technetium-tc-99m-exametazime and Spondylitis

Abdominal scintigraphy shows silent gut inflammation in patients with spondyloarthropathies (Sp) without clinical evidence of gut inflammation. Abdominal scintigraphy images are different than those obtained in patients with ulcerative colitis or Crohn's disease and are not related to the anti-inflammatory drugs administered. The aim of this study was to examine the clinical associations of findings on abdominal scintigraphy in patients with Sp. A total of 204 Sp patients (European Spondylarthropathy Study Group 1991 criteria) and 54 non-Sp controls receiving non-steroidal anti-inflammatory drugs were studied. Abdominal scintigraphy images were obtained at 30 and 120 min after injection of technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes. 99mTc-HMPAO-labelled leucocyte scans were positive in 104 Sp patients (50.9%) and in six non-Sp controls (2.9%) (P<0.001; OR=8.32; 95% CI=3.23-22.67). Silent gut inflammation was not associated with any of the following: age of onset, duration of evolution, sex, family history of Sp or psoriasis, articular manifestations, extra-articular manifestations, radiological findings or HLA-B27 positivity. Positive abdominal scintigraphy was associated with active disease (P < 0.0001; OR=52.7; 95% CI=19-145.6) and an increase in the C-reactive protein (P < 0.005; OR = 3.4; 95% CI = 1.5-7.4). It is concluded that (a) abdominal scintigraphy using 99mTc-HMPAO-labelled leucocytes is of value in detecting the silent gut inflammation in Sp patients, and (b) silent gut inflammation is related to the clinical activity, but is not associated with any particular type of illness or with HLA-B27.

Topics: Abdomen; Adult; Anti-Inflammatory Agents, Non-Steroidal; Female; HLA-B27 Antigen; Humans; Image Interpretation, Computer-Assisted; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spondylitis; Technetium Tc 99m Exametazime

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