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Comparative Analysis of 99mTc-MDP Three-Phase Bone Scan with SPECT/CT and 99mTc-HMPAO-Labeled WBC SPECT/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis

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Abstract

Purpose

To identify differences between three-phase bone scan and SPECT/CT (TBS) and WBC SPECT/CT (WS) and compare diagnostic accuracies of each modality in patients with suspicious post-traumatic osteomyelitis (OM).

Methods

Twenty-one patients with suspicious post-traumatic OM were enrolled. All patients performed TBS and WS within 1 week. Foci of MDP and WBC accumulation were divided into three categories: bone (OM), soft tissue (soft tissue inflammation; STI), negative for inflammation (NI). Confirmative diagnosis was made upon operative pathology or long-term clinical follow-up.

Results

Of 21 patients, four OM, eight STI, nine NI were finally diagnosed. TBS diagnosis was correct in three of four positive cases and nine of 17 negative cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of TBS were 75 %, 52.9 %, 57.1 %, 27.3 %, 90 %. WS diagnosis was correct in two of four positive cases and 17 of 17 negative cases. Sensitivity, specificity, accuracy, PPV, NPV were 50 %, 100 %, 81.0 %, 100 %, 89.5 %. Twelve of 21 cases showed agreement between TBS and WS. TBS misdiagnosed nine cases (six STI and two NI as eight OM; one OM as one STI), while WS misdiagnosed four cases (two OM as two STI; two STI as two NI). Combining results from TBS and WS led to better diagnostic accuracy (91.7 %) than either TBS or WS alone.

Conclusion

TBS and WS showed moderate agreement in assessment of clinically suspected post-traumatic OM. WS better evaluated inflammation than TBS. WS tended to underestimate inflammation whereas TBS tended to overestimate inflammation. Combining TBS and WS enhanced diagnostic accuracy.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Republic of Korea

    Chanwoo Kim, Soo Jin Lee, Ji Young Kim & Yun Young Choi

  2. Department of Orthopedic Surgery, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 133-792, Republic of Korea

    Kyu Tae Hwang

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  1. Chanwoo Kim
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  2. Soo Jin Lee
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  3. Ji Young Kim
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Correspondence to Yun Young Choi.

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Conflict of Interest

Chanwoo Kim, Soo Jin Lee, Ji Young Kim, Kyu Tae Hwang, and Yun Young Choi declare that they have no conflict of interest.

Ethical Statement

The study was approved by an institutional review board or equivalent and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All subjects in the study gave written informed consent or the institutional review board waived the need to obtain informed consent.

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Kim, C., Lee, S.J., Kim, J.Y. et al. Comparative Analysis of 99mTc-MDP Three-Phase Bone Scan with SPECT/CT and 99mTc-HMPAO-Labeled WBC SPECT/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis. Nucl Med Mol Imaging 51, 40–48 (2017). https://doi.org/10.1007/s13139-016-0441-x

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  • DOI: https://doi.org/10.1007/s13139-016-0441-x

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