Combined Labeled Leukocyte and Technetium 99m Sulfur Colloid Bone Marrow Imaging for Diagnosing Musculoskeletal Infection

Abstract

The use of labeled leukocyte (white blood cell [WBC]) studies in the diagnosis of osteomyelitis can be problematic. A combined study consisting of WBC imaging and complementary bone marrow imaging performed with technetium 99m (99mTc) sulfur colloid is approximately 90% accurate and is especially useful for diagnosing osteomyelitis in situations involving altered marrow distribution. There are limitations and pitfalls associated with a combined study. If there is no labeled WBC activity in the region of interest, marrow imaging is not useful. The sulfur colloid image becomes photopenic within about 1 week after the onset of infection, so that the study should be interpreted cautiously in the acute setting. Labeled WBC accumulation in lymph nodes can also confound image interpretation, although nodal activity can usually be recognized because it is typically round, discrete, multifocal, linear in distribution, and often bilateral. Furthermore, 99mTc-sulfur colloid that is improperly prepared or is more than about 2 hours old degrades image quality, potentially causing erroneous conclusions. Nevertheless, WBC-marrow imaging is a very accurate technique for diagnosing osteomyelitis. Knowledge of the criteria for image interpretation and of the aforementioned limitations and pitfalls, combined with careful attention to imaging technique, will maximize the value of this study.

A retrospective analysis of the accuracy of radioactively labeled autologous leukocytes in patients with infected prosthetic joints

“…The combination of LS and BMS in detecting infection has a reported accuracy of 86-98% [14][15][16][17][18][19][20][21][22][23][24][25]. LS has also been employed in patients with systemic infections, postoperative infections and in fever of unknown origin [26]. The indications for a combination imaging LS/BMS include prosthetic joint infection, musculoskeletal infections, and neuropathic joint [26].…”

Differentiating Osteomylelitis from Charcot Joint by Using Sulphur Colloid and Besilosomab (Scintimun®) Scan at Sarawak General Hospital

“…al [6] concluded that the combined study of WBC and bone marrow imaging; using 111 In-labelled WBC and sulphur colloid might have increased the accuracy of diagnosing OM up to 90% in altered marrow distribution cases. Palestro et.…”

“…Palestro et. al [6] study was based on the understanding that both WBCs and Sulphur Colloid accumulate in marrow regardless of its location, whereas only WBCs accumulate at the infection sites.…”

“…However, only the Scintimun accumulates at the site of infection. Sulphur Colloid is taken up by the reticuloendothelial system (RES) rich structures; which are monocytes predominant, thus uptake in this area marks inflammatory process in Charcot arthropathy [6,7]. In acute OM, there is a combination of low oxygen tension, acidic pH, vascular insufficiency, and elevated intraosseous pressure that suppresses or destroys the bone marrow macrophages at the infection site [2].…”

The Clinical Usefulness of 99mTc HMPAO Leukocyte/99mTc Phytate Bone Marrow Scintigraphy for Diagnosis of Prosthetic Knee Infection: A Preliminary Study

“…At present, combined radiolabeled leukocyte scintigraphy (LS)/ 99m Tc sulfur colloid bone marrow scintigraphy (BMS), which has approximately a 90 % accuracy, is the radionuclide imaging procedure of choice for diagnosing prosthetic joint infection [5,[11][12][13]. However, 99m Tc-labeled colloid agent is difficult to obtain in our country, which necessitates the identification of valid alternatives.…”