The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

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FIGURE 1.
Anterior-view ^99mTc-HMPAO WBC scans (left) and ^99mTc-MDP bone scans (right). (A) Images of patient with negative ^99mTc-HMPAO findings but positive ^99mTc-MDP findings, showing regions of interest drawn on suspected site of abnormality and on contralateral normal site. (B) Patient with positive findings on both types of scans.

TABLE 1

Quantitative ^99mTc-MDP and ^99mTc-HMPAO WBC Scan Results in Violated Peripheral Bone with Their Definitive Diagnosis

Patient no.	Underlying pathology	^99mTc-MDP A/N	^99mTc-HMPAO A/N	Scan report	Diagnostic criteria	Antibiotic therapy	Definitive diagnosis
1	Fracture	1.3	1.1	Negative	Clinical	No	TN
2	Fracture	2.6	2.2	Positive	Bone biopsy	Yes	TP
3	Fracture	1.4	1.2	Negative	Clinical	No	TN
4	Fracture	2.7	1.6	Positive	Bone biopsy	No	FP
5	Fracture	4.1	1.9	Positive	Bone biopsy	Yes	TP
6	Fracture	2.4	1.5	Positive	Bone biopsy	Yes	TP
7	Fracture	1.3	1.2	Negative	Clinical	No	TN
8	Fracture	2.2	1.5	Positive	Clinical	Yes	TP
9	Fracture	2.9	1.8	Positive	Bone biopsy	Yes	TP
10	Fracture	1.3	1.4	Positive	Clinical	Yes	TP
11	Prosthesis	2.1	1.5	Positive	Bone biopsy	Yes	TP
12	Prosthesis	1.4	1.5	Positive	Bone biopsy	Yes	TP
13	Prosthesis	2.1	1.7	Positive	Clinical	No	FP
14	Prosthesis	1.3	1.4	Positive	Bone biopsy	Yes	TP
15	Prosthesis	1.6	2.1	Positive	Bone biopsy	Yes	TP
16	Prosthesis	2.0	2.1	Positive	Bone biopsy	Yes	TP
17	Prosthesis	4.8	1.2	Negative	Clinical	No	TN
18	Diabetic foot ulcers	6.2	2.1	Positive	Bone biopsy	Yes	TP
19	Diabetic foot ulcers	5.0	2.0	Positive	Bone biopsy	Yes	TP
20	Diabetic foot ulcers	4.4	2.1	Positive	Bone biopsy	Yes	TP
21	Diabetic foot ulcers	4.8	2.0	Positive	Bone biopsy	Yes	TP
22	Chronic osteomyelitis	2.9	1.1	Negative	Clinical	No	TN
23	Chronic osteomyelitis	1.3	1.0	Negative	Clinical	No	TN
24	Chronic osteomyelitis	1.3	1.1	Negative	Clinical	No	TN

Negative = ^99mTc-MDP and ^99mTc-HMPAO WBC scans reported negative for osteomyelitis; positive = ^99mTc-MDP and ^99mTc-HMPAO WBC scans reported positive for osteomyelitis; clinical = clinical follow-up shows good response to antibiotic therapy and resolving radiologic and clinical findings; absence of bone infection was also confirmed by uneventful clinical and radiologic follow up without antibiotic therapy.
Definitive diagnostic criterion was bone biopsy with culture and sensitivity. For bone scanning, sensitivity = 100% and specificity = 30%. For HMPAO WBC scanning, sensitivity = 100% and specificity = 78%.