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Evaluation of Complicating Osteomyelitis with Tc-99m MDP, In-111 Granulocytes, and Ga-67 Citrate

Richard L. Roudebush Veterans Administration Medical Center, and Indiana University School of Medicine, Indianapolis, Indiana

Correspondence: For reprints contact: Donald S. Schauwecker, PhD, MD, VA Medical Center, 1481 West 10th St., Indianapolis, IN 46220.

ABSTRACT

Studies with gallium-67 and three-phase bone imaging (TPBS), though very sensitive, are not very specific in evaluating suspected osteomyelitis (OM) that is superimposed upon other disease causing increased bone turnover. A total 57 patients with suspected OM were studied; this included 48 with increased bone turnover. All of the patients were studied with granulocytes labeled with In-111 acetylacetone (In-111 GRAN), TPBS and 29 of these patients had Ga-67 studies as well. In-111 GRAN had a sensitivity of 100% in acute OM and 60% in chronic OM, with a specificity of 96%. Gallium-67 was excellent in ruling out OM when the study was normal, or in ruling in OM when the relative uptake of Ga-67 exceeded the uptake of Tc-99 MDP, or when the Ga-67 in bone had a different distribution from the TPBS. Unfortunately, these criteria were met in only 28% of our subjects. We conclude that when added to TPBS, the In-111 GRAN study plays an important role in detecting complicating OM.

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