Singh Baljinder, Sunil Hejjaji V, Sharma Sarika, Prasad Vikas, Kashyap Raghav, Bhattacharya Anish, Mittal Bhagwant R, Taneja Ashish, Rai Rajeev, Goni Vijay G, Aggarwal Sameer, Gill Shivinder S, Bhatnagar Aseem, Singh Ajay K
Department of Nuclear Medicine, PGIMER, Chandigarh, India.
Nucl Med Commun. 2008 Dec;29(12):1123-9. doi: 10.1097/MNM.0b013e328318b369.
To investigate the diagnostic efficacy of indigenously developed single vial kit preparation of Tc-ciprofloxacin (Diagnobact) for the detection of orthopedic infections.
Seventy-seven patients [25 with clinical suspicion of diabetic foot osteomyelitis (DFOM), 25 with orthopedic device-related infection (ODRI) and 27 with tubercular bone infection] underwent three-phase Tc-methylenediphosphonate bone scintigraphy followed by static Tc-ciprofloxacin imaging at 1, 4 and 24 h. Imaging (anterior and posterior views) was performed under a dual-head gamma-camera using a low-energy, high-resolution, parallel-hole collimator. The lesion-to-background ratio (LBR) of the radiotracer was calculated on the static isotime Tc-ciprofloxacin images using semiquantitative analysis. Scintigraphic (Diagnobact) results were compared with the histopathological and/or culture/PCR analysis as a gold standard.
The mean LBR of the radiotracer (Tc-ciprofloxacin) in the positive scans (n=29; 16 ODRI, 13 DFOM) was > or =2.0 at 1 h postinjection and remained consistent till 24 h. In contrast, the mean LBR in the negative scans (n=21; 12 DFOM, nine ODRI) was < or =1.5 at 1 h and declined significantly (P<0.05) at 24 h. The observed trend in the mean LBR in positive (n=18) and negative (n=9) scans for tubercular osteomyelitis was identical to that seen in the nontubercular bacterial infections.
The management protocol for patients with suspected bony infection may include a three-phase bone scan followed by Tc-ciprofloxacin scan. An LBR of > or =2.0 at 1 h that remained consistent till 24 h on Tc-ciprofloxacin scan is indicative of active bacterial infection. However, resistance to ciprofloxacin at the bacterial cell membrane may be a limitation of this technique.
研究国产单瓶试剂盒制备的锝-环丙沙星（Diagnobact）用于检测骨科感染的诊断效能。
77例患者[25例临床怀疑糖尿病足骨髓炎（DFOM）、25例骨科器械相关感染（ODRI）和27例结核性骨感染]先进行三相锝-亚甲基二膦酸盐骨显像，随后在1小时、4小时和24小时进行静态锝-环丙沙星显像。在双头γ相机下使用低能、高分辨率、平行孔准直器进行成像（前后位）。使用半定量分析在静态等时锝-环丙沙星图像上计算放射性示踪剂的病变与本底比值（LBR）。将闪烁显像（Diagnobact）结果与作为金标准的组织病理学和/或培养/聚合酶链反应分析进行比较。
阳性扫描（n = 29；16例ODRI，13例DFOM）中放射性示踪剂（锝-环丙沙星）的平均LBR在注射后1小时≥2.0，并一直保持到24小时。相比之下，阴性扫描（n = 21；12例DFOM，9例ODRI）中的平均LBR在1小时≤1.5，在24小时时显著下降（P<0.05）。结核性骨髓炎阳性（n = 18）和阴性（n = 9）扫描中观察到的平均LBR趋势与非结核细菌感染中所见相同。
疑似骨感染患者的管理方案可能包括三相骨扫描，随后进行锝-环丙沙星扫描。锝-环丙沙星扫描在1小时时LBR≥2.0并一直保持到24小时表明存在活动性细菌感染。然而，细菌细胞膜对环丙沙星的耐药性可能是该技术的一个局限性。
