Abstract
Objective: The aim of this prospective study was to evaluate the additional value of Tc 99m HMPAO white blood cell (WBC) SPECT for bone and soft tissue infections.Materials and Methods: Thirty-eight patients with suspected bone and joint infection were included in the study. Patients were assigned into 2 groups according to the presence of orthopedic implants. All patients had multiphase bone scan (BS) with Tc 99m methylene diphosphonate and WBC scintigraphy. The planar images of BS and WBC images were evaluated together. SPECT WBC images were evaluated separately.Results: Group 1 had 30 patients including 12 patients with diabetic foot, 17 patients with suspected relapse of chronic osteomyelitis and 1 with septic arthritis. In 19 of 30 patients, BS and planar WBC images were similar with SPECT images in terms of final diagnosis. In the remaining 11 patients, planar BS+planar WBC images and SPECT WBC images were discordant. Group 2 included 8 patients with suspected infection of orthopedic implants. There was no difference between planar BS+planar WBC images and SPECT WBC in 6 of 8 patients. SPECT WBC images changed the diagnosis of 13 (34.2%) patients in the whole group. SPECT WBC images did not have any contribution in the evaluation of the 6 patients who had reactive changes. Conclusion: SPECT images made significant contribution in discriminating soft tissue infection from osteomyelitis and improved diagnosis in terms of localization and the extent of disease.Conflict of interest:None declared.
Highlights
Localizing the site of infection is important for planning treatment, the diagnosis and localization of bone infection represent a challenge for the physicians
In 19 of 30 patients, bone scan (BS) and planar white blood cell (WBC) images were concordant with SPECT WBC images for the final diagnosis and location of infection
SPECT WBC did not have any additional contribution to the management of these patients
Summary
Localizing the site of infection is important for planning treatment, the diagnosis and localization of bone infection represent a challenge for the physicians. The complementary use of scintigraphic and anatomic imaging modalities can overcome many of the limitations in the assessment of infection. Computed tomography (CT) accurately depicts sequestra, involucra, cloacae as well as soft tissue abscesses, foreign bodies, and fistulas [1,2]. Despite of being very sensitive in detecting these bone changes, CT lacks specificity for bone infections which results in a high rate of false-positive findings [3,4]. Planar images may fail to differentiate between osteitis accompanying soft tissue infection (STI) and osteomyelitis (OM). It is well established that SPECT/CT device provides accurate fusion of functional and anatomic imaging for the evaluation of endocrine, oncologic, and orthopedic events [5,6,7]. SPECT/CT is not available in the vast majority of the nuclear medicine departments
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