Abstract:

Purpose. Was to estimate the informative value of scintigraphy (SG) with labeled leukocytes (LL) in detection of osteomyelitis in patients with various forms of diabetic foot syndrome (DFS)

Materials and methods. This study includes results of scintigraphy with labeled leukocytes of 39 patients with diabetes mellitus and with suspicion of osteomyelitis in diabetic foot. Results were compared with morphological study in 22 patients

Results. SG with LL has high informative value rate in diagnostics of inflammatory process: sensitivity - 100%, specificity - 100% accuracy - 100%; and also high in the diagnostics of osteomyelitis: sensitivity - 100%, specificity - 64,7%, accuracy - 84,6%.

Conclusions. LL CG is a highly effective method of identifying the presence of an inflammatory process. During high rate of sensitivity the level of specificity decreases in case of intraosseous inflammation. The reason of decreased specifity is in that SG has low resolution in differentiation of radiopharmaceutical accumulation in bones and soft tissues.

References 

1.    Senneville E. et al. Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot. Clin. Infect. Dis. 2009; 48: 888-893.

2.    Gil H.C. MR imaging of diabetic foot infection. H.C. Gil, W.B. Morrison. Semin. Musculoskelet. Radiol. 2004; 8(3): 189-198.

3.    Craig J.G. et al. Osteomyelitis of the diabetic foot: MR imaging-pathologic correlation. Radiology. 1997; 203 (3): 849-855.

4.    Vesco L. et al. The value of combined radionuclide and magnetic resonance imaging in the diagnosis and conservative management of minimal or localized osteomyelitis of the foot in diabetic patients. Metabolism. 1999; 48 (7): 922-927.

5.    Hopfner S. et al. Preoperative imaging of Charcot neuroarthropathy. Does the additional application of (18) F-FDG-PET make sense? Nuklearmedizin. 2010; 45 (1):15-20.

6.    Завадовская В.Д., Зоркальцев М.А., Килина О.Ю., Шульга О.С. Возможности радионуклидной диагностики синдрома диабетической стопы (часть 1). Диагностическая и интервенционная радиология. 2010; 4 (4): 31-40.

Abstract:

Purpose. Was to еstablish the informative value of 3-phase scintigraphy in assessment of blood flow and identify pyo-inflammatory process in patients with neuropathic, ischemic, and mixed forms of diabetic foot.

Materials and methods. This study includes the results of three-phase scintigraphy of 76 patients with diabetes mellitus and with suspicion of osteomyelitis in diabetic foot. Results were verified with morphological study in 39 patients.

Results. In patients with diabetic foot the depression of the main vessels blood flow and blood flow prevalence the changes intraosseous blood flow. Three-phase scintigraphy revealed a lower specificity (66,7%) in the diagnosis of osteomyelitis in patients with diabetes mellitus at the sensitivity (94,7%) and accuracy (73,7%).

Conclusions. Three-phase scintigraphy is high-performance method in revealing the arterial and peripheral blood flow disorder in patients with diabetes mellitus. The low specificity of the three-phase scintigraphy with high sensitivity indicates the limited possibilities of the method in the identification of pyo-inflammatory process in patients with diabetes mellitus. The observed preservation of blood flow makes it possible to expand indications of methods of nuclear medicines and applies scintigraphy with labeled leukocytes for indication purulent infection in patients with complicated course. 

References

1.    Capriotti G. et al. Nuclear medicine imaging of diabetic foot infection: results of meta-analysis. Nucl. Med. Commun. 2006; 27 (10):757–764.

2.    Kaim A. et al. Chronic complicated osteomyelitis of the appendicular skeleton.Diagnosis with 99mTc labeled monoclonal anti-granulocyte antibody-immunoscintigraphy. Eur. J. Nucl. Med. 1997; 24 (7): 732–738.

3.    Unal S.N. et al. Comparison of 99mTc methylene diphosphonate, 99mTc human immuneglobulin, and 99mTc labeled white blood cell scintigraphy in the diabetic foot. Clin. Nucl. Med. 2001; 26 (12): 101–1021.

4.    Devillers A. et al. Contribution of 99mTc hex-amethylpropylene amine oximelabelled leucocyte scintngraphy to the diagnosis of diabetic foot infection. Eur. J. Nucl. Med. 1998; 25(2): 132–138.

5.    E-Maghraby T.A. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. J. Nucl. Med. Mol. Imaging. 2006; 50 (3): 167–192.

6.    Soluri A. et al. High resolution mini-gammacamera and 99mTc [HMPAO] leukocytes for diagnosis of infection and radioguided surgery in diabetic foot. G. Chir. 2005; 26 (6–7): 246–250.

7.    Prandini N. et al. Nuclear medicine imaging of bone infections. Nucl. Med. Commun. 2006;27 (8): 633–644.

8.    Christopher J.P. et al. Osteomyelitis: Diagnosis with 99mTc labeled Antigranulocyte Anti-bodies Compared with Diagnosis with 111Inlabeled Leukocytes – Initial Experience. Radiology. 2002; 223: 758–764.

9.    Palestro C.J. et al. Rapid diagnosis of pedal osteomyelitis in diabetics with a technetium-99mTc labeled monoclonal antigranulocyte antibody. J. Foot. Ankle. Surg. 2003; 42 (1): 2–8.

10.  Stephen L.H. et al. The Effects of Peripheral Vascular Disease with Osteomyelitis in the Diabetic Foot. Am. J. of Surg. 1999; 177:282–286.

11.  Завадовская В.Д. Лучевая диагностика остеомиелита Дис. Д-ра мед. наук. Томск. 1995; 290.

Abstract:

Introduction. ¹⁹⁹Tl-chloride scintigraphy is used to visualize tumors. In addition to typical imaging of the musculoskeletal malignancy, unusually types of malignant tumor visualization were revealed by studies of diagnostic potentialities of ¹⁹⁹Tl-chloride scintigraphy, analogue of ²⁰¹Tl-chloride scintigraphy.

Aim. Was to study features of malignant tumor visualization of the musculoskeletal system with the help of ¹⁹⁹Tl-chloride scintigraphy.

Materials and methods. 85 patients with diseases of musculoskeletal system underwent ¹⁹⁹Tl-chloride scintigraphy. 107 localizations of malignant tumors (n=57) and benign lesion (n=50) were investigated. During the research in 107 patients malignant tumors were detected, 50 patients had bening tumors.

Results. Malignant tumors were visualized in 98.1%. Three types of malignant tumors' visualization were obtained - positive (82.4%) and rare negative (7.8%) and mixed (9.8%). Types of visualization were associated with tumor histological types, blood-flow, metabolism, and pharmacodynamic features of ¹⁹⁹Tl-chloride. Negative and mixed visual types were high specific for primary and recurrent malignant tumors, but no metastasis.

Conclusion. Accounting to negative and mixed visual types - ¹⁹⁹Tl-chloride scintigraphy sensitivity increased to 98.1% without decreasing of specificity in detection of malignant tumors of musculoskeletal system.