Postoperative bone marrow alterations: potential pitfalls in the diagnosis of osteomyelitis with In-111-labeled leukocyte scintigraphy.
Scintigraphy was used after injection of technetium-99m methylene diphosphonate (MDP) and indium-111-labeled white blood cells (WBCs) to assess for the presence of osteomyelitis in 97 patients who had undergone prior surgical procedures. Thirty-four patients with abnormal In-111-labeled WBC patterns underwent restudy with Tc-99m albumin colloid (AC). Scintigraphic findings were considered positive for osteomyelitis whenever localization of In-111-labeled WBCs exceeded Tc-99m AC activity in extent or focal intensity (discordant pattern). Ten of 12 patients with culture-proved osteomyelitis had discordant patterns; two had false-negative (concordant) patterns. The cases of 20 of 22 patients without infection who were considered to have osteomyelitis on the basis of patterns of In-111-labeled WBCs and Tc-99m MDP were reclassified correctly on the basis of concordant patterns of In-111-labeled WBCs and Tc-99m AC. Radiocolloid images improved the overall scintigraphic specificity for osteomyelitis from 59% without bone marrow imaging to 92%; sensitivity decreased from 94% to 88%.
Seabold
J E
JE
Department of Radiology, University of Iowa College of Medicine, Iowa City 52242.
Nepola
J V
JV
Marsh
J L
JL
Hawes
D R
DR
Justin
E P
EP
Ponto
J A
JA
Pettit
W A
WA
el-Khoury
G Y
GY
Kirchner
P T
PT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000000981:diagnostic imaging; D001842:Bone and Bones / Q000000981:diagnostic imaging; D003951:Diagnostic Errors; D005260:Female; D005599:Fractures, Ununited / Q000150:complications; D006801:Humans; D007205:Indium Radioisotopes; D007595:Joint Prosthesis; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate
D007205:Indium Radioisotopes; D013669:Technetium Tc 99m Medronate