technetium-tc-99m-exametazime and Osteomyelitis

Topics: Arthropathy, Neurogenic; Diabetic Foot; Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Osteomyelitis; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

With a current annual mortality rate of around 35% worldwide, infection remains a significant concern, and the diagnosis and localization of infectious foci is an important health issue. As an established infection-imaging modality, nuclear medicine plays a vital health-care role in the diagnosis and subsequent effective treatment of this condition. Despite the development of several newer radiopharmaceuticals, (67)Ga and leukocyte imaging procedures have maintained their established place for infection. Several techniques in nuclear medicine significantly aid infection diagnosis, including imaging with (111)In-oxine-, (99m)Tc-hexamethylpropyleneamine oxime-, and (99m)Tc-stannous fluoride colloid-labeled leukocytes and with (67)Ga-citrate. Each radiopharmaceutical has specific advantages and disadvantages that make it suitable to diagnose different infectious processes (e.g., soft-tissue sepsis, inflammatory bowel disease, osteomyelitis, occult fever, fever of unknown origin, and infections commonly found in immunocompromised patients). After finishing this article, the reader should be able to identify the properties of an ideal radiopharmaceutical for infection imaging, list a range of available infection-imaging radiopharmaceuticals, compare the relative results of a range of radiopharmaceuticals used internationally to detect infection in the body, understand several common infectious processes that can be diagnosed using nuclear medicine techniques, and select an appropriate radiopharmaceutical to image a range of infectious processes.

Topics: Citrates; Fever of Unknown Origin; Gallium; Humans; Infections; Irritable Bowel Syndrome; Leukocytes; Nuclear Medicine; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Practice Patterns, Physicians'; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sepsis; Technetium Compounds; Technetium Tc 99m Exametazime; Tin Fluorides; Tomography, Emission-Computed

Labeled leukocyte scintigraphy is the preferred imaging technique for the evaluation of suspected postoperative orthopedic infections. Labeled leukocyte localization returns to a normal pattern faster than MRI after bone trauma, surgical procedures, and treatment of osteomyelitis. 99mTc HMPAO labeled leukocyte scintigraphy is useful, particularly in children, because less peripheral blood volume is required for labeling. However, delayed 16-20 hour imaging is usually needed to detect low-grade osteomyelitis, and 111In WBC usually provides better images in adults. Combined 111In WBC/99mTc sulfur colloid marrow images improve the specificity for detection of osteomyelitis in regions containing active bone marrow. Simultaneous 111In leukocyte/99mTc bone SPECT imaging is usually necessary in regions such as the skull, spine, and hips, where there is overlapping bone, and soft tissues.

Topics: Bone and Bones; Humans; Indium Radioisotopes; Joint Prosthesis; Leukocytes; Orthopedics; Osteomyelitis; Postoperative Complications; Prosthesis-Related Infections; Radiography; Radionuclide Imaging; Technetium Tc 99m Exametazime

To demonstrate the combined use of scintigraphy and ultrasonography (US) in differentiating osteomyelitis from bone infarction in sickle cell disease.. Two patients with sickle cell disease were examined with a combination of bone, bone marrow, white blood cell and/or gallium scintigraphy and US.. The scintigraphic studies demonstrated areas of suspected osteomyelitis at the distal femur in both patients and at the proximal right tibia in one of them. US revealed subperiosteal fluid collections in these areas. Aspiration guided by US established the presence of pus at the femur in both instances, which was successfully treated with the US-guided insertion of a drainage catheter and aspiration only, respectively. Thick blood, due to bone infarction, was aspirated at the tibia.. The scintigraphic studies were useful in locating all areas of suspected osteomyelitis. The role of US was to confirm the presence of a subperiosteal fluid collection and to guide aspiration, which can show the distinction between a haematoma and an abscess.

Topics: Abscess; Adult; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Diagnosis, Differential; Female; Gallium Radioisotopes; Hematoma; Humans; Infarction; Male; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Ultrasonography

Osteomyelitis is a serious health problem that results in multiple limb amputations annually. This article reviews the current scintigraphic procedures used in the diagnosis of osteomyelitis and discusses some of the newer radiopharmaceuticals now being developed. The goal is to understand the strengths and weaknesses of each method so that the procedure most effective for specific clinical settings can be selected. In general, the three-phase bone scan is the procedure of choice if the suspected osteomyelitis is not superimposed on another disease that causes increased bone remodeling (i.e., findings on the radiograph are normal). If the suspected osteomyelitis is superimposed on a disease that causes increased bone remodeling, the combined 111In-labeled leukocyte-99mTc bone scan is the procedure of choice in the non-marrow-containing skeleton and the 111In-labeled leukocyte and 99mTc bone marrow scans are the procedures of choice in the marrow-containing skeleton.

Topics: Citrates; Citric Acid; Humans; Indium Radioisotopes; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Radioimmunodetection; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

The diagnosis of osteomyelitis is a challenge for diagnostic imaging. Nuclear medicine procedures including white blood cell imaging have been successfully used for the identification of bone infections. This multinational, phase III clinical study in 22 European centres was undertaken to compare anti-granulocyte imaging using the murine IgG antibody besilesomab (Scintimun) with (99m)Tc-labelled white blood cells in patients with peripheral osteomyelitis.. A total of 119 patients with suspected osteomyelitis of the peripheral skeleton received (99m)Tc-besilesomab and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells (WBCs) in random order 2-4 days apart. Planar images were acquired at 4 and 24 h after injection. All scintigraphic images were interpreted in an off-site blinded read by three experienced physicians specialized in nuclear medicine, followed by a fourth blinded reader for adjudication. In addition, clinical follow-up information was collected and a final diagnosis was provided by the investigators and an independent truth panel. Safety data including levels of human anti-mouse antibodies (HAMA) and vital signs were recorded.. The agreement in diagnosis across all three readers between Scintimun and (99m)Tc-HMPAO-labelled WBCs was 0.83 (lower limit of the 95% confidence interval 0.8). Using the final diagnosis of the local investigator as a reference, Scintimun had higher sensitivity than (99m)Tc-HMPAO-labelled WBCs (74.8 vs 59.0%) at slightly lower specificity (71.8 vs 79.5%, respectively). All parameters related to patient safety (laboratory data, vital signs) did not provide evidence of an elevated risk associated with the use of Scintimun except for two cases of transient hypotension. HAMA were detected in 16 of 116 patients after scan (13.8%).. Scintimun imaging is accurate, efficacious and safe in the diagnosis of peripheral bone infections and provides comparable information to (99m)Tc-HMPAO-labelled WBCs.

Topics: Adult; Animals; Chronic Disease; Female; Humans; Immunoglobulin G; Inflammation; Leukocytes; Mice; Middle Aged; Osteomyelitis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Vital Signs

Radiolabeled leukocyte scintigraphy is a well-established technique for the diagnosis of inflammation and infection with a typical presentation of a hot spot within the abnormal areas. However, in some cases of osteomyelitis of the axial skeleton, a cold defect pattern has been described. Tc-99m ciprofloxacin is a new agent claimed to be specific for imaging sites containing viable bacteria. In this report, we present three cases of proved bacterial infection of the axial skeleton with a mismatch pattern between Tc-99m ciprofloxin and tagged leukocytes. Although Tc-99m-labeled leukocyte scanning showed a cold defect, probably caused by bone marrow replacement, the Tc-99m ciprofloxacin consecutively revealed a hot spot at the site of infection. These data suggest that Tc-99m ciprofloxacin should be a better agent than radiolabeled leukocytes for detecting osteomyelitis of the axial skeleton.

