Detection of osteomyelitis at fracture nonunion sites: comparison of two scintigraphic methods

Journal Article · Mon May 01 04:00:00 EDT 1989 · AJR, Am. J. Roentgenol.; (United States)

DOI:https://doi.org/10.2214/ajr.152.5.1021· OSTI ID:6153510

Seabold, J E; Nepola, J V; Conrad, G R; Marsh, J L; Montgomery, W J; Bricker, J A; Kirchner, P T

Forty-nine patients with 50 fracture nonunions 4-48 months after injury underwent technetium-99m methylene diphosphonate (99mTc-MDP) scintigraphy on day 1, combined 99mTc-MDP and indium-111 leukocyte (111In-WBC) scintigraphy on day 2, and gallium-67 (67Ga) scintigraphy on day 3. The results were compared to evaluate the relative abilities of these scintigraphic techniques to detect osteomyelitis. Combined 99mTc-MDP/111In-WBC images were interpreted with the use of two criteria. A positive study by the first criterion required 111In-WBC localization in the region of the nonunion fracture. A positive study by the second criterion required 111In-WBC localization in bone at the fracture site. The first criterion yielded a sensitivity of 84%, specificity of 72%, and accuracy of 74%; the specificity improved to 97% with an accuracy of 88% when the second criterion was used. Ten (25%) of the 40 patients thought not to have osteomyelitis by clinical criteria at the time of imaging had true-positive 99mTc-MDP/111In-WBC studies by biopsy culture results. Gallium-67 studies were interpreted as nondiagnostic if localization of radioisotope at fracture sites was equal to that with 99mTc-MDP, positive if 67Ga localization was greater than that of 99mTc-MDP, and negative if it was less than that of 99mTc-MDP. Twenty-one 67Ga studies were interpreted as nondiagnostic; 11 (52%) of the 21 had culture-positive fracture sites. The accuracy of 67Ga/99mTc-MDP imaging was 39%. Combined 99mTc-MDP/111In-WBC imaging is useful in the detection of osteomyelitis at fracture nonunion sites and improves the specificity of 111In-WBC imaging by differentiating inflammation/infection in adjacent soft tissue from osteomyelitis at the fracture site.

• Research Organization: Univ. of Iowa Hospitals and Clinics, Iowa City (USA)
• OSTI ID: 6153510
• Journal Information: AJR, Am. J. Roentgenol.; (United States), Journal Name: AJR, Am. J. Roentgenol.; (United States) Vol. 152:5; ISSN AAJRD
• Country of Publication: United States
• Language: English

Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY FLUIDS
BONE FRACTURES
COMPARATIVE EVALUATIONS
COUNTING TECHNIQUES
DAYS LIVING RADIOISOTOPES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
ELECTRON CAPTURE RADIOISOTOPES
GALLIUM 67
GALLIUM ISOTOPES
HOURS LIVING RADIOISOTOPES
INDIUM 111
INDIUM ISOTOPES
INJURIES
INTERMEDIATE MASS NUCLEI
ISOMERIC NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
LEUKOCYTES
MATERIALS
MINUTES LIVING RADIOISOTOPES
NUCLEI
ODD-EVEN NUCLEI
ORGANS
OSTEOMYELITIS
PATIENTS
RADIOISOTOPE SCANNING
RADIOISOTOPES
SCINTISCANNING
SENSITIVITY ANALYSIS
SKELETAL DISEASES
SKELETON
TECHNETIUM 99
TECHNETIUM ISOTOPES
YEARS LIVING RADIOISOTOPES