Rapid diagnosis of pedal osteomyelitis in diabetics with a technetium-99m-labeled monoclonal antigranulocyte antibody

Christopher J. Palestro, Russell Caprioli, Charito Love, Hugh L. Richardson, Samuel L. Kipper, Frederick L. Weiland, Maria B. Tomas

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2-8
Number of pages7
JournalJournal of Foot and Ankle Surgery
Volume42
Issue number1
DOIs
StatePublished - Jan 1 2003
Externally publishedYes

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Keywords

  • Antigranulocyte antibody
  • Diabetic foot infection
  • Labeled leukocyte imaging
  • Osteomyelitis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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