Radionuclide Imaging of Skeletal Implants

  • Vetri Sudar Jayaprakasam
  • Patrick FieldingEmail author


Radionuclides are atomic species that are inherently unstable and decay emitting energy in the form of ionising radiation. Nuclear medicine or radionuclide imaging studies use a variety of radionuclides, usually bound to a further molecule to form a radiopharmaceutical. The radionuclide acts as the marker that allows localisation and formation of an image with a camera/scanner system, whilst the radiopharmaceutical (with the carrier molecule) gives the tracer specificity.


  1. 1.
    Rushton N, Coakley AJ, Tudor J, Wraight EP. The value of technetium and gallium scanning in assessing pain after total hip replacement. J Bone Joint Surg Br. 1982;64(3):313–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Smith SL, Wastie ML, Forster I. Radionuclide bone scintigraphy in the detection of significant complications after total knee joint replacement. Clin Radiol. 2001;56(3):221–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Levitsky KA, Hozack WJ, Balderston RA, Rothman RH, Gluckman SJ, Maslack MM, et al. Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration. J Arthroplasty. 1991;6(3):237–44.CrossRefPubMedGoogle Scholar
  4. 4.
    Gemmel F, Van den Wyngaert H, Love C, Welling MM, Gemmel P, Palestro CJ. Prosthetic joint infections: radionuclide state-of-the-art imaging. Eur J Nucl Med Mol Imaging. 2012;39(5):892–909.CrossRefPubMedGoogle Scholar
  5. 5.
    Merkel KD, Brown ML, Fitzgerald RH. Sequential technetium-99m HMDP-gallium-67 citrate imaging for the evaluation of infection in the painful prosthesis. J Nucl Med. 1986;27(9):1413–7.PubMedGoogle Scholar
  6. 6.
    Schauwecker DS, Park HM, Mock BH, Burt RW, Kernick CB, Ruoff AC, et al. Evaluation of complicating osteomyelitis with Tc-99m MDP, In-111 granulocytes, and Ga-67 citrate. J Nucl Med. 1984;25(8):849–53.PubMedGoogle Scholar
  7. 7.
    Palestro CJ, Swyer AJ, Kim CK, Goldsmith SJ. Infected knee prosthesis: diagnosis with In-111 leukocyte, Tc-99m sulfur colloid, and Tc-99m MDP imaging. Radiology. 1991;179(3):645–8.CrossRefPubMedGoogle Scholar
  8. 8.
    McAfee JG, Thakur ML. Survey of radioactive agents for in vitro labeling of phagocytic leukocytes. I. Soluble agents. J Nucl Med. 1976;17(6):480–7.PubMedGoogle Scholar
  9. 9.
    McAfee JG, Thakur ML. Survey of radioactive agents for in vitro labeling of phagocytic leukocytes. II. Particles. J Nucl Med. 1976;17(6):488–92.PubMedGoogle Scholar
  10. 10.
    Peters AM, Danpure HJ, Osman S, Hawker RJ, Henderson BL, Hodgson HJ, et al. Clinical experience with 99mTc-hexamethylpropylene-amineoxime for labelling leucocytes and imaging inflammation. Lancet. 1986;2(8513):946–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Palestro CJ, Love C, Bhargava KK. Labeled leukocyte imaging: current status and future directions. Q J Nucl Med Mol Imaging. 2009;53(1):105–23.PubMedGoogle Scholar
  12. 12.
    Palestro CJ, Torres MA. Radionuclide imaging of nonosseous infection. Q J Nucl Med. 1999;43(1):46–60.PubMedGoogle Scholar
  13. 13.
    Bosetti M, Cannas M. The effect of bioactive glasses on bone marrow stromal cells differentiation. Biomaterials. 2005;26(18):3873–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Palestro CJ, Mehta HH, Patel M, Freeman SJ, Harrington WN, Tomas MB, et al. Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99m sulfur colloid scintigraphy. J Nucl Med. 1998;39(2):346–50.PubMedGoogle Scholar
  15. 15.
