technetium-tc-99m-exametazime and Bone-Diseases--Infectious

Between January and July 1998, we conducted a prospective study to compare Tc-99m-labelled antigranulocyte monoclonal antibody fragment Fab' (LEUKOSCAN) scintigraphy versus Tc-99m-hexamethylpropyleneamine oxime (Tc-99m-HMPAO)-labelled leukocyte scintigraphy (HMPAO-LS) for the diagnosis of unselected patients with bone and joint infection. Twenty-three patients (16 men and 7 women; mean age, 67 years) with suspected bone infection were explored successively with bone scintigraphy, HMPAO-LS and LEUKOSCAN scintigraphy. Thirty-two foci were studied (diabetic foot = 11, prosthetic material = 8, joint disease = 4, others = diagnosed in 18 cases, eight on the basis of bacteriological and histological examination of surgical or puncture specimens, with or without radiographic signs, and 10 on the basis of clinical course and radiographic findings. Overall sensitivity, specificity and accuracy were 86%, 72% and 78%, respectively, for LEUKOSCAN scintigraphy (12 true positives (TP), 13 true negatives (TN), 5 false positives (FP), 2 false negatives (FN)), 93%, 100% and 96%, respectively, for HMPAO-LS (13TP, 18TN, 0FP, 1FN), and 100%, 17% and 53.3%, respectively, for bone scintigraphy. In this small series, LEUKOSCAN scintigraphy was found to be less specific for the diagnosis of osteomyelitis than HMPAO-LS. In addition, the interpretation of LEUKOSCAN scintigraphy is more difficult than HMPAO-LS for the diagnosis of bone infection in the diabetic foot, and would appear to be less discriminating for differentiating soft tissue infection from osteitis in the case of plantar perforating ulcers.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Bone Diseases, Infectious; Female; Humans; Image Interpretation, Computer-Assisted; Joint Diseases; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

White blood cell (WBC) scintigraphy for diagnosing fracture-related infections (FRIs) has only been investigated in small patient series. Aims of this study were (1) to establish the accuracy of WBC scintigraphy for diagnosing FRIs, and (2) to investigate whether the duration of the time interval between surgery and WBC scintigraphy influences its accuracy.. 192 consecutive WBC scintigraphies with. WBC scintigraphy had a sensitivity of 0.79, a specificity of 0.97, a positive predicting value of 0.91, a negative predicting value of 0.93 and a diagnostic accuracy of 0.92 for detecting an FRI in the peripheral skeleton. The duration of the interval between surgery and the WBC scintigraphy did not influence its diagnostic accuracy; neither did concomitant use of antibiotics or NSAIDs. There were 11 patients with a false-negative (FN) WBC scintigraphy, the majority of these patients (n = 9, 82%) suffered from an infected nonunion. Four patients had a false-positive (FP) WBC scintigraphy.. WBC scintigraphy showed a high diagnostic accuracy (0.92) for detecting FRIs in the peripheral skeleton. Duration of the time interval between surgery for the initial injury and the WBC did not influence the results which indicate that WBC scintigraphy is accurate shortly after surgery.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases, Infectious; Female; Fracture Fixation; Fractures, Bone; Humans; Image Interpretation, Computer-Assisted; Leukocytes; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Exametazime; Young Adult

Topics: Bone Diseases, Infectious; Female; Humans; Leukocytes; Male; Radiopharmaceuticals; Soft Tissue Infections; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Bone Diseases, Infectious; Female; Humans; Leukocytes; Male; Radiopharmaceuticals; Soft Tissue Infections; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The diagnosis of infection is often based on clinical, pathological and microbiological results. However, these investigations lack specificity. White blood cell (WBC) scintigraphy is considered the gold standard nuclear imaging technique for diagnosing infections in bone and soft tissues (except spondylodiscitis). However, image acquisition and interpretation criteria differ amongst centres throughout the world, leading to differences in reported results. The aim of this study was to identify the most accurate WBC scintigraphy acquisition and interpretation protocols for diagnosis of bone and soft tissue infections.. Included in this retrospective study were 297 patients with suspected bone or soft tissue infection who underwent WBC scintigraphy with (99m)Tc-HMPAO-labelled leucocytes between 2009 and 2012. Sensitivity, specificity, accuracy, and positive and negative predictive values of WBC scintigraphy were determined for two different dual time point acquisition protocols (fixed-time acquisition and time decay-corrected acquisition) and five image interpretation methods (visual and semiquantitative with four different reference regions of interest). Final diagnosis was based on pathological and microbiological reports, and when these were not available, on clinical follow-up of at least 6 months.. The best acquisition protocol was 4 h and 20 - 24 h dual time-point acquisition with time decay-corrected acquisition. When using this acquisition protocol, visual qualitative interpretation led to a sensitivity of 85.1 %, a specificity of 97.1 %, a diagnostic accuracy of 94.5 %, a positive predictive value of 88.8 % and a negative predictive value of 95.9 %. For semiquantitative analysis, the best results were found when lesion-to-reference ratios were calculated with the contralateral side as the reference tissue, except for osteomyelitis and infected osteosynthesis, for which the contralateral bone marrow was found to be the best reference tissue. Results of the semiquantitative analyses per se were not better than for visual analysis. In the optimal analysis protocol, scans are first visually evaluated, and if this gives equivocal results, semiquantitative analysis is performed. This strategy resulted in an improved sensitivity of 97.9 %, a specificity of 91.8 % and a diagnostic accuracy of 93.1 %.. WBC scintigraphy for bone and soft-tissue infection is best performed using a dual acquisition protocol at 4 h and at 20-24 h after injection, in which the acquisition time of the scans is corrected for decay. In most patients, visual analysis is sufficient and leads to high diagnostic accuracy. When interpretation by visual analysis is inconclusive, semiquantitative analysis adds accuracy. Based on our results, we propose a flow chart for analysing WBC scintigraphy in musculoskeletal infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases, Infectious; Child; Female; Humans; Image Interpretation, Computer-Assisted; Leukocytes; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Soft Tissue Infections; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Bone infection is a common issue in infectiology. The gold standard for evaluating bone infection is the white blood cell (WBC) scan. In our practice the WBC scan is coupled with a bone scan. Discordances in the results of these two examinations are a common occurrence in daily practice. We decided to investigate the meaning of these discordances.. Two hundred and ninety-six 99mTc-HMPA labelled white blood cells (WBC) and 99mTc-HMDP bone scanning (BS) examinations were performed in our department between 1997 and 2003 for evaluation of bone infection. Out of these 296 examinations, a first rating extracted 54 scans that were considered discordant. These 54 scans were reviewed by three observers. Clinical and paraclinical data were obtained for all the cases definitely considered as discordant by all three observers.. The observers finally retained 18 cases as discordant from the initial 296 (6.1%). Thirteen patients were not infected,and five patients were considered infected based on clinical follow-up or bacteriological and histological data. For the 17 patients with WBC-, BS+, 4 (23.5%) were infected.. Our study shows that in the vast majority(17 out of 18), discordances consist of a negative WBC scan with a positive bone scan. In these cases the accuracy of the WBC scan is diminished as 23.5% of the patients with a negative WBC and a positive bone scan are infected.

