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^99mTc-HMPAO–Labeled Autologous Versus Heterologous Leukocytes for Imaging Infection

¹ Department of Nuclear Medicine, University Medical Center Nijmegen, Nijmegen, The Netherlands
² Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany
³ Department of Hematology, University Medical Center Nijmegen, Nijmegen, The Netherlands

Radiolabeled autologous leukocytes are the gold standard for imaging infectious foci in patients. Good results have also been reported for radiolabeled heterologous leukocytes from noninfected donors. Until now, the 2 methods have not been directly compared. In this study, we compared the infection-imaging potential of ^99mTc-hexamethylpropyleneamine oxime (HMPAO)–labeled autologous granulocytes with that of ^99mTc-HMPAO–labeled granulocytes from either infected or noninfected donors in rabbits with Escherichia coli infection. Methods: The radiolabeled granulocyte preparations were studied in rabbits with an E. coli infection in the left calf muscle. The soft-tissue infections were scintigraphically visualized after injection of 18 MBq of either ^99mTc-HMPAO purified autologous granulocytes or radiolabeled purified heterologous granulocytes from infected or noninfected donor rabbits. Gamma camera images were acquired at 2 min and at 1, 2, and 4 h after injection. After the last image, the rabbits were killed and uptake of the radiolabel in the dissected tissues was determined. Results: The ^99mTc-HMPAO autologous granulocytes and heterologous granulocytes from infected donors accurately revealed the infectious focus in the calf muscle at 2 h after injection. At 4 h after injection, a significantly better (P < 0.05) delineation of the infection was established with the ^99mTc-HMPAO autologous granulocytes and ^99mTc-HMPAO heterologous granulocytes from the infected rabbits than with the heterologous granulocytes from noninfected donors. With both cell preparations, the intensity of uptake in the infected calf muscle continuously increased until 4 h after injection. The ^99mTc-HMPAO heterologous granulocytes from noninfected donors showed no significant increase in contrast after 2 h after injection. Absolute uptake in the infected calf muscle was much higher for ^99mTc-HMPAO autologous granulocytes (7.81 ± 1.21 percentage injected dose [%ID]) and ^99mTc-HMPAO heterologous infected granulocytes (8.91 ± 1.92 %ID) than for the radiolabeled heterologous noninfected granulocytes (2.32 ± 0.75 %ID) (P < 0.04) at 4 h after injection. The ratio of infected muscle to noninfected contralateral muscle was significantly higher for ^99mTc-HMPAO autologous granulocytes and ^99mTc-HMPAO heterologous granulocytes from infected donors than for ^99mTc-HMPAO heterologous granulocytes from noninfected donors (5.53 ± 1.09, 3.86 ± 0.75, and 1.86 ± 0.31, respectively; P < 0.05). Conclusion: For nuclear medicine imaging of infection, purified granulocytes derived from infected rabbits are superior to purified granulocytes derived from noninfected donor rabbits. In addition, autologous granulocytes gave similar results to heterologous granulocytes from infected donor rabbits, suggesting the need for intrinsic cell activation for specific granulocyte migration.

Key Words: radiolabeled leukocytes • ^99mTc-HMPAO • autologous granulocytes • heterologous granulocytes

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