title: Inability of 99mTc-ciprofloxacin scintigraphy to discriminate between septic and sterile osteoarticular diseases.
abstract: 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.
authors.affiliation: Service Hospitalier Frédéric Joliot, Commissariat à l'Energie Atomique, Orsay, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Sarda
authors.forename: Anne-Claude
authors.initials: AC
authors.lastname: Crémieux
authors.forename: Yves
authors.initials: Y
authors.lastname: Lebellec
authors.forename: Alain
authors.initials: A
authors.lastname: Meulemans
authors.forename: Rachida
authors.initials: R
authors.lastname: Lebtahi
authors.forename: Gilles
authors.initials: G
authors.lastname: Hayem
authors.forename: Rémi
authors.initials: R
authors.lastname: Génin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delahaye
authors.forename: Denis
authors.initials: D
authors.lastname: Huten
authors.forename: Dominique
authors.initials: D
authors.lastname: Le Guludec
mesh_terms: 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
chemical_list: D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C431804:Technetium Tc 99m ciprofloxacin; D002939:Ciprofloxacin