Efficacy of indigenously developed single vial kit preparation of 99mTc-ciprofloxacin in the detection of bacterial infection: an Indian experience.
OBJECTIVE
To investigate the diagnostic efficacy of indigenously developed single vial kit preparation of Tc-ciprofloxacin (Diagnobact) for the detection of orthopedic infections.


METHODS
Seventy-seven patients [25 with clinical suspicion of diabetic foot osteomyelitis (DFOM), 25 with orthopedic device-related infection (ODRI) and 27 with tubercular bone infection] underwent three-phase Tc-methylenediphosphonate bone scintigraphy followed by static Tc-ciprofloxacin imaging at 1, 4 and 24 h. Imaging (anterior and posterior views) was performed under a dual-head gamma-camera using a low-energy, high-resolution, parallel-hole collimator. The lesion-to-background ratio (LBR) of the radiotracer was calculated on the static isotime Tc-ciprofloxacin images using semiquantitative analysis. Scintigraphic (Diagnobact) results were compared with the histopathological and/or culture/PCR analysis as a gold standard.


RESULTS
The mean LBR of the radiotracer (Tc-ciprofloxacin) in the positive scans (n=29; 16 ODRI, 13 DFOM) was > or =2.0 at 1 h postinjection and remained consistent till 24 h. In contrast, the mean LBR in the negative scans (n=21; 12 DFOM, nine ODRI) was < or =1.5 at 1 h and declined significantly (P<0.05) at 24 h. The observed trend in the mean LBR in positive (n=18) and negative (n=9) scans for tubercular osteomyelitis was identical to that seen in the nontubercular bacterial infections.


CONCLUSIONS
The management protocol for patients with suspected bony infection may include a three-phase bone scan followed by Tc-ciprofloxacin scan. An LBR of > or =2.0 at 1 h that remained consistent till 24 h on Tc-ciprofloxacin scan is indicative of active bacterial infection. However, resistance to ciprofloxacin at the bacterial cell membrane may be a limitation of this technique.
Singh
Baljinder
B
Department of Nuclear Medicine, PGIMER, Chandigarh, India. pgichandigarh@yahoo.co.in
Sunil
Hejjaji V
HV
Sharma
Sarika
S
Prasad
Vikas
V
Kashyap
Raghav
R
Bhattacharya
Anish
A
Mittal
Bhagwant R
BR
Taneja
Ashish
A
Rai
Rajeev
R
Goni
Vijay G
VG
Aggarwal
Sameer
S
Gill
Shivinder S
SS
Bhatnagar
Aseem
A
Singh
Ajay K
AK
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D001850:Bone Diseases, Infectious / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D002939:Ciprofloxacin / Q000031:analogs & derivatives*; D017719:Diabetic Foot / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007194:India; D007249:Inflammation / Q000175:diagnosis / Q000000981:diagnostic imaging; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D015609:Organotechnetium Compounds; D009984:Orthopedic Fixation Devices / Q000009:adverse effects; D010019:Osteomyelitis / Q000000981:diagnostic imaging; D011849:Radioactive Tracers; D011877:Radionuclide Imaging; D014394:Tuberculosis, Osteoarticular / Q000000981:diagnostic imaging; D055815:Young Adult
D015609:Organotechnetium Compounds; D011849:Radioactive Tracers; C431804:Technetium Tc 99m ciprofloxacin; D002939:Ciprofloxacin