technetium-tc-99m-medronate and Infections

Topics: Acquired Hyperostosis Syndrome; Bone Neoplasms; Face; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Hyperplasia; Infections; Mandibular Condyle; Maxilla; Osteitis Deformans; Periodontitis; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sjogren's Syndrome; Technetium Tc 99m Medronate; Technology, Dental; Temporomandibular Joint Disorders; Tomography, X-Ray Computed

This article provides a brief overview of the current state of hybrid single-photon emission computed tomography/computer tomography (SPECT/CT) imaging in musculoskeletal infections. SPECT/CT imaging, compared with conventional planar study and SPECT alone, provides improved anatomic localization of infection and more accurate delineation of the extent of infection. This article emphasizes three clinical aspects where SPECT/CT is found to be most useful: differentiating between soft tissue and bone infections, assessing suspected infected sites with underlying structural bone alterations, and defining infective focus when complex anatomy is involved. The accurate assessment of site of infection is vital for selecting the most appropriate therapeutic strategy. Other advantages of SPECT/CT imaging such as reducing the inconvenience of combination planar studies, providing additional CT information, and increasing interobserver agreement are also discussed.

Topics: Bone Diseases; Child; Foot Diseases; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Musculoskeletal Diseases; Postoperative Complications; Soft Tissue Infections; Spinal Diseases; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Wounds and Injuries

The real place of isotopic imaging in intensive care patients remains still unclear. This review aimed to consider the indications of isotopic imaging for improved diagnosis and therapy and to specify its place among the other techniques of exploration. Pulmonary perfusion and ventilation scintigraphies are valuable for the diagnosis of pulmonary embolism (PE). A "high probability" scintigraphy of the lungs ascertains the diagnosis of PE and allows to start a specific treatment without requiring a pulmonary angiography. This is not the case in the presence of a history of previous PE or if the arguments for a PE are only weak. A normal lung scintigraphy eliminates the diagnosis of a clinically significant PE all the more as an exploration of good quality of the lower limb veins remains negative. In the opposite a "non diagnostic" scintigraphy justifies a pulmonary angiography in intensive care patients. The diagnosis of myocardial contusion is made uneasy as the clinical symptoms, the ECG, the cardiac enzymes and the chest X-ray are only of limited value. Isotopic explorations of the heart could provide additional valuable data or be an alternative for 2 D echocardiography. The comparison of CPK-MB concentrations with a myocardial scintigraphy using thallium 201 is given as being very reliable, with positive and negative predictive values higher than 80%. An exploration restricted to the cardiac ejection fractions is only of limited value. In the future, an improvement will perhaps be obtained with tracers such as MIBI labelled with technetium 99m, which allow the simultaneous assessment of myocardial perfusion and the ventricular ejection fractions as well. The localisation of centres of infection, especially when intra-abdominal, remains difficult in intensive care patients. Isotopic imaging, especially the scintigraphies with labelled polynuclears, could allow in combination with conventional imaging techniques (computed tomography and 2 D echocardiography) to prevent from errors in diagnosis. An array of arguments is essential for ascertaining the presence of an abscess. Scintigraphies with leucocytes labelled with indium 111 or technetium 99m are qualified as having a sensitivity and a specificity greater than 90%. The conventional techniques of measurement of the cerebral blood flow (CBF) using xenon 133 require a special equipment or are invasive. Other cerebral tracers, such as cyclic amines (HMPAO) labelled with technetium 99m and administrable b

Topics: Acute Kidney Injury; Cerebrovascular Circulation; Critical Care; Decision Trees; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Myocardial Ischemia; Pulmonary Embolism; Radionuclide Imaging; Technetium Tc 99m Medronate

