title: Cold-hot mismatch between Tc-99m HMPAO-labeled leukocytes and Tc-99m ciprofloxacin in axial skeleton infections: a report of three cases.
abstract: Radiolabeled leukocyte scintigraphy is a well-established technique for the diagnosis of inflammation and infection with a typical presentation of a hot spot within the abnormal areas. However, in some cases of osteomyelitis of the axial skeleton, a cold defect pattern has been described. Tc-99m ciprofloxacin is a new agent claimed to be specific for imaging sites containing viable bacteria. In this report, we present three cases of proved bacterial infection of the axial skeleton with a mismatch pattern between Tc-99m ciprofloxin and tagged leukocytes. Although Tc-99m-labeled leukocyte scanning showed a cold defect, probably caused by bone marrow replacement, the Tc-99m ciprofloxacin consecutively revealed a hot spot at the site of infection. These data suggest that Tc-99m ciprofloxacin should be a better agent than radiolabeled leukocytes for detecting osteomyelitis of the axial skeleton.
authors.affiliation: Clinica Alemana-Santiago, Nuclear Medicine Unit, Santiago, Chile. hamaral@alemana.cl
authors.forename: H
authors.initials: H
authors.lastname: Amaral
authors.forename: B
authors.initials: B
authors.lastname: Morales
authors.forename: R
authors.initials: R
authors.lastname: Pruzzo
authors.forename: K E
authors.initials: KE
authors.lastname: Britton
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D005260:Female; D006801:Humans; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013667:Technetium; D019690:Technetium Tc 99m Exametazime
chemical_list: D000890:Anti-Infective Agents; D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D002939:Ciprofloxacin; D013667:Technetium