Skip to main content
SpringerLink
Log in

99mTc-Ciprofloxacin planar and tomographic imaging for the diagnosis of infection in the postoperative spine: experience in 48 patients

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

The non-invasive assessment of postoperative spinal infections can pose a substantial diagnostic challenge, especially in the presence of orthopaedic devices. Whereas white blood cell scanning is of limited use in the spine, the low normal bone marrow uptake of technetium-99m ciprofloxacin combined with its claimed bacterial specificity makes it theoretically an ideal candidate for the evaluation of postoperative spinal infections. This study aimed to evaluate 99mTc-ciprofloxacin planar and single-photon emission tomography (SPET) imaging in relation to microbiological and clinical diagnosis in the postoperative spine. Planar imaging was performed at 1, 3 and 24 h and SPET was performed at 3 h post injection of 370 MBq 99mTc-ciprofloxacin. Images were scored by two independent certified nuclear medicine physicians, blinded to the final diagnosis. Within the 48 patients, there were 13 deep infections. Sensitivity, specificity and accuracy at visual scoring were respectively 54%, 71% and 67% (1 h), 62%, 77% and 73% (3 h), 42%, 91% and 77% (24 h) for planar imaging and 100%, 74% and 81% for SPET. When recently operated patients (<6 months) were excluded, the specificity of the SPET imaging rose to 81%. In conclusion, unlike white blood cell scanning, 99mTc-ciprofloxacin SPET is sensitive in evaluating infections in the postoperative spine. Sensitivity is much higher for SPET than for planar imaging. However, the results presented prove that its specificity is limited, especially in recently operated patients. Taking this limitation into account, we advise planar and SPET imaging at 3 h post injection and an interval of at least 6 months after surgery to minimise the likelihood of false positives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Crim JR, Seeger LL. Imaging evaluation of osteomyelitis. Crit Rev Diagn Imaging 1994; 35:201–256.

    CAS  PubMed  Google Scholar 

  2. Perry M. Erythrocyte sedimentation rate and C reactive protein in the assessment of suspected bone infection—are they reliable indices? J R Coll Surg Edinb 1996; 41:116–118.

    CAS  PubMed  Google Scholar 

  3. Palestro CJ, Love C, Tronco GG, Tomas MB. Role of radionuclide imaging in the diagnosis of postoperative infection. Radiographics 2000; 20:1649–1660.

    CAS  PubMed  Google Scholar 

  4. Britton KE, Vinjamuri S, Hall AV, Solanki K, Siraj QH, Bomanji J, Das S. Clinical evaluation of technetium-99m Infecton for the localisation of bacterial infection. Eur J Nucl Med 1997; 24:553–556.

    Article  CAS  PubMed  Google Scholar 

  5. Yapar Z, Kibar M, Yapar AF, Togrul E, Kayaselcuk U, Sarpel Y. The efficacy of technetium-99m ciprofloxacin (Infecton) imaging in suspected orthopaedic infection: a comparison with sequential bone/gallium imaging. Eur J Nucl Med 2001; 28:822–830.

    CAS  PubMed  Google Scholar 

  6. Sonmezoglu K, Sonmezoglu M, Halac M, Akgun I, Turkmen C, Onsel C, Kanmaz B, Solanki K, Britton KE, Uslu I. Usefulness of99mTc-ciprofloxacin (Infecton) scan in diagnosis of chronic orthopedic infections: comparative study with 99mTc-HMPAO leukocyte scintigraphy. J Nucl Med 2001; 42:567–574.

    CAS  PubMed  Google Scholar 

  7. Hall AV, Solanki KK, Vinjamuri S, Britton KE, Das SS. Evaluation of the efficacy of99mTc-Infecton, a novel agent for detecting sites of infection. J Clin Pathol 1998; 51:215–219.

    CAS  PubMed  Google Scholar 

  8. Malamitsi J, Giamarellou H, Kanellakopoulou K, Dounis E, Grecka V, Christakopoulos J, Koratzanis G, Antoniadou A, Panoutsopoulos G, Batsakis C, Proukakis C. Infecton: a99mTc-ciprofloxacin radiopharmaceutical for the detection of bone infection. Clin Microbiol Infect 2003; 9:101–109.

    Article  CAS  PubMed  Google Scholar 

  9. de Winter F, Van de Wiele C, Dumont F, Van Durme J, Solanki K, Britton K, Slegers G, Dierckx RA, Thierens H. Biodistribution and dosimetry of99mTc-ciprofloxacin, a promising agent for the diagnosis of bacterial infection. Eur J Nucl Med 2001; 28:570–574.

    PubMed  Google Scholar 

  10. Vinjamuri S, Hall AV, Solanki KK, Bomanji J, Siraj Q, O’Shaughnessy E, Das SS, Britton KE. Comparison of99mTc Infecton imaging with radiolabelled white-cell imaging in the evaluation of bacterial infection. Lancet 1996; 347:233–235.

    CAS  PubMed  Google Scholar 

  11. Grane P, Josephsson A, Seferlis A, Tullberg T. Septic and aseptic post-operative discitis in the lumbar spine: evaluation by MR imaging. Acta Radiol 1998; 39:108–115.

