Skip to main content

Advertisement

Log in

Added value of SPECT/CT in patients suspected of having bone infection: preliminary results

  • Basic Science
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Aim

We evaluated the contribution of SPECT/CT as an adjunct to combined three-phase bone scintigraphy (planar and SPECT) for diagnosing and localizing bone infection. Subsequently, the diagnostic performance of SPECT/CT was compared to visual fusion of SPECT with data of additional CT, X-ray, or MRI studies (SPECT + CT/X-ray/MRI).

Materials and methods

Thirty-one patients suspected of bone infection, presenting pathological findings on triple-phase bone scintigraphy, underwent additional SPECT/CT. The SPECT/CT-technology combines the acquisition of SPECT and CT data with the same imaging device enabling perfect overlay of anatomical and functional images. 99mTc-DPD was used as radiopharmaceutical in all patients. For data analysis findings of bone scintigraphy (planar scans as well as SPECT) were categorized as positive, negative, or equivocal for the presence of osteomyelitis. In a second step, they were compared with SPECT/CT and SPECT + CT/X-ray/MRI with respect to localization and classification of lesions. Validation was achieved by surgery, biopsy, or by clinical follow up over at least 9 months including microbiological and radiological findings.

Results

Three-phase bone scan (incl. SPECT) correctly classified 7 lesions as positive and 11 lesions as negative for osteomyelitis. Six scans were interpreted false positive, two false negative, and five as equivocal. Rating the latter as positive for osteomyelitis, sensitivity of bone scan was (78%), specificity (50%). SPECT/CT was true positive in 7 patients, and true negative in 19. There were two false positive and two false negative findings, one scan was equivocal (sensitivity 78%, specificity 86%). Definition of anatomical localization of inflammatory foci was much easier by SPECT/CT due to better depiction of underlying anatomical details. SPECT + CT/X-ray/MRI yielded the highest sensitivity (100% compared to 78% of SPECT/CT), if equivocal findings (5/31 compared to 1/31 for SPECT/CT) are rated as true positive for osteomyelitis. Among radiological techniques, MRI (2 × FP) and CT (2 × FN) proved equal and expectedly superior to X-ray in delivering the correct diagnosis.

Conclusion

SPECT/CT improves the diagnostic performance of three-phase bone scan for osteomyelitis by avoiding false positive or equivocal results. An additional benefit over visual fusion of SPECT with X-ray, CT, or MRI studies could not be confirmed in our study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wing VW, Federle MP, Helms CA, Jeffrey RB, Trafton P (1985) Chronic osteomyelitis examined by CT. Radiology 154:171–174

    PubMed  CAS  Google Scholar 

  2. Seltzer SE (1984) Value of computed tomography in planning medical and surgical treatment of chronic osteomyelitis. J Comput Assist Tomogr 8:482–487

    Article  PubMed  CAS  Google Scholar 

  3. Tumeh SS, Aliabadi P, McNeil BJ, Weissman BN (1987) Disease activity in osteomyelitis: role of radiography. Radiology 165:781–784

    PubMed  CAS  Google Scholar 

  4. Alazraki N, Datz F, Dries D, Greenberg E, Lawrence P, Taylor A Jr (1985) Value of a 24-hour image (four phase bone scan) in assessing osteomyelitis in patients with peripheral vascular disease. J Nucl Med 26:711–717

    PubMed  CAS  Google Scholar 

  5. Israel O, Frenkel A, Front D, Gips S, Jerushalmi J (1987) Osteomyelitis and soft tissue infection: differential diagnosis with 24 hour/4 hour ratio of Tc99m MDP uptake. Radiology 163:725–726

    PubMed  CAS  Google Scholar 

  6. Front D, Israel O, Jerushalmi J, et al. (1989) Quantitative bone scintigraphy using SPECT. J Nucl Med 30:240–245

    PubMed  CAS  Google Scholar 

  7. Palestro C, Kipper S, Love C, Tomas M, Weiland F (2002) Osteomyelitis: diagnosis with 99m-Tc-labelled antigranulocyte antibodies compared with diagnosis with 111In-labelled leukocytes-initial experience. Radiology 223:758–764

