Inability of 99mTc-ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases.
Ciprofloxacin labeled with (99m)Tc specifically binds to various bacteria. Thus, it potentially constitutes a specific marker allowing discrimination between septic arthritis/osteomyelitis and aseptic osteoarticular diseases. The aim of this prospective study was to evaluate such properties in patients with skeletal diseases.


METHODS
We prospectively investigated 2 groups of patients: patients with suspected osteoarticular infections (G1, n = 16) and a control group of patients with a presentation of osteoarticular diseases and no sign suggestive of infection (G2, n = 11). All had clinical, biologic, and radiologic evaluations and had 1-, 4-, and 24-h images from (99m)Tc-ciprofloxacin scintigraphy (370 MBq) before planned biopsy or surgery. For 23 patients, the scintigraphic results were compared with histologic and bacteriologic analyses of biopsy tissue samples; for 4 patients, the scintigraphic results were compared with the findings from 23 +/- 5 mo of follow-up.


RESULTS
In G1, (99m)Tc-ciprofloxacin findings were true-positive in all 11 infected sites, true-negative in 2 cases, and false-positive in 3. In G2, (99m)Tc-ciprofloxacin was true-negative in 4 cases and false-positive in 7. Neither the location of (99m)Tc-ciprofloxacin activity nor its intensity or kinetics between 1, 4, and 24 h allowed discrimination between infection and aseptic diseases (sterile loosened joint replacement, pseudoarthrosis, or arthrosis). Sensitivity, specificity, and accuracy were 100%, 37.5%, and 63%.


CONCLUSIONS
(99m)Tc-Ciprofloxacin scintigraphy showed good sensitivity and a high negative predictive value for the detection of bone and joint infection, but it did not discriminate between infected and aseptic osteoarticular diseases in symptomatic patients referred for surgery.
Sarda
Laure
L
Service Hospitalier Frédéric Joliot, Commissariat à l'Energie Atomique, Orsay, France.
Crémieux
Anne-Claude
AC
Lebellec
Yves
Y
Meulemans
Alain
A
Lebtahi
Rachida
R
Hayem
Gilles
G
Génin
Rémi
R
Delahaye
Nicolas
N
Huten
Denis
D
Le Guludec
Dominique
D
D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000000981:diagnostic imaging / Q000473:pathology; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D002939:Ciprofloxacin / Q000031:analogs & derivatives*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C431804:Technetium Tc 99m ciprofloxacin; D002939:Ciprofloxacin