Radionuclide imaging of musculoskeletal infection

Conventional agents

Christopher J. Palestro, Charito Love

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

The diagnosis of musculoskeletal infection can be clinically challenging, and radionuclide imaging is often performed as part of the diagnostic workup. Conventional studies include bone scan, gallium imaging, and labeled leukocyte imaging. No single test is equally efficacious in all situations, and thus the procedure(s) performed should be optimized for the individual patient. Three-phase bone imaging, readily available and relatively inexpensive, is very accurate in unviolated bone. In the setting of underlying osseous abnormalities, however, the specificity of the test decreases. Four-phase bone, sequential bone/gallium, and labeled leukocyte imaging all have been used in an effort to enhance specificity. Labeled leukocyte imaging is the radionuclide procedure of choice for diagnosing so-called complicating osteomyelitis such as infected joint prostheses, diabetic pedal osteomyelitis, and infection of the neuropathic joint. To maximize the accuracy of the study, complementary bone marrow imaging often must be performed. Labeled leukocyte imaging is of limited value in spinal osteomyelitis, however, because this entity often presents as a nonspecific photopenic defect on white cell studies. The conventional radionuclide study for evaluating spinal osteomyelitis is gallium imaging, which should be performed regardless of the findings on a contemporaneous bone scan. The reasons for this are as follows: Gallium improves the specificity of the bone scan; gallium detects accompanying soft tissue infection, whereas the bone scan does not, and gallium may be more sensitive than the bone scan in elderly patients.

Original languageEnglish (US)
Pages (from-to)335-352
Number of pages18
JournalSeminars in Musculoskeletal Radiology
Volume11
Issue number4
DOIs
StatePublished - Dec 2007
Externally publishedYes

Fingerprint

Radionuclide Imaging
Gallium
Bone and Bones
Osteomyelitis
Infection
Leukocytes
Joint Prosthesis
Soft Tissue Infections
Diabetic Foot
Radioisotopes
Joints
Bone Marrow

Keywords

  • Bone scan
  • Diabetic foot infection
  • Gallium
  • Leukocyte imaging
  • Osteomyelitis
  • Prosthetic joint infection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Surgery

Cite this

Radionuclide imaging of musculoskeletal infection : Conventional agents. / Palestro, Christopher J.; Love, Charito.

In: Seminars in Musculoskeletal Radiology, Vol. 11, No. 4, 12.2007, p. 335-352.

Research output: Contribution to journalArticle

@article{184c3234e8614eb2a1c4116e1cff66b4,
title = "Radionuclide imaging of musculoskeletal infection: Conventional agents",
abstract = "The diagnosis of musculoskeletal infection can be clinically challenging, and radionuclide imaging is often performed as part of the diagnostic workup. Conventional studies include bone scan, gallium imaging, and labeled leukocyte imaging. No single test is equally efficacious in all situations, and thus the procedure(s) performed should be optimized for the individual patient. Three-phase bone imaging, readily available and relatively inexpensive, is very accurate in unviolated bone. In the setting of underlying osseous abnormalities, however, the specificity of the test decreases. Four-phase bone, sequential bone/gallium, and labeled leukocyte imaging all have been used in an effort to enhance specificity. Labeled leukocyte imaging is the radionuclide procedure of choice for diagnosing so-called complicating osteomyelitis such as infected joint prostheses, diabetic pedal osteomyelitis, and infection of the neuropathic joint. To maximize the accuracy of the study, complementary bone marrow imaging often must be performed. Labeled leukocyte imaging is of limited value in spinal osteomyelitis, however, because this entity often presents as a nonspecific photopenic defect on white cell studies. The conventional radionuclide study for evaluating spinal osteomyelitis is gallium imaging, which should be performed regardless of the findings on a contemporaneous bone scan. The reasons for this are as follows: Gallium improves the specificity of the bone scan; gallium detects accompanying soft tissue infection, whereas the bone scan does not, and gallium may be more sensitive than the bone scan in elderly patients.",
keywords = "Bone scan, Diabetic foot infection, Gallium, Leukocyte imaging, Osteomyelitis, Prosthetic joint infection",
author = "Palestro, {Christopher J.} and Charito Love",
year = "2007",
month = "12",
doi = "10.1055/s-2008-1060336",
language = "English (US)",
volume = "11",
pages = "335--352",
journal = "Seminars in Musculoskeletal Radiology",
issn = "1089-7860",
publisher = "Thieme Medical Publishers",
number = "4",

}

TY - JOUR

T1 - Radionuclide imaging of musculoskeletal infection

T2 - Conventional agents

AU - Palestro, Christopher J.

