Diagnosis of pyogenic pelvic inflammatory diseases by 99mTc-HMPAO leucocyte scintigraphy

99mTc-HMPAO labelled white blood cell scintigraphy in the diagnosis and monitoring of response of the therapy in patients with active bronchiectasis

AIM

The aim of this study was to assess the role of labelled leukocyte scintigraphy in the diagnosis and monitorization of response to therapy of patients with active bronchiectasis.

MATERIAL AND METHODS

Twenty patients underwent (99m)Technetium hexamethylpropyleneamine oxime ((99m)Tc-HMPAO) labelled white blood cell (WBC) scintigraphy. A second scintigraphy was performed in 13 patients at 10 day of the treatment. Regional (99m)Tc-HMPAO WBC uptake and radiologic imaging findings (high resolution computed tomography or Chest X-Ray) in the lungs were classified into 3 categories in 6 lung areas. scintigraphic, radiological and clinical disease scores were calculated for all patients.

RESULTS

An abnormal accumulation was visually observed in 19 of 20 patients on the pre-treatment scans, the scintigraphy showing 95% sensitivity. A significant difference was found between early and late ratios (P=0.001) in the pre-treatment scans. The infected areas revealed a significant decrease in uptake ratios on the post-treatment scans compared to the pre-treatment scans (P=0.001). However, no significant correlation was determined between clinical and radiological scores, clinical and scintigraphic scores and also between scintigraphic and radiological scores (P ≥ 0.05).

CONCLUSIONS

(99m)Tc-HMPAO WBC scintigraphy may be a useful tool to evaluate response to therapy in patients with active bronchiectasis.

The labeled-leukocyte scan in the study of abdominal abscesses

AIM

The purpose of the present paper was to review the literature over the last 30 years to assess the value of radionuclide imaging, particularly labeled leukocyte scan, as compared to other imaging modalities in the management of abdominal abscesses.

METHODS

A systematic review of the published studies in humans cited in PubMed written in English, French, German, Italian, and Spanish was made.

RESULTS

Ultrasound (US) has lower sensitivity than leukocyte scan (LS), particularly in patients without localizing signs, while CT has higher sensitivity than US, but less than LS. On the other hand, CT had higher specificity than both LS and US.

DISCUSSION

LS is the more sensitive method to localize abdominal abscesses and may guide dedicated US and CT investigations to improve their diagnostic potential. Further diagnostic evolution is expected from the routine use of hybrid SPECT/CT systems.

99mTc-HMPAO labelled leucocyte scintigraphy in the diagnosis of pelvic inflammatory disease

BACKGROUND

Scintigraphy using leucocytes labelled with 99mTc hexamethylpropyleneamine oxime (99mTc-HMPAO) is widely used for the localization of inflammatory foci and abscesses in cases of acute pelvic inflammatory disease, which is one of the serious health problems of women of child-bearing age. Early diagnosis and effective management of this condition can preserve fertility and prevent serious complications, such as peritonitis and sepsis.

AIM

To evaluate the importance of scintigraphy using 99mTc-HMPAO labelled leucocytes in the early diagnosis of patients with pelvic inflammatory disease.

METHODS

Fifteen women (mean age 29.2+/-8 years, range 25-46 years) with suspicion of pyogenic pelvic inflammatory disease based on gynaecological examinations, clinical findings and blood tests were included in this study. The patients received 555 MBq 99mTc-HMPAO labelled leucocytes, by injection, and were scanned by scintigraphy 0.5-1, 3 and 24 h later in the anterior abdominal projection. Ten of the patients were then evaluated by abdominal or transvaginal ultrasonography, four by computed tomography and two by both ultrasound and computed tomography. The final diagnosis was made by surgical intervention.

RESULTS

Scintigraphy detected pelvic inflammatory disease in five of the patients. In three of them the disease was apparent on the scans taken at 0.5-1 h, and in the other two it was apparent at 3 h. There were no false negative results, and one false positive result. The scan accurately reflected the absence of pelvic inflammatory disease in nine patients showing non-pathological tracer uptake in the lower abdominal region.

