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Title: False-positive indium-111 labeled leukocyte scintigram in a patient with a painful hip prosthesis

Abstract

A Tronzo hip prosthesis is designed to elicit an inflammatory reaction in order to promote prosthesis stability. A three-phased bone scan and Ga-67 imaging in conjunction with physical examination and laboratory findings failed to demonstrate evidence for osteomyelitis in a patient with a painful hip prosthesis, in whom images obtained with In-111-labeled leukocytes were positive. This observation demonstrated that the interpretation of the latter technique in demonstrating inflammation can cause a false impression of an infectious process.

Authors:
; ;
Publication Date:
Research Org.:
Hospital of the Univ. of Pennsylvania, Philadelphia
OSTI Identifier:
5844249
Resource Type:
Journal Article
Resource Relation:
Journal Name: Clin. Nucl. Med.; (United States); Journal Volume: 1
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BONE JOINTS; SCINTISCANNING; FEMUR; GALLIUM 67; GRAFTS; INDIUM 111; INFLAMMATION; LEUKOCYTES; OSTEOMYELITIS; PAIN; PATIENTS; BETA DECAY RADIOISOTOPES; BIOLOGICAL MATERIALS; BLOOD; BLOOD CELLS; BODY; BODY FLUIDS; COUNTING TECHNIQUES; DAYS LIVING RADIOISOTOPES; DIAGNOSTIC TECHNIQUES; DISEASES; ELECTRON CAPTURE RADIOISOTOPES; GALLIUM ISOTOPES; INDIUM ISOTOPES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; MATERIALS; MINUTES LIVING RADIOISOTOPES; NUCLEI; ODD-EVEN NUCLEI; ORGANS; PATHOLOGICAL CHANGES; RADIOISOTOPE SCANNING; RADIOISOTOPES; SKELETAL DISEASES; SKELETON; SYMPTOMS; TRANSPLANTS; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Feldman, N., Makler, P.T. Jr., and Alavi, A. False-positive indium-111 labeled leukocyte scintigram in a patient with a painful hip prosthesis. United States: N. p., 1986. Web. doi:10.1097/00003072-198601000-00013.
Feldman, N., Makler, P.T. Jr., & Alavi, A. False-positive indium-111 labeled leukocyte scintigram in a patient with a painful hip prosthesis. United States. doi:10.1097/00003072-198601000-00013.
Feldman, N., Makler, P.T. Jr., and Alavi, A. 1986. "False-positive indium-111 labeled leukocyte scintigram in a patient with a painful hip prosthesis". United States. doi:10.1097/00003072-198601000-00013.
@article{osti_5844249,
title = {False-positive indium-111 labeled leukocyte scintigram in a patient with a painful hip prosthesis},
author = {Feldman, N. and Makler, P.T. Jr. and Alavi, A.},
abstractNote = {A Tronzo hip prosthesis is designed to elicit an inflammatory reaction in order to promote prosthesis stability. A three-phased bone scan and Ga-67 imaging in conjunction with physical examination and laboratory findings failed to demonstrate evidence for osteomyelitis in a patient with a painful hip prosthesis, in whom images obtained with In-111-labeled leukocytes were positive. This observation demonstrated that the interpretation of the latter technique in demonstrating inflammation can cause a false impression of an infectious process.},
doi = {10.1097/00003072-198601000-00013},
journal = {Clin. Nucl. Med.; (United States)},
number = ,
volume = 1,
place = {United States},
year = 1986,
month = 1
}
  • Indium-111 (In-111) leukocyte scintigraphy was performed in two patients with postsurgical pseudoaneurysms as part of preoperative evaluation for evidence of graft infection. Despite positive In-111 uptake by the pseudoaneurysms, surgical and pathologic examinations failed to reveal any evidence of infection. The most likely explanation for the false-positive results is the labeling of contaminating platelets and erythrocytes in the leukocyte mixture. Caution must be exercised in interpretation of In-111 leukocyte scans in patients with postsurgical pseudoaneurysms.
  • Although it is not clear why coronary occlusion and restenosis occur after successful coronary angioplasty, factors related to the procedure may influence early and late results. The possible adverse effects of a medial tear documented histologically and produced during balloon angioplasty of the common carotid arteries were studied in 30 fully heparinized (100 U/kg body weight) normal pigs. Scanning electron microscopy showed endothelial denudation and extensive platelet deposition in all dilated arterial segments. Visible macroscopic mural thrombus was present within an hour of the procedure in 29 (91%) of the 32 arteries that had a medial tear documented by histologicmore » study; the tear produced an indium-111-labeled platelet deposition of 116.4 +/- 26.5 X 10(6)/cm2 (mean +/- SE) and total thrombotic occlusion in 2 arteries (4%). None of the 24 arteries without a medial tear had a thrombus, and the mean platelet deposition in that group was 7.0 +/- 0.5 X 10(6)/cm2 (p less than 0.0008). In 12 pigs scanned with a gamma camera, visible thrombus was associated with platelet deposition in excess of 20 X 10(6)/cm2 in 12 arteries, 9 of which had a positive indium-111-labeled platelet scintigram. Thus, arterial angioplasty causes deep arterial injury, which appears to be a major cause of mural thrombosis, heavy platelet deposition, a positive indium-111-labeled platelet scintigram and acute arterial occlusion. A positive indium-111-labeled platelet scintigram was always associated with macroscopic thrombus of at least 20 > 10(6) platelets/cm2 and underlying deep arterial injury.« less
  • Unexplained false-positive accumulation of In-111 leukocyte in the gastrointestinal tract has been reported previously. In a pediatric population, uptake in the submandibular gland was noted in 19 of 42 children. This is believed to be a normal finding in children that is not seen in adults. In some of these 19 children, unexplained gastrointestinal activity was also noted. Saliva from a patient with false-positive gastrointestinal uptake and positive submandibular activity was positive for In-111. One suggested cause of unexplained gut activity may be secondary to swallowed activity in the saliva from the normal submandibular activity in children.
  • A case is reported in which In-111-labeled leukocytes accumulated in the left colon on a 24-hr delayed image. This was found to be secondary to an upper gastrointestinal bleed in progress at the time of injection of the radiolabeled leukocytes.
  • A case is reported in which In-111-labeled leukocytes accumulated in the left colon on a 24-hr delayed image. This was found to be secondary to an upper gastrointestinal bleed in progress at the time of injection of the radiolabeled leukocytes.