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Clinical feasibility of two-step streptavidin/111In-biotin scintigraphy in patients with suspected vertebral osteomyelitis

  • Elena Lazzeri
  • Ernest K. J. Pauwels
  • Paola A. Erba
  • Duccio Volterrani
  • Mario Manca
  • Lisa Bodei
  • Donatella Trippi
  • Antonio Bottoni
  • Renza Cristofani
  • Vincenzo Consoli
  • Christopher J. Palestro
  • Giuliano Mariani
Original Article

Abstract

Purpose

Streptavidin accumulates at sites of inflammation and infection as a result of increased capillary permeability. In addition to being utilised by bacteria for their own growth, biotin forms a stable, high-affinity non-covalent complex with avidin. The objective of this investigation was to determine the diagnostic performance of two-step streptavidin/111In-biotin imaging for evaluating patients with suspected vertebral osteomyelitis.

Methods

We evaluated 55 consecutive patients with suspected vertebral osteomyelitis (34 women and 21 men aged 27–86 years), within 2 weeks after the onset of clinical symptoms. Thirty-two of the patients underwent magnetic resonance imaging (MRI) and 24, computed tomography (CT). DTPA-conjugated biotin was radiolabelled by incubating 500 μg of DTPA-biotin with 111 MBq of 111In-chloride. Two-step scintigraphy was performed by first infusing 3 mg streptavidin intravenously, followed 4 h later by 111In-biotin. Imaging was begun 60 min later.

Results

Streptavidin/111In-biotin scintigraphy was positive in 32/34 patients with spinal infection (94.12% sensitivity). The study was negative in 19/21 patients without infection (95.24% specificity). The corresponding results for MRI and CT were 54.17% and 35.29% (sensitivity), and 75% and 57.14% (specificity), respectively. All statistical parameters of diagnostic performance (Youden’s J index, kappa measure of agreement with correct classification, accuracy, sensitivity, specificity, positive likelihood and negative likelihood) were clearly better for streptavidin/111In-biotin scintigraphy than for either MRI or CT.

Conclusion

Streptavidin/111In-biotin scintigraphy is highly sensitive and specific for detecting vertebral osteomyelitis in the first 2 weeks after the onset of clinical symptoms, and is potentially very useful for guiding clinical decisions on instituting appropriate therapy.

Keywords

Vertebral osteomyelitis Two-step streptavidin/111In-biotin scintigraphy Imaging modalities Diagnostic performance 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Elena Lazzeri
    • 1
  • Ernest K. J. Pauwels
    • 2
  • Paola A. Erba
    • 1
  • Duccio Volterrani
    • 1
  • Mario Manca
    • 3
    • 8
  • Lisa Bodei
    • 4
  • Donatella Trippi
    • 5
  • Antonio Bottoni
    • 1
  • Renza Cristofani
    • 6
  • Vincenzo Consoli
    • 3
  • Christopher J. Palestro
    • 7
  • Giuliano Mariani
    • 1
  1. 1.Regional Center of Nuclear MedicineUniversity of Pisa Medical SchoolPisaItaly
  2. 2.Division of Nuclear MedicineUniversity Medical Center LeidenLeidenThe Netherlands
  3. 3.Division of OrthopedicsUniversity of Pisa Medical SchoolPisaItaly
  4. 4.Division of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  5. 5.Division of RadiologyUniversity of Pisa Medical SchoolPisaItaly
  6. 6.Section of Biostatistics and Epidemiology, CNR Institute of Clinical Physiology and Division of EpidemiologyUniversity of Pisa Medical SchoolPisaItaly
  7. 7.Division of Nuclear MedicineLong Island Jewish Medical CenterNew YorkUSA
  8. 8.Division of OrthopedicsTown HospitalMassa CarraraItaly

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