Devillers A, Garin E, Polard J L, Poirier J Y, Arvieux C, Girault S, Moisan A, Bourguet P
Department of Nuclear Medicine, Centre Eugene Marquis, Rennes, France.
Nucl Med Commun. 2000 Aug;21(8):747-53. doi: 10.1097/00006231-200008000-00008.
Between January and July 1998, we conducted a prospective study to compare Tc-99m-labelled antigranulocyte monoclonal antibody fragment Fab' (LEUKOSCAN) scintigraphy versus Tc-99m-hexamethylpropyleneamine oxime (Tc-99m-HMPAO)-labelled leukocyte scintigraphy (HMPAO-LS) for the diagnosis of unselected patients with bone and joint infection. Twenty-three patients (16 men and 7 women; mean age, 67 years) with suspected bone infection were explored successively with bone scintigraphy, HMPAO-LS and LEUKOSCAN scintigraphy. Thirty-two foci were studied (diabetic foot = 11, prosthetic material = 8, joint disease = 4, others = diagnosed in 18 cases, eight on the basis of bacteriological and histological examination of surgical or puncture specimens, with or without radiographic signs, and 10 on the basis of clinical course and radiographic findings. Overall sensitivity, specificity and accuracy were 86%, 72% and 78%, respectively, for LEUKOSCAN scintigraphy (12 true positives (TP), 13 true negatives (TN), 5 false positives (FP), 2 false negatives (FN)), 93%, 100% and 96%, respectively, for HMPAO-LS (13TP, 18TN, 0FP, 1FN), and 100%, 17% and 53.3%, respectively, for bone scintigraphy. In this small series, LEUKOSCAN scintigraphy was found to be less specific for the diagnosis of osteomyelitis than HMPAO-LS. In addition, the interpretation of LEUKOSCAN scintigraphy is more difficult than HMPAO-LS for the diagnosis of bone infection in the diabetic foot, and would appear to be less discriminating for differentiating soft tissue infection from osteitis in the case of plantar perforating ulcers.
1998年1月至7月期间，我们开展了一项前瞻性研究，比较锝-99m标记的抗粒细胞单克隆抗体片段Fab'（白细胞扫描）闪烁显像与锝-99m-六甲基丙烯胺肟（Tc-99m-HMPAO）标记的白细胞闪烁显像（HMPAO-LS）在诊断未经挑选的骨与关节感染患者中的应用。23例疑似骨感染患者（16例男性和7例女性；平均年龄67岁）先后接受了骨闪烁显像、HMPAO-LS和白细胞扫描闪烁显像检查。共研究了32个病灶（糖尿病足11个、假体材料相关8个、关节疾病4个、其他9个）。18例确诊，其中8例基于手术或穿刺标本的细菌学和组织学检查确诊，有无影像学征象均可；10例基于临床病程和影像学表现确诊。白细胞扫描闪烁显像的总体敏感性、特异性和准确性分别为86%、72%和78%（12例假阳性（TP）、13例假阴性（TN）、5例假阳性（FP）、2例假阴性（FN）），HMPAO-LS分别为93%、100%和96%（13例TP、18例TN、0例FP、1例FN），骨闪烁显像分别为100%、17%和53.3%。在这个小样本系列研究中，发现白细胞扫描闪烁显像在诊断骨髓炎方面的特异性低于HMPAO-LS。此外，对于糖尿病足骨感染的诊断，白细胞扫描闪烁显像的解读比HMPAO-LS更困难，而且在足底穿通性溃疡的情况下，对于区分软组织感染和骨炎的鉴别能力似乎更弱。
