Abstract
Chronic post-traumatic osteomyelitis (OM) represents a particular challenge for nuclear medicine and radiology since clinical and biochemical parameters are frequently unreliable. The aim of this study was to investigate the value of combined bone scan (BS) and immunoscintigraphy (IS) with technetium-99m labelled monoclonal antigranulocyte antibody (MAB) in patients with suspected chronic OM of the appendicular skeleton. Twenty-four patients (17 females and 7 males) with suspected chronic post-traumatic OM were evaluated with three-phase BS/99mTc-MAB-IS. The final diagnosis was established by means of bone culture and histology in 19 cases and clinical follow-up in five cases. The studies were reviewed by two independent and experienced observers; the interobserver agreement was calculated by kappa statistics. The sensitivity, specificity and accuracy of BS alone were 92%, 18% and 58%, respectively. Combined BS/99mTc-MAB-IS. had a sensitivity, specificity and accuracy of 84%, 72% and 79%, respectively. Of 24 studies, 11 were true-positive, two false-negative, eight true-negative and three false-positive. Two patients presented with unexpected ectopic haematopoietic bone marrow in the appendicular skeleton that caused falsepositive results. A high degree of interobserver agreement was found (κ=0.85). It is concluded that combined BS/99mTc-MAB-IS. represents a very sensitive and reproducible method with an acceptable specificity for the investigation of chronic OM. Problems may occur in the differentiation of low-grade OM from aseptic inflammation. Another problem is ectopic marrow that may occur in the appendicular skeleton due to a chronic inflammatory stimulus. A former intramedullary intervention in the femur with displacement of haematopoietic marrow may also lead to an ectopic location.
Similar content being viewed by others
References
Sorsdahl OA, Goodhart GL, Williams HT, Hanna LJ, Rodriquez J. Quantitative bone gallium scintigraphy in osteomyelitis.Skeletal Radiol 1993; 22: 239–242.
Al-sheikh W, Sfakianokis GN, Mnaymnehz W, et al. Subacute and chronic hone infection: diagnosis using111In,67Ga and99mTc-MDP hone scintigraphy and radiography.Radiology 1985; 155: 501–506.
Flivik G, Sloth M, Rydholm U, Herrlin K, Lidgren L.99mTc-nanocolloid scintigraphy in orthopedic infections: a comparison with111In-labeled leukocytes.J Nucl Med 1993; 34: 1646–1650.
Datz FL, Anderson CE, Ahluwalia R, et al. The efficiency of111In-polyclonal IgG for the detection of infection and inflammation.J Nucl Med 1994; 35: 74–83.
Ang ES, Sundram FX, Goh ASW.99mTc-polyclonal IgG and99mTc-nanocolloid scans in orthopedics: a comparison with conventional hone scan.Nucl Med Commun 1993; 14: 419–432.
Sciuk J, Brandau W, Vollet B, Snicker R, Erlemann R, Bartenstein P, Peters PE, Schober O. Comparison of99mTc polyclonal human immunoglobin and99mTc monoclonal antibodies for imaging chronic osteomyelitis. First clinical results.Eur J Nucl Med 1991; 18: 401–407.
Esper EL, Dacquet V, Paillard J, Bascoulergue G, Talion MM, Fonroget J.99mTc-HMPAO-labeled leukocyte scintigraphy in suspected chronic osteomyelitis related to an orthopedic device: clinical usefulness.Nucl Med Commun 1992; 13: 799–805.
Roddie ME, Peters AM, Osman S, Danpure HJ, Lavender JP, Neirinckx RD. Osteomyelitis.Nucl Med Commun 1988; 9: 713–717.
Schauwecker DS. Osteomyelitis: diagnosis with111ln-labeled leucocytes.Radiology 1989; 171: 141–146.
Becker W, Bair J, Behr T, Repp R, Streckenbach H, Beck H, Gramatzki M, Winship MJ, Goldenberg DM, Wolf F. Detection of soft tissue infection and osteomyelitis using a99mTc-la-beled antigranulocyte monoclonal antibody fragment.J Nucl Med 1994; 35: 1436–1443.
Seabold JE, Ferlic RJ, Mash JL, Nepola JV. Periarticular bone sites associated with traumatic injury: false positive findings with111In-labeled white blood cell and99mTc-MDP scintigraphy.Radiology 1993; 186: 845–849.