    PubMed  Google Scholar 

  8. Reuland P, Heuchert T, Winkler KH, et al. (1991) Detection of infection in postoperative patients with technetium-99m-labelled monoclonal antibodies against granulocytes. J Nucl Med 32:2209–2214

    PubMed  CAS  Google Scholar 

  9. Kaim A, Jundt G, Kirsch E, Müller-Brand J, Maurer T, Ochsner P (1997) Chronic complicated osteomyelitis of the appendicular skeleton: diagnosis with technetium-99m-labelled monoclonal antigranulocyte antibody-immunoscintigraphy. Eur J Nucl Med 24:732–738

    PubMed  CAS  Google Scholar 

  10. Schauwecker DS (1992) The scintigraphic diagnosis osteomyelitis. AJR 158:9–18

    PubMed  CAS  Google Scholar 

  11. Kampen WU, Brenner W, Bohuslavvizki KH, Henze E, Terheyden H (1999) Decisive diagnosis of infected mandibular osteoradionecrosis with a Tc-99m-labelled Anti-granulocyte Fab’-fragment. Nuklearmedizin 38(7):309–311

    PubMed  CAS  Google Scholar 

  12. Horger M, Pfannenberg C, Storek D, Dammann F, Eschmann SM, Claussen CD, Vonthein R, Bares R (2003) The Value of SPECT/CT in chronic osteomyelitis. Eur J Nucl Med Mol Imaging 30:1665–1673

    Article  PubMed  Google Scholar 

  13. Guhlmann A, Brecht-Krauss, Glatting G, Kotzerke J, Kinzl L, Reske SN, Suger G (1998) Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic ostemyelitis. J Nucl Med 39:2145–2152

    PubMed  CAS  Google Scholar 

  14. Sonmezoglu K, Akgün I, Britton KE Halac M, Kanmaz B, Önsel C, Sonmezoglu M, Solanki K, Türkmen C, Uslu I (2001) Usefulness of 99mTc-Ciprofloxacin (Infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy. J Nucl Med 42:567–574

    PubMed  CAS  Google Scholar 

  15. Gallowitsch HJ, Gomez I, Heinisch M, Kresnik E, Kumnig G, Lind P, Mikosch P (2002) Tc-99m ciprofloxacin in clinically selected patients suspected for peripheral osteomyelitis, spondylodiscitis and fever of unknown origin: preliminary results. Nuklearmedizin 41(1):30–36

    PubMed  CAS  Google Scholar 

  16. Bamberger DM (1990) Diagnosis and treatment of osteomyelitis. Comp Ther 16:48–53

    CAS  Google Scholar 

  17. Boutin RD, Brossmann J, Resnick D, Reilly D, Sartoris DJ (1998) Update on imaging of orthopedic infections. Orthop Clin North Am 29:41–66

    Article  PubMed  CAS  Google Scholar 

  18. Crim J R, Seeger LL (1994) Imaging evaluation of osteomyelitis. Crit Rev Diagn Imaging 35:201–256

    PubMed  CAS  Google Scholar 

  19. Maurer AH, Alderson PO, Camargo EE, Chen DCP, Wagner H Jr, Wong DF (1981) Utility of three-phase scintigraphy in suspected osteomyelitis. J Nucl Med 22:941–949

    PubMed  CAS  Google Scholar 

  20. Schlesinger AE; Hernandez RJ (1992) Diseases of the musculoskeletal system in children: imaging with CT, sonography and MR. Am J Radiol 158:729–741

    Google Scholar 

  21. Rosenthall L, Hernandez M, Lisbona R, et al (1979) Tc99m-PP and Ga67 following insertion of orthopedic devices. Radiology 133:717

    PubMed  CAS  Google Scholar 

  22. Utsunomiya D, Shiraishi S, Imuta, et al. (2005) Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 238:264–271

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marius Horger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horger, M., Eschmann, S.M., Pfannenberg, C. et al. Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg 127, 211–221 (2007). https://doi.org/10.1007/s00402-006-0259-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-006-0259-6

Keywords

Navigation