraphy. 24 Recently, advances in instrumentation have allowed simultaneous acquisition of single photon emission tomographs (SPECT) using two radiotracers. This technology provides two complementary functional images with exact coregistration.…”

“…Gallium‐67 citrate (Ga‐67) scintigraphy has been used to follow the resolution of osteomyelitic disease and to assess when antibiotic therapy can be discontinued 3,12,17 . However, it takes 4 to 6 months after successful treatment for a Ga‐67 scan to return to normal 21,22,24 …”

SPECT Gallium Scintigraphy in Malignant External Otitis: Initial Staging and Follow‐up. Case Reports

“…Our experience with SPECT in this population is limited due to the low incidence of this disease, but these preliminary results demonstrate the possibility of detection of deep‐seated bone involvement. The low sensitivity of Ga 67 scintigraphy as described by Epstein et al 12 can be explained in that SPECT was not used in all patients. The initial interpretation in this study was done on planar images.…”