Topics: Adult; Anti-Infective Agents; Ciprofloxacin; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Exametazime

Topics: Aged; Anti-Bacterial Agents; Diabetes Complications; Female; Fluorodeoxyglucose F18; Humans; Leukocytes; Male; Osteomyelitis; Positron Emission Tomography Computed Tomography; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Skull Base; Technetium Tc 99m Exametazime

An adult male rhesus macaque (

Topics: Animals; Brain; Inflammation; Leukocytes; Macaca mulatta; Male; Monkey Diseases; Osteomyelitis; Prostheses and Implants; Prosthesis-Related Infections; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Skull; Technetium Tc 99m Exametazime

There is no consensus yet on the best protocol for planar image acquisition and interpretation of radiolabelled white blood cell (WBC) scintigraphy. This may account for differences in reported diagnostic accuracy amongst different centres.. This was a multicentre retrospective study analysing 235 WBC scans divided into two groups. The first group of scans (105 patients) were acquired with a fixed-time acquisition protocol and the second group (130 patients) were acquired with a decay time-corrected acquisition protocol. Planar images were interpreted both qualitatively and semiquantitatively. Three blinded readers analysed the images.. The most accurate imaging acquisition protocol comprised image acquisition at 3 - 4 h and at 20 - 24 h in time mode with acquisition times corrected for isotope decay.. Using this protocol, visual analysis had high sensitivity and specificity in the diagnosis of infection. Semiquantitative analysis could be used in doubtful cases, with no cut-off for the percentage increase in radiolabelled WBC over time, as a criterion to define a positive scan.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Female; Hip Prosthesis; Humans; Knee Prosthesis; Leukocytes; Male; Middle Aged; Osteomyelitis; Perfusion Imaging; Prosthesis-Related Infections; Radiopharmaceuticals; Sensitivity and Specificity; Single-Blind Method; Soft Tissue Infections; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

The goal of this teaching case study is to demonstrate the novel use of (99m)Tc-HMPAO-labeled white blood cells (WBCs) in diagnosing chronic recurrent multifocal osteomyelitis (CRMO). (99m)Tc-HMPAO-labeled white blood cells were utilized to diagnose CRMO. Classically, CRMO is evaluated scintigraphically using (99m)Tc-methylene diphosphonate/hydroxymethylene diphosphonate. (99m)Tc-HMPAO-labeled WBCs were chosen over (111)In-labeled WBCs because of the former's improved imaging characteristics and decreased radiation dose. (99m)Tc-HMPAO-labeled WBCs were successful in diagnosing CRMO. (99m)Tc-HMPAO-labeled WBC scanning is specific for the diagnosis of CRMO.

Topics: Child; Humans; Leukocytes; Magnetic Resonance Imaging; Male; Osteomyelitis; Technetium Tc 99m Exametazime

Two cases of successful detection of inflammatory foci using Tc-99m exametazime (HMPAO)-labeled leukocyte scintigraphy in premature infants were reported. Necrotizing enterocolitis was detected in a child with a body weight of 1.6 kg. Scintigraphy confirmed a neonatal osteomyelitis in the distal part of the leg of another patient weighing 2.2 kg. These 2 cases indicate that it is feasible to perform Tc-99m HMPAO-labeled leukocyte scintigraphy even if the blood sample volume is lower than the minimal volumes required by the guidelines for pediatric patients.

Topics: Enterocolitis, Necrotizing; Female; Humans; Infant; Isotope Labeling; Leukocytes; Osteomyelitis; Pregnancy; Premature Birth; Radionuclide Imaging; Technetium Tc 99m Exametazime

White blood cell (WBC) scintigraphy is considered the nuclear medicine imaging gold standard for diagnosing osteomyelitis in the diabetic foot. Recent papers have suggested that the use of (18)F-FDG PET/CT produces similar diagnostic accuracy, but clear interpretation criteria have not yet been established. Our aim was to evaluate the role of sequential (18)F-FDG PET/CT in patients with a high suspicion of osteomyelitis to define objective interpretation criteria to be compared with WBC scintigraphy.. Thirteen patients whom clinicians considered positive for osteomyelitis (7 with ulcers, 6 with exposed bone) were enrolled. The patients underwent (99m)Tc-exametazime WBC scintigraphy with acquisition times of 30 min, 3 h, and 20 h and sequential (18)F-FDG PET/CT with acquisition times of 10 min, 1 h, and 2 h. A biopsy or tissue culture was performed for final diagnosis. Several interpretation criteria (qualitative and quantitative) were tested.. At final biopsy, 7 patients had osteomyelitis, 2 had soft-tissue infection without osteomyelitis, and 4 had no infection. The best interpretation criterion for osteomyelitis with WBC scintigraphy was a target-to-background (T/B) ratio greater than 2.0 at 20 h and increasing with time. A T/B ratio greater than 2.0 at 20 h but stable or decreasing with time was suggestive of soft-tissue infection. A T/B ratio of no more than 2.0 at 20 h excluded an infection. Thus, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for osteomyelitis were 86%, 100%, 100%, 86%, and 92%, respectively. For (18)F-FDG PET/CT, the best interpretation criterion for osteomyelitis was a maximal standardized uptake value (SUVmax) greater than 2.0 at 1 and 2 h and increasing with time. A SUVmax greater than 2.0 after 1 and 2 h but stable or decreasing with time was suggestive of a soft-tissue infection. An SUVmax less than 2.0 excluded an infection. (18)F-FDG PET at 10 min was not useful. Using these criteria, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for osteomyelitis were 43%, 67%, 60%, 50%, and 54%, respectively. Combining visual assessment of PET at 1 h and CT was best for differentiating between osteomyelitis and soft-tissue infection, with a diagnostic accuracy of 62%.. (18)F-FDG PET/CT, even with sequential imaging, has a low diagnostic accuracy for osteomyelitis and cannot replace WBC scintigraphy in patients with diabetic foot.

Topics: Aged; Aged, 80 and over; Diabetic Foot; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Image Processing, Computer-Assisted; Leukocytes; Male; Middle Aged; Osteomyelitis; Positron-Emission Tomography; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Exametazime; Time Factors; Tomography, X-Ray Computed

In this article, we present a rare case of B-cell bone lymphoma in a child with multifocal asymptomatic lesions detected by bone scintigraphy and a chronic clinical history characterized by limping and fever episodes for over a year. Initially, multifocal osteomyelitis was suspected and antibiotic therapy was administered with no clinical improvement. The biopsy of the main lesion in the left distal femur along with bone marrow cytology established the final diagnosis. This rare case illustrates the utility of routinely low cost-effective nuclear medicine studies like whole body bone scan and 99mTc hexamethylpropyleneamine oxime-labeled leukocytes to orientate similar cases to a correct diagnosis.

Topics: Antineoplastic Agents; Bone Neoplasms; Child, Preschool; Diagnosis, Differential; Gait; Humans; Leukocytes; Lymphoma, B-Cell; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Diagnosis, Differential; Female; Hemangioma; Humans; Leukocytes; Lumbar Vertebrae; Middle Aged; Osteomyelitis; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC) with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. 99mTc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. 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 camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of99mTc-HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.

