Diagnostic Role of Combined 99mTc-Hmpao Leucocyte Scintigraphy
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- Category: Vol. 77, June 2009
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Diagnostic Role of Combined 99mTc-Hmpao Leucocyte Scintigraphy and 99mTc-MDP Bone Scintigraphy in the Diagnosis of Osteomyelitis in the Diabetic Foot,KHALED KHALAF ALLAH, EBAA AHMED and OMAR A.M. HASANIN
Abstract
Background: The aim of this study to assess the role of 99mTc-HMPAO leucocyte scintigraphy combined with 99mTc-MDP bone scintigraphy in the diagnosis of the diabetic foot infection.
Methods: 50 diabetic patients with suspected osteomyelitis were included. The HMPAO-Leucocytes/MDP scan was con-sidered to be consistent with osteomyelitis when the HMPAO-Leucocytes uptake was concordant with MDP bone uptake. A HMPAO-Leucocytes uptake without concordant bone MDP activity was considered as a soft-tissue infection. The results of the HMPAO-Leucocytes/MDP scan were compared to the following diagnostic criteria: bone infection was confirmed by radiological follow-up or bone biopsy; the absence of bone infection was confirmed by clinical (healing of the ulcer without antibiotic therapy) and radiological follow-up.
Results: According to these criteria, among the 56 ulcers, bone infection was observed in 27 (48.2%): the HMPAO-Leucocytes/MDP scan was positive in 25 cases, including 7 ulcers with normal or equivocal radiographs at inclusion. In the group of 29 ulcers without proven bone infection, the HMPAOLeucocytes/MDP scan was negative in 28 cases, including 8 lesions with a soft-tissue infection.
Conclusion: With a sensitivity of 92.6%, a specificity of 96.5%, the HMPAO-Leucocytes/MDP scan is a reliable tool for the diagnosis of osteomyelitis in the diabetic foot. Neu-roarthropathy did not affect the performances of the HMPAO-Leu/MDP scan. Owing to a high spatial resolution this test is very helpful to differentiate bone infection from soft-tissue infection especially in case of neuroarthropathy.