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Clinical Investigations |
1 Service Hospitalier Frédéric Joliot, Commissariat à l’Energie Atomique/Direction des Sciences du Vivant/Département de Recherche Médicale, Orsay, France
2 Nuclear Medicine Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3 Internal Medicine Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
4 Orthopedic Surgery Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
5 Rheumatology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Ciprofloxacin labeled with 99mTc specifically binds to various bacteria. Thus, it potentially constitutes a specific marker allowing discrimination between septic arthritis/osteomyelitis and aseptic osteoarticular diseases. The aim of this prospective study was to evaluate such properties in patients with skeletal diseases. Methods: We prospectively investigated 2 groups of patients: patients with suspected osteoarticular infections (G1, n = 16) and a control group of patients with a presentation of osteoarticular diseases and no sign suggestive of infection (G2, n = 11). All had clinical, biologic, and radiologic evaluations and had 1-, 4-, and 24-h images from 99mTc-ciprofloxacin scintigraphy (370 MBq) before planned biopsy or surgery. For 23 patients, the scintigraphic results were compared with histologic and bacteriologic analyses of biopsy tissue samples; for 4 patients, the scintigraphic results were compared with the findings from 23 ± 5 mo of follow-up. Results: In G1, 99mTc-ciprofloxacin findings were true-positive in all 11 infected sites, true-negative in 2 cases, and false-positive in 3. In G2, 99mTc-ciprofloxacin was true-negative in 4 cases and false-positive in 7. Neither the location of 99mTc-ciprofloxacin activity nor its intensity or kinetics between 1, 4, and 24 h allowed discrimination between infection and aseptic diseases (sterile loosened joint replacement, pseudoarthrosis, or arthrosis). Sensitivity, specificity, and accuracy were 100%, 37.5%, and 63%. Conclusion: 99mTc-Ciprofloxacin scintigraphy showed good sensitivity and a high negative predictive value for the detection of bone and joint infection, but it did not discriminate between infected and aseptic osteoarticular diseases in symptomatic patients referred for surgery.
Key Words: osteoarticular disease • infection • radiolabeled ciprofloxacin
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