A novel approach of 67-Gallium-citrate three-phase bone scan to diagnose bone infection: A report of three cases.

Abstract

Objectives:67-Gallium-citrate three-phase bone scan (Ga-TPBS), a new approach for the diagnosis of bone infection is evaluated. The interpretation of TPBS is based on the normal physiological vascular endothelial-related response noted in infection.Materials and Methods:Three cases of suspected bone infection as determined by clinical, laboratory, and radiological examinations were further subjected to conventional technetium-99m-TPBS (Tc-99m-TPBS) and Ga-TPBS. Nuclear scan diagnosis of bone infection was made by the presence of generalized vasodilatation with increased capillary permeability noted on the flow and the pool phase of the TPBS and the comparative evaluation of the 4 h delayed Tc-TPBS and 24–48 h delayed Ga-TPBS. Diagnosis of bone infection was confirmed in all three cases on histopathologcal examination of the surgically excised tissues.Results:The data clearly indicated that all three cases of bone infection (osteomyelitis) had generalized massive flow and pool pattern. Infection could be diagnosed only on the Ga-TPBS by noting generalized vasodilatation with increased capillary permeability on the flow and the pool phase with focal retention of the radiotracer on the delayed scan.Conclusions:By incorporating the concept of vascular endothelial-related response causing massive vasodilatation in infection, the interpretation of the Ga-TPBS can be more précised as it is based on the normal physiology. In comparison to two Tc-99m scans (white blood cell scan + bone marrow scan), a single Ga-TPBS is also cost-effective and compliance friendly. Larger, comparative, and statistically unbiased studies are needed.