Topics: Aged; Brain Abscess; Humans; Leukocytes; Male; Osteomyelitis; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Exametazime; Temporal Bone; Tomography, Emission-Computed, Single-Photon

Our objective in this study was to evaluate whether measurement of quantitative uptake of (99m)Tc-methylene diphosphate (MDP) and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO) white blood cells (WBCs) is useful in detecting osteomyelitis in peripheral bony lesions.. Twenty-four patients (12 men and 12 women; age range, 25-72 y) were referred for imaging because of clinically suspected osteomyelitis. They had a traumatic fracture (n = 10), knee prosthesis (n = 5), hip prosthesis (n = 2), diabetic foot (n = 4), or chronic osteomyelitis (n = 3). Three-phase bone scanning and (99m)Tc-HMPAO WBC studies were performed on all patients within the same week. Regions of interest were drawn over the abnormal bony sites and the contralateral normal sites, and the abnormal-to-normal uptake ratios (A/N ratios) were obtained for both studies.. All patients had abnormal findings on 3-phase bone scanning, whereas 17 (71%) had abnormal findings on (99m)Tc-HMPAO WBC studies, of which 15 were confirmed to be true-positive. In those 15 patients, the mean A/N ratios for (99m)Tc-MDP and (99m)Tc-HMPAO WBC were 3.0 +/- 1.6 (range, 1.3-6.2) and 1.8 +/- 0.3 (range, 1.4-2.2), respectively. In the other 9 patients, whose scan results were clinically confirmed to be true-negative, the mean A/N ratios for (99m)Tc-MDP and (99m)Tc-HMPAO WBC were 2.1 +/- 1.2 and 1.2 +/- 0.2, respectively. In the group with a (99m)Tc-MDP A/N ratio greater than 2 (n = 15), 87% (13/15) had a high (99m)Tc-HMPAO WBC A/N ratio (>1.5), including 2 that were false-positive. In the remaining 2 patients, one with chronic osteomyelitis and the other with a recent hip prosthesis, (99m)Tc-HMPAO WBC ratios were normal. In the group with a bone A/N ratio of less than 2 (n = 9), only 4 patients (44%) were true-positive for acute osteomyelitis.. (99m)Tc-MDP bone scanning alone, with an A/N ratio of more than 2, is useful in detecting osteomyelitis in violated bone except in the case of a recent hip prosthesis or chronic osteomyelitis.

Topics: Adult; Aged; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical.. We compared the diagnostic values of labelled leucocyte scanning with Tc(99)m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty-one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of > or = grade 3 according to the classification of Wagner.. Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%.. Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.

Topics: Adult; Aged; Biopsy; Blood Sedimentation; Bone and Bones; Bone Marrow; C-Reactive Protein; Diabetic Foot; Female; Humans; Isotope Labeling; Leukocyte Count; Leukocytes; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

We wished to determine the frequency and significance of cold bone defect on granulocytes labelled with technetium-99-m-hexamethylpropyleneamine oxime (99mTc-HMPAO-PMN) in non-spinal bone infection. Cold bone defect was investigated as part of a retrospective review during a 2-y period. Patients who had possible osteoarticular infection underwent bone scintigraphy combined with 99mTc-HMPAO-PMN for diagnosis and follow-up. Osteomyelitis was confirmed by isolation of the responsible pathogen. Among 210 patients who had possible infection, 17 (8%) demonstrated a cold bone defect. The site of cold bone defect was for all patients the hip. All 17 patients had proven bacterial orthopaedic hardware-related infection. The single causative micro-organism was staphylococcus. Whatever the outcome, cold bone defect was constant regardless of follow-up equal to or longer than 18 months. These data suggest that this uncommon scintigraphic pattern is an indication of an infectious process similar to increased uptake.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Reactive; Bone and Bones; Female; Follow-Up Studies; Granulocytes; Humans; Image Enhancement; Male; Middle Aged; Osteomyelitis; Prosthesis-Related Infections; Radionuclide Imaging; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Survival Rate; Technetium Tc 99m Exametazime; Treatment Outcome

Topics: Abscess; Coronary Artery Bypass; Diagnosis, Differential; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Staphylococcal Infections; Sternum; Surgical Wound Infection; Technetium Tc 99m Exametazime

The aim of this study was to evaluate, retrospectively, the diagnostic value of Tc hexamethylpropylene amine oxime (99mTc-HMPAO) labelled autologous leucocytes for the preferred septic localizations of the infection of the endoprosthesis. We retrospectively reviewed 67 patients with implanted endoprostheses. Diagnosis was found in 42/67 patients. In 25/67 patients we were able to negate an acute pathological process of infection of the endoprosthesis. Our patients were divided into three groups according to the type of endoprosthesis (hip joint, knee joint, shoulder joint). The localizations of the endoprosthesis disorders are shown. The preferred localizations of the acute infection of the hip endoprosthesis are the regio intertrochanterica and the middle part of the shaft of the prosthesis. The preferred localization of the acute infection of the knee endoprosthesis is the proximal shaft of the tibia. The preferred localization of the acute infection of the shoulder endoprosthesis is the distal end of the prosthesis in the proximal humerus. It is hoped that the knowledge of these preferred localizations of infection of endoprosthesis will help patients and doctors in diagnosis and treatment in the future.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Bacterial Infections; Female; Hip Prosthesis; Humans; Joint Prosthesis; Knee Prosthesis; Leukocytes; Male; Middle Aged; Osteomyelitis; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Shoulder Joint; Technetium Tc 99m Exametazime

Topics: Child; Humans; Leukocytes; Lung; Male; Osteomyelitis; Pulmonary Embolism; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Staphylococcal Infections; Technetium Tc 99m Exametazime

The aim of this prospective study was to assess the role of 99mTc-HMPAO leucocyte scintigraphy combined with a 99mTc-MDP bone scintigraphy in the diagnosis of the diabetic foot infection (HMPAO-Leu/MDP).. 75 diabetic patients with suspected osteomyelitis were included. The HMPAO-Leu/MDP scan was considered to be consistent with osteomyelitis when the HMPAO-Leu uptake was concordant in all the incidences with an MDP bone uptake. A HMPAO-Leu uptake without concordant bone MDP activity was considered as a soft-tissue infection. The results of the HMPAO-Leu/MDP scan were compared to the following diagnostic criteria: bone infection was confirmed by radiological follow-up or bone biopsy; the absence of bone infection was confirmed by clinical (healing of the ulcer without antibiotherapy) and radiological follow up.. According to these criteria, among the 83 ulcers, bone infection was observed in 41 (49.4%): the HMPAO-Leu/MDP scan was positive in 38 cases, including 14 ulcers with normal or doubtful radiographs at inclusion. In the group of 42 ulcers without proven bone infection, the HMPAO-Leu/MDP scan was negative in 41 cases, including 17 lesions with a soft-tissue infection.. With a sensitivity of 92.6%, a specificity of 97.6%, the HMPAO-Leu/MDP scan is a reliable tool for the diagnosis of osteomyelitis in the diabetic foot. Neuroarthropathy did not affect the performances of the HMPAO-Leu/MDP scan. Owing to a high spatial resolution this test is very helpful to differentiate bone infection from soft-tissue infection especially in case of neuroarthropathy.

Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Diabetic Foot; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Chronic Disease; Female; Femur; Fistula; Humans; Leukocytes; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Skin; Soft Tissue Infections; Technetium Tc 99m Exametazime

Avascular osteonecrosis can be associated with septic arthritis and osteomyelitis. Combined labeled leukocyte-marrow imaging scintigraphy has demonstrated excellent accuracy for the detection of infection since both tracers accumulate in the bone marrow and only leukocytes accumulate in infection. We report an unusual total absence of 99mTc HMPAO leukocytes/9mTc-sulfur colloid tracer accumulation, not only in the femoral head but also in the acetabulum and hip in hip osteonecrosis secondary to septic arthritis and osteomyelitis.

