technetium-tc-99m-exametazime and Joint-Diseases

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

To investigate the sensitivity and specificity of 99mTc-HMPAO-leukocyte imaging in evaluating therapy result in patients with prosthetic joint infection (PJI) and in diagnosing suspected chronic PJI.. Sixty-two patients (63 joints) with microbiologically verified PJI were examined by leukocyte imaging to evaluate therapy result during or at the end of antibiotic treatment or if the patient had a chronic PJI after treatment. Group 1 consisted of 49 patients with on-going or within less than 14 days of ending antibiotic treatment examined to evaluate response. Group 2 consisted of 13 patients examined after completed treatment on suspicion of chronic PJI with no or recently initiated renewed antibiotic treatment. This study applied a combination of different imaging approaches of 99mTc-HMPAO-leukocyte scintigraphy: delayed and late planar images, bone marrow imaging and SPECT/CT imaging. All joints were examined with at least two of the approaches and 53 joints with all three approaches. The report was based on the combined results of the approaches used. A chronic PJI was confirmed with a positive microbiological culture. A cured infection was confirmed with either a negative culture or at least 24 months antibiotic-free follow-up with no relapse.. In the therapy evaluation group sensitivity was 0.57 and specificity was 0.81. In the suspected chronic infection group sensitivity was 1.00 and specificity 0.91.. 99mTc-HMPAO-leukocyte imaging appears to be an accurate method to diagnose or exclude chronic PJI, but cannot be recommended for therapy evaluation of PJI in patients with on-going antibiotic treatment.

Topics: Aged; Anti-Bacterial Agents; Chronic Disease; Cohort Studies; Female; Humans; Image Processing, Computer-Assisted; Joint Diseases; Leukocytes; Male; Prosthesis-Related Infections; Retrospective Studies; Technetium Tc 99m Exametazime; Treatment Outcome

99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections.. Fifty-six sites with suspected bone or joint infection were examined with 99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370-400 MBq infecton or 185-200 MBq 99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies.. There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With 99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients.. Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Bone and Bones; Child; Child, Preschool; Chronic Disease; Ciprofloxacin; Female; Humans; Infant; Joint Diseases; Joints; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Prospective Studies; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Exametazime

The aim of this study was to determine the rates, types, clinical features and treatment of osteoarthricular involvement of brucellosis in Turkey. In a restrospective study in adults, we investigated 238 patients diagnosed with brucellosis over a period of 6 years. A diagnosis of brucellosis was established by isolation of Brucella species in blood or by a compatible clinical picture together with a standard tube agglutination titre of > or = 1/160 of antibodies for brucellosis and/or demonstration of an at least four-fold rise in antibody titre in serum specimens taken over 2 or 3 weeks. Osteoarthricular involvement was defined by inflammatory signs in peripheral joints or by unrelieved pain at rest together with radiological alterations and/or radionuclide uptake in any deep joint. Eighty-seven patients (36.5%) had osteoarthricular involvement (58.6% female, 41.4% male), 47 (54.1%) of whom were reported to consume unpasteurised dairy products. The mean age was 32.3 +/- 16 years. Sacroiliitis was the most common involvement (n = 53, 60.9%) followed by peripheral arthritis (n = 17, 19.5%), spondylitis (n = 12, 13.8%) and bursitis (n = 5, 5.7%). During the observation period, 60 (69%) patients with osteoarthricular involvement and radiographic abnormalities. A bone scan was positive in 15 patients with no radiographic abnormalities. All patients received merely medical treatment and relapse occurred in five (5.7%) patients. Sacroiliitis has been determined as the most frequently observed type of osteoarthricular involvement in brucellosis in Turkey.

Topics: Adolescent; Adult; Age Distribution; Aged; Brucella; Brucellosis; Doxycycline; Female; Humans; Joint Diseases; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Ofloxacin; Retrospective Studies; Sacroiliac Joint; Technetium Tc 99m Exametazime; Tetracycline; Tomography, X-Ray Computed; Turkey

