Jacobson A F, Harley J D, Lipsky B A, Pecoraro R E
Department of Nuclear Medicine Section, Department of Veterans Affairs Medical Center, Seattle, WA 98108.
AJR Am J Roentgenol. 1991 Oct;157(4):807-12. doi: 10.2214/ajr.157.4.1892041.
To evaluate the usefulness of 111In-leukocyte scintigraphy for identifying osteomyelitis in the presence of soft-tissue infection, we prospectively studied 45 bone sites adjacent to soft-tissue infection in patients with abnormal findings on radiographs and 99mTc bone scans that were suggestive of osteomyelitis. 111In-leukocyte scans were analyzed in terms of the intensity of abnormal uptake and its location relative to bone. The diagnosis of osteomyelitis was established from results of percutaneous bone biopsy culture (n = 35), histologic examination of surgical specimens (n = 8), and clinical follow-up (n = 2). Osteomyelitis was present at 22 sites, including 16 of 18 sites with increased leukocyte uptake in bone, resulting in a sensitivity of 73%, specificity of 91%, and positive predictive value of 89% for this finding. Osteomyelitis was present at four of 17 sites with predominantly soft-tissue localization of leukocyte activity in the region of bone, none of seven sites with normal leukocyte scans, and two of three sites with diminished leukocyte uptake in bone. Although not helpful in distinguishing infectious from noninfectious bone abnormalities, 3- and especially 24-hr bone scans viewed in conjunction with leukocyte studies provided important correlation to aid in estimating the location of focal abnormal leukocyte uptake. The finding of soft-tissue infection with increased uptake of labeled leukocytes that extends to involve adjacent bone strongly suggests concurrent osteomyelitis. When the presence of abnormal leukocyte uptake in bone is uncertain, additional imaging and possibly biopsy may be required to establish or exclude the diagnosis of osteomyelitis.
为了评估铟-111 白细胞闪烁显像在软组织感染存在时识别骨髓炎的效用，我们对 45 个与软组织感染相邻的骨部位进行了前瞻性研究，这些患者的 X 线片和锝-99m 骨扫描结果异常，提示可能存在骨髓炎。对铟-111 白细胞扫描结果，根据异常摄取的强度及其相对于骨的位置进行分析。骨髓炎的诊断依据经皮骨活检培养结果（n = 35）、手术标本的组织学检查结果（n = 8）以及临床随访结果（n = 2）确定。22 个部位存在骨髓炎，其中 18 个骨部位白细胞摄取增加的部位中有 16 个存在骨髓炎，该表现的敏感性为 73%，特异性为 91%，阳性预测值为 89%。17 个骨部位中，有 4 个存在骨髓炎，这些部位白细胞活性主要定位于软组织；7 个白细胞扫描正常的部位均未发现骨髓炎；3 个骨部位白细胞摄取减少的部位中有 2 个存在骨髓炎。虽然在区分感染性与非感染性骨异常方面并无帮助，但 3 小时尤其是 24 小时骨扫描结合白细胞研究可提供重要的相关性，有助于估计局灶性异常白细胞摄取的位置。发现软组织感染且标记白细胞摄取增加并累及相邻骨，强烈提示并发骨髓炎。当骨中白细胞摄取异常的情况不确定时，可能需要额外的影像学检查甚至活检来确定或排除骨髓炎的诊断。
