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Indium-111-Leukocyte/Technetium-99m-MDP Bone and Magnetic Resonance Imaging: Difficulty of Diagnosing Osteomyelitis in Patients with Neuropathic Osteoarthropathy

Departments of Radiology and Orthopaedic Surgery, The University of Iowa College of Medicine, Iowa City, Iowa

Correspondence: For reprints contact: J. E. Seabold, MD, Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242.

ABSTRACT

Fourteen patients (16 sites) with clinical and/or radiographic evidence of neuropathic osteoarthropathy (Charcot joints) were evaluated with combined indium-111-leukocyte (¹¹¹In-WBC) and technetium-99m-methylene diphosphonate (^99mTc-MDP) bone imaging for suspected osteomyelitis. Magnetic resonance (MR) images were obtained in seven patients. Using a positive bone culture as the criterion for the presence of osteomyelitis, there were four true-positive studies, six true-negative sites, and one false-negative ¹¹¹In-WBC study. Five of 16 sites (31%) had false-positive ¹¹¹In-WBC uptake at noninfected sites. There were four true-positive and three false-positive MR studies. All false-positives showed at least moderately abnormal findings by both techniques at sites of rapidly progressing osteoarthropathy of recent onset. In this preliminary study, both techniques appear to be sensitive for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of ¹¹¹In-WBC/^99mTc-MDP and MR images at sites of rapidly progressing, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis.

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