111In-labelled leucocyte and 99mTc-methylene diphosphonate bone scanning in pelvic osteomyelitis

Area of Science:

• Nuclear Medicine
• Diagnostic Imaging
• Skeletal System Imaging

Background:

• Pelvic osteomyelitis is a challenging bone infection requiring accurate diagnosis.
• Radionuclide imaging plays a crucial role in diagnosing and managing osteomyelitis.
• Distinguishing infection from other pelvic pathologies can be difficult.

Observation:

• A 15-year-old female presented with symptoms suggestive of pelvic osteomyelitis.
• A technetium-99m-labeled methylene diphosphonate (99mTc-MDP) bone scan showed increased uptake in the pelvic region, indicating osteomyelitis.
• An indium-111-labeled white blood cell (111In-WBC) scan was subsequently performed.

Findings:

• The 99mTc-MDP bone scan confirmed the presence of osteomyelitis.
• The 111In-WBC scan demonstrated localized areas of infection and confirmed the presence of pus.
• The white blood cell scan provided superior anatomical localization compared to the bone scan.
• The detailed imaging from the 111In-WBC scan facilitated the selection of the optimal surgical approach.

Implications:

• Leukocyte scintigraphy is a valuable tool for confirming and precisely localizing osteomyelitis, especially when bone scans are equivocal or require further anatomical detail.
• This imaging modality aids in surgical planning for complex bone infections, potentially improving outcomes.
• The combined use of bone and white blood cell scintigraphy offers a comprehensive diagnostic strategy for pelvic osteomyelitis.