Topics: Acetabulum; Arthritis, Infectious; Bone Marrow; Chemotaxis, Leukocyte; Female; Femur Head Necrosis; Gallium Radioisotopes; Humans; Leukocytes; Middle Aged; Osteomyelitis; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

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 diagnosis of diabetic foot osteomyelitis is often difficult both clinically and radiologically with a delay in radiological sign occurrence and difficulties of imaging interpretation. Bone biopsy is known to be the diagnosis gold standard. However, if negative, the diagnosis of osteomyelitis cannot be excluded and this method is not harmless. An early diagnosis of osteomyelitis is necessary to start an antibiotic treatment in conjunction with conservative surgery. (99m)Tc-HMPAO labelled leucocyte scintigraphy performed in conjunction with bone scintigraphy significantly contributes to the diagnosis of osteomyelitis (sensitivity=100% and specificity > 95%). In case of osteomyelitis suspicion, after plain radiography, the (99m)Tc-MDP bone scintigraphy is the first step. If negative, osteomyelitis is unlikely. If positive, a (99m)Tc-HMPAO leucocyte scintigraphy should be performed in order to exclude or to confirm the diagnosis of bone infection.

Topics: Diabetic Foot; Humans; Osteomyelitis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime

The results of the survey carried out in our country during the present year on the nuclear medicine studies in infectious and inflammatory studies during 1999 are presented. They survey was sent to 89 centers with a nuclear medicine service, 45 of which were publicly owned and 44 of which were privately owned. A total of 32 centers (36%) replied to the survey. 51.1% (23 out of 45) of the public hospitals responded but only a 20.5% (9 out of 44) of the private ones did.A total of 70.92% (4,344) out of the 6,125 explorations were carried out to discard and infectious process and 29.07% (1,781) to discard inflammation. The most frequent indication was to discard infections resulting from bone prostheses (2,099 explorations accounting for 48.31% of the total infectious process), followed by bone infection or osteomyelitis (965 explorations, 22.21% of the total). Within the osteomyelitis cases, acute processes motivated the most frequent requests (60.31% of all osteomyelitis cases). Assessment of the scope and localization of the intestinal inflammatory disease was the most frequent request in the inflammation group. Concerning the radiopharmaceuticals used, 99mTc HMAPO or 111I marked-leukocytes were ranked first, these accounting for 47% of the cases. Gallium, used in 44% of all cases, was the second most frequently used, even though it continues to be the more commonly used radiopharmaceuticals for infectious processes.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Drug Utilization; Fever of Unknown Origin; Gallium Radioisotopes; Health Care Surveys; Hospitals, Public; Humans; Infections; Inflammation; Intestinal Diseases; Iodine Radioisotopes; Leukocytes; Nuclear Medicine; Osteomyelitis; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Spain; Technetium Tc 99m Exametazime

Topics: Abscess; Aged; Aged, 80 and over; Humans; Intervertebral Disc Displacement; Leukocytes; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Thoracic Vertebrae

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

In this study, the diagnostic value of Tc-99m hexamethylpropylene amine oxime (HMPAO) leukocyte scans and the role of additional SPECT in the diagnosis of bone infection were evaluated.. The Tc-99m HMPAO leukocyte scans of 37 patients with clinically suspected bone infection were reviewed. The patients were divided into two groups according to the presence of orthopedic implants. Early (4 to 6 hours) and delayed (18 to 20 hours) planar images and early SPECT images were obtained. The final diagnosis of infection was made based on the pathologic, bacteriologic, and surgical data and clinical follow-up.. Group 1 (25 patients with orthopedic implants) included 15 true-positive, 1 false-negative, 7 true-negative, and 2 false-positive results. Group 2 (12 patients without orthopedic implants) included 7 true-positive, 1 false-negative, and 4 true-negative results. The overall sensitivity of the Tc-99m HMPAO leukocyte scan with SPECT to detect bone infection was 92%, with a specificity rate of 85%. (Group 1: sensitivity, 94%; specificity, 78%. Group 2: 88% and 100% sensitivity and specificity, respectively.). The Tc-99m HMPAO leukocyte scan is useful in the diagnosis of bone infection, regardless of the presence of orthopedic implants. The additional SPECT images may be helpful to localize the site of infection more accurately.

Topics: Adult; Case-Control Studies; Female; Humans; Leukocytes; Male; Osteomyelitis; Prostheses and Implants; Prosthesis-Related Infections; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We report here the results of a validation study of the avidin/indium-111 biotin approach in patients with skeletal lesions. This study involved 54 patients with orthopaedic conditions: 20 patients with intermediate suspected osteomyelitis of the trunk, 19 patients with infection/inflammation of prosthetic joint replacements, and 15 patients with suspected osteomyelitis of appendicular bones. Avidin (3 mg) was injected as an i.v. bolus, followed 4 h later by 111In-biotin; imaging was acquired 30 min and 16-18 h after administration of 111In-biotin. Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocyte scintigraphy was performed in 39/54 patients. The overall sensitivity of the avidin/111In-biotin scan was 97.7% (versus 88.9% for 99mTc-HMPAO leucocyte scintigraphy). While the diagnostic performance of avidin/111In-biotin scintigraphy was similar to that of 99mTc-HMPAO leucocyte scintigraphy in patients with prosthetic joint replacements or osteomyelitis of appendicular bones, the avidin/111In-biotin approach clearly performed better than 99mTc-HMPAO leucocyte scintigraphy in patients with suspected osteomyelitis of the trunk (100% sensitivity, specificity and accuracy versus 50% sensitivity, 100% specificity and 66.7% accuracy for 99mTc-HMPAO-leucocyte scintigraphy). These results demonstrate the feasibility of the avidin/111In-biotin approach for imaging sites of infection/inflammation in the clinical setting. Although no systematic advantages of avidin/111In-biotin scintigraphy were found versus 99mTc-HMPAO leucocyte scintigraphy, the newer scintigraphic method is more practicable and involves lower biological risk for the operators.

Topics: Avidin; Biotin; Discitis; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Early diagnosis of osteomyelitis is helpful for a successful conservative treatment. The value of bone scanning combined with granulocytes labeled with hexamethylpropylene amine oxime (HMPAO) granulocyte-Tc99m (GN) radionuclide imaging (combined [RI]) with magnetic resonance imaging (MRI) for the diagnosis of osteomyelitis was assessed in 24 diabetic patients with foot ulcers. Evidence of osteomyelitis was based on the presence of at least one of the following criteria: (1) clinical bone involvement, (2) radiological bone involvement, (3) both positive combined RI and MRI, and (4) evidence of clinical bone involvement during the follow-up period. Thirteen patients had osteomyelitis. Seven patients had clinical bone involvement (sensitivity, 54%), five had radiological bone involvement (sensitivity, 38%), and 10 had positive combined RI for osteomyelitis (sensitivity, 77%). MRI demonstrated a higher sensitivity (100%). The specificity for combined RI and MRI was 82%. These results lead to a new diagnostic strategy for the early detection of minimal or localized osteomyelitis to avoid amputations. MRI is most appropriate following a negative x-ray in determining whether to treat osteomyelitis, since a negative MRI result rules out osteomyelitis. Antibiotic therapy should be used in the case of a positive MRI result, but Charcot joint disease can lead to false-positive MRI results. In this case, combined RI should be performed.

