Role of nuclear medicine imaging in evaluation of orthopedic infections, current concepts

A Pain in the Foot: Delayed Diagnosis of Primary Septic Arthritis of Naviculocuneiform and Second/Third Tarsometatarsal Joints

“…While other imaging demonstrates anatomical changes, nuclear imaging shows the physiologic state and bone metabolism. As early as 2–3 days from the onset of infection, a triple-phase bone scan can show the presence of increased focal uptake indicating osteomyelitis [ 15 , 27 ]. In this case, if the patient had primary osteomyelitis, nuclear imaging would have identified an early reactive or infectious activity.…”

“…In this case, if the patient had primary osteomyelitis, nuclear imaging would have identified an early reactive or infectious activity. Nevertheless, findings are also not specific for infection and it is more useful in ruling out osteomyelitis when results are negative [ 15 , 27 ]. If results are unclear, a gallium scan can be utilized because it offers higher specificity [ 28 ].…”

Combined Techniques of Non-invasive 99mTcBesilesomab/ 99mTc-Sulfur Colloid with Hybrid SPECT/CT Imaging in Characterising Cellulitis from Symptomatic Perimegaprosthetic Infection: A Case Report

“…Unlike conventional imaging, NM imaging uses specific radioactive pharmaceuticals or radiotracers to visualise and detect orthopaedic infections 4 . A three-phase bone scan is usually performed with 99m Tc-labeled diphosphonates as a first-line screening method with a negative scan ruling out prosthetic infection with a high degree of certainty.…”

“…As granulocytes are abundant at the site of infection, the 99m Tc-besilesomab will show intense uptake in the infected areas. The role of bone marrow scan with 99m Tc-labeled sulfur colloid is to aid in delineating the patient's hematopoietic marrow distribution, thus acting as a comparator to the marrow uptake by besilesomab 4 . It is considered to be positive for infection when the findings from both NM procedures are dissimilar or spatially incongruent (uptake of besilesomab is higher than sulfur colloid).…”

“…Here, the uptake for 99m Tc-besilesomab was shown to be similar to 99m Tc-sulfur colloid, hence negative for PMI. However, it is interesting to mention that the active compound found in besilesomab may trigger the formation of human anti-mouse antibodies (HAMA), which could alter the biodistribution of subsequent radiotracer injections and result in an allergic response 4 . To prevent such events, the determination of HAMA levels is warranted before anti-granulocyte studies, and the re-administration to HAMA-positive patients is inadvisable.…”