Topics: Bone and Bones; Bone Diseases, Infectious; False Negative Reactions; Humans; Leukocytes; Radionuclide Imaging; Retrospective Studies; Staining and Labeling; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

White blood cell scanning with (99m)Tc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. The aim of this prospective study was to evaluate the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of bone and joint infections.. (99m)Tc-HMPAO scintigraphy was performed on 28 consecutive patients: 15 with suspected bone infection (group 1) and 13 with suspected orthopedic implant infection (group 2). Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head gamma-camera coupled with a low-power x-ray tube. In all patients, scintigraphic results were matched with the results of surgery or cultures and of clinical follow-up.. (99m)Tc-HMPAO scintigraphy was true-positive for infection in 18 of 28 patients (for a total of 21 sites of uptake) and true-negative in 10 of 28 subjects. SPECT/CT provided an accurate anatomic localization of all positive foci. With regard to the final diagnosis, SPECT/CT added a significant clinical contribution in 10 of 28 patients (35.7%). In fact, SPECT/CT differentiated soft-tissue from bone involvement both in patients with osteomyelitis and in patients with orthopedic implants, allowed correct diagnosis of osteomyelitis in patients with structural alterations after trauma, and identified synovial infection without prosthesis involvement in patients with a knee implant.. Our results indicate that SPECT/CT performed using a hybrid device can improve imaging with (99m)Tc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Infectious; Bone Diseases, Infectious; Female; Humans; Image Enhancement; Leukocytes; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To assess the reliability of MRI and scintigraphy with 99mTc-HMPAO-labelled granulocytes in the diagnosis of bone infection.. Between November 2001 and November 2003, 25 patients (16 men and 9 women; age range 22-72 years; mean age 48 years) with suspected bone infection were evaluated. The lower limbs were more frequently involved (20/25 cases). MRI (T1 and T2-w sequences, both with and without fat suppression; T1-w fat-suppressed sequence after Gadolinium administration) and scintigraphy with 99mTc-HMPAO-labelled granulocytes were performed in all patients; the study was performed 30 min, 150 min and 24 h after the injection of 99mTc labelled autologous granulocytes. The maximum interval between MRI and scintigraphy was 15 days. The diagnosis was confirmed surgically (18/25 cases) or by clinical follow-up (7/25 cases).. In 10/25 cases the clinical suspicion of bone infection was confirmed by MRI, scintigraphy and surgery. In 12/25 cases the clinical suspicion of bone infection was not confirmed either by imaging, surgery (5/12 cases) or follow-up (7/12 cases). In 3/25 cases the results were discordant: in 1/3 cases with chronic osteomyelitis confirmed by MRI and surgery, a false-negative diagnosis was made by scintigraphy. In 2/3 cases with negative MRI diagnoses confirmed by surgery, a false-positive diagnosis was made by scintigraphy owing to the infection of adjacent soft tissues.. MRI is more reliable for the detection and evaluation of the local spread of bone infection. Conversely, when metallic devices causing artefacts on MR images are present, scintigraphy is the preferred alternative modality.

Topics: Adult; Aged; Bone Diseases, Infectious; Female; Granulocytes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Exametazime

Topics: Anticoagulants; Bone Diseases, Infectious; Heparin; Humans; Isotope Labeling; Leukocytes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

In order to evaluate the importance of 99mTc-hexamethylpropylene amine oxime (99mTc-HMPAO) leukocyte scintigraphy in the diagnosis of bone infection, we retrospectively reviewed 324 patients. Abnormal findings were seen in 221 patients. In the other 103 cases acute pathological inflammation could be ruled out. The patients with pathological findings were divided into four groups according to the location of the infection. This method showed the localizations of skeletal disorders and its differences to other diagnostic imaging modalities. The underlying abnormalities causing the inflammation were determined. In conclusion, 99mTc-HMPAO leukocyte scintigraphy is still a very sensitive method for either whole body screening or local detection of acute or exacerbated chronic osteomyelitis. The advantages of this method over other diagnostic imaging methods are shown.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Bone Diseases, Infectious; Chronic Disease; Female; Humans; Inflammation; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Exametazime; Wounds and Injuries