Topics: Aged; Bone Marrow; Diabetes Complications; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Time Factors; Treatment Outcome

We conducted a prospective study in order to evaluate the contribution of technetium-99m hexamethylpropylene amine oxime (HMPAO) labelled leucocyte scintigraphy to the diagnosis and follow-up of osteomyelitis in the diabetic foot. The study was conducted between October 1992 and November 1996 and included 42 patients (30 men and 12 women; mean age 63 years) with diabetes mellitus (type 1, n = 22, type 2, n = 20) who had a total of 56 diabetic foot ulcers. The initial exploration included standard radiography, three-phase bone scintigraphy and 99mTc-HMPAO labelled leucocyte scintigraphy (HMPAO-LS), performed within a 3-day interval. For the 56 ulceration sites, 26 cases of osteomyelitis were diagnosed: ten on the basis of radiographic and histological/bacteriological criteria after bone biopsy, 11 after radiographic follow-up and five on the basis of biopsy results alone. No osteomyelitis was present at 30 sites, there were seven cases of cellulitis. The sensitivity and specificity of 99mTc-HMPAO-LS were 88.4% and 96.6% respectively (23 true-positives, 29 true-negatives, one false-positive, three false-negatives). The accuracy of radiography, 99mTc-methylene diphosphonate and HMPAO-LS was 69.6%, 62.5%, and 92.9%, respectively. Follow-up scintigraphy (n = 14) 4 months after initial diagnosis and 1 month after antibiotic withdrawal confirmed cure of osteomyelitis despite the absence of complete clinical regression of the ulcers. In conclusion, 99mTc-HMPAO labelled leucocyte scintigraphy was found to be an excellent method for the diagnosis of osteomyelitis in the diabetic foot. It can contribute to follow-up, particularly when clinical regression of perforating ulcers is incomplete and cure of osteomyelitis must be confirmed in order that antibiotic treatment may be discontinued.

Topics: Adult; Aged; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; False Negative Reactions; False Positive Reactions; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime

Technetium-99m labelled antigranulocyte antibodies are ready to use and are sensitive and specific in the diagnosis of infectious diseases. 99mTc-SSEA antigranulocyte antibodies have a very high affinity constant (Kd 10(-12) M) for human neutrophils (PMNs), and excellent imaging qualities with high target/background ratios. The aim of this study was to compare the diagnostic accuracy of the 99mTc-anti-SSEA-1 monoclonal antibody (Mab) with that of 99mTc-hexamethylpropylene amine oxime (HMPAO)-labelled white blood cells (WBCs). To this end, 17 patients with 23 proven infectious foci were examined with 555 MBq 99mTc-anti-SSEA-1 MAb and with 370 MBq 99mTc-HMPAO labelled autologous leucocytes within a period of 7 days. All the infections were confirmed by culture, biopsy, surgery and follow-up. Whole-body images and planar spot views with the antibody were performed at 1-h, 4-h and 24-h post injection; the biodistribution of the antibody was quantified, absorbed radiation doses were calculated and the diagnostic results were compared with the 99mTc-HMPAO WBC images. Human anti-mouse antibody (HAMA) evaluation was performed in all patients before and 3 months after antibody injection. Blood was drawn at different times after 99mTc-anti-SSEA-1 MAb injection to determine the amount of granulocyte-associated radioactivity and to calculate recovery. 99mTc-anti-SSEA-1 MAb scintigraphy detected all 23 lesions, while 21 were detected with 99mTc-HMPAO WBC scan. In this small group of patients, the sensitivity and specificity of 99mTc-anti-SSEA-1 MAb scintigraphy were 95% and 96% respectively, as compared with 91% and 82% respectively for 99mTc-HMPAO WBC scan. An increasing uptake of the injected activity in the lesion at different time points was indicative of high affinity and of specific PMN binding. There was no HAMA formation. In four of five patients investigated, a transient mild leukopenia was found at 15 min p.i.. There was increased uptake of the antibody in liver and spleen and normal uptake in kidneys and bone marrow. The estimated radiation doses for the whole body and the red bone marrow were 1.1x10(-2) cGy/37 MBq and 5.3x10(-2) cGy/37 MBq, respectively. The activity associated to the PMNs in vivo was 33.5%, 30.6%, 21.3% and 9% at 5, 15, 30 and 45 min. post-injection, respectively. It is councluded that use of 99mTc-anti-SSEA-1 antigranulocyte antibodies demonstrates promising results comparable to those obtained with 99mTc-labelled autologous WBCs. The 99

Topics: Adult; Animals; Antibodies, Monoclonal; Female; Humans; Leukocytes; Lewis X Antigen; Male; Mice; Osteomyelitis; Radiation Dosage; Radioimmunodetection; Radiopharmaceuticals; Soft Tissue Infections; Technetium; Technetium Tc 99m Exametazime; Tissue Distribution

We evaluated radiolabeled liposomes (liposomes labeled both with 99mTc and 111In) for the early detection of osteomyelitis in an experimental model.. Liposomes, containing 5% polyethylene glycol-distearoyl phosphatidylethanolamine with encapsulated glutathione and deferoxamine, were prepared and labeled with 99mTc and 111In by a previously described method. Acute osteomyelitis was induced in male New Zealand rabbits by intramedullary injection of sodium-morrhuate and Staphylococcus aureus in the tibial bone marrow. Serial imaging studies, consisting of radiolabeled liposome imaging (2-4 mCi 99mTc and 75-125 microCi 111In), 99mTc-methylene diphosphonate (MDP) (3-5 mCi) and 67Ga-citrate (500 microCi), were performed starting at the third day after injection. Each radionuclide study was separated by at least 2 days. The animals also underwent radiography of the lower extremities. The animals were then killed and the infected tibia was excised for histopathology.. For interpreting relative efficacy of individual radiopharmaceuticals, only animals showing positive histopathological findings (n = 9) were considered. Radiographs (Days 12, 13) were conclusive for osteomyelitis in only 3 rabbits. Radiolabeled liposome imaging (Days 4-6) showed positivity in 8 cases and was equivocal in 1. Though the lesion could be delineated as early as 8 hr postinjection in the 99MTc window, the best target-to-nontarget ratio (T/NT) of 1.86 +/- 0.19 was obtained at 48 hr in the 111In window. Three-phase 99mTc-MDP scan (Day 7) was positive in only 5 rabbits with 3 hr T/NT of 1.6 +/- 0.23. Galium-67-citrate images (Days 9-11) were positive in 8 cases and equivocal in 1, the mean 48 hr T/NT being 1.74 +/- 0.24. These results show liposomes are better than 99mTc-MDP for imaging bone infection. Given the early localization and better quality of the images, radiolabeled liposomes also exhibited advantages over 67Ga-citrate for detection of acute osteomyelitis.

Topics: Acute Disease; Animals; Citrates; Gallium; Indium Radioisotopes; Liposomes; Male; Osteomyelitis; Rabbits; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Posttraumatic osteomyelitis was investigated in 23 patients using nuclear medicine techniques. Tc-99m hexamethylpropilene amine oxime (HMPAO)-labeled leukocyte scintigraphy was performed in 11 patients, and Tc-99m nanocolloid scanning was performed in the other 12 patients. The scintigraphic findings were compared with clinical, laboratory, radiologic, and bacteriologic results. The findings on leukocyte imaging were consistent with the clinical symptoms in 7 of 11 patients, with the laboratory pattern in 7 of 10 patients, with the radiologic findings in 7 of 11 patients, and with the results of bacteriology in 6 of 7 patients. The findings on nanocolloid scintigraphy corresponded with the clinical symptoms in 9 of 12 patients, with the laboratory pattern in 8 of 10 patients, with the radiologic findings in 8 of 12 patients, and with the bacteriology in 4 of 5 patients. The results suggest that both methods were of similar value for the detection of chronic posttraumatic osteomyelitis regardless of whether the process was active. Conversely, on the basis of semiquantitative analysis of the images, leukocyte scintigraphy seemed to characterize the grade of inflammation better than did nanocolloid scintigraphy.

