title: Comparative Analysis of99mTc-MDP Three-Phase Bone Scan with SPECT/CT and99mTc-HMPAO-Labeled WBC SPECT/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis.
abstract: OBJECTIVE
  To identify differences between three-phase bone scan and SPECT/CT (TBS) and WBC SPECT/CT (WS) and compare diagnostic accuracies of each modality in patients with suspicious post-traumatic osteomyelitis (OM).
  
  
  METHODS
  Twenty-one patients with suspicious post-traumatic OM were enrolled. All patients performed TBS and WS within 1 week. Foci of MDP and WBC accumulation were divided into three categories: bone (OM), soft tissue (soft tissue inflammation; STI), negative for inflammation (NI). Confirmative diagnosis was made upon operative pathology or long-term clinical follow-up.
  
  
  RESULTS
  Of 21 patients, four OM, eight STI, nine NI were finally diagnosed. TBS diagnosis was correct in three of four positive cases and nine of 17 negative cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of TBS were 75 %, 52.9 %, 57.1 %, 27.3 %, 90 %. WS diagnosis was correct in two of four positive cases and 17 of 17 negative cases. Sensitivity, specificity, accuracy, PPV, NPV were 50 %, 100 %, 81.0 %, 100 %, 89.5 %. Twelve of 21 cases showed agreement between TBS and WS. TBS misdiagnosed nine cases (six STI and two NI as eight OM; one OM as one STI), while WS misdiagnosed four cases (two OM as two STI; two STI as two NI). Combining results from TBS and WS led to better diagnostic accuracy (91.7 %) than either TBS or WS alone.
  
  
  CONCLUSIONS
  TBS and WS showed moderate agreement in assessment of clinically suspected post-traumatic OM. WS better evaluated inflammation than TBS. WS tended to underestimate inflammation whereas TBS tended to overestimate inflammation. Combining TBS and WS enhanced diagnostic accuracy.
authors.affiliation: Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu Seoul, 133-792 Republic of Korea.
authors.forename: Chanwoo
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu Seoul, 133-792 Republic of Korea.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu Seoul, 133-792 Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu Seoul, 133-792 Republic of Korea.
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
authors.affiliation: Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu Seoul, 133-792 Republic of Korea.
authors.forename: Yun Young
authors.initials: YY
authors.lastname: Choi
keywords: 99mTc-HMPAO-labeled WBC SPECT/CT; 99mTc-MDP three-phase bone scan and SPECT/CT; Post-traumatic osteomyelitis; Soft tissue inflammation