Combat-related extremity injuries are regularly associated with long-term complications such as chronic infection, especially osteomyelitis. Clinical examination and laboratory parameters do not usually allow reliable diagnosis. In contrast, imaging techniques enable constructive assertions to be made about the location and extent of an infection of the peripheral musculoskeletal system. The aim of this study was therefore to determine the diagnostic reliability of three-phase bone scanning and antigranulocyte scintigraphy using Tc-99m-sulesomab (Leukoscan) in the diagnostic clarification of infections associated with combat-related extremity injuries.. Twenty-seven male patients (mean age 33.9 years) with suspected combat-associated infections of the extremities were included in this retrospective analysis. All patients underwent three-phase bone scanning using Tc-99m-HDP followed by antigranulocyte scintigraphy with Tc-99m-sulesomab. In 26 of the 27 patients, a CT scan of affected limb was obtained, where the secondary fusion with single photon emission CT data set was possible. The diagnostic reliability of imaging techniques was validated against microbiological samples obtained during surgery and used as gold standard.. Three-phase bone scanning yielded a positive result in all patients, with 18 scans classified as true positive (TP) and nine scans as false positive (FP). This produced a sensitivity of 100%, a specificity of 0% and a positive predictive value (PPV) of 67%. Antigranulocyte scintigraphy recognised 13 patients as TP, 1 patient as FP, 8 patients as true negative (TN) and 5 patients as false negative (FN), which gave a sensitivity of 72%, a specificity of 88%, a PPV of 93%, a negative predictive value (NPV) of 62% and an accuracy of 78%. CT recognised in 7 cases a TP result, in 3 cases an FP, in 5 cases a TN and in 11 cases an FN result. This produced a sensitivity of 39%, a specificity of 63%, a PPV of 70%, an NPV of 31% and an accuracy of 46%.. Three-phase bone scanning did not deliver any diagnostic benefit, since no result was able to differentiate unequivocally between infection-related and reactive changes. Antigranulocyte scintigraphy using Tc-99m-sulesomab represented a highly suitable technique for diagnostically clarifying combat-related infections of the extremities. It is superior to CT in sensitivity, specificity, PPV, NPV and accuracy.

Topics: Adult; Antibodies, Monoclonal, Murine-Derived; Humans; Infections; Jordan; Libya; Male; Middle Aged; Musculoskeletal Diseases; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Syria; Technetium Tc 99m Medronate; Ukraine; Warfare

The three-phase bone scan has been shown to be useful in the diagnosis of osteomyelitis, with a high sensitivity and specificity under optimal conditions. However, there are many causes of focally-increased uptake of Tc-99m diphosphonates in the extremities that may mimic infection, especially when there is increase on all three phases. Radiolabeled leukocyte scintigraphy is often performed in this clinical setting, although many pitfalls resulting in false-positive scans still remain. The authors present three cases of gouty arthritis in which skeletal scintigraphy illustrates this lack of specificity. Further causes of increased extremity uptake are reviewed, with attention to those that have been reported to show an increase on all three phases of the bone scan. Additional factors that can improve the specificity of the bone scan are discussed, as are the panoply of more recent scintigraphic approaches aimed at distinguishing infection from aseptic inflammation in the extremity. Unfortunately, no nuclear medicine procedure to date has proven itself to be reliably specific for infection.

Topics: Aged; Arthritis, Gouty; Bone and Bones; Humans; Infections; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The early diagnosis of loosening is very important, since it provides a chance to protect the bone structure by means of a good postrevision outcome. Although the delayed stage of infected loosenings can easily be detected by clinical presentations, significant laboratory data and plain X-rays, diagnosis becomes a problem in the early stage. In this study the value of Tc-99m Nanocolloid (NCol) scintigraphy in the diagnosis of infected loosenings was evaluated in 28 patients with painful total hip arthroplasty and 10 controls without any complaint after total hip arthroplasty, by comparing this method with laboratory data, plain X-rays and 3-phase Tc-99m methylene diphosphonate (MDP) scintigraphy. Tc-99m NCol scintigraphy was found out to be a very valuable method with 100% sensitivity, 84% specificity in the diagnosis of infected prosthesis and it was superior to laboratory data, plain X-rays and 3-phase Tc-99m MDP scintigraphy, but requires to be evaluated in conjunction with plain X-rays for more information and in order to prevent false positive results.

