Comparison of Tc-99m-labelled antileukocyte fragment Fab′ and Tc-99m-HMPAO leukocyte scintigraphy in the diagnosis of bone and joint infections: a prospective study

Devillers, Anne; Garin, Étienne; Polard, J.-L.; Poirier, Jean-Yves; Arvieux, Cédric; Girault, Sylvie; Moisan, Annick; Bourguet, P.

doi:10.1097/00006231-200008000-00008

Cited by 49 publications

(20 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a group of unselected patients appearing quite similar to our population, with violated bones and suspected osteomyelitis, Devillers et al reported an overall sensitivity, specificity, and accuracy of 93%, 100%, and 96%, respectively, for 99m Tc-HMPAO WBC scanning and 100%, 17%, and 53.3%, respectively, for 99m Tc-MDP bone scanning (18). In our study also, combined 99m Tc-HMPAO/MDP imaging proved useful in diagnosing osteomyelitis.…”

Section: Discussionsupporting

confidence: 78%

“…A high bone uptake is expected in these patients because of underlying neuropathic bone changes (19)(20)(21). Previous studies with combined 99m Tc-HMPAO/MDP imaging in diabetic foot ulcers prove to be useful in diagnosing osteomyelitis (18,22). Poirier et al reported a sensitivity of 92.6% and a specificity of 97.6% for 99m Tc-HMPAO/MDP scanning for the diagnosis of osteomyelitis in diabetic foot ulcers and concluded that neuroarthropathy did not affect the performance of this scan (23).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

Ballani

Al-Huda²,

Khan³

et al. 2007

Journal of Nuclear Medicine Technology

View full text Add to dashboard Cite

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. Methods: 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 5 10), knee prosthesis (n 5 5), hip prosthesis (n 5 2), diabetic foot (n 5 4), or chronic osteomyelitis (n 5 3). Threephase 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. Results: 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 6 1.6 (range, 1.3-6.2) and 1.8 6 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 6 1.2 and 1.2 6 0.2, respectively. In the group with a 99m Tc-MDP A/N ratio greater than 2 (n 5 15), 87% (13/15) had a high 99m Tc-HMPAO WBC A/N ratio (.1.5), including 2 that were falsepositive. 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 5 9), only 4 patients (44%) were true-positive for acute osteomyelitis. Conclusion: 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.

show abstract

Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

Ballani

Al-Huda²,

Khan³

et al. 2007

Journal of Nuclear Medicine Technology

View full text Add to dashboard Cite

show abstract

“…Therefore, similarly to in vitro labelled leucocytes, both radiopharmaceuticals are proposed as promising agents for imaging of inflammation and infection. The results of these agents for diagnosing PJI, however, have been variable [58][59][60][61][62][63].…”

Section: Bsmentioning

confidence: 99%

Prosthetic joint infections: radionuclide state-of-the-art imaging

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

170

151

View full text Add to dashboard Cite

Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort has been devoted to developing alternative radiotracers, such as radiolabelled HIGs, liposomes, antigranulocyte antibodies and fragments, as well as more investigational tracers such as radiolabelled antibiotics, antimicrobial peptides, bacteriophages and thymidine kinase. On the other hand, positron emission tomography (PET) is still growing in the field of PJI imaging with radiotracers such as (18)F-fluorodeoxyglucose (FDG), (18)F-FDG white blood cells and (18)F-fluoride. But unfortunately this superb tomographic technique will only receive full acceptance when specific PET uptake patterns can be successfully developed. The emergence of hybrid modality imaging using integrated single photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) may also have a contributing role for more accurate assessment of joint replacement complications, especially combined with new radiotracers such as (68)Ga and (64)Cu. Finally, in searching for infection-specific tracers, currently there is no such diagnostic agent available.

show abstract

“…Newer methods of labelling white cells are promising [23,24], as are scans using labelled anti-neutrophil antibodies [25,26]. In most instances, leucocyte scans are currently used only when magnetic resonance imaging scans (MRI) are unavailable.…”

Section: Radionuclide White Blood Cell Scansmentioning

confidence: 99%

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Berendt

Peters

Баккер³

et al. 2008

Diabetes Metab. Res. Rev.

278

214

View full text Add to dashboard Cite

SummaryThe International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006.The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations.The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae.We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed.

show abstract

Comparison of Tc-99m-labelled antileukocyte fragment Fab′ and Tc-99m-HMPAO leukocyte scintigraphy in the diagnosis of bone and joint infections: a prospective study

Cited by 49 publications

References 7 publications

The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

Prosthetic joint infections: radionuclide state-of-the-art imaging

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Contact Info

Product

Resources

About