title: Diagnostic efficacy of technetium-99m pentavalent-dimercapto succinic acid versus gallium-67 citrate, imaging in patients with highly suspected acute bone and joint infections.
abstract: The purpose of this study was to evaluate and compare the diagnostic efficacy of (99m)Tc(V) dimercaptosuccinic acid ((99m)Tc(V)DMSA) with the (67)Ga-citrare ((67)Ga-C) scintigraphy in patients with suspected bone and joint infection. Thirty one patients, 19 men and 12 women, aged 18-78 y with median age 56 y, with suspected acute bone infection, were enrolled in this study. Besides (67)Ga-C and (99m)Tc(V)DMSA scintigraphy, all patients underwent X-ray radiography and technetium-99m methylene disphosphonate ((99m)Tc-MDP) bone scan for supporting the initial diagnosis. The (99m)Tc-MDP bone scan was considered positive for acute bone and joint infection when all its four scintigraphic phases were positive. Final diagnosis was based on needle aspiration and/or biopsy findings. Sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV) were calculated. Our results have shown the following: Seventeen patients (17/31) had histologically confirmed acute bone and joint infections, while the remaining patients had no infection. (99m)Tc(V)DMSA diagnosed bone and joint infections in all positive (17/31) patients while (67)Ga-C in 16/31 patients. Discordant scintigraphic results were observed by (67)Ga-C in 2/31 cases: in one positive case of femur postoperative infection (false negative for (67)Ga-C) and in one case of clinicaly suspected infection in the femur while the patient had a preexisting fracture (false positive with (67)Ga-C). No false negative results were observed with (99m)Tc(V)DMSA. Sensitivity, specificity, PPV, NPV and accuracy were maximum for (99m)Tc(V)DMSA, while for (67)Ga-C were: 94.1%, 93%, 94.1%, 93%, and 93.5% respectively. It is concluded that considering the high sensitivity and specificity of (99m)Tc(V)DMSA in the detection of acute bone and joint infections, the lower radiation dose, the cost and the shorter time spent for the imaging procedure, as compared to (67)Ga-C, (99m)Tc(V)DMSA should be preferred to (67)Ga-C as a bone scan agent for the detection of acute bone and joint infections.
authors.affiliation: Department of Nuclear Medicine, University Hospital Heraklion, Crete, Greece. sophiak@her.forthnet.gr
authors.forename: Sophia
authors.initials: S
authors.lastname: Koukouraki
authors.forename: Ioannis
authors.initials: I
authors.lastname: Gaitanis
authors.forename: Alexandros
authors.initials: A
authors.lastname: Hatjipaulou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karkavitsas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000000981:diagnostic imaging*; D002951:Citrates; D005260:Female; D005708:Gallium; D006801:Humans; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
chemical_list: D002951:Citrates; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D005708:Gallium; C103850:gallium citrate