    Palestro CJ, Roumanas P, Swyer AJ, Kim CK, Goldsmith SJ. Diagnosis of musculoskeletal infection using combined In-111 labeled leukocyte and Tc-99m SC marrow imaging. Clin Nucl Med. 1992;17(4):269–73.CrossRefPubMedGoogle Scholar
  16. 16.
    de Vries EF, Roca M, Jamar F, Israel O, Signore A. Guidelines for the labelling of leucocytes with (99m)Tc-HMPAO. Inflammation/Infection Taskgroup of the European Association of Nuclear Medicine. Eur J Nucl Med Mol Imaging. 2010;37(4):842–8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Hammersley PA, Nkohkwo AT. Studies on white blood cell labelling: (99)Tc(m)-HMPAO preferentially labels granulocytes. Nucl Med Commun. 2001;22(9):981–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Peters AM. The utility of [99mTc]HMPAO-leukocytes for imaging infection. Semin Nucl Med. 1994;24(2):110–27.CrossRefPubMedGoogle Scholar
  19. 19.
    Roca M, de Vries EF, Jamar F, Israel O, Signore A. Guidelines for the labelling of leucocytes with (111)In-oxine. Inflammation/Infection Taskgroup of the European Association of Nuclear Medicine. Eur J Nucl Med Mol Imaging. 2010;37(4):835–41.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Agool A, Glaudemans AW, Boersma HH, Dierckx RA, Vellenga E, Slart RH. Radionuclide imaging of bone marrow disorders. Eur J Nucl Med Mol Imaging. 2011;38(1):166–78.CrossRefPubMedGoogle Scholar
  21. 21.
    Wilhelm AJ, Mijnhout GS, Franssen EJ. Radiopharmaceuticals in sentinel lymph-node detection—an overview. Eur J Nucl Med. 1999;26(4 Suppl):S36–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Erba PA, Glaudemans AW, Veltman NC, Sollini M, Pacilio M, Galli F, et al. Image acquisition and interpretation criteria for 99mTc-HMPAO-labelled white blood cell scintigraphy: results of a multicentre study. Eur J Nucl Med Mol Imaging. 2014;41(4):615–23.CrossRefPubMedGoogle Scholar
  23. 23.
    Palestro CJ, ML. Brown, Forstrom LA, Bennett S. Greenspan, McAfee JG, Royal HD, et al. Society of nuclear medicine procedure guideline for 99mTc-exametazime (HMPAO)-labeled leukocyte scintigraphy for suspected infection/inflammation, version 3.0. Society of nuclear medicine procedure guidelines; 2004.Google Scholar
  24. 24.
    Palestro CJ, Brown ML, Forstrom LA, McAfee JG, Royal HD, Schauwecker DS, et al. Society of nuclear medicine procedure guideline for 111In-leukocyte scintigraphy for suspected infection/inflammation, version 3.0. Society of nuclear medicine procedure guidelines; 2004.Google Scholar
  25. 25.
    Kim HO, Na SJ, Oh SJ, Jung BS, Lee SH, Chang JS, et al. Usefulness of adding SPECT/CT to 99mTc-hexamethylpropylene amine oxime (HMPAO)-labeled leukocyte imaging for diagnosing prosthetic joint infections. J Comput Assist Tomogr. 2014;38(2):313–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Djekidel M, Brown RK, Piert M. Benefits of hybrid SPECT/CT for (111)In-oxine- and Tc-99m-hexamethylpropylene amine oxime-labeled leukocyte imaging. Clin Nucl Med. 2011;36(7):e50–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Filippi L, Schillaci O. Usefulness of hybrid SPECT/CT in 99mTc-HMPAO-labeled leukocyte scintigraphy for bone and joint infections. J Nucl Med. 2006;47(12):1908–13.PubMedGoogle Scholar
  28. 28.
    Hulme KW, Kappadath SC. Implications of CT noise and artifacts for quantitative 99mTc SPECT/CT imaging. Med Phys. 2014;41(4):042502.CrossRefPubMedGoogle Scholar
  29. 29.
    Palestro CJ, Love C, Tronco GG, Tomas MB, Rini JN. Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Radiographics. 2006;26(3):859–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Love C, Palestro CJ. Radionuclide imaging of inflammation and infection in the acute care setting. Semin Nucl Med. 2013;43(2):102–13.CrossRefPubMedGoogle Scholar
  31. 31.
    Love C, Opoku-Agyemang P, Tomas MB, Pugliese PV, Bhargava KK, Palestro CJ. Pulmonary activity on labeled leukocyte images: physiologic, pathologic, and imaging correlation. Radiographics. 2002;22(6):1385–93.CrossRefPubMedGoogle Scholar
  32. 32.
    el Esper I, Dacquet V, Paillard J, Bascoulergue G, Tahon MM, Fonroget J. 99Tcm-HMPAO-labelled leucocyte scintigraphy in suspected chronic osteomyelitis related to an orthopaedic device: clinical usefulness. Nucl Med Commun. 1992;13(11):799–805.CrossRefPubMedGoogle Scholar
  33. 33.
    Devillers A, Moisan A, Jean S, Arvieux C, Bourguet P. Technetium-99m hexamethylpropylene amine oxime leucocyte scintigraphy for the diagnosis of bone and joint infections: a retrospective study in 116 patients. Eur J Nucl Med. 1995;22(4):302–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Pelosi E, Baiocco C, Pennone M, Migliaretti G, Varetto T, Maiello A, et al. 99mTc-HMPAO-leukocyte scintigraphy in patients with symptomatic total hip or knee arthroplasty: improved diagnostic accuracy by means of semiquantitative evaluation. J Nucl Med. 2004;45(3):438–44.PubMedGoogle Scholar
  35. 35.
    Scher DM, Pak K, Lonner JH, Finkel JE, Zuckerman JD, Di Cesare PE. The predictive value of indium-111 leukocyte scans in the diagnosis of infected total hip, knee, or resection arthroplasties. J Arthroplast. 2000;15(3):295–300.CrossRefGoogle Scholar
  36. 36.
    Wukich DK, Abreu SH, Callaghan JJ, Van Nostrand D, Savory CG, Eggli DF, et al. Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells. J Bone Joint Surg Am. 1987;69(9):1353–60.CrossRefPubMedGoogle Scholar
  37. 37.
    Rand JA, Brown ML. The value of indium 111 leukocyte scanning in the evaluation of painful or infected total knee arthroplasties. Clin Orthop Relat Res. 1990;259:179–82.Google Scholar
  38. 38.
    Magnuson JE, Brown ML, Hauser MF, Berquist TH, Fitzgerald RH, Klee GG. In-111-labeled leukocyte scintigraphy in suspected orthopedic prosthesis infection: comparison with other imaging modalities. Radiology. 1988;168(1):235–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Bar-Shalom R, Yefremov N, Guralnik L, Keidar Z, Engel A, Nitecki S, et al. SPECT/CT using 67Ga and 111In-labeled leukocyte scintigraphy for diagnosis of infection. J Nucl Med. 2006;47(4):587–94.PubMedGoogle Scholar
  40. 40.
    Seabold JE, Nepola JV, Marsh JL, Hawes DR, Justin EP, Ponto JA, et al. Postoperative bone marrow alterations: potential pitfalls in the diagnosis of osteomyelitis with In-111-labeled leukocyte scintigraphy. Radiology. 1991;180(3):741–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Becker W, Palestro CJ, Winship J, Feld T, Pinsky CM, Wolf F, et al. Rapid imaging of infections with a monoclonal antibody fragment (LeukoScan). Clin Orthop Relat Res. 1996;(329):263–72.Google Scholar
  42. 42.
    Sousa R, Massada M, Pereira A, Fontes F, Amorim I, Oliveira A. Diagnostic accuracy of combined 99mTc-sulesomab and 99mTc-nanocolloid bone marrow imaging in detecting prosthetic joint infection. Nucl Med Commun. 2011;32(9):834–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Rubello D, Rampin L, Banti E, Massaro A, Cittadin S, Cattelan AM, et al. Diagnosis of infected total knee arthroplasty with anti-granulocyte scintigraphy: the importance of a dual-time acquisition protocol. Nucl Med Commun. 2008;29(4):331–5.CrossRefPubMedGoogle Scholar
  44. 44.
    Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18 F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses. Nucl Med Commun. 2002;23(7):645–53.CrossRefPubMedGoogle Scholar
  45. 45.
    Basu S, Kwee TC, Saboury B, Garino JP, Nelson CL, Zhuang H, et al. FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses. Clin Nucl Med. 2014;39(7):609–15.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Hospital of WalesCardiffUK

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