Clinical utility of 99mTc-ubiquicidin (29–41) as an adjunct to bone scan in differentiating infected versus noninfected loosening of prosthesis before revision surgery

Abstract

Patient dose of Tc-UBI (29-41) was prepared successfully and a simple quality control method to check radiolabeling yield was used at the hospital radiopharmacy. Tc-UBI (29-41) showed promise in localizing foci of infection, with optimal visualization at 20-60 min, for the evaluation of prosthesis loosening.

Molecular imaging in musculoskeletal infections with 99mTc-UBI 29-41 SPECT/CT

“…A more recent study which also used 99m Tc-MDP bone scan to correlate findings on 99m Tc-UBI planar imaging reported sensitivity, specificity, PPV and NPV of 100, 85.7, 93.75, 100%, respectively, in 22 patients with painful prostheses evaluated for septic loosening [25]. The perfect NPV reported in this study may be attributed to the inclusion of bone scan in image interpretation.…”

Application of 99mTc-UBI 29–41 scintigraphy in knee periprosthetic infection diagnosis

“…The gold standard for differentiation of aseptic loosening and periprosthetic infection is an indirect method utilizing a combination of radiolabeled leukocyte scintigraphy ( 111 In-WBC or 99m Tc-HM-PAO-WBC) with bone marrow nuclear imaging (e.g. 99m Tc-sulfur colloid) [4,5,7,8,[10][11][12][13]. The limitations of this approach include difficult and time-consuming preparation [5,8,10,13], risk of blood-borne infections [10,13], impossibility to perform on neutropenic patients, inefficient results in low-grade infections [6] and false positive results due to probability of radiolabeled leukocytes accumulation in the inflammatory noninfectious process [8].…”

“…In this category, the clinician encounters a variety of data obtained from plain radiographs, cross-sectional imaging techniques (such as CT scan and MRI) and radionuclide imaging methods [4]. However, all of these techniques have limitations and thus there is a vacancy of a definitive diagnostic imaging modality [10,11].…”

“…99m Tc-ubiquicidine scintigraphy is an imaging technique for the diagnosis of musculoskeletal infections. UBI (29-41) is a safe synthetic agent for humans; and so far no complications have been reported after its use [10,11,[13][14][15][16][17]. According to the literature, the 99m Tc-UBI scan has a key role in diagnosing osteomyelitis in the diabetic foot, infectious spondylitis, and musculoskeletal and periprosthetic infection detection [9,10,[13][14][15][16][17][18][19].…”

“…UBI (29-41) is a cationic antimicrobial micro peptide consisting of thirteen amino acids [16,20]. The positive charge of this micro peptide interacts with the negative charge of microorganism cell wall through the electrostatic forces [9,10,14,16]. Hence, the labeled form of UBI (29-41) with 99m Tc (with Hynic mediation) can be employed as a radiotracer to detect infections.…”