Seybold K, Frey LD, Locher J. Immunoscintigraphy of infections using123I and99mTc-labeled monoclonal antibodies. Advanced experiences in 230 patients.Angiology 1992; 43: 85–90.
Seybold K, Locher J. Infektdiagnostik mit monoklonalen Antigranulozyten-Antikörpern.Therapiewoche Schweiz 1994; 10: 275–283.
Hotze AL, Briele B, Overbeck B, Kropp J, Grünwald F, Mekkawy MA, von Smekal A, Möller F, Biersack HJ.99mTc-la-beled antigranulocyte antibodies in suspected hone infections.J Nucl Med 1992; 33: 526–531.
Reuland P, Winkler KH, Heuchert T, Ruck R, Müller-Schauenburg W, Weller S, Feine U. Detection of infection in postoperative patients with99mTc-labeled monoclonal antibodies against granulocytes.J Nucl Med 1991; 32: 2209–2214.
Scheidler J, Leinsinger G, Pfahler M, Kirsch CM. Diagnosis of osteomyelitis. Accuracy and limitations of antigranulocyte antibody imaging compared to three-phase bone scan.Clin Nucl Med 1994; 19: 731–737.
Boubaker A, Bischof Delaloye A, Blanc CH, Dutoit M, Leyvraz PF, Delaloye B. Immunoscintigraphy with antigranulocyte monoclonal antibodies for the diagnosis of septic loosening of hip prostheses.Eur J Nucl Med 1995; 22: 139–147.
Sachs L.Angewandte Statistik, 7th edn. Berlin Heidelberg New York, Springer; 1991: 472–473.
Andres RY, Schubiger PA, Tiefenauer L, Seybold K, Locher JT, Mach JP, Buchegger F. Immunoscintigraphic localization of inflammatory lesions: concept, radiolablling and in-vitro testing of a granulocyte specific antibody.Eur J Nucl Med 1988; 13: 582–586.
Becker W, Borst U, Fischbach W, Pasurka B, Schäfer R, Borner W. Kinetic data of in-vivo labeled granulocytes in humans with a murine99mTc-labeled monoclonal antibody.Eur J Nucl Med 1989; 15: 361–366.
Steinstraesser A, Oberhausen E. Granulocyte labelling kit BW 250/183. Result of the European multicenter trial.Nucl-Med 1996; 35: 1–11.
Hyams D, Reynolds JC, Carrasquillo JA, et al. The effect of circulating antimurine antibody on the pharmacokinetics and biodistribution of injected radiolabeled monoclonal antibody [abstract].J Nucl Med 1986; 27: 922.
Ivancevic V, Dodig D, Livakovic M, Hancevic J, Ivancevic D. Comparison of three-phase bone scan,99mTc-HMPAO leukocyte scan and67gallium scan in chronic hone infection.Prog Clin Biol Res 1990; 355: 189–198.
Becker W, Palestro CJ, Winship J, Feld T, Pinsky CM, Wolf F, Goldenberg DM. Rapid imaging of infections with a monoclonal antibody fragment (LeukoScan).Clin Orthop 1996; 329: 263–272.
Ochsner PE, Brunazzi MG. Intramedullary reaming and soft tissue procedures in treatment of long hones.Orthopedics 1994; 17: 433–440.
Oyen WIG, van Horn JR, Claessens AMJ, Sloof TJJH, van der Meer JWM, Corstens FHM. Diagnosis of hone, joint and joint prosthesis infection with111In-labeled nonspecific human immunoglobulin.Radiology 1992; 182: 195–199.
Groopman JE, Molina JM, Scadden DT. Hematogenic growth factors: biology and clinical applications.N Engl J Med 1989; 321: 1449–1459.
Moore MAS. Clinical implications of positive and negative hematopoietic stem regulators.Blood 1991; 78: 1–19.
Kawai M, Hattori H, Yasue K, Mizutani H, Ueda M, Kaneda T, Hoshino T. Development of hemopoietic hone marrow within the ectopic bone induced by bone morphogenetic protein.Blood Cells 1994; 20: 191–191.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kaim, A., Maurer, T., Ochsner, P. et al. Chronic complicated osteomyelitis of the appendicular skeleton: Diagnosis with technetium-99m labelled monoclonal antigranulocyte antibody-immunoscintigraphy. Eur J Nucl Med 24, 732–738 (1997). https://doi.org/10.1007/BF00879660
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00879660