Biodistribution of 111In-labelled IgG and IgM in experimental infection

Oyen, Wim J.G.; Boerman, Otto C.; Subramanian, Ramaswamy; Koenders, E.B.; Claessens, R.A.M.J.; Meer, J.W.M. van der; Corstens, F.H.M.

doi:10.1097/00006231-199607000-00013

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“…111 In-IgG scintigraphy differentiated infectious from sterile inflammatory processes in 25 adult patients with complicated osteomyelitis or septic arthritis with a sensitivity of 90% and specificity of 95% (19). Oyen et al have reported that a recent bone trauma or fracture might be misleading in IgG scan interpretation (20)(21)(22). Unal et al, examining 20 cases of diabetic foot, reported a 100% versus 94% sensitivity and a 59% versus 100% specificity for 99m Tc-IgG and 99m Tcwhite blood cell labeling, respectively (18).…”

Section: Discussionmentioning

confidence: 99%

The Diagnostic Value of 99mTc-IgG Scintigraphy in the Diabetic Foot and Comparison with 99mTc-MDP Scintigraphy

Asli

Javadi²,

Seddigh³

et al. 2011

Journal of Nuclear Medicine Technology

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Diabetic foot infection is the most common etiology of nontraumatic amputation of the lower extremities, and early diagnosis is of great importance in its management. The aim of this prospective study was to evaluate the strength of 99m TcIgG scintigraphy in diagnosis of osteomyelitis of the diabetic foot and to compare 99m Tc-IgG scintigraphy with 99m Tc-methylene diphosphonate (MDP) scintigraphy. Methods: A prospective university hospital-based study was performed over 24 mo. Eighteen patients with type II diabetes and foot ulcers (15 men and 3 women; age range, 45-80 y) were referred for imaging because of clinically suspected osteomyelitis. Early (5-h) and late (24-h) 99m Tc-IgG scanning and 3-phase skeletal scintigraphy were completed for all patients at a 3-to 4-d interval.Regions of interest over the involved bony sites and the contralateral normal sites were drawn, and the abnormal-to-normal ratios were acquired for both 99m Tc-IgG and 99m Tc-MDP studies. Results: From a total of 23 lesions, we observed 10 sites of osteomyelitis, 10 sites of cellulitis, and 3 sites of aseptic inflammation confirmed by MRI, clinical presentation, histopathologic examination, and follow-up evaluation as a gold standard. Both 99m Tc-IgG and 99m Tc-MDP scanning showed excellent sensitivity for diagnosis of osteomyelitis, but the specificity was significantly lower (69.2% and 53.8%, respectively). Sensitivity, specificity, and accuracy in the diagnosis of osteomyelitis were, respectively, 100%, 53.8%, 73.9% for 99m Tc-MDP scanning; 100%, 69.2%, 82.6% for 5-h 99m Tc-IgG scanning; and 60%, 76.9%, 69.5% for 24-h 99m Tc-IgG scanning. There was no significant difference between the semiquantitative indices of 5-h and 24-h 99m Tc-IgG scanning for inflammation, cellulitis, and osteomyelitis. Conclusion: Although both 99m Tc-IgG and 99m Tc-MDP scintigraphy have high sensitivity for the diagnosis of osteomyelitis, the specificity of these studies is poor. For 99m Tc-IgG scintigraphy, 5-h images appear to be adequate, and there is little benefit to performing additional imaging at 24 h. Peri pheral neuropathy and metabolic and vascular disorders are important contributing factors leading to infection of obscured wounds in diabetic patients (1,2). When there is evidence of osteomyelitis, invasive procedures are needed to avoid amputation (3). Radiographic evaluation is not sensitive for the development of osteomyelitis, whereas labeled leukocyte imaging followed by bone marrow scintigraphy, although both sensitive and specific, is labor-intensive and limited by the risks associated with handling blood products (4). 111 In-IgG and 99m Tc-methylene diphosphonate (MDP) scintigraphy can be helpful for the diagnosis of inflammation and infection (5-11).The aim of this prospective study was to assess the role of 99m Tc-IgG scintigraphy in the diagnosis of osteomyelitis in the diabetic foot and to compare 99m Tc-IgG scintigraphy with 99m Tc-MDP scintigraphy. In addition to qualitatively assessing the 99m Tc-MDP and 99m Tc-IgG studies, we have...

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Section: Discussionmentioning

confidence: 99%