title: Granulocytes and three-phase bone scintigraphy for differentiation of diabetic gangrene with and without osteomyelitis.
abstract: 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.
authors.affiliation: Medical Department II, University of Munich, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Ritter
authors.forename: W O
authors.initials: WO
authors.lastname: Richter
authors.forename: G
authors.initials: G
authors.lastname: Leinsinger
authors.forename: C M
authors.initials: CM
authors.lastname: Kirsch
authors.forename: P
authors.initials: P
authors.lastname: Schwandt
mesh_terms: 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
chemical_list: D007205:Indium Radioisotopes; D007457:Iodine Radioisotopes; D013669:Technetium Tc 99m Medronate