COMBINED BONE-SCINTIGRAPHY AND IN-111 LEUKOCYTE SCANS IN NEUROPATHIC FOOT DISEASE

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  • 1 October 1988
    • journal article
    • research article
    • Vol. 29  (10) , 1651-1655
Abstract
It is difficult to diagnose osteomyelitis in the presence of neurotrophic osteoarthropathy. We performed combined [99mTc]MDP bone scans and indium-111 (111In) leukocyte studies on 35 patients who had radiographic evidence of neuropathic foot disease and clinically suspected osteomyelitis. The [111In] leukocyte study determined if there was an infection and the bone scan provided the anatomic landmarks so that the infection could be localized to the adjacent soft tissue. Seventeen patients had osteomyelitis and all showed increased [111In]leuckocyte activity localized to the bone, giving a sensitivity of 100%. Among the 18 patients without osteomyelitis eight had no accumulation of [111In]leukocytes, seven had the [111In]leukocyte activity correctly localized to the soft tissues, two had [111IN]leukocyte activity mistakenly attributed to the bone, and one had [111IN]leukocyte accumulation in a proven neuroma which was mistakenly attributed to bone. These three false-postive results for osteomyelitis reduced the specificity to 83%. Considering only the 27 patients with a positive [111In]leukocyte study, the combined bone scan and [111In)leukocyte study correctly localized the infection to the soft tissues or bone in 89%. Unifected neurotrophic osteoarthropathy does not accumulate [111In]leuckocytes. We found the combined bone scan and [111In] leukocyte study useful for the detection and localization of infection to soft tissue or bone in patients with neuropathic foot disease.