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Comparison of technetium-99m-MDP, technetium-99m-WBC and technetium-99m-HIG in musculoskeletal inflammation
F Palermo1, F Boccaletto, A Paolin
1Orthopedic Division of Regional Hospital, Treviso, Italy.
Unlabelled:
This study compared three radionuclide techniques in distinguishing musculoskeletal infection from noninfectious inflammation.
Methods:
Thirty-five orthopedic patients with suspected musculoskeletal infection were examined using three radionuclide techniques in sequence: triphasic bone scintigraphy, 99mTc radioleukocytes (99mTc-WBC) scintigraphy and 99mTc human immunoglobulin (99mTc-Hig) scintigraphy. Two "early" and "late" acquisitions were performed, at 4-6 hr and 20-24 hr postinjection, respectively. Patients who were diagnosed as suffering from noninflammatory lesions became the controls. We calcu"late"d for all studies one index of inflammation (Infl) as the ratio between counts in the uptake area and counts in an equal area of normal tissue.
Results:
The "early" radiolabeled leukocytes and "late" Hig scintigraphy allowed the greatest ability to distinguish between infections and noninfectious inflammations (p < 0.011 and p < 0.016) with a sensitivity of 96.6% and 96.5% and specificity of 71% and 100%, respectively. Hig and radioleukocytes allowed distinguishing infections from noninflammatory diseases at both examinations.
Conclusion:
The "early" radioleukocyte scintigraphy allowed us to separate infections from noninfectious inflammations. In contrast, the same result can be obtained only with the "late" scan in the Hig study, but Hig mapped the spread of the inflammation into soft tissues better. Hig might be an alternative to radioleukocytes because of its simple preparation, similar accuracy and safety.
Insights
Early radioleukocyte scintigraphy and late human immunoglobulin (Hig) scintigraphy effectively distinguish musculoskeletal infections from inflammation. Hig also better maps inflammation spread, offering a safe and accurate alternative to radioleukocytes.
Area of Science:
- Nuclear medicine
- Orthopedic imaging
- Infectious disease diagnostics
Background:
- Distinguishing musculoskeletal infection from noninfectious inflammation is clinically challenging.
- Radionuclide techniques offer potential for improved diagnostic accuracy.
Purpose of the Study:
- To compare the efficacy of three radionuclide techniques in differentiating musculoskeletal infection from noninfectious inflammation.
- To evaluate early and late imaging protocols for enhanced diagnostic performance.
Main Methods:
- Thirty-five orthopedic patients with suspected infection underwent triphasic bone scintigraphy, 99mTc radioleukocytes (99mTc-WBC), and 99mTc human immunoglobulin (99mTc-Hig) scintigraphy.
- Early (4-6 hr) and late (20-24 hr) acquisitions were performed for WBC and Hig scans.
- An inflammation index (Infl) was calculated as the ratio of counts in the uptake area to normal tissue.
Main Results:
- Early 99mTc-WBC and late 99mTc-Hig scintigraphy demonstrated the highest ability to distinguish infection from inflammation (p < 0.011 and p < 0.016, respectively).
- Sensitivity for early 99mTc-WBC was 96.6% (specificity 71%), and for late 99mTc-Hig was 96.5% (specificity 100%).
- Both techniques differentiated infections from noninflammatory diseases at both early and late examinations.
Conclusions:
- Early radioleukocyte scintigraphy effectively separates infection from noninfectious inflammation.
- Late Hig scintigraphy achieves similar diagnostic separation and superior mapping of soft tissue inflammation.
- 99mTc-Hig is a potentially valuable alternative to radioleukocytes due to its simple preparation, comparable accuracy, and safety.