Tc-99m Labeled HMPAO white Blood Cell Scintigraphy in Pediatric Patients

Abstract

Objective: 99mTc labeled hexamethylpropylene amine oxime (HMPAO) white blood cell (WBC) scintigraphy is a frequently used option for acute infection, particularly in pediatric patients. This scintigraphy is applied to detect sites of infection/inflammation in patients with fever of unknown origin, to find and follow up osteomyelitis, and to detect suspicion of acute appendicitis. The aim of this retrospective study was to evaluate the value of 99mTc-HMPAO labeled WBC scintigraphy in pediatric patients.Material and Methods: The study was conducted between January 2006 and December 2008 and included 13 patients (5 boys, 8 girls; mean age 6.9±6.2 years). Those patients who had suspicion of bone infection (n=7), fever of unknown origin (n=3), and suspicion of acute appendicitis (n=3) were evaluated retrospectively. 99mTc-HMPAO labeled WBC scintigraphy imaging was performed to all patients. Diagnosis was done according to operation and pathological results or clinical follow-up.Results: 99mTc-HMPAO labeled WBC scintigraphy has been found to be true positive in 6 cases, true negative in 6 cases, and false negative in one patient who had fewer unknown origin. The false negative case has been found to have encephalitis with MRI. Conclusion: Leukocyte scintigraphy has been described as a useful diagnostic tool in the diagnosis of suspicion of bone infection, fever of unknown origin and suspicion of acute appendicitis. 99mTc-HMPAO labeled WBC scintigraphy is a rapid and very accurate method for detecting those pathologies. Our results showed that WBC scintigraphy might be reliably used for diagnosis of suspected bone infection and acute appendicitis, fever of unknown origin, and acute appendicitis, in pediatric patient population.Conflict of interest:None declared.

SPECT- and PET-Based Approaches for Noninvasive Diagnosis of Acute Renal Allograft Rejection

“…Approaches to visualise these infiltrating cells and therefore to image inflammation have been performed via radiolabelled white blood cells (WBC) and it has been shown that autologous leukocytes radiolabelled with either 99m Tc-HMPAO or 111 In-oxine for SPECT or 18 F-FDG or 64 Cu for PET, respectively, specifically are enriched in inflamed tissues [ 32 – 34 ]. In fact, this is an established clinical procedure used in many different pathologic settings such as Crohn's disease [ 35 ], osteomyelitis [ 36 ], fever of unknown origin, infection [ 37 ], acute appendicitis [ 38 ], and arterial and colonic inflammation [ 39 ].…”

Charcot foot and ankle with osteomyelitis

“…(99m)Tc-HMPAO-labeled WBC scintigraphy is a frequently used option for acute infection. In one small study, (99m)Tc-HMPAO labeled WBC scintigraphy was found to be true positive in six cases, true negative in six cases, and false negative in one patient who had a fever of unknown origin (31). Ubiquicidin 29-41 (UBI 29-41) is a synthetic antimicrobial peptide fragment reported to be highly infection-specific.…”

Methods of Granulocyte Isolation from Human Blood and Labeling with Multimodal Superparamagnetic Iron Oxide Nanoparticles

“…To determine the localization, extent and severity of inflammation, imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) can be performed but have limitations in the early stages of the disease, as they are dependent on morphological changes [16][17][18]. Accurate and early diagnosis of inflammation and infection helps reduce mortality and morbidity and increase drug treatment success [19][20][21].Proinflammatory effects help leukocytes migrate from the blood vessel to the site of injury, due to increased vascular permeability through stimulation by cytokines and interleukins. There is an initial accumulation of granulocytes, mainly neutrophils, in the inflamed area and later of lymphocytes and macrophages [22][23][24].…”

“…To determine the localization, extent and severity of inflammation, imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) can be performed but have limitations in the early stages of the disease, as they are dependent on morphological changes [16][17][18]. Accurate and early diagnosis of inflammation and infection helps reduce mortality and morbidity and increase drug treatment success [19][20][21].…”