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Utility of 99mTc-labelled antimicrobial peptide ubiquicidin (29-41) in the diagnosis of diabetic foot infection

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Detection of osteomyelitis beneath a diabetic foot ulcer is imperative for proper management; however, accurate and noninvasive diagnosis of osteomyelitis remains a challenge. Ubiquicidin 29-41 (UBI 29-41) is a synthetic antimicrobial peptide fragment reported to be highly infection-specific. 99mTc-UBI 29-41 has recently been reported to be a promising radiotracer for infection imaging. The aim of this prospective study was to evaluate the utility of 99mTc-UBI 29-41 scintigraphy in diabetic patients with suspected osteomyelitis of the foot.

Methods

Included in the study were 65 patients with type 2 diabetes mellitus and foot ulcer and with clinical suspicion of osteomyelitis . Each patient had a three-phase bone scan and a 99mTc-UBI scan at 30 and 60 min after injection. The scan was considered to be consistent with osteomyelitis when the 99mTc-UBI 29-41 uptake was concordant with the 99mTc-MDP uptake. It was considered negative for osteomyelitis if there was no uptake of 99mTc-UBI 29-41 or if 99mTc-UBI 29-41 accumulated in an area not concordant with the abnormal uptake of 99mTc-MDP on the bone scan. In the latter case a diagnosis of soft-tissue infection was made. Bone infection was confirmed by bone biopsy/culture and by clinical and radiological follow-up.

Results

Final analysis was done in 55 patients. Osteomyelitis was confirmed in 37 patients, and 18 patients were free of bone infection. 99mTc-UBI 29-41 was positive in all 37 patients and with the bone scan as the reference for the bone identified all osteomyelitic foci (68 in total). 99mTc-UBI 29-41 was negative for osteomyelitis in all 18 patients, and 17 of these patients were diagnosed with soft-tissue infection (99mTc-UBI 29-41 accumulation without concordant abnormal uptake on bone scintigraphy). The sensitivity, specificity and accuracy of 99mTc-UBI 29-41 scan in combination with three-phase bone scan for the diagnosis of osteomyelitis in diabetic foot was 100 %. Accuracy for soft-tissue infection was also 100 %. Maximum accumulation of the 99mTc-UBI 29-41 with maximum target to background activity was observed in the infectious foci at 30 min after injection.

Conclusion

Tc-UBI 29-41 may be a useful agent for the accurate diagnosis of bone infection in diabetic foot because of the high accuracy demonstrated in this pilot study. It was able to differentiate between bone and soft-tissue involvement effectively in combination with a bone scan.

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Acknowledgments

The authors thank Mr. Shamim, Mr. Illyas and Ms. Rubina of the Nuclear Medicine Oncology Radiotherapy Institute for their technical help and help in data acquisition.

Conflicts of interest

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Authors and Affiliations

  1. Pakistan Institute of Engineering and Applied Sciences, Islamabad, Pakistan

    Shabana Saeed

  2. Medical Unit 1, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

    Jamal Zafar

  3. Isotope Production Division, Pakistan Institute of Nuclear Science and Technology, Islamabad, Pakistan

    Bashar Khan

  4. Surgical Unit 5, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

    Ali Akhtar & Sumair Qurieshi

  5. Nuclear Medicine Oncology and Radiotherapy Institute, Islamabad, Pakistan

    Shazia Fatima, Naseer Ahmad & Javed Irfanullah

  6. Department of Medical Sciences, Pakistan Institute of Engineering and Applied Sciences (PIEAS), P.O. Nilore, Islamabad, Pakistan

    Shabana Saeed

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  1. Shabana Saeed
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Correspondence to Shabana Saeed.

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Saeed, S., Zafar, J., Khan, B. et al. Utility of 99mTc-labelled antimicrobial peptide ubiquicidin (29-41) in the diagnosis of diabetic foot infection. Eur J Nucl Med Mol Imaging 40, 737–743 (2013). https://doi.org/10.1007/s00259-012-2327-1

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  • DOI: https://doi.org/10.1007/s00259-012-2327-1

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