Indium-111 WBC scan

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Indium-111 WBC scan
Synonyms Indium leukocyte imaging, Indium-111 scan, Indium scan
ICD-10-PCS C?1?DZZ (planar)
C?2?DZZ (tomographic)
ICD-9-CM 92.18
OPS-301 code 3-70c
LOINC 25032-4, 41772-5, 41836-8, 42711-2

The indium white blood cell scan is a nuclear medicine procedure in which white blood cells (mostly neutrophils) are removed from the patient, tagged with the radioisotope Indium-111, and then injected intravenously into the patient. The tagged leukocytes subsequently localize to areas of relatively new infection. The study is particularly helpful in differentiating conditions such as osteomyelitis from decubitus ulcers for assessment of route and duration of antibiotic therapy. [1] [2]

In imaging of infections, the gallium scan has a sensitivity advantage over the indium white blood cell scan in imaging osteomyelitis (bone infection [3] ) of the spine, lung infections and inflammation, and in detecting chronic infections. In part, this is because gallium binds to neutrophil membranes, even after neutrophil death, whereas localization of neutrophils labeled with indium requires them to be in relatively good functional order. However, indium leukocyte imaging is better at localizing acute (i.e., new) infections, where live neutrophils are still rapidly and actively localizing to the infection, for imaging for osteomyelitis that does not involve the spine, and for locating abdominal and pelvic infections.

Both the gallium scan and indium-111 white blood cell imaging may be used to image fever of unknown origin (elevated temperature without an explanation). However, the indium leukocyte scan will localize only to the approximately 25% of such cases which are caused by acute infections, while gallium is more broadly sensitive, localizing to other sources of fever, such as chronic infections and tumors. Gallium may be a better choice for spleen study because gallium does not normally accumulate in the spleen.

See also

Related Research Articles

Agranulocytosis, also known as agranulosis or granulopenia, is an acute condition involving a severe and dangerous lowered white blood cell count and thus causing a neutropenia in the circulating blood. It is a severe lack of one major class of infection-fighting white blood cells. People with this condition are at very high risk of serious infections due to their suppressed immune system.

Neutrophilia Medical condition

Neutrophilia is leukocytosis of neutrophils, that is, a high number of neutrophils in the blood. Because neutrophils are the main type of granulocytes, mentions of granulocytosis often overlap in meaning with neutrophilia.

Nuclear medicine Medical specialty

Nuclear medicine is a medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. Nuclear medicine imaging, in a sense, is "radiology done inside out" or "endoradiology" because it records radiation emitting from within the body rather than radiation that is generated by external sources like X-rays. In addition, nuclear medicine scans differ from radiology, as the emphasis is not on imaging anatomy, but on the function. For such reason, it is called a physiological imaging modality. Single photon emission computed tomography (SPECT) and positron emission tomography (PET) scans are the two most common imaging modalities in nuclear medicine.

Septic arthritis Medical condition

Acute septic arthritis, infectious arthritis, suppurative arthritis, osteomyelitis, or joint infection is the invasion of a joint by an infectious agent resulting in joint inflammation. Generally speaking, symptoms typically include redness, heat and pain in a single joint associated with a decreased ability to move the joint. Onset is usually rapid. Other symptoms may include fever, weakness and headache. Occasionally, more than one joint may be involved especially in neonates and younger children. In neonates, infants i.e. during the first year of life and toddlers, the signs and symptoms of septic arthritis can be deceptive and mimic other infectious and non-infectious disorders.

Granulocyte Category of white blood cells

Granulocytes are cells in the innate immune system characterized by the presence of specific granules in their cytoplasm. They are also called polymorphonuclear leukocytes because of the varying shape of the nucleus, which is usually lobed into three segments. This distinguishes them from the mononuclear agranulocytes. The term polymorphonuclear leukocyte often refers specifically to "neutrophil granulocytes", the most abundant of the granulocytes; the other types have fewer lobes. Granulocytes are produced via granulopoiesis in the bone marrow.

Osteomyelitis Medical condition

Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the feet, spine, and hips are most commonly involved in adults.

Leukocytosis is a condition in which the white cell is above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, but may also occur following certain parasitic infections or bone tumors as well as leukemia. It may also occur after strenuous exercise, convulsions such as epilepsy, emotional stress, pregnancy and labor, anesthesia, as a side effect of medication, and epinephrine administration. There are five principal types of leukocytosis:

  1. Neutrophilia
  2. Lymphocytosis
  3. Monocytosis
  4. Eosinophilia
  5. Basophilia

Leukopenia is a decrease in the number of leukocytes (WBC). Found in the blood, they are the white blood cells, and are the body's primary defense against an infection. Thus the condition of leukopenia places individuals at increased risk of infection.
Symptoms may include:

The term leukemoid reaction describes an increased white blood cell count, which is a physiological response to stress or infection. It often describes the presence of immature cells such as myeloblasts or red blood cells with nuclei in the peripheral blood.