AU - Love, Charito

PY - 2007/12

Y1 - 2007/12

N2 - The diagnosis of musculoskeletal infection can be clinically challenging, and radionuclide imaging is often performed as part of the diagnostic workup. Conventional studies include bone scan, gallium imaging, and labeled leukocyte imaging. No single test is equally efficacious in all situations, and thus the procedure(s) performed should be optimized for the individual patient. Three-phase bone imaging, readily available and relatively inexpensive, is very accurate in unviolated bone. In the setting of underlying osseous abnormalities, however, the specificity of the test decreases. Four-phase bone, sequential bone/gallium, and labeled leukocyte imaging all have been used in an effort to enhance specificity. Labeled leukocyte imaging is the radionuclide procedure of choice for diagnosing so-called complicating osteomyelitis such as infected joint prostheses, diabetic pedal osteomyelitis, and infection of the neuropathic joint. To maximize the accuracy of the study, complementary bone marrow imaging often must be performed. Labeled leukocyte imaging is of limited value in spinal osteomyelitis, however, because this entity often presents as a nonspecific photopenic defect on white cell studies. The conventional radionuclide study for evaluating spinal osteomyelitis is gallium imaging, which should be performed regardless of the findings on a contemporaneous bone scan. The reasons for this are as follows: Gallium improves the specificity of the bone scan; gallium detects accompanying soft tissue infection, whereas the bone scan does not, and gallium may be more sensitive than the bone scan in elderly patients.

AB - The diagnosis of musculoskeletal infection can be clinically challenging, and radionuclide imaging is often performed as part of the diagnostic workup. Conventional studies include bone scan, gallium imaging, and labeled leukocyte imaging. No single test is equally efficacious in all situations, and thus the procedure(s) performed should be optimized for the individual patient. Three-phase bone imaging, readily available and relatively inexpensive, is very accurate in unviolated bone. In the setting of underlying osseous abnormalities, however, the specificity of the test decreases. Four-phase bone, sequential bone/gallium, and labeled leukocyte imaging all have been used in an effort to enhance specificity. Labeled leukocyte imaging is the radionuclide procedure of choice for diagnosing so-called complicating osteomyelitis such as infected joint prostheses, diabetic pedal osteomyelitis, and infection of the neuropathic joint. To maximize the accuracy of the study, complementary bone marrow imaging often must be performed. Labeled leukocyte imaging is of limited value in spinal osteomyelitis, however, because this entity often presents as a nonspecific photopenic defect on white cell studies. The conventional radionuclide study for evaluating spinal osteomyelitis is gallium imaging, which should be performed regardless of the findings on a contemporaneous bone scan. The reasons for this are as follows: Gallium improves the specificity of the bone scan; gallium detects accompanying soft tissue infection, whereas the bone scan does not, and gallium may be more sensitive than the bone scan in elderly patients.

KW - Bone scan

KW - Diabetic foot infection

KW - Gallium

KW - Leukocyte imaging

KW - Osteomyelitis

KW - Prosthetic joint infection

UR - http://www.scopus.com/inward/record.url?scp=40949090605&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40949090605&partnerID=8YFLogxK

U2 - 10.1055/s-2008-1060336

DO - 10.1055/s-2008-1060336

M3 - Article

VL - 11

SP - 335

EP - 352

JO - Seminars in Musculoskeletal Radiology

JF - Seminars in Musculoskeletal Radiology

SN - 1089-7860

IS - 4

ER -