Document Detail

The value of quantitative uptake of (99m)Tc-MDP and (99m)Tc-HMPAO white blood cells in detecting osteomyelitis in violated peripheral bones.
MedLine Citation:
PMID:  17496004     Owner:  NLM     Status:  MEDLINE    
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. CONCLUSION: (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.
Nasser S Ballani; Fawaz Abu Al-Huda; Haider A Khan; Shihab Al-Mohannadi; Hanan Mahmood; Farha Al-Enezi
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Publication Detail:
Type:  Journal Article     Date:  2007-05-11
Journal Detail:
Title:  Journal of nuclear medicine technology     Volume:  35     ISSN:  0091-4916     ISO Abbreviation:  J Nucl Med Technol     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-31     Completed Date:  2007-08-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0430303     Medline TA:  J Nucl Med Technol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  91-5     Citation Subset:  IM    
Biomedical Sciences, Lebanese International University, Beirut, Lebanon.
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MeSH Terms
Leukocytes / metabolism,  radionuclide imaging*
Middle Aged
Osteomyelitis / metabolism,  radionuclide imaging*
Radiopharmaceuticals / diagnostic use
Reproducibility of Results
Sensitivity and Specificity
Technetium Tc 99m Exametazime / diagnostic use*,  pharmacokinetics
Technetium Tc 99m Medronate / diagnostic use*,  pharmacokinetics*
Reg. No./Substance:
0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime; 63347-66-0/Technetium Tc 99m Medronate

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