technetium-tc-99m-medronate and Soft-Tissue-Infections

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 successful management of infected pelvic pressure ulcer patients (PPUP) depends on the distinction between infections limited to soft tissue (STI) and those with underlying osteomyelitis (OM), which can be difficult to determine clinically. Dual-isotope (DI) comprehensive imaging has excellent accuracy in localizing diabetic foot infection and differentiating OM from STI with SPECT/CT utilization. In this study, we assess the accuracy and confidence of the different DI SPECT/CT imaging steps in PPUP with confirmed diagnoses.. Pelvic flow and blood pool imaging were followed by labeled white blood cell reinjection and Tc-99m hydroxymethylene-diphosphonate bone (bone scan) and In-111-leukocytes (white blood cell scan) DI planar and SPECT/CT (step 1) acquisitions. Tc-99m sulfur colloid (bone marrow scan)/WBCS SPECT/CT (step 2) images were obtained on the following day. DI step 1 planar, step 1 SPECT/CT, step 2 SPECT/CT, and combined step 1/step 2 SPECT/CT were reviewed separately for diagnosis and diagnosis confidence. The final diagnosis was confirmed by culture/pathology in 21 patients and clinical/imaging follow-up in 12 patients.. There were 19 OM patients, three STI patients, and 11 patients with no infection. The final diagnosis agreement to DI combined step 1/step 2 SPECT/CT was higher than DI step 2 or step 1 SPECT/CT alone, or DI step 1 planar, as assessed by λ and error reduction %, respectively. Combined DI step 1/step 2 SPECT/CT was more sensitive than DI step 2 SPECT/CT and more specific than DI step 1 SPECT/CT, and showed higher diagnostic confidence than both imaging techniques.. DI SPECT/CT is highly useful in evaluating PPUP with suspected infection. DI step 1 is more sensitive, whereas step 2 is more specific. Both step 1 and step 2 DI SPECT/CT images are needed to accurately and confidently assess for infection and distinguish OM from STI, which are crucial for optimal management.

Topics: Adult; Aged; Aged, 80 and over; Diabetic Foot; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Pelvis; Pressure Ulcer; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Soft Tissue Infections; Technetium Tc 99m Medronate

Topics: Chronic Disease; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Proteus Infections; Proteus mirabilis; Radiopharmaceuticals; Soft Tissue Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To evaluate use of positron emission tomography (PET) with 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG) in detection of chronic osteomyelitis.. Thirty-one patients suspected to have chronic osteomyelitis in the peripheral (n = 21) or central (n = 10) skeleton were evaluated prospectively with FDG PET. Analysis of the receiver operating characteristic curve was performed. The final diagnosis was made by means of bacteriologic culture of surgical specimens and histopathologic analysis.. FDG PET allowed identification of 17 of 18 patients with osteomyelitis and 12 of 13 without osteomyelitis. There was one false-positive and one equivocal result. The area under the ROC curve was 0.96 for all patients, 1.00 for patients suspected to have osteomyelitis in the peripheral skeleton, and 0.88 for patients suspected to have osteomyelitis in the central skeleton. The overall accuracy of FDG PET was 97% with a high degree of interobserver concordance (kappa = 0.93). The overall sensitivity and specificity were 100% and 92%, respectively.. FDG PET enables noninvasive detection and demonstration of the extent of chronic osteomyelitis with a high degree of accuracy. Especially in the central skeleton within active bone marrow, FDG PET is highly accurate and shows great promise in diagnosis of chronic osteomyelitis.

Topics: Bone and Bones; Chronic Disease; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radioimmunodetection; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Soft Tissue Infections; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Indium-111-labeled human nonspecific immunoglobin G (111In-IgG) is one of the newer agents suggested for scintigraphic evaluation of infection and inflammation. In this study, the utility of this agent was studied in routine clinical practice.. A dose of 75 MBq 111In labeled to 2 mg IgG (MacroScint) was administered intravenously in 226 patients with 232 possible foci of infection or inflammation. Imaging was performed 4, 24 and 48 hr postinjection. The results were verified by culture, obtained either surgically (42%) or via puncture (19%) and long-term clinical and roentgenological follow-up (39%). Follow-up data were used in patients of whom the vast majority had a negative work-up, including negative 111In-IgG scintigraphy.. All infected total hip (THA) and total knee arthroplasties, focal osteomyelitis, diabetic foot infections, septic arthritis and soft-tissue infections were detected (61 foci). Only one patient with early, low-grade spondylodiscitis was false negative with 111In-IgG. Since 111In-IgG scintigraphy does not discriminate between infectious and sterile inflammation, careful interpretation is necessary in cementless THA up to 1 yr after insertion, uptake only around the neck of the femoral component of a THA, recent fractures and pseudarthrosis, in which uptake may be caused by sterile inflammation and not by infection (specificity for inflammation 100%, specificity for infection of 77%).. Indium-111-IgG scintigraphy is a very sensitive tool for detection of infectious bone and joint disease. Moreover, when uptake patterns of 111In-IgG, which are characteristic for sterile inflammation, are excluded, infection can be ruled out with a high degree of certainty.

Topics: Arthritis; Arthritis, Infectious; Diabetic Foot; Discitis; Female; Hip Prosthesis; Humans; Immunoglobulin G; Indium Radioisotopes; Knee Prosthesis; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prosthesis-Related Infections; Pseudarthrosis; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Medronate

Topics: Abscess; Adult; Buttocks; Gallium Radioisotopes; Humans; Male; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Tract Infections

Heterotopic ossification is a disorder of unknown etiology characterized by bone formation in the mesenchymal tissues. It occurs most commonly in patients who have had traumatic brain injury, spinal cord injury, or joint trauma or surgery.

Topics: Adult; Citrates; Citric Acid; Diagnosis, Differential; Gallium Radioisotopes; Humans; Knee; Male; Ossification, Heterotopic; Radiography; Radionuclide Imaging; Soft Tissue Infections; Technetium Tc 99m Medronate; Thigh