title: The value of quantitative uptake of (99m)Tc-MDP and (99m)Tc-HMPAO white blood cells in detecting osteomyelitis in violated peripheral bones.
abstract: Our objective in this study was to evaluate whether measurement of quantitative uptake of (99m)Tc-methylene diphosphate (MDP) and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO) white blood cells (WBCs) is useful in detecting osteomyelitis in peripheral bony lesions.
  
  
  METHODS
  Twenty-four patients (12 men and 12 women; age range, 25-72 y) were referred for imaging because of clinically suspected osteomyelitis. They had a traumatic fracture (n = 10), knee prosthesis (n = 5), hip prosthesis (n = 2), diabetic foot (n = 4), or chronic osteomyelitis (n = 3). Three-phase bone scanning and (99m)Tc-HMPAO WBC studies were performed on all patients within the same week. Regions of interest were drawn over the abnormal bony sites and the contralateral normal sites, and the abnormal-to-normal uptake ratios (A/N ratios) were obtained for both studies.
  
  
  RESULTS
  All patients had abnormal findings on 3-phase bone scanning, whereas 17 (71%) had abnormal findings on (99m)Tc-HMPAO WBC studies, of which 15 were confirmed to be true-positive. In those 15 patients, the mean A/N ratios for (99m)Tc-MDP and (99m)Tc-HMPAO WBC were 3.0 +/- 1.6 (range, 1.3-6.2) and 1.8 +/- 0.3 (range, 1.4-2.2), respectively. In the other 9 patients, whose scan results were clinically confirmed to be true-negative, the mean A/N ratios for (99m)Tc-MDP and (99m)Tc-HMPAO WBC were 2.1 +/- 1.2 and 1.2 +/- 0.2, respectively. In the group with a (99m)Tc-MDP A/N ratio greater than 2 (n = 15), 87% (13/15) had a high (99m)Tc-HMPAO WBC A/N ratio (>1.5), including 2 that were false-positive. In the remaining 2 patients, one with chronic osteomyelitis and the other with a recent hip prosthesis, (99m)Tc-HMPAO WBC ratios were normal. In the group with a bone A/N ratio of less than 2 (n = 9), only 4 patients (44%) were true-positive for acute osteomyelitis.
  
  
  CONCLUSIONS
  (99m)Tc-MDP bone scanning alone, with an A/N ratio of more than 2, is useful in detecting osteomyelitis in violated bone except in the case of a recent hip prosthesis or chronic osteomyelitis.
authors.affiliation: Biomedical Sciences, Lebanese International University, Beirut, Lebanon. nasser.ballani@liu.edu.lb
authors.forename: Nasser S
authors.initials: NS
authors.lastname: Ballani
authors.forename: Fawaz Abu
authors.initials: FA
authors.lastname: Al-Huda
authors.forename: Haider A
authors.initials: HA
authors.lastname: Khan
authors.forename: Shihab
authors.initials: S
authors.lastname: Al-Mohannadi
authors.forename: Hanan
authors.initials: H
authors.lastname: Mahmood
authors.forename: Farha
authors.initials: F
authors.lastname: Al-Enezi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000378:metabolism; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019690:Technetium Tc 99m Exametazime / Q000493:pharmacokinetics; D013669:Technetium Tc 99m Medronate / Q000493:pharmacokinetics*
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime; D013669:Technetium Tc 99m Medronate