Utility of radiolabeled leukocyte and bone marrow scintigraphy with SPECT/CT in the diagnostic work-up- of the painful prosthetic joint: A single-institution experience

@#In tbhe assessment of prosthetic joint pains, differentiating between aseptic loosening and infection can be challenging due to their similarities in clinical presentation and histopathology. Combined radiolabeled leukocyte and bone marrow scintigraphy and SPECT/CT is considered the most suitable nuclear imaging modality for this purpose. However, this is infrequently performed in our local setting. We present two cases where these studies were appropriately performed with different scan outcomes. The first case involved a 67-year-old male with painful right knee prosthesis and an alleged history of recurrent periprosthetic joint infection (PJI). The leukocyte tagging scan and marrow scan images were found to be congruent, which was more compatible with aseptic loosening. No emergent surgical intervention was done in our hospital, and the patient returned to this home territory for further management. The second case was a 72-year-old male with progressive pain in his left prosthetic hiip which began after surgery a year prior. Scan images were incongruent, suggestive of PJI; this was confired on joint aspiration and eventual surgical revision. Despite this imaging study's high sensitvity and high specificity, it has not been well-received in management algorihms of PJI. Collaboration between clinicans and nuclear imaging specilists is key in increasing the general use of these procedures.

Scintigraphic Evaluation of Hematologic Diseases with Tc-99m Labeled Antigranulocyte Antibody / 대한혈액학회지

BACKGROUND: Bone marrow scintigraphy using Tc-99m labeled antigranulocyte antibody has been reported to be able to evaluate bone marrow status. We have performed antigranulocyte antibody scan and hematopoietic activity in order to identify bone marrow status in patients with hematologic diseases. METHODS: Sixty-nine patients were enrolled in this study from October 1995 to May 1997. Images were acquired at four and twenty-four hour after injecion of 20mCi 99mTc labeled antigranulocyte antibody (BW 250/183). Patients were divided into four groups according to scintigraphic findings, those with increased marrow uptake (marrow expansion), decreased uptake, focal defect and normal findings. RESULTS: Leukemias and myelodysplastic syndromes frequently showed bone marrow expansion. Seventeen of 21 patients (81%) with AML, and all of ALL and biphenotypic leukemias showed bone marrow expansion. Five of 6 with CML, all Hodgkin's diseases and 3 of 4 MDS also showed marrow expansion. In contrast, all aplastic anemia patients showed decreased marrow uptake, and extra-axial noted in 2 patients with aplastic anemia. All of ten patients with multiple myeloma and 2 of 4 (50%) with Hodgkin disease showed focal marrow defects. Three of 11 with non-Hodgkin lymphoma and 4 of 21 with AML also showed focal marrow defects. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibody has clearly demonstrated the distribution of bone marrow in various hematologic diseases. Thus, it seems to be a useful method in the assessment of bone marrow status in patients with hematologic disease.

Bone Marrow Scintigraphy with Antigranulocyte Antibody in Multiple Myeloma: Comparison with Simple Radiography and Bone Scintigraphy / 대한핵의학회잡지

PURPOSE: Simple X-ray study and bone scan have limiitations for early diagnosis of bone or bone marrow lesions in multiple myeloma. The purpose of this study was to evaluate the diagnostic usefulness of bone marrow imrnunoscintigraphy using anti-granulocyte monoclonal antibody for the evaluation of bone involvement I:n multiple myeloma. MATERIALS AND METHODS: In 22 patients (Male: 15, Female: 7) with multiple myeloma, we perforrned whole-body immunoscintigraphy using ' Tc-labelled antigranulocyte antibody (BW 250/183, Scintimum Granulozyt CIS, France) and compared the findings with those of simple bone radiography and "" Tc-MDP bone scan. Abnonnal findings in bone marrow scintigraphy were, considered to be present in case of expansion of peripheral bone marrow or focal photan defect in axial bones. RESULTS: Marrow expansion was noted in 15 of 22 patients (68%). Focal photon defects were found in 18 patients (82%). While one (33%) of 3 patients with Stage II disease showed focal defects in bone marrow scan, abnormal focal defects were observed in 17 of 19 (90%) patients with Stage III. Among 124 focal abnormal sites which were observed in bone marrow scan, bone scan or simple bone radiography, bone rnarrow scan detected 92 sites (74%), whereas 82 sites (66%) were observed in simple bone radiography(58 sites, 47%) or bone scan(40 sites, 32%). Fifty-one (41%) out of 124 bone lesions were detected by bone marrow scan only, and located mostly in thoracolumbar spine. CONCLUSION: Bone marrow scan using "" Tc-labelled antigranulocyte antibody seems to be a more sensitive procedure for the detection of pathologic bone lesions than simple bone X-ray ar bone sean in patients with multiple myeloma.