CONCLUSION

We showed that scintigraphy with 99mTc-HMPAO labelled leucocytes had a sensitivity of 100%, specificity of 90%, overall accuracy of 93%, positive predictive value of 83%, and negative predictive value of 100%. Therefore, we conclude that 99mTc-HMPAO labelled leucocyte scans provide a rapid and highly accurate method for diagnosing pelvic inflammatory disease in women of child-bearing age. This adds an important contribution to the diagnosis of infection and helps determine further operative or conservative treatment.

[Diagnosis of the infectious complications of continuous ambulatory peritoneal dialysis by 99mTc-HMPAO labelled leukocytes]

OBJECTIVE

To assess the utility of abdominal scintigraphy with 99mTc-HMPAO labelled leukocytes in the diagnosis of infectious complications of continuous ambulatory peritoneal dialysis (CAPD).

MATERIAL AND METHODS

17 patients in CAPD were evaluated (35 studies). They were divided into three groups: group control in asymptomathic patients (5), group of studies in patients with suspicion of exit site infection/catheter tunnel (18) and group of studies in patients with clinical suspicion of peritonitis (12). All patients underwent abdominal scintigraphy with 99mTc-HMPAO labelled leukocytes. The results were compared to final clinical diagnosis, assessing the exit site or dialysis liquid external aspect, material or exit site secretion culture and clinical follow up.

RESULTS

In the case studied, we obtained high sensitivity and specificity values for the exit site infection diagnosis (83 % and 75 % respectively), and a sensitivity of 100 % in the diagnosis of peritonitis as well. We detected a case of catheter tunnel infection confirmed by culture. No pathological uptake was observed in any control case.

CONCLUSIONS

Abdominal scintigraphy with 99mTc-HMPAO labelled leukocytes allows the early diagnosis of infectious complications of CAPD, and the control of treatment response, avoiding its unnecessary prolongation.

The usefulness of Tc-99m-HMPAO-labeled leukocyte scintigraphy in the diagnosis of multiple intra-abdominal abscesses following in vitro fertilization (IVF) procedure

Pelvic infection is a rare but well-known complication following IVF procedures with a reported incidence <1%. A case of multiple abdominal abscesses following IVF procedure was established by Tc-99m-HMPAO-labeled leukocyte scintigraphy and confirmed by laparotomy. This imaging technique should be recommended for early and precise diagnosis of pelvic infection following IVF.

Gynecologic infections

The scope of gynecologic infections presenting to the emergency department is quite diverse. This article presents an update on the current literature for vaginitis, cervicitis, pelvic inflammatory disease, tubo-ovarian abscesses, the Fitz-Hugh-Curtis syndrome, herpes, and syphilis. Inadequate identification or treatment of these diseases can result is significant morbidity or mortality for the patient and for the fetus.

111Indium labelled leukocyte scintigraphy in the detection of acute prostatitis

Although prostatitis is a common problem the diagnosis is still controversial despite the availability of a wide variety of diagnostic tools. In fact, there is still no accurate method of localizing the infected tissue. The aims of the present study were to assess whether 111In labelled leukocytes (ILLs) accumulated in the infected tissue of acute prostatitis and if such uptake responded to treatment. We prospectively studied 10 adult male patients who had community acquired prostatitis and compared them with six male patients who had urinary tract infections but without prostatitis. An initial urinary culture and two blood cultures were carried out for each patient. All patients were followed up for 8 weeks after therapy was completed. Pre- and post-treatment scintigraphies were performed. Before treatment, all patients with prostatitis showed uptake of ILLs in the prostate area. After the patients had completed treatment with antibiotics, the scintigraphy results showed no uptake in the prostate area in 9/10 patients. The remaining patient showed a marked decrease in the uptake of ILLs. None of the six patients with urinary tract infection showed ILL uptake in the prostate region. It is suggested that ILLs could be useful for detecting acute prostatitis, especially in clinically ambiguous patients with urological infections. Furthermore, scintigraphy with 111In labelled leukocytes could help to determine the most appropriate course of therapy.