The computer-generated bone marrow subtraction image: a valuable adjunct to combined In-111 WBC/Tc-99m in sulfur colloid scintigraphy for musculoskeletal infection.
In-111 WBC scintigraphy supplemented by visual comparison with concurrent Tc-99m SC bone marrow imaging is used to identify infection within the marrow-containing skeleton. This retrospective study demonstrates the value of the computer-generated WBC/SC bone marrow subtraction image. Thirty-one patients with various conditions (postsurgery with or without orthopedic hardware, bacteremia with persistent fever, joint arthroplasty, and miscellaneous) underwent combined WBC/SC with bone marrow subtraction imaging. Infection was present in 21 of 36 possible sites (14 osseous, 7 soft tissue; 8 acute, 13 chronic). The bone marrow subtraction image identified two of these sites, which were not appreciated by visual inspection. The sensitivity, specificity, and accuracy for bone marrow subtraction were 95%, 93%, and 94%, respectively, as compared to 86%, 93%, and 89%, respectively, for the visual assessment of WBC and SC images. Computer-assisted subtraction imaging improves overall accuracy and enhances diagnostic certainty of combined WBC/SC scintigraphy for infection in the marrow-containing skeleton.
Department of Radiology, New England Medical Center, Boston, Massachusetts.
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D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001853:Bone Marrow / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007205:Indium Radioisotopes; D007962:Leukocytes; D008297:Male; D009135:Muscular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging* / Q000453:epidemiology; D013671:Technetium Tc 99m Sulfur Colloid
D007205:Indium Radioisotopes; D013671:Technetium Tc 99m Sulfur Colloid