And 67Ga Citrate Scintigraphy in Skeletal Infections

Acute infection of bones and joints can be diagnosed using 99mTc-MDP scintigraphy reinforced with nuclear angiography and the pinhole technique. However, white blood cells labeled with 111In or 99mTc are employed for more specific diagnosis of bone infection superimposed on fracture, operative wound, or prosthesis. One latest clinical study has confirmed the accuracy of 111In-leukocyte scintigraphy in the diagnosis of posttraumatic and postoperative cranial and spinal infections (Medina et al. 2000). In order to replace expensive 111In with readily available 99mTc, leukocytes are labeled with hexamethyl-propylene

Scan Rib Labeled

Fig. 6.41A-C Rib caries. A CT of the anterior portion of left rib 7 in a 66-year-old male with tuberculosis shows irregular osteolytic change with host bone fragmentation and soft-tissue abscess (arrows). B Tilted AP radiograph of the left lower chest demonstrates flaring and osteolysis in the anterior part of the left rib 7 (arrow). C Anterior pinhole scan reveals fan-shaped tracer uptake with the more intense uptake in the main infective focus at the costochondral junction, the site analogous to the long bone metaphysis

Costal Chondral Junction Costal Chondral Junction

Fig. 6.42A, B Value of 67Ga citrate scan in the diagnosis > of infective focus. A 99mTc MDP whole-body bone scan shows intense uptake in the right tibia and fibula without indicating the infective focus (?). B 67Ga scan shows tracer specifically accumulated in the infective focus in the right proximal tibia (arrow)

amine oxime (HMPAO). The image quality of 99mTc-HMPAO leukocyte scans is acceptable (Fig. 6.42), and has been shown to be superior to that of 111In-leukocyte scans (Peters 1994). Unfortunately, however, 99mTc-HMPAO avidly accumulates in the axial skeleton even in its normal state. In general, the 99mTc-HMPAO leukocyte scan is more suited to rapid screening of acute infection, whereas the mIn-leuko-cyte scan is suited to chronic infection. Once 67Ga citrate was used for the diagnosis of infective diseases but it indiscriminately accumulates in tumors. Some radioantibodies such as 99mTc-antigranulocyte antibodies have been tested but have been found to be neither reliable nor advantageous (Hotze et al. 1992; McAfee et al. 1991).

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