Osteomyelitis: diagnosis with In-111-labeled leukocytes

Area of Science:

• Nuclear Medicine
• Radiology
• Infectious Disease Imaging

Background:

• Osteomyelitis diagnosis can be challenging, requiring accurate imaging to differentiate bone infection from soft tissue involvement.
• Indium-111 leukocyte scintigraphy is a key imaging modality for detecting osteomyelitis.

Purpose of the Study:

• To evaluate the diagnostic performance of simultaneous versus sequential bone and indium-111 leukocyte scanning for osteomyelitis.
• To assess the impact of infection location (central, middle, peripheral) on diagnostic sensitivity and specificity.

Main Methods:

• Retrospective review of 485 patients with suspected osteomyelitis.
• Analysis of 453 patients who underwent both bone scintigraphy and indium-111 leukocyte scanning.
• Comparison of simultaneous and sequential scanning protocols.

Main Results:

• Simultaneous scanning demonstrated superior ability to localize infection to bone versus adjacent soft tissue compared to sequential scanning.
• Overall sensitivity was significantly lower in central bone locations (containing active bone marrow) than in peripheral or middle locations.
• Specificity remained high (~90%) across all locations.
• Sensitivity for acute osteomyelitis was high regardless of location, but lower in central locations for chronic osteomyelitis.

Conclusions:

• Simultaneous bone and indium-111 leukocyte scintigraphy is more effective than sequential imaging for diagnosing osteomyelitis.
• Infection location significantly impacts sensitivity, with central sites posing a greater diagnostic challenge, particularly for chronic osteomyelitis.