Vicente A Garcia, Almoguera M, Alonso J C, Heffernan A Jimenez, Gomez A, Contreras P I, Martin-Comin J
Nuclear Medicine and Traumatology Departments, Hospital de Alarcos (Ciudad Real), Spain.
Clin Nucl Med. 2004 Dec;29(12):781-5. doi: 10.1097/00003072-200412000-00001.
The aim of the study was to analyze the use of Tc-99m-labeled antigranulocyte monoclonal antibody fragment Fab'2 (SMab, Leukoscan) in the diagnosis of acute osteomyelitis and articular prosthesis infection. One hundred seventeen patients (118 studies) have been included, 92 women and 25 men. Thirty-seven had a suspicion of osteomyelitis and 81 with suspicion of infection of a hip (35 patients) or a knee (45 patients) prosthesis. The mean age was 64 years. A 3-phase bone scan and a SMab scan were obtained in all patients. Antigranulocyte scans were obtained within 3 and 8 hours postinjection of 20 mCi (740 MBq) of Tc-99m-labeled antibody. Diagnosis of infection was based on bone biopsy in 8 cases and on at least 2 positive cultures in the remaining cases. Infection was ruled out with negative cultures or 1-year patient follow up with negative C-reactive protein and normal erythrocyte sedimentation rate.
Sensitivity, specificity, accuracy, and negative predictive value of Tc 99m-SMab scintigraphy were: 75%, 95%, 87%, and 92% for long bone osteomyelitis and 80%, 89%, 87%, and 91% for articular prosthesis infection, respectively. Positive predictive values were 83% and 63%, respectively.
Tc-99m-antigranulocyte monoclonal antibody fragment Fab'2 scintigraphy seems to be a useful method in the diagnosis of osteoarticular infection.
本研究旨在分析锝-99m标记的抗粒细胞单克隆抗体片段Fab'2（SMab，白细胞扫描剂）在急性骨髓炎和人工关节感染诊断中的应用。纳入了117例患者（118项研究），其中92例女性，25例男性。37例怀疑患有骨髓炎，81例怀疑髋关节（35例患者）或膝关节（45例患者）假体感染。平均年龄为64岁。所有患者均进行了三相骨扫描和SMab扫描。在注射20毫居里（740兆贝可）锝-99m标记抗体后的3小时和8小时内进行抗粒细胞扫描。8例患者的感染诊断基于骨活检，其余患者基于至少2次阳性培养结果。通过阴性培养结果或对患者进行1年随访，C反应蛋白阴性且红细胞沉降率正常来排除感染。
锝-99m-SMab闪烁扫描术对长骨骨髓炎的敏感性、特异性、准确性和阴性预测值分别为75%、95%、87%和92%，对人工关节感染的分别为80%、89%、87%和91%。阳性预测值分别为83%和63%。
锝-99m抗粒细胞单克隆抗体片段Fab'2闪烁扫描术似乎是诊断骨关节炎感染的一种有用方法。