Topics: Adult; Aged; Bone and Bones; Chronic Disease; Escherichia coli Infections; Female; Femur; Follow-Up Studies; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Proteus Infections; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Staphylococcal Infections; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Exametazime; Thumb; Tibia

To evaluate the diagnostic value of technetium-99m d, l-hexamethylpropylene amine oxime (HMPAO) labelled leucocytes in combination with a 99mTc-methylene diphosphonate (MDP) bone scan in the detection of chronic osteomyelitis, we retrospectively reviewed 55 patients. Prior to the 99mTc-d,l-HMPAO labelled leucocyte scan, all patients underwent a 99mTc-MDP bone scan. The correct diagnosis was confirmed by long-term clinical follow-up (n=29) or by bacteriological cultures (n=26). We found an overall sensitivity of 94%, a specificity of 91% and an accuracy of 92% for 99mTc-d,l-HMPAO labelled leucocyte scintigraphy in the diagnosis of chronic osteomyelitis. When the patients were divided into three groups according to the location of the infection, our study results showed a sensitivity and specificity for the central location (containing active bone marrow) of 94% and 100% respectively; for the peripheral location (hands and feet) both parameters were 100%, and for the middle location (all sites between the central and the peripheral location) the values were 92% and 81% respectively. Specificity and accuracy were significantly lower in the middle location than in the central and peripheral locations. The results of our study confirm that a 99mTc-d,l-HMPAO labelled leucocyte scan in combination with an 99mTc-MDP bone scan is a reliable way to diagnose chronic osteomyelitis, except for vertebral osteomyelitis.

Topics: Case-Control Studies; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

To assess the value of imaging by 0.1 T MR and by 99mTc-HMPAO-labeled leukocytes in confirming skeletal infection in patients with soft-tissue infections and/or bone pathology.. Thirty-nine anatomical sites (35 patients) with suspected bone infection were prospectively imaged with 0.1 T MR and 99mTc-HMPAO-labeled leukocytes. Thirty-two infected areas were confirmed: 12 osteomyelitis (out of which 3 were spondylitis) and 27 soft-tissue infections (both bone and soft-tissue infection in 7 areas).. MR imaging showed 31 true-positive, 3 true-negative, 4 false-positive and one false-negative diagnosis of infection and scintigraphy 27, 7, 0 and 5 respectively. The sensitivity of MR for osteomyelitis was 100% (12/12) and of scintigraphy 42% (5/12), p<0.01. The specificity of MR and of scintigraphy for osteomyelitis were 81% (22/27) and 93% (25/27) respectively. The sensitivity of MR for soft-tissue infection was 96% (26/27) and specificity 75% (9/12). The correspoding figures for scintigraphy were 85% (23/27) and 100% (12/12). MR and scintigraphy were concordant with respect to the final diagnosis in 28/39 (72%) sites and discordant in 10 (26%). In one patient with Charcot osteoarthropathy a false-positive finding was found by both methods. MR detected all 3 cases of spondylitis, scintigraphy none. Nonpyogenic inflammations and neuroarthropathic joints were indistinguishable from infection by MR.. Combined imaging with MR and 99mTc-labeled leukocytes is recommended in diagnostically complicated bone infections except for spondylitis where MR is the method of choice. Congruent positive findings are highly suggestive of infection, the extent of which can be determined. Congruent negative results exclude infection.

Topics: Adolescent; Adult; Aged; False Positive Reactions; Female; Humans; Leukocytes; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Infections; Spondylitis; Technetium Tc 99m Exametazime

Nonspecific osteomyelitis in children and adolescents can be diagnosed in patients 2 to 16 years old and may present as acute, subacute or chronic. During the last 9 years, 40 pediatric patients (aged 2 to 16 years) affected with extra-axial inflammatory bone lesions were examined. The series of cases was then reviewed. This work was aimed at investigating the role of various imaging modalities: conventional radiology (CR), bone scan with technetium-99 methylene diphosphonate (99mTc-MDP), scintigraphy with technetium-esamethylpropylenaminoxima labelled leukocytes (99mTc-HMPAO), computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect the lesions, to make a differential diagnosis and to assess different disease stages. As for acute osteomyelitis (6 patients), CR showed a lytic lesion, periosteal new bone and soft tissue swelling in 4/6 patients; no abnormalities were demonstrated in the other two. Bone scan, CT and MRI depicted bone involvement. CT and MRI also showed inflammatory lesion spread to surrounding soft tissue. 99mTc-HMPAO scintigraphy was not performed in acute osteomyelitis, because of technical difficulties in performing the exam promptly; thus, the early diagnosis of lesion nature was made with bone biopsy. As for subacute osteomyelitis (23 patients), 99mTc-HMPAO scintigraphy was performed in 8/23 patients and proved to be a highly sensitive method, showing cell clusters and confirming the diagnosis of inflammatory lesion. MRI showed a focal area of intermediate-low signal intensity on T1-weighted sequences, with small focal intralesional areas of low intensity, a low-signal perifocal rim and diffusely low signal of surrounding bone marrow. T2-weighted images showed high signal intensity in both the abscess lesion and bone marrow, the latter probably due to edema. In 5 patients, a paramagnetic contrast agent (Gd-DTPA) was administered during MRI and showed inhomogeneous enhancement of both the inflammatory lesion and surrounding bone marrow. As for chronic osteomyelitis (7 patients), MRI was performed in 5/7 patients. In 4 patients the lesion appeared as a low-signal area on T1-weighted images while T2-weighted images showed an inhomogeneous high-signal area. In the same patients, 99mTc-HMPAO scintigraphy was always positive. In patient 5, the lesion was represented by a low-signal area on both T1 and T2-weighted images, while 99mTc-HMPAO was negative. Therefore, in chronic osteomyelitis, both MRI and 99mTc-HMPAO wer

Topics: Acute Disease; Adolescent; Biopsy; Bone and Bones; Child; Child, Preschool; Chronic Disease; Contrast Media; Female; Gadolinium; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oximes; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this study was to evaluate the diagnostic value of technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy (HMPAO-LS) by means of a retrospective review of 116 patients divided into three groups of bone and joint infection. One hundred and thirty-one LS examinations were performed, and 143 sites analysed. The final diagnosis of infection was based on surgical, histological and bacteriological data and follow-up. Ninety-four suspected localizations were examined in group 1, which included 74 patients with an infection suspected to involve orthopaedic implants. In this group, there were 38 true-positives, 1 false-negative, 49 true-negatives and 6 false-positives. Surgical confirmation was obtained in 34 cases. In group 2 (24 patients with suspected osteomyelitis), there were 27 localizations of which 14 were true-positives and 13 were true-negatives (including seven surgical confirmations). In group 3 (18 patients suspected of septic arthritis) there were eight true-positives, two false-negatives, ten true-negatives and two false-positives. Overall sensitivity of 99mTc-HMPAO-LS for the detection of bone and joint infection was 95%, with a specificity of 90% (group 1: sensitivity 97%, specificity 89%; group 2: 100% and 100%; group 3: 80% and 83%). It may be concluded that HMPAO-LS is an effective tool for the diagnosis of both bone infection involving implants and chronic osteomyelitis.