Topics: Adult; Aged; Female; Hip Prosthesis; Humans; Infections; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

This retrospective study looked at the role of indium 111-labeled white blood cell (111In WBC) scintigraphy in head and neck infections. The efficacy of 111In WBCs was compared to gallium 67 citrate (67Ga) and technetium Tc99m methylene diphosphonate (99mTc MDP) scintigraphy in detecting and monitoring the resolution of infection. For 22 active infections, the sensitivities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 94%, 56%, and 86%, respectively, and the specificities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 100%, 43%, and 0%, respectively. For 8 successfully treated infections, all seven 111In WBC studies became negative after therapy, in as short an interval as 1 month. In contrast, all seven 99mTc MDP images remained positive for as long as 6 months after therapy. The seven 67Ga studies had variable results, with four (57%) remaining positive, including two (28%) positive at 6 months after therapy. These results suggest that 111In WBC scintigraphy should be the initial radionuclide imaging tool in detecting active head and neck infections because of its greater accuracy, and its ability to revert to normal much sooner than 67Ga or 99mTc MDP scintigraphs when applied to a subset of patients with resolved infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Female; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Osteomyelitis; Otorhinolaryngologic Diseases; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Forty-one possible cases of infected total knee prostheses studied with indium-111-labeled leukocyte scintigraphy were retrospectively reviewed. Twenty-four of the prostheses were studied with technetium-99m methylene diphosphonate bone scintigraphy and 19 with Tc-99m sulfur colloid marrow scintigraphy. Nine prostheses were infected, and 32 were uninfected. The accuracy of combined labeled leukocyte and sulfur colloid marrow imaging (95%) was higher than that of labeled leukocyte scintigraphy alone (78%), bone scintigraphy alone (74%), or combined labeled leukocyte and bone scintigraphy (75%). The authors conclude that combined labeled leukocyte and sulfur colloid imaging is an accurate method for diagnosis of infected knee prostheses. In this series, this technique was superior to labeled leukocyte and bone imaging, alone or in combination.

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Infections; Knee Prosthesis; Leukocytes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

The utility of 99Tcm-HMPAO leucocytes has been studied in combination with 99Tcm-MDP bone scanning in the diagnosis of bone infection in a series of 50 patients with a clinical suspicion of bone infection. Thirty-three patients were referred to our Service from the Department of Orthopaedic Surgery (Group A) and seventeen from the Infectious Disease Unit (Group B). A total of 52 lesion sites were studied. The leucocyte and bone studies were performed within four days. The leucocyte scan was obtained at 30-60 min and 4-6 h after i.v. injection of 370 +/- 74 MBq of 99Tcm-HMPAO leucocytes. After confirming the scintigraphic findings, the results obtained were: Group A, 12 true positive, 21 true negative and 2 false positive; and in Group B, 5 true positive, 9 true negative and 4 false negative. The overall sensitivity was 80.9% with a specificity of 93.7%. Although the high bone marrow activity seen with 99Tcm-HMPAO leucocytes may reduce sensitivity, very good results were obtained in bone infection. The use of 99Tcm means great progress in the radiolabelling of white blood cells in terms of availability and better image quality. The combination of 99Tcm-HMPAO leucocytes and 99Tcm-MDP can be recommended as one of the most suitable methods for use in the diagnosis of bone infection, especially in patients with previous bone disease.

Topics: Adolescent; Adult; Aged; Bone Diseases; Female; Humans; Infections; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Although few reports address the use of three-phase bone scanning (TPBS) and 111In-labeled white blood cell (In-WBC) scintigraphy in hip arthroplasty utilizing a porous coated prosthesis, the literature suggests that scintigraphic patterns in the uncomplicated patient may differ from that seen in the cemented prosthesis. In an attempt to determine the scintigraphic natural history, 25 uncomplicated porous coated hip arthroplasties in 21 patients were prospectively studied with serial TPBS and In-WBC at approximately 7 days, and at 3, 6, 12, 18, and 24 mo postoperatively. This report deals with findings related to the prosthetic tip. Only one of 136 flow studies were abnormal and only two of 136 blood-pool images demonstrated focally increased activity. All 25 prostheses (120 of 143 scans) demonstrated increased uptake on the bone phase images. The area about the tip was divided into three segments; increased uptake at 24 mo was noted in the medial, distal, and lateral segments in 16%, 72%, and 56% of prostheses, respectively. Twenty of 25 prostheses (82 of 142 scans) showed uptake on In-WBC scintigraphy, being noted in 48% of prostheses at 24 mo. We conclude that scintigraphic patterns in the uncomplicated patient with a porous coated prosthesis appear to differ from patterns described in cemented prostheses.

