Infecton: a 99mTc-ciprofloxacin radiopharmaceutical for the detection of bone infection.
OBJECTIVE
To evaluate Infecton scintigraphy, with technetium-99m-radiolabeled ciprofloxacin, as a means to detect bone infection, in comparison with other conventional scintigraphic and radiologic methods.


METHODS
Forty-five patients with known or suspected bone infection underwent 50 scans with Infecton. Almost all were also subjected to a three-phase 99mTc-methylene diphosphonate bone scan and most of them to a 99mTc-human polyclonal immunoglobulin scan as well as to a gallium-67-citrate scan, plus computerized tomography or magnetic resonance imaging or both. Clinical laboratory criteria for the presence of osteomyelitis were based on the definitions of the Centers for Disease Control and Prevention.


RESULTS
Staphylococcus aureus and Pseudomonas aeruginosa were the most frequently isolated pathogens. Based on the CDC clinical laboratory criteria as well as on conventional scan results, Infecton was characterized in 35 studies as 'true positive', in eight as 'true negative', in two as 'false positive', in one as 'false negative', and in four as 'indeterminate'. The sensitivity and specificity of Infecton scintigraphy were found to be 97.2% and 80%, respectively, with positive and negative predictive values of 94.6% and 88.9%.


CONCLUSIONS
It is concluded that Infecton is a very sensitive and quite specific marker of bone infection, but care must be taken in cases of excessive new bone formation and primary bone tumors, where false-positive results may be obtained.
Malamitsi
J
J
Department of Medical Physics, Sismanoglion General Hospital, Athens University Medical School, Athens, Greece.
Giamarellou
H
H
Kanellakopoulou
K
K
Dounis
E
E
Grecka
V
V
Christakopoulos
J
J
Koratzanis
G
G
Antoniadou
A
A
Panoutsopoulos
G
G
Batsakis
C
C
Proukakis
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002939:Ciprofloxacin / Q000031:analogs & derivatives*; D002951:Citrates; D004164:Diphosphonates; D005260:Female; D005708:Gallium; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000382:microbiology; D011237:Predictive Value of Tests; D011552:Pseudomonas Infections / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging; D013667:Technetium; D014057:Tomography, X-Ray Computed
D002951:Citrates; D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C431804:Technetium Tc 99m ciprofloxacin; C114890:technetium 99m methylene bisphosphonate; D002939:Ciprofloxacin; D013667:Technetium; D005708:Gallium; C103850:gallium citrate