Topics: Arthritis, Infectious; Case-Control Studies; False Negative Reactions; False Positive Reactions; Humans; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Prostheses and Implants; Prosthesis-Related Infections; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Technetium-99m hexamethylpropylene amine oxime (HMPAO)-labeled leukocytes are well established for the investigation of inflammatory disease. Their kinetics and normal distribution are similar to those of indium-111-labeled leukocytes except for nonspecific activity in urine, kidneys, gall bladder, and bowel, which results from the elution of secondary 99mTc-labeled HMPAO complexes. The principal clinical indications for [99mTc]HMPAO-leukocytes include inflammatory bowel disease (IBD), osteomyelitis, soft tissue sepsis, and, to a lesser extent, occult fever. The superior resolution and count density of 99mTc places [99mTc]HMPAO-leukocytes at an advantage over 111In-leukocytes in IBD, especially for the identification of small bowel involvement in patients with Crohn's disease. However, quantification of disease activity is more difficult than with 111In. Technetium-99m HMPAO-leukocytes are indicated for most forms of acute soft tissue and abdominal sepsis, although when compared with 111In, it may be more difficult to demonstrate communication between an abdominal abscess and bowel lumen. Chronic osteomyelitis, including infected joint prostheses, are better approached with 111In-labeled leukocytes. Occult fever and fever of unknown origin (FUO) are more controversial. There is still a place for gallium-67 in FUO, of which there is a wide spectrum of causes. Occult fever implies a pyogenic cause for an undiagnosed fever and should probably be imaged with 111In-leukocytes. With the advances being made in other imaging modalities and in interventional radiology, there is a clear need for radionuclide agents that can be used for whole-body screening in patients with undiagnosed fever. Such agents may include fluorine-18-fluorodeoxy-glucose and radiolabeled monoclonal antibodies to endothelial adhesion molecules activated at the foci of inflammation.

Topics: Bone and Bones; Digestive System; Fever of Unknown Origin; Humans; Infections; Inflammatory Bowel Diseases; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Thoracic Diseases

Imaging of osteomyelitis and soft-tissue infections can be problematic with currently available agents; bone scans are often false-positive. Indium-111-oxine and 99mTc-HMPAO white blood cell (WBC) scans require ex vivo handling of blood with potential exposure to infectious agents, and 99mTc-antigranulocyte (IgG1) antibodies need 24 hr for final diagnosis.. We investigated the use of 99mTc-murine anti-granulocyte monoclonal Fab' fragment in 20 patients with suspected osteomyelitis of soft-tissue infections. All patients also had 99mTc bone scans and 111In-oxine or 99mTc-HMPAO white blood cell scans. The final diagnosis was confirmed by culture, biopsy, surgery, follow-up, x-rays, CT or MRI. In vitro studies performed on granulocytes demonstrated no effect on their function when the anti-granulocyte monoclonal antibody fragment was added.. Sensitivity, specificity and diagnostic accuracy to detect infection was 88%, 75% and 80%, respectively. All lesions could be detected as early as 1 hr after injection of the antibody fragment. In comparison, WBC scanning had values of 86%, 78% and 81%, respectively. Some lesions could only be detected 24 hr following the injection of labeled WBCs. LeukoScan had three false-positives and WBC scanning had two false-positives.. Immunoscintigraphy with 99mTc-NCA-90 Fab' fragments offers rapid localization of foci, rapid and simple use, a negligible HAMA response rate, no effect on granulocyte function and an accuracy comparable to WBC scanning.

Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Chemotaxis, Leukocyte; Female; Granulocytes; Humans; Infections; Male; Middle Aged; Nitroblue Tetrazolium; Organotechnetium Compounds; Osteomyelitis; Oximes; Phagocytosis; Radionuclide Imaging; Technetium Tc 99m Exametazime; Tetrazolium Salts; Thiazoles

Several radionuclides and different methods have been employed as cellular labels to study inflammatory sites in man. Here we present the results obtained with white blood cells (WBC) labeled with 99mTc using a simple and low cost new technique (SnTec). WBC were incubated with 12 micrograms/ml of stannous chloride for 10 min at room temperature. Then 99mTc was added. After 10 min, the 99mTc-labeled WBC were washed and injected into the patient. Comparison studies with 99mTc-labeled WBC using the HMPAO technique were carried out in patients with suspected osteomyelitis. Since the results are similar with both methods, we suggest the use of SnTec to label WBC, in cases of inflammatory diseases.

Topics: Adolescent; Adult; Female; Humans; Isotope Labeling; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime

Topics: Humans; Isotope Labeling; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Tissue Distribution

An 11-year-old girl presented with the clinical picture of osteomyelitis of the distal tibia. A bone scintigram, although abnormal, did not confirm the diagnosis, but a 99mTc leucocyte scan showed focal white cell uptake in the distal tibia. This was felt to confirm infection and subsequent aspiration revealed what was thought to be pus. However, histology of the aspirated material demonstrated Ewing's Sarcoma. The differential diagnosis and the place of scintigraphy in this clinical situation are discussed.

Topics: Bone Neoplasms; Child; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Organotechnetium Compounds; Osteomyelitis; Oximes; Radiography; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Exametazime; Tibia

Thirty-five patients with suspected chronic osteomyelitis related to an orthopaedic device had 50 99Tcm-HMPAO-labelled leucocyte scans (LS). The scan appearances were compared with the bacteriological or clinical results and gave a sensitivity and specificity of HMPAO-LS of 83 and 100%, respectively. Bacteriological examination is often inaccurate in the diagnosis of osteomyelitis and therefore we assessed the clinical utility of HMPAO-LS. When the clinical, biological and radiological data were clearly suggestive of osteomyelitis (16/50) LS was unhelpful or even misleading when falsely negative (3/16). When the clinical, biological and radiological data were poorly suggestive of osteomyelitis (20/50) or conflicting (14/50) LS was misleading in only one patient (false negative). It is concluded that HMPAO-LS should only be performed to assist in the diagnosis of chronic osteomyelitis when there is no preexisting strong suspicion based on clinical, biological and radiological signs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Chronic Disease; Female; France; Humans; Joint Prosthesis; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Orthopedic Equipment; Orthopedic Fixation Devices; Osteomyelitis; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Seven children (aged 7 to 16 years) with confirmed osteomyelitis underwent imaging with Tc-99m HMPAO labeled leukocytes and with Tc-99m diphosphonates. The patients were scanned at 1/2 hour and at 3 hours. The scans were evaluated visually, and the lesion-to-normal bone ratios were quantitated. All the lesions on leukocyte scans and six out of seven lesions in bone scans were readily detectable 1/2 hour after injection of the radiopharmaceutical, but 3 hours is the better imaging time. In quantitative analysis, the lesion-to-normal bone ratio increased with leukocytes significantly higher than with the bone scans (P less than 0.05). When the scintigraphic findings were compared with surgical and radiologic results, the leukocyte images detected and localized lesions better than the bone scans. According to these preliminary results, Tc-99m HMPAO labeled leukocytes seem to offer a rapid and accurate method for detecting bone infections.