Leukocyte-promoting factor, more commonly known as leukopoietin, is a category of substances produced by neutrophils when they encounter a foreign antigen. Leukopoietin stimulates the bone marrow to increase the rate of leukopoiesis in order to replace the neutrophils that will inevitably be lost when they begin to phagocytose the foreign antigens.

Felty's syndrome (FS), also called Felty syndrome, is rare autoimmune disease characterized by the triad of rheumatoid arthritis, enlargement of the spleen and low neutrophil count. The condition is more common in those aged 50–70 years, specifically more prevalent in females than males, and more so in Caucasians than those of African descent. It is a deforming disease that causes many complications for the individual.

A gallium scan is a type of nuclear medicine test that uses either a gallium-67 (67Ga) or gallium-68 (68Ga) radiopharmaceutical to obtain images of a specific type of tissue, or disease state of tissue. Gallium salts like gallium citrate and gallium nitrate may be used. The form of salt is not important, since it is the freely dissolved gallium ion Ga3+ which is active. Both 67Ga and 68Ga salts have similar uptake mechanisms. Gallium can also be used in other forms, for example 68Ga-PSMA is used for cancer imaging. The gamma emission of gallium-67 is imaged by a gamma camera, while the positron emission of gallium-68 is imaged by positron emission tomography (PET).

Technetium (99mTc) fanolesomab is a mouse monoclonal antibody formerly used to aid in the diagnosis of appendicitis. It is labeled with a radioisotope, technetium-99m (99mTc).

Basophilia Medical condition

Basophilia is the condition of having greater than 200 basophils/μL in the venous blood.

Indium-111 (111In) is a radioactive isotope of indium (In). It decays by electron capture to stable cadmium-111 with a half-life of 2.8 days. Indium-111 chloride (111InCl) solution is produced by proton irradiation of a cadmium target in a cyclotron, as recommended by International Atomic Energy Agency (IAEA). The former method is more commonly used as it results in a high level of radionuclide purity.

White blood cell Type of cells of the immunological system

White blood cells, also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are found throughout the body, including the blood and lymphatic system.

Vertebral osteomyelitis is a type of osteomyelitis that affects the vertebrae. It is a rare bone infection concentrated in the vertebral column. Cases of vertebral osteomyelitis are so rare that they constitute only 2%-4% of all bone infections. The infection can be classified as acute or chronic depending on the severity of the onset of the case, where acute patients often experience better outcomes than those living with the chronic symptoms that are characteristic of the disease. Although vertebral osteomyelitis is found in patients across a wide range of ages, the infection is commonly reported in young children and older adults. Vertebral osteomyelitis often attacks two vertebrae and the corresponding intervertebral disk, causing narrowing of the disc space between the vertebrae. The prognosis for the disease is dependent on where the infection is concentrated in the spine, the time between initial onset and treatment, and what approach is used to treat the disease.

Osteomyelitis of the jaws is osteomyelitis which occurs in the bones of the jaws. Historically, osteomyelitis of the jaws was a common complication of odontogenic infection. Before the antibiotic era, it was frequently a fatal condition.

White blood cell differential Blood test

A white blood cell differential is a medical laboratory test that provides information about the types and amounts of white blood cells in a person's blood. The test, which is usually ordered as part of a complete blood count (CBC), measures the amounts of the five normal white blood cell types – neutrophils, lymphocytes, monocytes, eosinophils and basophils – as well as abnormal cell types if they are present. These results are reported as percentages and absolute values, and compared against reference ranges to determine whether the values are normal, low, or high. Changes in the amounts of white blood cells can aid in the diagnosis of many health conditions, including viral, bacterial, and parasitic infections and blood disorders such as leukemia.

A granulocyte transfusion is a medical procedure in which granulocytes are infused into a person's blood. Granulocyte transfusions were historically used to prevent and treat infections in people with neutropenia, but the practice declined in popularity in the 1980s. Interest in the procedure increased in the 1990s due to the development of more effective methods for harvesting granulocytes and a growing population of people with severe neutropenia from chemotherapy. However, the treatment's efficacy remains poorly understood and its use is controversial.

References

  1. American Board of Radiology. "American Board Of Radiology". American Board of Radiology. Retrieved July 16, 2009.
  2. Van Nostrand, D.; Abreu, S. H.; Callaghan, J. J.; Atkins, F. B.; Stoops, H. C.; Savory, C. G. (May 1988). "In-111-labeled white blood cell uptake in noninfected closed fracture in humans: prospective study". Radiology. Radiological Society of North America, Inc. 167 (2): 495–498. doi:10.1148/radiology.167.2.3357961. PMID   3357961. Archived from the original on 2012-07-14. Retrieved July 20, 2011.
  3. Verberne SJ, Raijmakers PG, Temmerman OP (2016). "The Accuracy of Imaging Techniques in the Assessment of Periprosthetic Hip Infection: A Systematic Review and Meta-Analysis". The Journal of Bone and Joint Surgery. American Volume. 98 (19): 1638–1645. doi:10.2106/JBJS.15.00898. PMID   27707850.