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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING
Rivista di Medicina Nucleare e Imaging Molecolare
A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the and to the International Research Group of Immunoscintigraphy
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index (SciSearch), Scopus
Impact Factor 2,413
The Quarterly Journal of Nuclear Medicine 1999 Marzo;43(1):29-37
Polyclonal, nonspecific 111In-IgG scintigraphy in the evaluation of complicated osteomyelitis and septic arthritis
Molina-Murphy I. L. 1,3, Palmer E. L. 1, Scott J. A. 1, Prince M. R. 1, Strauss H. W. 1, Rubin R. H. 1,2, Fischman A. J. 1,2
1 Division of Nuclear Medicine of the Department of Radiology Massachusetts General Hospital and the Department of Radiology Harvard Medical School, Boston MA
2 Center for Experimental Pharmacology and Therapeutics Harvard - M.I.T. Division of Health Sciences and Technology, Cambridge MA
3 Department of Nuclear Medicine Veterans Affairs, Medical Center, San Juan, PR
Background. In this investigation we tested the hypothesis that 111In-IgG scintigraphy can differentiate infectious from sterile inflammatory processes in patients with complicated osteomyelitis or septic arthritis.
Methods. A prospective university hospital based study was performed over 18 months. We studied 31 sites of suspected infection, in 25 adult patients, (age 18 to 74 years, 12 females and 13 males) referred with clinical presentations compatible with complicated osteomyelitis or septic arthritis and in whom proof of the infection was likely to be obtained. The clinical setting in these patients was previous trauma, recent surgery, peripheral vascular disease or adjacent soft tissue infection. Whole body scintigraphy was performed at 1-6, 18-24 and 42-48 hours after administration of 55 MBq of 111In-IgG and results were compared to radiographs, 99mTc-MDP skeletal scintigraphy, biopsy specimens (9 sites) or synovial fluid aspirates (4 sites) and clinical follow-up.
Results. Of the 31 sites evaluated, 68% (21/31) were interpreted as negative for abnormal tracer accumulation and 32% (10/31) were considered positive. In patients who underwent biopsy and/or synovial fluid aspiration, 6 of 7 sites were correctly interpreted as positive; sensitivity 86%. Five of 6 sites were correctly interpreted as negative; specificity 83%. When all patients were considered using clinical follow-up in addition to culture results, 9 of 10 sites were correctly interpreted as positive (sensitivity 90%) and 20 of 21 patients were correctly interpreted as negative (specificity 95%).
Conclusions. 111In-IgG scintigraphy is useful for detection of musculoskeletal infection in patients in whom sterile inflammatory events simulate infectious processes.