Scintigraphic Techniques for the Diagnosis of Infectious Disease of the Musculoskeletal System

In imaging infectious diseases of the musculoskeletal system, the metabolic information provided by nuclear medicine studies complements the structural information of radiologic modalities. Often the diagnosis can be confirmed by combining the methods in a diagnostic algorithm. The decision about whether a single study is best depends on the clinical setting and the questions that require an answer. Whereas radiography, magnetic resonance imaging (MRI), and computed tomography (CT) usually focus on a single area, nuclear medicine imaging offers the advantage of whole body imaging. However, despite significant improvements it cannot approach the detailed anatomical visualization provided by MRI or CT. In most cases scintigraphy is a very sensitive (e.g., bone scan, positron emission tomography) and often quite specific tool (e.g., white blood cell scintigraphy). The metabolic information of the single scintigraphic procedure depends on the accumulation mechanism. For the work-up of infectious disorders different radiopharmaceuticals can be used, and the decision for the best modality should be tailored to the clinical question and the special pathophysiologic condition of the infection. This article describes the most common nuclear medicine studies and their clinical relevance in some infectious diseases.

KEYWORDS

Nuclear medicine studies - infection - musculoskeletal system

REFERENCES

• 1 Müller-Schauenburg W, Feine U. Qualitätskontrolle in vivo: Skelett.  Nucl Med. 1988;  27 163-164
• 2 Bureau N J, Chhem R K, Cardinal E. Musculoskeletal infections: US manifestations.  Radiographics. 1999;  19 1585-1592
• 3 Mazur J M, Roos G, Cummings R J, Hahn G A, McCluskey W P. Usefulness of magnetic resonance imaging for the diagnosis of acute musculoskeletal infections in children.  J Pediatr Orthop. 1995;  15 144-147
• 4 Schauwecker D S. Osteomyelitis: diagnosis with In-111-leukocytes.  Radiology. 1989;  171 141-146
• 5 Wegener W A, Alavi A. Diagnostic imaging of musculoskeletal infection.  Orthop Clin North Am. 1991;  22 401-418
• 6 Bohndorf K. Bildgebende Diagnostik der akuten und chronischen Osteomyelitis.  Radiologe. 1996;  36 786-794
• 7 Sciuk J. Radiologische und szintigraphische Diagnsotik entzündlicher Skeletterkrankungen. In Günther RW Jahrbuch der Radiologie. Zülpich, Germany; Biermann Verlag 1995: 177-180
• 8 Sciuk J, Erlemann R, Schober O, Peters P E. Bildgebende Diagnostik der Osteomyelitis.  Dtsch Arztebl. 1992;  89 2462-2473
• 9 Hotze A L, Briele B, Overbeck B et al.. Technetium-99m-labeled anti-granulocyte antibodies in suspected bone infections.  J Nucl Med. 1992;  33 526-531
• 10 Datz F L. Indium-111-labeled leukocytes for the detection of infection: current status.  Semin Nucl Med. 1994;  24 92-109
• 11 Whalen J, Brown M, McLeod R, Fitzgerald R. Limitations of indium leukocyte imaging for the diagnosis of spine infections.  Spine. 1991;  16 193-197
• 12 Guhlmann A, Brecht-Krauss D, Suger G et al.. Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis.  J Nucl Med. 1998;  39 2145-2152
• 13 Guhlmann A, Brecht-Krauss D, Suger G et al.. Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings.  Radiology. 1998;  206 749-754
• 14 Kälicke T, Schmitz A, Risse J H et al.. Fluorine-18 fluorodeoxyglucose PET in infectious bone diseases. Results of histologically confirmed cases.  Eur J Nucl Med. 2000;  27 524-528
• 15 Meller J, Köster G, Liersch T et al.. Chronic bacterial osteomyelitis: prospective comparison of (18)-F-FDG imaging with a dual-head coincidence camera and (111)In-labelled autologous leucocyte scintigraphy.  Eur J Nucl Med Mol Imaging. 2002;  29 53-60
• 16 de Winter F, van de Wiele C, Vogelaers D, de Smet K, Verdonk R, Dierckx R A. Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections.  J Bone Joint Surg Am. 2001;  83 651-660
• 17 Zhuang H, Duarte P S, Pourdehand M, Shnier D, Alavi A. Exclusion of chronic osteomyelitis with F-18 fluorodeoxyglucose positron emission tomographic imaging.  Clin Nucl Med. 2000;  25 281-284
• 18 Al Sheikh W, Sfakianakis G N, Mnaymneh W et al.. Subacute and chronic bone infections: diagnosis using In-111, Ga-67 and Tc-99m MDP bone scintigraphy and radiography.  Radiology. 1985;  155 501-506
• 19 Williamson B RJ, McLaughlin R E, Wang G J, Miller C W, Teates D, Bray S T. Radionuclide bone imaging as a means of differentiating loosening and infection in patients with a painful hip prosthesis.  Radiology. 1979;  133 723-725
• 20 Sciuk J, Puskás C, Greitemann B, Schober O. White blood cell scintigraphy with monoclonal antibodies in the study of the infected prosthesis.  Eur J Nucl Med. 1992;  19 497-502
• 21 Becker W, Goldenberg D M, Wolf F. The use of monoclonal antibodies and antibody fragments in the imaging of infectious lesions.  Semin Nucl Med. 1994;  24 142-153
• 22 Love C, Tomas M B, Marwin S E, Pugliese P V, Palestro C J. Role of nuclear medicine in diagnosis of the infected joint replacement.  Radiographics. 2001;  21 1229-1238
• 23 Manthey N, Reinhard P, Moog F, Knesewitsch P, Hahn K, Tatsch K. The use of [18F]fluorodeoxyglucose positron emission tomography to differentiate between synovitis, loosening and infection of hip and knee prostheses.  Nucl Med Commun. 2002;  23 645-653
• 24 Love C, Pugliese P V, Afriyie M O, Thomas M B, Marwin S E, Palestro C J. Utility of F-18 FDG imaging for diagnosing the infected joint replacement.  Clin Positron Imaging. 2000;  3 159