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

Abstract

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.

Accuracy of diagnostic imaging modalities for peripheral post-traumatic osteomyelitis – a systematic review of the recent literature

“…1). Eventually, 14 studies remained for further analysis [21, 45–57] and underwent qualitative assessment according to the QUADAS-2 criteria by two authors (Table 3). This resulted in four more exclusions [50, 51, 56, 57].…”

“…For this process, additional information was obtained by email from two corresponding authors [52, 55]. Finally, 10 studies [21, 45–49, 52–55] remained for inclusion in this systematic review. The inclusion process is summarized in Fig.…”

“…Four of the 10 articles [45, 46, 49, 52] had a comparative design which made it possible to include the results of, in total, 17 patient series (three studies [46, 49, 52] investigated three imaging modalities). Six studies addressed the value of FDG-PET in the diagnostic process for PTO [46, 48, 52–55], 5 studies addressed WBC or AGA scintigraphy [21, 45, 47, 49, 52], 2 studies addressed MRI [46, 49], 3 studies addressed bone scintigraphy [45, 49, 52], and one study focused on CT [46].…”

“…Six studies addressed the value of FDG-PET in the diagnostic process for PTO [46, 48, 52–55], 5 studies addressed WBC or AGA scintigraphy [21, 45, 47, 49, 52], 2 studies addressed MRI [46, 49], 3 studies addressed bone scintigraphy [45, 49, 52], and one study focused on CT [46]. A schematic overview of the included studies is presented in Table 4.…”

Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

“…Charcot disease usually presents with moderate widespread uptake without any WBC recruitment at 20 h [34]. Recent trauma could involve recruitment of WBC owing to debridement by neutrophils and macrophages, but the fusion images with thin CT slices often allow diagnosis [35,36]. It is also possible to differentiate non-septic arthritis from septic forms as the latter present WBC recruitment at 20 h [37].…”