Molecular imaging in musculoskeletal infections with 99m Tc-UBI 29-41 SPECT/CT
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ORIGINAL ARTICLE
Molecular imaging in musculoskeletal infections with 99mTc-UBI 29-41 SPECT/CT Mike Sathekge1 · Osvaldo Garcia‑Perez2 · Diana Paez3 · Noura El‑Haj3 · Taylor Kain‑Godoy3 · Ismaheel Lawal1 · Enrique Estrada‑Lobato3 Received: 14 November 2017 / Accepted: 16 November 2017 © The Author(s) 2017. This article is an open access publication
Abstract Objective To determine the added value of CT over planar and SPECT-only imaging in the diagnosis of musculoskeletal infection using 99mTc-UBI 29-4. Materials and methods 184 patients with suspected musculoskeletal infection who underwent planar and SPECT/CT imaging with 99mTc-UBI 29-41 were included. Planar, SPECT-only and SPECT/CT images were reviewed by two independent analysts for presence of bone or soft tissue infection. Final diagnosis was confirmed with tissue cultures, surgery/histology or clinical follow-up. Results 99mTc-UBI 29-41 was true positive in 105/184 patients and true negative in 65/184 patients. When differentiating between soft tissue and bone infection, planar + SPECT-only imaging had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 95.0, 74.3, 84.8, 91.3 and 86.9%, respectively, versus 99.0, 94.5, 92.5, 98.5 and 94.5% for SPECT/CT. SPECT/CT resulted in a change in reviewers’ confidence in the final diagnosis in 91/184 patients. Inter-observer agreement was better with SPECT/CT compared with planar + SPECT imaging (kappa 0.87, 95% CI 0.71–0.85 versus kappa 0.81, 95% CI 0.58–0.75). Conclusion Addition of CT to planar and SPECT-only imaging led to an increase in diagnostic performance and an improvement in reviewers’ confidence and inter-observer agreement in differentiating bone from soft tissue infection. Keywords 99mTc-UBI 29-41 · SPECT/CT · Infection · Musculoskeletal
Introduction The diagnosis and localization of musculoskeletal infection remains a challenge for physicians as infectious diseases can be difficult to detect [1]. Molecular imaging now plays a critical role in the diagnosis of musculoskeletal infections. Radiolabelled leukocyte or white blood cell (WBC) imaging is a common modality for infection diagnosis. Its excellent diagnostic performance has led to it being considered as the gold-standard imaging modality for peripheral bone * Mike Sathekge [email protected] 1
Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria 0001, South Africa
2
Nuclear Medicine Department, National Cancer Institute in México, Mexico City, Mexico
3
International Atomic Energy Agency, Vienna, Austria
osteomyelitis. However, the process of using radiolabelled WBCs has also had a fair number of drawbacks [2]. These include the need to collect and label individual patient’s blood followed by reinjection, the need for a team of welltrained staff to perform in vitro labelling as well as sufficient facilities, the risk of acquiring an infection and/or cross-contaminating samples, and the cost required for cell labellin
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