TY - JOUR
T1 - Rapid diagnosis of pedal osteomyelitis in diabetics with a technetium-99m-labeled monoclonal antigranulocyte antibody
AU - Palestro, Christopher J.
AU - Caprioli, Russell
AU - Love, Charito
AU - Richardson, Hugh L.
AU - Kipper, Samuel L.
AU - Weiland, Frederick L.
AU - Tomas, Maria B.
N1 - Funding Information:
Supported by a grant from Palatin Technologies, Inc., Princeton, NJ; research grants from Palatin Technologies (C.J.P., S.L.K., F.L.W.); honoraria from Palatin Technologies (C.J.P., S.L.K.). S.L.K. is a stockholder in Palatin Technologies.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2003
Y1 - 2003
N2 - An in vivo method of labeling white cells that diagnoses diabetic pedal osteomyelitis safely, rapidly, and accurately is desirable. The objectives of this investigation were to evaluate a technetium-99m-labeled monoclonal antigranulocyte antibody for diagnosing diabetic pedal osteomyelitis, compared with indium-111-labeled leukocyte and 3-phase bone imaging for this purpose. Twenty-five diabetic patients with pedal ulcers, 22 in the forefoot and 3 in the midfoot, underwent antibody, indium-111-labeled leukocyte, and technetium-99m methylene diphosphonate 3-phase bone imaging. The 1-hour antibody, 24-hour labeled leukocyte, and 3-phase bone images were interpreted separately for the presence of osteomyelitis. The antibody and labeled leukocyte images also were interpreted together with the bone images to determine if the combined study was more accurate than each individual study. There were 10 cases of osteomyelitis among the 25 patients. The sensitivity, specificity, and accuracy of the antibody were .90, .67, and .76, respectively. These results were not significantly different from those obtained with labeled leukocyte imaging: .80, .67, and .72, respectively. The antibody was significantly more specific (P = .004) than 3-phase bone imaging (.27). Interpreting the antibody together with the bone scan did not alter the results. When interpreted with the bone images, the accuracy of labeled leukocyte imaging improved from .72 to .80. This was not significantly more accurate than either the antibody or labeled leukocyte imaging alone. The data suggest that the monoclonal antigranulocyte antibody is comparable with in vitro labeled leukocyte imaging for diagnosing pedal osteomyelitis in diabetic patients, and warrants further investigation in a larger population.
AB - An in vivo method of labeling white cells that diagnoses diabetic pedal osteomyelitis safely, rapidly, and accurately is desirable. The objectives of this investigation were to evaluate a technetium-99m-labeled monoclonal antigranulocyte antibody for diagnosing diabetic pedal osteomyelitis, compared with indium-111-labeled leukocyte and 3-phase bone imaging for this purpose. Twenty-five diabetic patients with pedal ulcers, 22 in the forefoot and 3 in the midfoot, underwent antibody, indium-111-labeled leukocyte, and technetium-99m methylene diphosphonate 3-phase bone imaging. The 1-hour antibody, 24-hour labeled leukocyte, and 3-phase bone images were interpreted separately for the presence of osteomyelitis. The antibody and labeled leukocyte images also were interpreted together with the bone images to determine if the combined study was more accurate than each individual study. There were 10 cases of osteomyelitis among the 25 patients. The sensitivity, specificity, and accuracy of the antibody were .90, .67, and .76, respectively. These results were not significantly different from those obtained with labeled leukocyte imaging: .80, .67, and .72, respectively. The antibody was significantly more specific (P = .004) than 3-phase bone imaging (.27). Interpreting the antibody together with the bone scan did not alter the results. When interpreted with the bone images, the accuracy of labeled leukocyte imaging improved from .72 to .80. This was not significantly more accurate than either the antibody or labeled leukocyte imaging alone. The data suggest that the monoclonal antigranulocyte antibody is comparable with in vitro labeled leukocyte imaging for diagnosing pedal osteomyelitis in diabetic patients, and warrants further investigation in a larger population.
KW - Antigranulocyte antibody
KW - Diabetic foot infection
KW - Labeled leukocyte imaging
KW - Osteomyelitis
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U2 - 10.1053/jfas.2003.0420001
DO - 10.1053/jfas.2003.0420001
M3 - Article
C2 - 12567360
AN - SCOPUS:0037278582
SN - 1067-2516
VL - 42
SP - 2
EP - 8
JO - Journal of Foot and Ankle Surgery
JF - Journal of Foot and Ankle Surgery
IS - 1
ER -