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Indium-111-Granulocyte Scintigraphy in Brain Abscess Diagnosis: Limitations and Pitfalls

Department of Nuclear Medicine, Department of Neurosurgery, and Institute of Pathological Anatomy, Odense University Hospital, Odense, Denmark

Correspondence: For reprints contact: Kai G. Schmidt, MD, PhD, Department of Nuclear Medicine, Odense University Hospital, DK-5000 Odense C, Denmark.

ABSTRACT

The scintigrams and records of 28 patients referred for indium-111-granulocyte scintigraphy (¹¹¹In-GS) because a suspected brain abscess were studied retrospectively. The final diagnosis was brain abscess in 8 patients, brain tumor in 18 patients, and infarct and hematoma in 1 patient each. Five patients not on corticosteroid treatment showed intense focal ¹¹¹In accumulation in abscesses, whereas an abscess patient receiving a high steroid dose showed uptake. Two patients studied twice showed intense uptake in abscesses when not on steroid therapy or on a low dose, whereas no uptake was seen when they received high or medium doses. Weak or moderate ¹¹¹In uptake was observed in nine tumors. Microscopically assessed degree of tumor granulocyte infiltration, vessel proliferation, and hemorrhage did not correlate with the outcome of ¹¹¹In GS. Our results suggest that intense focal cerebral ¹¹¹In uptake favors the abscess diagnosis. Abscesses may go undetected, however, in patients on high- or medium- dose steroid therapy.

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