Mora RFG, Isunza RA, López MA, Palma RRM, Guízar CS, Mora MI, Velázquez PVH

Language: Spanish
References: 16
Page: 248-251
PDF size: 389.81 Kb.

ABSTRACT

Introduction: the Tc-99m-ciprofloxacin complex, introduced in 1993, has been extensively evaluated all over the world with good results for the diagnosis of active bacterial osteoarticular infections. There are only a few publications on the use of this procedure in pediatric ages. In our study we evaluated the efficacy of the Tc-99m ciprofloxacin scan for the diagnosis of osteoarticular infections in the pediatric population assessing its sensitivity, specificity, and positive and negative predictive value. Material and methods: a retrospective, descriptive, observational study was done in 94 patients with clinical suspicion of osteoarticular infection in whom a Tc-99m ciprofloxacin bone scan was performed; the diagnosis was confirmed with intraoperative cultures and blood cultures. The results obtained with the Tc-99m ciprofloxacin scan and the culture reports were analyzed, as well as the sensitivity, specificity and the positive and negative predictive values of the Tc-99m ciprofloxacin scan. Results: Among the patients with intraoperative and blood cultures, 80 cases (85.1%) were positive and 14 cases (14.9%) were negative for bone infection. In the Tc-99m ciprofloxacin scan 78 cases (83%) were found to be positive for infection and 16 cases (17%) were negative. There were two false negatives. We found a 97.6% sensitivity and 100% specificity, with a 100% positive predictive value and an 87.5% negative predictive value. Conclusion: the Tc-99m-ciprofloxacin complex is useful to make the differential diagnosis between inflammation and infection in pediatric patients in whom an osteoarticular infectious process is suspected.

REFERENCES

1. Appelboom T, P emery, et al: Evaluation of tecnetium-99m-ciprofloxacin (infection) for detecting sites of inflammation in arthritis. Rheumatology 2003; 42: 1179-82.

2. Bererhi H, Hussein S, Wali Y: Comparison of Tc 99 ciprofloxacin (infection) and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy in the diagnosis of osteomyelitis in patients with sickle cell disease. World J of Nucl Med 2003; 2(2): 110-5.

3. Hall AV, Solanki KK, Vinjamuri S: Evaluation of the efficacy of 99mTC-infecton, a novel agent for detecting sites of infection. J Clin Pathol 1998; 51: 215-9.

4. Malamitsi J, Giamarellou, et al: Infection: a 99m-tcciprofloxacin radiopharmaceutical for the detection of bone infection. Cin Microbiol Infect 2003; 9: 101-9.

5. Wareham D, Michael J, Das S: Advances in bacterial specific imaging. Braz Arch of Biol and Tech 2005; 48: 145-52.

6. Devasenan D, Farmer K: Diagnosing osteomyelitis in patients with diabetic neuropathic osteoarthropathy. Diabetes Care 2002; 24(12): 2154-5.

7. Kerin S, Meral S, et al: Usefilness of 99 Tc-ciprofloxacin (infection) scan in diagnosis of chronic orthopedic infection: comparative study with 99mTc-HMPAO leukocyte scintigraphy. J Nucl Med 2001; 42: 567-74.

8. Amaral H: Cold-hot mismatch between Tc 99m HMPAO-labeled leukocytes and Tc99m ciprofloxacin in axial skeleton infections: a case report. Clin Nucl Med 1999; 24(11): 855-61.

9. Ettore P, Cinizia B, Michele P, et al: 99mTc-HMPAO-Leukocyte scintigraphy in patients with synptomatic total hip or knee artrhoplasty: improved diagnostic accuracy by means of semiquantitative evaluation. J of Nucl Med 2004; 45: 438-44.

10. Britton K, Wareham D, Das S, et al: Imaging bacterial infection with 99mTc-ciprofloxacin (infection). J Clin Pathol 2002; 55: 817-23.

11. Gemmel F, De winter F, et al: 99mTc ciprofloxacin imaging for the diagnosis of infection in the postoperative spine. Neclear Medicine Communications 2004; 25(3): 277-83.

12. Singh BR, Aggarwal A, et al: Technetium-99m ciprofloxacin imaging in the diagnosis of the response to antibiotic therapy: a case report. J of Otrhop Surg 2005; 13(2): 190-4.

13. Vinjamuri S, Hall AV, Solanki K, et al: Comparison of 99mTC infection imaging with radiolabelled white-cell imaging in the evaluation of bacterial infection. The Lancet 1996; 347: 233-5.

14. Marrero R, Alvarez R, Hernandez A, et al: Valor de la gammagrafía con 99mTc-ciprofloxacina cubana en la detección de prótesis de cadera infectadas. Rev Cubana Ortop Traumatol [On line] 2006; 20(1).

15. Mei-Hsiu L, Cheng-Xiang Y, et al: 99m-Tc-ciprofloxacin: a potencial radiopharmaceutical for the detection of infection. Ann Nucl Med Sci 2004; 17: 147-51.

16. Soroa V: Rol de la medicina nuclear en el diagnóstico de las infecciones/inflamaciones, tema de actualización médica, Asociación Argentina para el estudio de cadera y Rodilla, en http://www.acaro.org.ar/protected/tema/tema_1/tema1 revisado 07/11/06.