[Scintigraphy with radiolabeled granulocytes for the detection of peripheral septic osteoarticular sites].
Radiolabeled granulocyte scintigraphy is a recently introduced technique for detecting osteoarticular infections. Technetium-99m-labeled hexamethylpropylamineoxime (HMPAO), in use since 1986, provides excellent resolution with less radiation exposure than indium-111. Elimination of lymphocytes provides further improvements in image quality and safety, making the technique suitable for use in children. The authors prospectively studied 30 scintigraphies performed with isolated autologous 99mTc-HMPAO-labeled granulocytes to evaluate suspected osteoarticular infection. Image quality was outstanding. In peripheral sites, infection manifested as a focus of increased uptake visible in all three phases (30 min, 3 hours and 18 hours after the injection). Performance was excellent, with 11 true-positive scans, 14 true negative scans, 4 false-positive scans (including two ascribable to recent surgery), and one false-negative scan. Among the 28 evaluable cases, positive predictive value was 85%, negative predictive value was 90%, and sensitivity, specificity, and accuracy were 92%, 88%, and 89%, respectively. The only limitation to routine use of this technique is the need for in vitro granulocyte separation which is time-consuming and requires special precautions to preserve granulocyte function. Nevertheless, these data demonstrate that 99mTc-HMPAO-labeled granulocyte scintigraphy is of value for the detection of osteoarticular infections in patients without chronic inflammatory joint disease.
Sevice de Médecine Nucléaire, CHRU Lapeyronie, Montpellier.
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Auvert-Colin
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Couret
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O
Fajon
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M
Rossi
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000000981:diagnostic imaging*; D002648:Child; D002908:Chronic Disease; D005121:Extremities; D005260:Female; D006098:Granulocytes; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate
D013669:Technetium Tc 99m Medronate
Scintigraphie aux polynucléaires marqués dans la détection des foyers septiques ostéoarticulaires de siège périphérique.