    CAS  PubMed  Google Scholar 

  12. Kaim AH, Gross T, von Schulthess GK. Imaging of chronic posttraumatic osteomyelitis. Eur Radiol 2002; 12:1193–1202.

    Article  PubMed  Google Scholar 

  13. Seabold JE, Nepola JV. Imaging techniques for evaluation of postoperative orthopedic infections. Q J Nucl Med 1999; 43:21–28.

    CAS  PubMed  Google Scholar 

  14. Van Goethem JW, Parizel PM, van den Hauwe L, Van de Kelft E, Verlooy J, De Schepper AM. The value of MRI in the diagnosis of postoperative spondylodiscitis. Neuroradiology 2000; 42:580–585.

    PubMed  Google Scholar 

  15. Van Goethem JWM, Parizel PM, Jinkins JR. Review article: MRI of the postoperative lumbar spine. Neuroradiology 2002; 44:723–739.

    Article  PubMed  Google Scholar 

  16. Wolf G, Aigner RM, Schwarz T. Diagnosis of bone infection using99mTc-HMPAO labelled leukocytes. Nucl Med Commun 2001; 22:1201–1206.

    Article  CAS  PubMed  Google Scholar 

  17. Schauwecker DS. Osteomyelitis : Diagnosis with In-111-labeled leukocytes. Radiology 1989; 171:141–146.

    CAS  PubMed  Google Scholar 

  18. Datz FL. Indium-111-labeled leukocytes for the detection of infection: current status. Semin Nucl Med 1994; 24:92–109.

    Google Scholar 

  19. Love C, Patel M, Lonner BS, Tomas MB, Palestro CJ. Diagnosing spinal osteomyelitis: a comparison of bone and Ga-67 scintigraphy and magnetic resonance imaging. Clin Nucl Med 2000; 25:963–977.

    Article  CAS  PubMed  Google Scholar 

  20. Gratz S, Dörner J, Oestmann JW, Opitz M, Behr T, Meller J, Grabbe E, Becker W.67Ga-citrate and 99Tc-MDP for estimating the severity of vertebral osteomyelitis. Nucl Med Commun 2000; 21:111–120.

    CAS  PubMed  Google Scholar 

  21. Britton KE, Wareham DW, Das SS, Solanki KK, Amaral H, Bhatnagar A, Katamihardja AH, Malamitsi J, Moustafa HM, Soroa VE, Sundram FX, Padhy AK. Imaging bacterial infection with99mTc-ciprofloxacin (Infecton). J Clin Pathol 2002; 55:817–823.

    Article  PubMed  Google Scholar 

  22. Sarikaya I, Sarikaya A, Holder LE. The role of single photon emission computed tomography in bone imaging. Semin Nucl Med 2001; 31:3–16.

    CAS  PubMed  Google Scholar 

  23. Larikka MJ, Ahonen AK, Niemela O, Puronto O, Junila JA, Hamalainen MM, Britton K, Syrjala HP.99mTc-ciprofloxacin (Infecton) imaging in the diagnosis of knee prosthesis infections. Nucl Med Commun 2002; 23:167–170.

    Article  CAS  PubMed  Google Scholar 

  24. Dumarey N, Blocklet D, Appelboom T, Tant L, Schoutens A. Infecton is not specific for bacterial osteo-articular infective pathology. Eur J Nucl Med Mol Imaging 2002; 29:530–535.

    Article  CAS  PubMed  Google Scholar 

  25. Sarda L, Saleh-Mghir A, Peker C, Meulemans A, Cremieux AC, Le Guludec D. Evaluation of99mTc-ciprofloxacin scintigraphy in a rabbit model of Staphylococcus aureus prosthetic joint infection. J Nucl Med 2002; 43:239–245.

    PubMed  Google Scholar 

  26. Ledermann HP, Kaim A, Bongartz G, Steinbrich W. Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis. Eur Radiol 2000; 10:1815–1823.

    Article  CAS  PubMed  Google Scholar 

  27. Palestro CJ. The current role of gallium imaging in infection. Semin Nucl Med 1994; 24:128–141.

    Google Scholar 

  28. de Winter F, Van de Wiele C, Vogelaers D, de Smet K, Verdonk R, Dierckx RA. Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am 2001; 83:651–660.

    Google Scholar 

  29. de Winter F, Gemmel F, Van de Wiele C, Poffijn B, Uyttendaele D, Dierckx R. 18-fluorine fluorodeoxyglucose positron emission tomography for the diagnosis of infection in the postoperative spine. Spine 2003; 28:1314–1319.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nuclear Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    Frederic De Winter, Frederic De Winter, Filip Gemmel, Koen Van Laere, Olivier De Winter, Olivier De Winter, Rudi A. Dierckx & Christophe Van de Wiele

  2. Department of Nuclear Medicine, Leuven University Hospital, Belgium

    Koen Van Laere

  3. Division of Orthopaedic Surgery, Ghent University Hospital, Belgium

    Bart Poffijn

Authors
  1. Frederic De Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Filip Gemmel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koen Van Laere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier De Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bart Poffijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rudi A. Dierckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christophe Van de Wiele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Filip Gemmel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Winter, F., Gemmel, F., Van Laere, K. et al. 99mTc-Ciprofloxacin planar and tomographic imaging for the diagnosis of infection in the postoperative spine: experience in 48 patients. Eur J Nucl Med Mol Imaging 31, 233–239 (2004). https://doi.org/10.1007/s00259-003-1349-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-003-1349-0

Keywords

Search

Navigation