Granulocytes and three-phase bone scintigraphy for differentiation of diabetic gangrene with and without osteomyelitis.
OBJECTIVE
In diabetic gangrene, concomitant osteopathy and soft-tissue infection often render laboratory and roentgenographic signs unreliable as indicators of osteomyelitis. In this situation, scintigraphic methods can be helpful.


METHODS
Relying on the long-term clinical course as the final indicator of presence or absence of osteomyelitis, we prospectively compared in 31 patients three-phase bone scintigraphy with either indium-labeled autologous granulocytes (n = 20) or 123I-labeled antibodies against granulocytes (n = 11).


RESULTS
Three-phase bone scintigraphy and imaging with indium-labeled autologous granulocytes yielded sensitivities and specificities of 95 and 70% for bone scintigraphy and 77 and 100% for granulocyte scintigraphy, respectively. One patient with severe angiopathy and proved osteomyelitis had a negative bone scintigraphy but a positive scintigraphy with labeled antibodies against granulocytes. One patient with aseptic bone necrosis presented with a formally false positive result with both methods.


CONCLUSIONS
In contrast to former retrospective studies, three-phase bone scintigraphy compares very well with granulocyte scintigraphy. The care of most patients can be managed with clinical data and this widely available scintigraphic method.
Ritter
M M
MM
Medical Department II, University of Munich, Germany.
Richter
W O
WO
Leinsinger
G
G
Kirsch
C M
CM
Schwandt
P
P
D001842:Bone and Bones / Q000000981:diagnostic imaging*; D048909:Diabetes Complications; D003925:Diabetic Angiopathies / Q000150:complications; D003937:Diagnosis, Differential; D005260:Female; D005734:Gangrene / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006098:Granulocytes; D006801:Humans; D007205:Indium Radioisotopes; D007457:Iodine Radioisotopes; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D013669:Technetium Tc 99m Medronate; D014055:Tomography, Emission-Computed
D007205:Indium Radioisotopes; D007457:Iodine Radioisotopes; D013669:Technetium Tc 99m Medronate