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The Quarterly Journal of Nuclear Medicine 1999 March;43(1):29-37


language: English

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

From the 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.

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