chiniofon and Osteomyelitis

The clinical use and mechanisms of action of technetium 99m pyrophosphate, gallium 67 citrate, and indium 111 oxine have been presented. The diagnosis of osteomyelitis in the lower extremity can often be made on the basis of clinical, laboratory, and conventional radiographic evaluations. In the case report of diabetic osteolysis, initial evaluations revealed osteomyelitis. The use of scanning involving leukocytes labeled with technetium and indium 111 oxine lessened the possibilities of an osseous infection. Studies show the sensitivity, specificity, and accuracy of scans using leukocytes labeled with indium 111 oxine to be superior to those of any other form of nucleotide imaging, but further clinical research is needed.

Topics: Adult; Diabetes Mellitus, Type 1; Diagnosis, Differential; Foot Diseases; Gallium Radioisotopes; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Organometallic Compounds; Osteolysis; Osteomyelitis; Oxyquinoline; Radionuclide Imaging; Technetium

Topics: Crohn Disease; Granulocytes; Humans; Hydroxyquinolines; Leukapheresis; Leukocyte Count; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging

Gamma-camera imaging after injection of radiolabelled autologous leucocytes can be very helpful in the diagnosis, localization and further clinical treatment of inflammatory diseases. We present a technique allowing sterile separation of white blood cells and labelling with 99mTc-phytate or -oxine and with 111In-oxine, -oxine sulphate or -tropolone. The method is non-invasive and the radiation dose amounts to less than 80 mrad using 100 microCi 111Indium. The use of radiolabelled granulocytes is of particular diagnostic value in patients with septicaemia of unknown origin. Whole body scanning allows not only visualization of enhanced splenic uptake in septicaemia, but also localization of an inflammatory process. Preferential indications for a diagnostic approach using radiolabelled granulocytes are inflammatory abdominal processes which cannot easily be documented by means of other non-invasive techniques, such as inflammatory bowel disease (Crohn's diseases and ulcerative colitis), arthritic processes and abscesses of the liver and spleen, as well as subphrenic and retroperitoneal abscesses. Untreated osteomyelitis can be located with the help of labelled granulocytes, but in patients treated with antibiotics a false negative result is obtained in approximately 50% of cases for as yet unknown reasons, even in the presence of a still active osteomyelitic process.

Topics: Abscess; Aged; Bacterial Infections; Diagnosis, Differential; Female; Granulocytes; Humans; Hydroxyquinolines; Indium Radioisotopes; Male; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oxyquinoline; Peritonitis; Phagocytosis; Radionuclide Imaging; Subphrenic Abscess; Surgical Wound Infection; Technetium

Fifty-seven investigations of the skeletal system were performed on 54 patients, using a 99Tcm-labelled nanometer-sized HSA colloid in a crossover comparison with 111In oxine-labelled granulocytes for the detection of sites of infection. The findings were in agreement in 55 out of 57 investigations (96.5%). Based on 44 studies in which a final clinical diagnosis was obtained, both methods were found to display the same specificity (93%), whilst the sensitivity of 99Tcm nanocolloid scintigraphy (87%) was slightly higher than that obtained with 111In leucocyte scintigraphy (81%). In our opinion, 99Tcm nanocolloid is easier to use and the total duration of the investigation is considerably shorter. The use of 99Tcm is scintigraphically more advantageous and, with the dosage required, the absorbed radiation dose to the red bone marrow is three times lower than with 111In granulocytes. For the detection and therapy monitoring of osteomyelitis, as well as for the investigation of arthroplasties suspected of infective loosening, we consider scintigraphy with 99Tcm nanocolloid to be equivalent to leucocyte scintigraphy. Identical findings were obtained with both tracers in suspected spondylodiscitis.

Topics: Female; Granulocytes; Hip Prosthesis; Humans; Hydroxyquinolines; Indium Radioisotopes; Intervertebral Disc; Knee Prosthesis; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Prosthesis Failure; Radionuclide Imaging; Spondylitis; Technetium Tc 99m Aggregated Albumin

Earlier clinical studies revealed that in patients suffering from chronic osteomyelitis (n = 10) undergoing antibiotic therapy the white blood cell scanning missed the right diagnosis in 40% of cases, whereas all the acute untreated cases (n = 6) were imaged correctly. Thus, it was suspected that an impaired labelling efficiency and white blood cell function might have been causative. Retrospective analysis of labelling efficiency exhibited no difference between patients on antibiotics (n = 12) and those not on antibiotics (n = 29). Prospective cellular viability testing in 81 patients, 71 of whom were on various antibiotics, using latex particles (phagocytosis) and the Trypan blue exclusion test, did not reveal any different function behaviour either. Examining the labelling efficiency (after 111In-oxine and 111In-oxine-sulphate labelling), recovery, half-life and viability of white blood cells of 107 patients undergoing therapy with various antibodies as compared to controls, it becomes evident that the antibiotic therapy is not causative of the clinical difference observed.

Topics: Adult; Aged; Anti-Bacterial Agents; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Isotope Labeling; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging

Twenty patients were studied prospectively with indium-labeled leukocyte imaging to evaluate its effectiveness in differentiating noninfected delayed or nonunion from osteomyelitis complicating these entities. All patients underwent an open surgical procedure within 24 h of the scan. Bone specimens from the nonunion site were obtained for microbiological and histological analysis to confirm the presence or absence of osteomyelitis. In these twenty patients, the sensitivity of the indium scintigraphy was 100%, the specificity 100%, and the overall accuracy 100%. Indium-labeled leukocyte scintigraphy is significantly more accurate than 99mtechnetium and 67gallium imaging had been, when studied earlier, in detecting subclinical osteomyelitis complicating nonunion. Indium-labeled leukocyte scintigraphy should supplant sequential technetium and gallium studies in this patient population when the surgeon must determine whether subclinical osteomyelitis is complicating fracture management of delayed and nonunions.