Topics: Adolescent; Bone and Bones; Child; Diphosphonates; Female; Humans; Leukocytes; Male; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Time Factors

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteoarthritis; Osteomyelitis; Oximes; Prosthesis-Related Infections; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Antibodies, Monoclonal; Cell Movement; Granulocytes; Hip Prosthesis; Humans; Indium Radioisotopes; Kinetics; Knee Prosthesis; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oximes; Oxyquinoline; Radionuclide Imaging; Surgical Wound Infection; Technetium Tc 99m Exametazime; Tissue Distribution

Topics: Animals; Blood Platelets; Cattle; Cell Survival; Escherichia coli Infections; Humans; Indium Radioisotopes; Isotope Labeling; Lipids; Mice; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oximes; Pyridines; Rabbits; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Solubility; Technetium Tc 99m Exametazime; Thiones; Tissue Distribution; Tropolone

Labelling leucocytes with 99Tcm using hexamethylpropyleneamine oxime (HMPAO) utilizes the advantages of technetium over indium in imaging inflammation. A retrospective study has been performed on 43 consecutive patients imaged with 99Tcm HMPAO labelled leucocytes in order to assess the reliability of the technique. Particular attention was paid to the different handling characteristics of the 99Tcm HMPAO labelled cells compared with those labelled with indium. It was found that 99Tcm HMPAO labelled leucocytes gave an overall accuracy of 93.2%, a sensitivity of 92.8%, a specificity of 93.3% and a positive predictive value of 86%. 99Tcm HMPAO labelled leucocyte scanning provides a reliable method of imaging inflammation, though errors in interpretation may occur due to the hepato-biliary excretion of activity that occurs with this technique.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Crohn Disease; Humans; Inflammation; Leukocytes; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Pelvis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Exametazime

The uptake of white blood cells (WBC) into normal bone marrow may lead to difficulty in detecting bone infection. Twenty-one patients in whom the WBC scan was equivocal or positive underwent a technetium 99m colloid scan to show the distribution of bone marrow. Six patients had a positive WBC scan, and in five of them a discordant colloid scan confirmed infection. However, in one the colloid scan was concordant, indicating that the WBC activity was not due to infection but the result of normal bone marrow uptake. Fifteen patients had an equivocal WBC scan. In 14, infection was excluded by a concordant scan, and 1 patient with a discordant scan was lost to follow-up. We conclude that the combination of a WBC scan and a colloid scan is an effective method to distinguish infection from normal bone marrow activity and, in particular, reduces the number of incorrect diagnoses of infection.

Topics: Bone Marrow; Female; Hip Prosthesis; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Sulfur Colloid

The use of labelled granulocyte scintigraphy is recognized as a reliable method for detecting osteomyelitis and other skeletal sepsis. Tc-99m hexamethyl propyleneamine oxime (Tc-99m HM-PAO), a lipophilic chelate offers the advantages of availability, lower radiation dose and higher image resolution, compared to other labelling agents. We have scanned 36 orthopedic patients with suspected infection, using autologous granulocytes labelled with Tc-99m HM-PAO. In all cases, scans were compared with clinical, microbiological and/or surgical findings. Sensitivity was 94% and specificity was 80%. We therefore believe that Tc-99m HM-PAO leucocyte scanning provides a useful method for detecting osteomyelitis and other skeletal infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Female; Granulocytes; Hip Prosthesis; Humans; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Predictive Value of Tests; Radionuclide Imaging; Surgical Wound Infection; Technetium Tc 99m Exametazime

Topics: Adolescent; Adult; Aged; Chronic Disease; Diphosphonates; Female; Gallium Radioisotopes; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Exametazime

Fifty-five patients with 60 suspected infections of bones or joints were studied with 99mTc-hexamethylpropyleneaminooxine- (HMPAO-) labelled leucocytes and 99mTc-labelled antigranulocyte antibodies, in part supplemented with 99mTc-labelled nanocolloid. The findings using the different procedures were in good agreement. Apart from in vertebral lesions, a negative scan--even if the radionuclide bone scan is positive--excludes an infection with high probability (sensitivity 94%). The low specificity (57%) is due to positive imaging of various non-infected lesions. Spondylitis usually shows as non-specific cold lesions. A subtraction technique with computer assisted analysis of HMPAO and nanocolloid scans provides a more precise diagnosis of this condition.

Topics: Adolescent; Adult; Aged; Antibodies; Arthritis, Infectious; Diagnosis, Differential; Evaluation Studies as Topic; Female; Granulocytes; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime

Topics: Arthritis, Infectious; Bacterial Infections; Focal Infection; Humans; Immunoglobulin G; Indium Radioisotopes; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Adult; Aged; Humans; Leukocytes; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

70 patients with confirmed (23 patients) or suspected (47 patients) bacterial infection in the skeleton following diseases, injuries or operations in orthopedic surgery were investigated using Tc-99m-HMPAO leucocyte scintigraphy in order to evaluate the accuracy of this procedure. Infections could be detected correctly in 37 of 70 patients (right positives) while 28 patients had negative scans corresponding to the clinical course (right negatives). One false negative finding was observed. Five patients with clinically suspected infection had a focal uptake in the WBC-scan and were not operated subsequently. They range as false positive results, although they belong to a special group (Infection: Yes-Operation: No [IYON]-group). In the assessment of the Tc-99m-HMPAO-WBC-scan there was a senstivity of 97.1%, specificity of 82.9% and an overall accuracy of 90%. The method is suitable for detection of early and late infection as well as chronic or hematogenous osteomyelitis in the locomotor system. This means an important contribution in diagnosis of infection determining further operative or conservative treatment.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Child; Female; Follow-Up Studies; Fracture Fixation, Internal; Hip Prosthesis; Humans; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Surgical Wound Infection; Technetium Tc 99m Exametazime

Six patients with proven or suspected osteomyelitis were studied with both 99mTc-HMPAO-labelled leukocytes and 99mTc-nanocolloid. In all cases the findings of both procedures were in good agreement. In 3 patients there was markedly increased accumulation of labelled cells and colloid, respectively. Two patients showed slightly increased accumulation of both agents and in one patient the finding was (correctly) negative. Further studies are necessary to determine whether or not colloid scintigraphy might replace the time-consuming leukocyte scintigraphy.

Topics: Adult; Aged; Colloids; Female; Humans; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Exametazime

Two weeks after the introduction of osteomyelitis in three dogs, autologous leukocytes were dual-labeled with both [99mTc]HM-PAO and [111In]tropolonate, and reinjected. Blood sampling and imaging were then performed. Two weeks later, the same dogs received simultaneous injections of singly-labeled [99mTc]WBC and [111In]WBC for comparison. For both studies, blood samples were drawn over 6 hr to determine the respective blood clearance half-time (TB) and % recovery (%R0) of cell-bound radioactivity. There were no significant differences in the average TB results of the 99mTc and 111In groups, either within or between the dual- and singly-labeled studies. The %R0 of singly-labeled [99mTc]WBC was about half that of the other groups (p less than 0.01); however, this difference was attributed to the dissimilar radiochemical purity of the [99mTc]HM-PAO reagents. Region of interest analysis of the 6 and 24 hr images revealed no significant differences between either cell label in the relative or absolute in vivo uptake at known sites of osteomyelitis, noninfected surgery, and normal bone marrow.

Topics: Animals; Cycloheptanes; Dogs; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium; Technetium Tc 99m Exametazime; Tropolone

Topics: Adult; Aged; Female; Gastrointestinal Diseases; Humans; Inflammation; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime

Topics: Adult; Aged; Aged, 80 and over; Arthritis; Female; Gallium Radioisotopes; Humans; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Technetium Tc 99m Exametazime