HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nijhof, M. W. Articles by Corstens, F. H.M. Search for Related Content PubMed PubMed Citation Articles by Nijhof, M. W. Articles by Corstens, F. H.M.

Evaluation of Infections of the Locomotor System with Indium-111-Labeled Human IgG Scintigraphy

University Hospital Nijmegen, Departments of Nuclear Medicine, Orthopedics, and Internal Medicine, Nijmegen, The Netherlands

Correspondence: For correspondence or reprints contact: Wim J.G. Oyen, MD, University Hospital Nijmegen, Department of Nuclear Medicine, P. O. Box 9101, 6500 HB Nijmegen, The Netherlands.

ABSTRACT

Indium-111-labeled human nonspecific immunoglobin G (¹¹¹In-IgG) is one of the newer agents suggested for scintigraphic evaluation of infection and inflammation. In this study, the utility of this agent was studied in routine clinical practice. Methods: A dose of 75 MBq¹¹¹In labeled to 2 mg IgG (MacroScint®) was administered intravenously in 226 patients with 232 possible foci of infection or inflammation. Imaging was performed 4, 24 and 48 hr postinjection. The results were verified by culture, obtained either surgically (42%) or via puncture (19%) and long-term clinical and roentgenological follow-up (39%). Follow-up data were used in patients of whom the vast majority had a negative work-up, including negative ¹¹¹In-IgG scintigraphy. Results: All infected total hip (THA) and total knee arthroplasties, focal osteomyelitis, diabetic foot infections, septic arthritis and soft-tissue infections were detected (61 foci). Only one patient with early, low-grade spondylodiscitis was false negative with ¹¹¹In-lgG. Since ¹¹¹In-IgG scintigraphy does not discriminate between infectious and sterile inflammation, careful interpretation is necessary in cementless THA up to 1 yr after insertion, uptake only around the neck of the femoral component of a THA, recent fractures and pseudarthrosis, in which uptake may be caused by sterile inflammation and not by infection (specificity for inflammation 100%, specificity for infection of 77%). Conclusion: Indium-111-IgG scintigraphy is a very sensitive tool for detection of infectious bone and joint disease. Moreover, when uptake patterns of ¹¹¹In-IgG, which are characteristic for sterile inflammation, are excluded, infection can be ruled out with a high degree of certainty.

Key Words: indium-111 • spondylodiscitis • arthroplasty • diabetic foot • osteomyelitis

This article has been cited by other articles:

				C J Mathews, G Kingsley, M Field, A Jones, V C Weston, M Phillips, D Walker, and G Coakley Management of septic arthritis: a systematic review Postgrad. Med. J., May 1, 2008; 84(991): 265 - 270. [Abstract] [Full Text] [PDF]

				C J Mathews, G Kingsley, M Field, A Jones, V C Weston, M Phillips, D Walker, and G Coakley Management of septic arthritis: a systematic review Ann Rheum Dis, April 1, 2007; 66(4): 440 - 445. [Abstract] [Full Text] [PDF]

				M.F. Termaat, P.G.H.M. Raijmakers, H.J. Scholten, F.C. Bakker, P. Patka, and H.J.T.M. Haarman The Accuracy of Diagnostic Imaging for the Assessment of Chronic Osteomyelitis: A Systematic Review and Meta-Analysis J. Bone Joint Surg. Am., November 1, 2005; 87(11): 2464 - 2471. [Abstract] [Full Text] [PDF]

				D. Rubello, A. M. Peters, and J. R. Ballinger Timing for Evaluating "Specific" Binding of 99mTc-Sulesomab in Peripheral Bone Infection J. Nucl. Med., February 1, 2005; 46(2): 382 - 383. [Full Text] [PDF]