Topics: Adult; Aged; Female; Hip Joint; Hip Prosthesis; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Organometallic Compounds; Oxyquinoline; Prosthesis Failure; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone and Bones; Female; Hip Prosthesis; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Postoperative Complications; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Medronate

The lesion-to-nonlesion 24 hour/4 hour ratio of technetium-99m methylene diphosphonate (MDP) uptake was used to distinguish osteomyelitis from increased bone uptake caused by adjacent soft-tissue infection. In a prospective study, this ratio was measured in 38 patients with 41 sites of increased uptake that were suspected to be osteomyelitis. The mean ratio was 1.18 +/- 0.18 in patients with proved osteomyelitis, which was significantly higher (P less than .001) than that in patients with increased uptake resulting from soft-tissue infection (0.98 +/- 0.05). On the basis of a receiver operating characteristic curve, a ratio of 1.06 was selected as the cutoff for differentiating osteomyelitis from soft-tissue infection. This method resulted in a sensitivity of 82%, a specificity of 92%, and an accuracy of 85%, and it appears to be more reliable than three- and four-phase scintigraphy, which are subjective and nonquantitative techniques.

Topics: Adolescent; Adult; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infections; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

In order to evaluate the clinical utility of sequential technetium-99m HMDP-gallium-67 scanning in patients with painful orthopedic prosthesis, a retrospective review was made of 154 sequential scans performed in 130 patients. Criteria for a positive study included spatially incongruent gallium-technetium uptake or gallium uptake that was congruent but more intense than technetium. Images were interpreted as negative if gallium was congruent and less intense than technetium. Sixty-six patients underwent surgery (31 infected, 35 aseptic), and 64 were evaluated clinically (3 infected, 61 aseptic). The combined results of the surgical and nonsurgical patients yielded a sensitivity of 66%, a specificity of 81%, and an accuracy of 77%. In this series, the technetium-gallium scan combination has proven to be helpful but more recent techniques such as indium-111-labeled leukocytes may prove to be superior to sequential technetium-gallium imaging.

Topics: Adult; Aged; Female; Gallium Radioisotopes; Humans; Infections; Joint Prosthesis; Male; Middle Aged; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

The usefulness of indium-111 white blood cell scintigraphy in the diagnosis of subacute or chronic bone infection was examined in 21 orthopedic patients. In-111 WBC imaging was compared with gallium-67 and technetium-99m methylene diphosphonate skeletal scintigraphy and bone radiography, all studies being performed within 1 week. In-111 WBC scintigraphy showed no definite advantage over Ga-67 scintigraphy in the identification of chronic bone infection. The two tests had the same sensitivity (80%) and similar specificity (In-111 WBC 75%, Ga-67 83%; difference not significant). Bone radiography had a sensitivity of 60% and a specificity of 67%. A negative Tc-99m MDP bone scintigram ruled out infection (sensitivity 100%), but because of low specificity (25%), final evaluation required performance of Ga-67 or In-111 WBC scintigraphy.

Topics: Adult; Aged; Bone Diseases; Chronic Disease; Diphosphonates; Gallium Radioisotopes; Humans; Indium; Infections; Leukocytes; Middle Aged; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A simultaneous dual isotope technique incorporating computer subtraction for the diagnosis of bone, joint, or soft-tissue infection using [67Ga]citrate and [99mTc]MDP or sulfur colloid is described. Comparison of this technique with visual congruence or noncongruence of the two radionuclide images in 41 patients shows that the two techniques have identical sensitivity (93%) and specificity (92%) but the computer technique gave additional information in 17% of all cases (44% of abnormals) concerning the anatomic location of the infective focus which aided in the subsequent surgical management of the patient.

Topics: Adolescent; Adult; Aged; Bone Diseases; Child; Child, Preschool; Computers; Connective Tissue Diseases; Diphosphonates; Female; Gallium Radioisotopes; Humans; Infections; Male; Middle Aged; Radionuclide Imaging; Subtraction Technique; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. 99mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

Topics: Bone Cements; Diphosphonates; Etidronic Acid; Female; Hip Joint; Hip Prosthesis; Humans; Infections; Male; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Synovial Fluid; Technetium; Technetium Tc 99m Medronate