The aim of this study was to investigate the ability of 111In-labelled human polyclonal immunoglobulin G (111In-IgG) to localize bone and joint infections compared with 99Tcm-HMAPO-labelled leukocytes (99Tcm-WBC). Thirty-four patients routinely referred for investigation of bone and joint infections were studied. In all patients, a bone scan using 99Tcm-MDP was initially obtained. Subsequently, 99Tcm-WBC and 111In-IgG were simultaneously injected and images obtained at 30 min, 4 h and 24 h post-injection. Diagnostic accuracy was established by bacteriology of specimens obtained by needle aspiration and/or surgery, other imaging methods and clinical follow-up. The images were read by three experienced observers blinded to any other information; the clinical suspicion of infection and the diagnosis were established when two observers agreed. Infection was confirmed in 11 patients. The 99Tcm-WBC scans gave 8 true-positive, 5 false-positive, 18 true-negative and 3 false-negative results. With 111In-IgG, the figures were 7, 6, 17 and 4, respectively. The sensitivity, specificity and accuracy were 72.7%, 78.2% and 76.4% respectively for the labelled leukocytes and 63.6%, 73.9% and 70.6% respectively for 111In-IgG. There was greater agreement between the observers with 99Tcm-WBC than 111In-IgG. In this study, 111In-IgG was less sensitive and less specific than 99Tcm-WBC scintigraphy for the diagnosis of chronic infections, but these differences were not significant. Both tracers appear to be useful in the diagnosis of bone and joint infections. However, our results were less reliable for the diagnosis of an infected prosthesis.

Topics: Adult; Aged; Aged, 80 and over; Bone Diseases; Chronic Disease; Diagnostic Errors; Female; Hip Prosthesis; Humans; Immunoglobulin G; Indium Radioisotopes; Infections; Joint Diseases; Knee Prosthesis; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radioimmunodetection; Technetium Tc 99m Exametazime

MRI can be regarded as a standard procedure for diagnosis of the painful wrist. Because of its high costs, it must be used with discretion. For the detection of lesions of the marrow, joint effusions and soft tissue pathology (exception for ruptured ligaments), MRI is generally the most sensitive imaging modality. It shows the living part of bone and soft tissue with unique contrast. An integrative imaging approach including MRI is often successful. X-ray of the wrist is the basic investigation. Ultrasound often allows the diagnosis of pathology of ganglia, tendons and vessels. Lesions of the ligaments are shown best by arthrography, although MRI can also demonstrate these lesions. The introduction of MRI has limited the use of CT to pathologic changes in cortical and cancellous bone and displacement or malalignment. Scintigraphy and MRI are mostly complementary rather than mutually exclusive.

Topics: Arthrography; Humans; Joint Diseases; Magnetic Resonance Imaging; Organotechnetium Compounds; Oximes; Technetium Tc 99m Exametazime; Ultrasonography; Wrist Joint

The in vitro and in vivo behaviour of 99Tcm-HMPAO (hexamethylpropyleneamineoxime) (n = 12) and 111In-oxine (n = 11) labelled granulocytes, isolated by density-gradient centrifugation (Metrizamide/plasma gradients), was compared in patients with suspected inflammatory diseases. The in vitro elution of both labels and the viability of the labelled cells (99Tcm, 98.5%; 111In, 96.5%) was comparable but the labelling efficiency was different (99Tcm, 44 +/- 13%; 111In, 72.5 +/- 5.5%). In vivo, the lung (t1/2 max: 7.7 min), liver and spleen perfusion patterns were nearly identical; the image quality for detail in 99Tcm scans was superior to 111In images. The blood disappearance curves of 99Tcm and 111In were comparable. In the small number of patients examined all infections could be diagnosed correctly, without false-positive or false-negative results. Disadvantageous is the renal excretion of 99Tcm complexes (3+% over 20 h) with kidney and bladder activity from the beginning of the study. The biliary excretion in half of the patients (n = 6) with unspecific positive small and large bowel visualization and the late intestinal excretion also render the diagnosis more difficult. The recommended best imaging times for abdominal and retroperitoneal inflammations are 30 min to 2 h after injection. Late scans in septic prosthetic joints have disproportionate long acquisition times. As a potential cell labelling compound, 99Tcm-HMPAO has a promising future in comparison to 111In scans because of the good availability of 99Tcm, the image quality and the lower radiation exposure to the patient when lower activities for the early diagnosis of abdominal inflammatory diseases are reinjected.

Topics: Colitis, Ulcerative; Crohn Disease; Female; Granulocytes; Humans; Hydroxyquinolines; Indium Radioisotopes; Inflammation; Isotope Labeling; Joint Diseases; Lung Diseases; Male; Organometallic Compounds; Oximes; Oxyquinoline; Polycystic Kidney Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime