Abstract
The skeletal distribution of red marrow-containing sites with a decreased uptake of indium-111-labelled leucocytes was examined as part of a retrospective review of 128 consecutive scans in 113 patients. The prevalence of photopenic defects was determined for sites of suspected osteomyelitis and for other skeletal locations included as part of limited or total-body surveys. Of 52 sites suspected of osteomyelitis based upon radiological and clinical data, 21 (40%) demonstrated a decreased leucocyte uptake. The prevalence of photopenia ranged from 79% (11/14) in the spine and 63% (5/8) in the pelvis to 25% (4/16) in the proximal femur and 0% elsewhere in the extremities (0/9) and in the skull (0/3). Fourteen of these 21 defects (67%) were due to active (n=9) or healed (n = 5) osteomyelitis/discitis. All sites of active osteomyelitis showed destructive changes on correlative radiographs and were associated with infectious processes of more than 1 months duration. Thirty-seven photopenic defects were observed as incidental findings. The prevalence of photopenia as an incidental finding ranged from 0% in the skull, neck and chest to 3%–4% in the thoracolumbar spine and pelvis and 14% in the femoral heads, the latter reflecting primarily bilateral loss of femoral head marrow. No incidentally found photopenic defect reflected active osteomyelitis. At sites in the spine and pelvis with radiologic evidence of bone destruction suggetive of osteomyelitis, an absence of normal red marrow uptake of labelled leucocytes often reflects a variant presentation for active chronic infection. In contrast, incidental photopenia is uncommon at all skeletal sites except the femoral heads, and should not raise concern over unsuspected active osteomyelitis.
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Brown ML, Hauser MF, Aznarez A, Fitzgerald RH (1986) Indium-111 leukocyte imaging. The skeletal photopenic lesion. Clin Nucl Med 11:611–613
Cerqueira MD, Jacobson AF (1989) Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis. J Nucl Med 30:703–706
Coleman RE, Welch D (1980) Possible pitfalls with clinical imaging of indium-111 leukocytes: concise communication. J Nucl Med 21:122–125
Datz FL, Taylor AT Jr (1986) Cell labeling: techniques and clinical utility. In: Freeman LM (ed) Freeman and Johnson's clinical radionuclide imaging, vol 3. Grune and Stratton, Orlando, pp 1785–1847
Datz FL, Thorne DA (1987) Cause and significance of cold bone defects on indium-111-labeled leukocyte imaging. J Nucl Med 28:820–823
Eisenberg B, Powe JE, Alavi A (1991) Cold defects in In-111 leukocyte imaging of osteomyelitis in the axial skeleton. Clin Nucl Med 16:103–106
Froehlich JW, Swanson D (1984) Imaging of inflammatory processes with labeled cells. Semin Nucl Med 14:128–140
King AD, Peters AM, Stuttle AWJ, Lavender JP (1990) Imaging of bone infection with labelled white blood cells: role of contemporaneous bone marrow imaging. Eur J Nucl Med 17:148–151
Knochel JQ, Koehler PR, Lee TG, Welch DM (1980) Diagnosis of abdominal abscesses with computed tomography, ultrasound, and 111In leukocyte scans. Radiology 137:425–432
McAfee JG, Thakur MC (1976) Survey of radioactive agents for in vitro labeling of phagocytic leukocytes. I. Soluble agents. J Nucl Med 17:480–487
McAfee JG, Gagne GM, Subramanian ZD, et al. (1980) Distribution of leukocytes labeled with In-111 oxine in dogs with acute inflammatory lesions. J Nucl Med 21:1059–1068
McCarthy K, Velchik MG, Alavi A, Mandell GA, Esterhai JL, Goll S (1988) Indium-111 labeled white blood cells in the detection of osteomyelitis complicated by a preexisting condition. J Nucl Med 29:1015–1021
Merkel KD, Brown ML, Dewanjee MK, Fitzgerald RH Jr (1985) Comparison of indium-labeled leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis. J Bone Joint Surg [Am] 67:465–476
Mok YP, Carney WH, Fernandez-Ulloa M (1984) Skeletal photopenic lesions in In-111 WBC imaging. J Nucl Med 25:1322–1326
Palestro CJ, Kim CK, Swyer AJ, Capozzi JD, Solomon RW, Goldsmith SJ (1990) Total hip arthroplasty: periprosthetic indium-111-labeled leukocyte activity and complementary technetium-99m sulfur colloid imaging in suspected infection. 31:1950–1955
Palestro CJ, Chun CK, Swyer AJ, Vallabhajosula S, Goldsmith SJ (1991) Radionuclide diagnosis of vertebral osteomyelitis: indium-111 leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy. J Nucl Med 32:1861–1865
Schauwecker DS (1989) Osteomyelitis: diagnosis with In-111-labeled leukocytes. Radiology 171:141–146
Schauwecker DS, Park H-M, Mock BH, et al. (1984) Evaluation of complicating osteomyclitis with Tc-99m MDP, In-111 granulocytes, and Ga-67 citrate. J Nucl Med 25:849–853
Seabold JE, Nepola JV, Marsh JL, et al (1991) Post-operative bone marrow alterations: potential pitfalls in the diagnosis of osteomyelitis with In-111-labeled leukocyte scintigraphy. Radiology 180:741–747
Sfakianakis GN, Al-Shiekh W, Heal A, Rodman G, Zeppa R, Serafini A (1982) Comparisons of scintigraphy with In-111 leukocytes and Ga-67 in the diagnosis of occult sepsis. J Nucl Med 23:618–626
Spencer RP, Lee YSL, Sziklas JJ, Rosenberg RJ, Karimeddini MK (1983) Failure of uptake of radiocolloid by the femoral heads: a diagnostic problem. Concise communication. J Nucl Med 24:116–118
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Jacobson, A.F., Gilles, C.P. & Cerqueira, M.D. Photopenic defects in marrow-containing skeleton on indium-111 leucocyte scintigraphy: prevalence at sites suspected of osteomyelitis and as an incidental finding. Eur J Nucl Med 19, 858–864 (1992). https://doi.org/10.1007/BF00168161
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DOI: https://doi.org/10.1007/BF00168161