Evaluation of a 3-Hour Indium-111 Leukocyte Image as a Surrogate for a Technetium-99m Nanocolloid Marrow Scan in the Diagnosis of Orthopedic Infection

Dutton, Jane A. E.; Bird, Nicholas J.; Skehan, Stephen J.; Peters, A. M.

doi:10.1097/01.rlu.0000132880.77924.b1

Cited by 11 publications

(7 citation statements)

References 22 publications

(16 reference statements)

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“…We did not do a bone marrow scintigraphy; however, we compared the early white blood cell images with the late images-and if there was increased leukocyte accumulation, we interpreted it as infection ( Figure 2). This technique has been shown to increase the diagnostic accuracy in other studies (Larikka et al 2001, Dutton et al 2004, Pelosi et al 2004). In our study, 5 of 27 infected patients were false negative in the scintigraphy.…”

Section: Discussionmentioning

confidence: 91%

White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

et al. 2007

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Section: Discussionmentioning

confidence: 91%

White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

et al. 2007

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“…Although for many applications, regularly used radionuclides appear to be sufficient, there is ongoing research regarding more specific potential tracers and techniques for imaging experimental arthritis, such as 1102 OSTENDORF ET AL 99m Tc- (22) and 111 In-labeled monoclonal and polyclonal antibodies and nanocolloids (23,24). These allow examination of protease-activated near-infrared fluorescence, enabling noninvasive acquisition, on a molecular level, of quantitative information about the presence and anatomic location of transgene expression (25) and target enzymes in arthritis research (26).…”

Section: Discussionmentioning

confidence: 99%

High‐resolution multipinhole single‐photon–emission computed tomography in experimental and human arthritis

Ostendorf

Scherer

Wirrwar

et al. 2006

Arthritis & Rheumatism

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Objective. To image inflammatory arthritic lesions in experimental arthritis and in patients with arthritis, using a newly developed high-resolution multipinhole single-photon-emission computed tomography (MPH-SPECT) technique.Methods. Six interleukin-1 receptor antagonistdeficient mice with arthritis of the front and back paws and 2 control BALB/c mice were imaged with MPH-SPECT and scored macroscopically for arthritis. SPECT imaging was performed with a conventional gamma camera upgraded with a pyramidal lead collimator affixed with MPH apertures. All images were reconstructed, and uptake in the paws was quantified in counts/weight and injected activity. To transfer the imaging technique to humans we examined the clinically dominant hand of 6 individuals (3 with established rheumatoid arthritis [RA], 1 with early RA, 1 with osteoarthritis, and 1 healthy control).Results. MPH-SPECT images were highresolution 3-dimensional tomographic images, which allowed exact localization and quantifiable observation of increased bone metabolism. MPH-SPECT counts of inflamed joints in mice correlated with macroscopic scoring and histologic joint analysis postmortem. In humans, MPH-SPECT images depicted a detailed visualization of tracer accumulation in bony structures of hand and finger joints, and were also capable of imaging increased bone metabolism that had appeared normal with other imaging modalities, e.g., magnetic resonance imaging.Conclusion. The MPH-SPECT technique represents a new diagnostic tool in the detection of bone pathology in small-animal arthritis research. Compared with macroscopic scoring, this new method provides a more objective and higher-precision quantifiable measurement of bone reaction, allowing visualization of inflammatory processes of the whole skeleton in vivo. These results suggest that MPH-SPECT may be useful as a diagnostic instrument for monitoring experimental arthritis, with further potential for use in human studies of RA.

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“…The hypothesis is that early leucocyte images reflects white blood cell uptake in marrow, since neutrophil uptake in the bone marrow, as in the spleen, is immediate and the result of extensive physiological margination in sinusoids, while the late leucocyte images reflect white blood cell uptake in infection [53,54]. Subsequently, incongruence between early and late images, analogous to conventional LS/BMS, is indicative of infection.…”

Section: Bsmentioning

confidence: 95%

Prosthetic joint infections: radionuclide state-of-the-art imaging

Gemmel¹,

Wyngaert²,

Love

et al. 2012

Eur J Nucl Med Mol Imaging

164

151

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Prosthetic joint replacement surgery is performed with increasing frequency. Overall the incidence of prosthetic joint infection (PJI) and subsequently prosthesis revision failure is estimated to be between 1 and 3%. Differentiating infection from aseptic mechanical loosening, which is the most common cause of prosthetic failure, is especially important because of different types of therapeutic management. Despite a thorough patient history, physical examination, multiple diagnostic tests and complex algorithms, differentiating PJI from aseptic loosening remains challenging. Among imaging modalities, radiographs are neither sensitive nor specific and cross-sectional imaging techniques, such as computed tomography and magnetic resonance imaging, are limited by hardware-induced artefacts. Radionuclide imaging reflects functional rather than anatomical changes and is not hampered by the presence of a metallic joint prosthesis. As a result scintigraphy is currently the modality of choice in the investigation of suspected PJI. Unfortunately, there is no true consensus about the gold standard technique since there are several drawbacks and limitations inherent to each modality. Bone scintigraphy (BS) is sensitive for identifying the failed joint replacement, but cannot differentiate between infection and aseptic loosening. Combined bone/gallium scintigraphy (BS/GS) offers modest improvement over BS alone for diagnosing PJI. However, due to a number of drawbacks, BS/GS has generally been superseded by other techniques but it still may have a role in neutropenic patients. Radiolabelled leucocyte scintigraphy remains the gold standard technique for diagnosing neutrophil-mediated processes. It seems to be that combined in vitro labelled leucocyte/bone marrow scintigraphy (LS/BMS), with an accuracy of about 90%, is currently the imaging modality of choice for diagnosing PJI. There are, however, significant limitations using in vitro labelled leucocytes and considerable effort has been devoted to developing alternative radiotracers, such as radiolabelled HIGs, liposomes, antigranulocyte antibodies and fragments, as well as more investigational tracers such as radiolabelled antibiotics, antimicrobial peptides, bacteriophages and thymidine kinase. On the other hand, positron emission tomography (PET) is still growing in the field of PJI imaging with radiotracers such as (18)F-fluorodeoxyglucose (FDG), (18)F-FDG white blood cells and (18)F-fluoride. But unfortunately this superb tomographic technique will only receive full acceptance when specific PET uptake patterns can be successfully developed. The emergence of hybrid modality imaging using integrated single photon emission computed tomography (SPECT) and PET with computed tomography (SPECT/CT and PET/CT) may also have a contributing role for more accurate assessment of joint replacement complications, especially combined with new radiotracers such as (68)Ga and (64)Cu. Finally, in searching for infection-specific tracers, currently there is no such diagnostic agent available.

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Evaluation of a 3-Hour Indium-111 Leukocyte Image as a Surrogate for a Technetium-99m Nanocolloid Marrow Scan in the Diagnosis of Orthopedic Infection

Abstract: A 3-hour image is helpful using In-111-labeled leukocyte scintigraphy.

Cited by 11 publications

References 22 publications

White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

White blood cell scintigraphy for differentiation of infection and aseptic loosening: A retrospective study of 76 painful hip prostheses

High‐resolution multipinhole single‐photon–emission computed tomography in experimental and human arthritis

Prosthetic joint infections: radionuclide state-of-the-art imaging

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