Technetium-99-labeled leukocytes in diagnosing diabetic osteomyelitis in the foot

Hexamethylpropylamineoxine (HMPAO)-labeled leukocytes were studied to examine the scintigraphic significance of the procedure in diagnosing bone infection in patients with chronic nonhealing foot ulcerations. Fifty-two patients were scanned with Technetium-99-labeled white blood cells and scintigraphic results were compared with histological analysis, bone culture, and radiographic findings. Twenty-one patients demonstrated positive uptake with imaging and focal accumulation of leukocytes at the area of suspected infection. Sensitivity, specificity, and accuracy were calculated and found to be 86%, 90%, and 88%, respectively. Thirty-one members of the population were also scanned with Tc-99 methylene diphosphate (MDP) triphasic scintigraphy. Sensitivity equaled 91% and specificity was found to be significantly lower (40%) when compared with the leukocyte-labeled scans. Technetium-99 (HMPAO) leukocyte scintigraphs demonstrated a significantly higher specificity and accuracy rate when compared with Technetium-99 (MDP) triphasic scans.