Topics: Adult; Female; Fractures, Ununited; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Prospective Studies; Radionuclide Imaging; Time Factors

Although photon deficient defects on bone scan have received a great deal of interest, such defects in bones on Indium-111 (111In) leukocyte imaging have not been as well recognized. We therefore undertook a retrospective review to determine the frequency and significance of such "cold" defects on 111In-labeled leukocyte imaging. Three hundred thirty-two scans on 290 patients were reviewed and 40 cases of decreased activity involving bone were found, for an incidence of 12%. The causes of the defects were: fracture (eight), nontraumatic avascular necrosis (eight), solid tumor (six), prostheses and other orthopedic hardware (four), advanced age (four), radiation (three), leukemia (two), osteomyelitis (two), myelofibrosis (one), postlaminectomy (one), and idiopathic (one). To determine the frequency of cold defects in osteomyelitis, all 15 cases of osteomyelitis in this series were reviewed and 12 showed increased activity, two were cold, and one was normoactive. Thus, 14% of cases of osteomyelitis presented as cold defects. We conclude that cold bone defects do occur on 111In-labeled leukocyte scans and that the causes of such defects are similar to those reported for bone and bone marrow scanning.

Topics: Bone and Bones; Bone Diseases; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging; Retrospective Studies

111In-labeled leukocyte imaging has shown greater accuracy and specificity than alternative noninvasive methods in the detection of uncomplicated osteomyelitis. Forty patients with suspected osteomyelitis complicating fractures (with and without surgical intervention) were evaluated with 111In-labeled leukocytes. All five patients with intense focal uptake, but only one of 13 with no uptake, had active osteomyelitis. However, mild to moderate 111In leukocyte uptake, observed in 22 cases, indicated the presence of osteomyelitis in only four of these; the other false-positive results were observed in noninfected callus formation, heterotopic bone formation, myositis ossificans, and sickle-cell disease. These results suggest that 111In-labeled leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating fracture but must be used in conjunction with clinical and radiographic correlation to avoid false-positive results.

Topics: Adult; False Positive Reactions; Follow-Up Studies; Fractures, Bone; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Radionuclide Imaging; Retrospective Studies

Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.

Topics: Adult; Aged; Bacterial Infections; False Negative Reactions; False Positive Reactions; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Preoperative Care; Radionuclide Imaging; Technetium Tc 99m Medronate

We prospectively compared sequential technetium-gallium imaging with indium-labeled-leukocyte imaging in fifty patients with suspected low-grade musculoskeletal sepsis. Adequate images and follow-up examinations were obtained for forty-two patients. The presence or absence of low-grade sepsis was confirmed by histological and bacteriological examinations of tissue specimens taken at surgery in thirty of the forty-two patients. In these thirty patients, the sensitivity of sequential Tc-Ga imaging was 48 per cent, the specificity was 86 per cent, and the accuracy was 57 per cent, whereas the sensitivity of the indium-labeled-leukocyte technique was 83 per cent, the specificity was 86 per cent, and the accuracy was 83 per cent. When the additional twelve patients for whom surgery was deemed unnecessary were considered, the sensitivity of sequential Tc-Ga imaging was 50 per cent, the specificity was 78 per cent, and the accuracy was 62 per cent, as compared with a sensitivity of 83 per cent, a specificity of 94 per cent, and an accuracy of 88 per cent with the indium-labeled-leukocyte method. In patients with a prosthesis the indium-labeled-leukocyte image was 94 per cent accurate, compared with 75 per cent accuracy for sequential Tc-Ga imaging. Statistical analysis of these data demonstrated that the indium-labeled-leukocyte technique was superior to sequential Tc-Ga imaging in detecting areas of low-grade musculoskeletal sepsis.

Topics: Adolescent; Adult; Aged; Diphosphonates; Female; Gallium Radioisotopes; Humans; Hydroxyquinolines; Indium; Isotope Labeling; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Prospective Studies; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Acute osteomyelitis was induced in 18 rabbits after direct injection of a solution of Staphylococcus aureus culture into a proximal tibial metaphysis. Serial plain radiographs and radionuclide studies with indium-111 oxide labeled while blood cells and technetium-99m methylene diphosphonate were performed over the next 4 weeks. Visual and quantitative analysis by measuring the isotope activity of 111In and 99mTc over the infected tibias as compared with the opposite bones revealed that the white blood cell scans were positive in 15 (83%) of the 18 rabbits during the first week after injection of the microorganism. During the same period, the 99mTc bone scans were positive in only 22% of the animals (p less than 0.005). In the animals that survived, both white blood cell and bone scans were positive during the second week, and thereafter, the bone scans revealed consistently higher activity than was observed with white blood cell scans. Computed tomography performed in six rabbits revealed an increased attenuation coefficient of the medullary cavities in the infected bones of four animals during the first week and of one more during the second week. Plain radiographs became positive after the 12th day. Results indicate that in patients with suspected acute osteomyelitis, white blood cell scans and probably computed tomography can detect the disease earlier than 99mTc bone scans and plain radiographs.

Topics: Animals; Diphosphonates; Hindlimb; Hydroxyquinolines; Indium; Leukocytes; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Rabbits; Radionuclide Imaging; Staphylococcus aureus; Technetium; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed