Comparison of technetium 99m polyclonal human immunoglobulin and technetium 99m monoclonal antibodies for imaging chronic osteomyelitis

Abstract

The accuracy of technetium-99m human immunoglobulin (HIG) for the detection of chronic osteomyelitis (OM) was compared with white blood cell scintigraphy using 99mTc-labelled monoclonal mouse antibodies (MAB). Seventeen patients suspected of having OM in 20 lesions went through three-phase skeletal scintigraphy, HIG scintigraphy and MAB scintigraphy. The final diagnosis was established by open surgery, histology and bacteriology. Chronic OM was proved in 14/20 lesions. Six of these 14 infections were located in peripheral areas without active bone marrow and 8/14 in central areas with active bone marrow. In peripheral OM, 5/6 with HIG and 6/6 with MAB were true positives. In the central skeleton all 8/8 infections appeared as cold lesions in the MAB study, which were defined as being false negative due to their non-specificity. Using HIG, 5/8 central infections were determined to be truly positive by showing photon-rich lesions. These 5 lesions were located in the hip region and in the pelvis, whereas 3 lesions of the spine were missed. There were no false-positive results in either studies. In conclusion, MAB was superior to HIG in peripheral OM concerning sensitivity, anatomical landmarks and differentiation of soft tissue versus bone infection. In central OM MAB detected all lesions accurately, but no differential diagnosis was possible due to the non-specificity of photon-low areas. In this respect HIG seems to be more specific due to the increased accumulation even in central infection sites.

Chronic complicated osteomyelitis of the appendicular skeleton: Diagnosis with technetium-99m labelled monoclonal antigranulocyte antibody-immunoscintigraphy

“…Currently there are four published series with small numbers of patients reporting the use of 99mTc-MAB in chronic osteomyelitis [6,[14][15][16]. The reported sensitivity (79%-100%) and specificity (64%-100%) show a wide range due to the different inclusion criteria for chronic osteomyelitis.…”

“…The reported sensitivity (79%-100%) and specificity (64%-100%) show a wide range due to the different inclusion criteria for chronic osteomyelitis. A major part of the reported data has been based on patient groups with acute and subacute infections [6,14,15]. Furthermore, patients with septic hip arthroplasties [15] and even chronic infection of the axial skeleton [6,14] have been included.…”

“…All patients suffered from longstanding, post-traumatic chronic osteomyelitis; the mean interval from first surgery to the present study was 8.6 years (range 2 months to 42 years). The average number of operations due to recurrent osteomyelitis was four (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15], and the interval from last surgery to the present averaged 3.5 years (2 months to 42 years). Six patients had orthopaedic devices (metal plate, intramedullary nail, external fixator).…”

“…Beside radiological methods [X-ray plain film, computed tomography (CT), magnetic resonance imaging (MRI)], nuclear medicine offers a wide variety of radiopharmaceuticals for the imaging of inflammation or infection, e.g. gallium-67 citrate [1,2], technetium-99m labelled nanocolloids [3], 99mTc-labelled human immunoglobulins [4][5][6], indium-111 oxine and 99mTc-hexamethylpropylene amine oxime (HMPAO)-labelled autologous leucocytes [7][8][9][10][11]. 99mTc-labelled monoclonal antigranulocyte antibody (MAB) immunoscintigraphy (IS) represents a simple, practicable and specific method that has been extensively studied for the detection of inflammatory and septic processes.…”

“…99mTc-labelled monoclonal antigranulocyte antibody (MAB) immunoscintigraphy (IS) represents a simple, practicable and specific method that has been extensively studied for the detection of inflammatory and septic processes. Extra-osseous infection [12,13], acute and subacute osteomyelitis [14][15][16], spondylodiscitis [6,14] and infection of hip arthoplasties [ 12,13,16,17] have been the main subjects of these publications. Until now no study has specifically considered the value of IS in chronic recurrent or low-grade osteomyelitis of the appendicular skeleton.…”