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Photopenia in Chronic Vertebral Osteomyelitis with Technetium-99m-Antigranulocyte Antibody (BW 250/183)

Departments of Nuclear Medicine and Orthopedics, Georg-August University of Göttingen, Germany

Correspondence: For correspondence or reprints contact: W. Becker, MD, Prof. of Nuclear Medicine, Department of Nuclear Medicine, University of Göttingen, Robert Koch-str. 40, D-37075 Göttingen, Germany.

ABSTRACT

Photon-deficient areas in ^99mTc/¹¹¹In white blood cell( WBC) images for diagnosing vertebral osteomyelitis have been published often. This study retrospectively evaluated whether the use of ^99mTc labeled monoclonal antigranulocyte antibodies (BW 250/183) is superior to WBC and whether it offers higher specificity. Methods: The study included 81 patients (46 men, 35 women; mean age 55 ± 2 yr, from 1989 to 1995) with clinically suspected vertebral osteomyelitis who underwent scintigraphic imaging after intravenous injection of 555 MBq ^99mTc-labeled monoclonal antigranulocyte antibodies. Forty patients suffered from osteomyelitis (20 men, 20 women; mean age 56 ± 6yr), 6 patients had metastases, 28 patients had spondylosis and disk herniation and 5 patients vertebral compression fractures. Diagnosis was not histologically verified in 2 patients. Planar imaging was performed at 4 and 24 hr postinjection. Histology of osteomyelitis was available in 30 patients, clinical follow-up in 10 patients. Visual uptake scores and quantitative uptake scores of the suspected areas were calculated. The results were compared to a semiquantitative histological score (high, medium, low grade) as well as to the Scintigraphic scores. Results: Scintigraphy showed photopenia in all patients with histologically proven vertebral osteomyelitis, independent of the grade of infection. A quantitative evaluation of 4 and 24 hr postinjection demonstrated a 58% increase of the uptake score in cases of histologically proven high-grade infections. This increase was seen predominantly in the thoracic spine but not in lumbar spine. all nonosseous paravertebral abscesses (n = 2) showed positive images and an increasing uptake over 24 hr. Conclusion: Paravertebral soft tissue infections can be differentiated excellently, whereas vertebral osteomyelitis, vertebral tumors or fractures can be localized, but no differentiation is possible.

Key Words: vertebral osteomyelitis • technetium-99m antigranulocyte antibodies • photopenic lesion • quantitative uptake

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