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Guardia-Jimena P, Martínez-Valle Torres MD, Arenas Aguaza R, González Ramírez AR, Becerra-García D, Guirado D. Semi-quantitative analysis with 99mTc-Besilesomab in musculoskeletal system infections. Bone Rep 2023; 19:101708. [PMID: 37664143 PMCID: PMC10474153 DOI: 10.1016/j.bonr.2023.101708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives To evaluate the usefulness of 99mTc-Besilesomab to diagnose infectious processes by using monoclonal antibodies BW 250/183 in a semi-quantitative analysis, and to determine the effect on diagnostic capacity of different thresholds for the difference between counts in early versus delayed images. Methods The study included 77 patients with suspected osteomyelitis who underwent scintigraphy with 99mTc-Besilesomab. After confirming the absence of human anti-mouse antibodies in all patients, early and delayed static images were acquired at 4 and 24 h post-injection, respectively. Visual and semi-quantitative analyses were conducted of regions of interest (ROIs) in areas suspected of infection on early and delayed images. Findings were considered positive when the ratio between counts in delayed and early images exceeded a given threshold after correction for decay. The definitive diagnosis was obtained by clinical follow-up, microbiological culture, or response to medical and/or surgical treatment. Results The optimal threshold was 1.02 (i.e., positive result = count increase of >2 % in delayed image), obtaining a sensitivity of 0.864, specificity of 0.858, positive predictive value of 0.708, negative predictive value of 0.940, and accuracy of 0.860. Application of the usual threshold of 1.10 (10 %) reduced the sensitivity to 0.734. Conclusion Semi-quantitative analysis of studies with 99mTc-Besilesomab is a useful technique for the diagnosis of musculoskeletal system infections and contributes to the definitive diagnosis when visual assessments are doubtful or non-conclusive.
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Affiliation(s)
| | | | - Raquel Arenas Aguaza
- Nuclear Medicine Service, San Cecilio Clinical University Hospital, Granada, Spain
| | - Amanda Rocío González Ramírez
- Methodological and Statistical Support Unit of the Fundación Pública Andaluza para la Investigación Biosanitaria Andalucía Oriental (FIBAO), Clinical University Hospital, Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Radiophysics Unit, San Cecilio Clinical University Hospital, Granada, Spain
| | - Diego Becerra-García
- Nuclear Medicine Service, San Cecilio Clinical University Hospital, Granada, Spain
| | - Damián Guirado
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Radiophysics Unit, San Cecilio Clinical University Hospital, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
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Romanò CL, Petrosillo N, Argento G, Sconfienza LM, Treglia G, Alavi A, Glaudemans AW, Gheysens O, Maes A, Lauri C, Palestro CJ, Signore A. The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements. J Clin Med 2020; 9:jcm9082548. [PMID: 32781651 PMCID: PMC7466174 DOI: 10.3390/jcm9082548] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques. This paper highlights the pros and cons of available imaging techniques—X-ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems—single photon emission tomography/computed tomography (SPECT/CT), PET/CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019.
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Affiliation(s)
- Carlo Luca Romanò
- Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza, University of Milan, 20100 Milan, Italy;
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infective Diseases “L. Spallanzani”, 00144 Rome, Italy;
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
- Department of Biomedical Sciences for Health, University of Milan, 20123 Milan, Italy
| | - Giorgio Treglia
- Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale Via Lugano 4F, CH-6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 1904, USA;
| | - Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk Belgium and Department of Imaging and Pathology @ KULAK, KU Leuven campus Kulak, 8500 Kortrijk, Belgium;
| | - Chiara Lauri
- Nuclear Medicine Unit Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Christopher J. Palestro
- Department of Radiology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA;
| | - Alberto Signore
- Nuclear Medicine Unit Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00161 Rome, Italy;
- Correspondence:
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99mTc-Besilesomab Scintigraphy in Soft Tissue Infections of the Lower Limbs. Clin Nucl Med 2020; 45:444-445. [DOI: 10.1097/rlu.0000000000003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schreuder N, Koopman D, Jager PL, Kosterink JGW, van Puijenbroek E. Adverse Events of Diagnostic Radiopharmaceuticals: A Systematic Review. Semin Nucl Med 2019; 49:382-410. [PMID: 31470933 DOI: 10.1053/j.semnuclmed.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diagnostic radiopharmaceuticals used in nuclear medicine can cause adverse events. Information on these adverse events is available in case reports and databases but may not be readily accessible to healthcare professionals. This systematic review provides an overview of adverse events of diagnostical radiopharmaceuticals and their characteristics. A median frequency for adverse events in diagnostical radiopharmaceuticals of 1.63 (interquartile range: 1.09-2.29) per 100,000 is reported. Most common are skin and subcutaneous tissue disorders, and general disorders and administration site conditions. Many adverse events reported are minor in severity, although 6.7% can be classified as important. In rare cases, adverse events are serious and potentially life-threatening. With the introduction of new radiopharmaceuticals and the increasing use of positron emission tomography-computed tomography, previously unknown adverse events may be detected in daily practice. Future work should cover the experience of the patient with adverse events from diagnostic radiopharmaceuticals.
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Affiliation(s)
- Nanno Schreuder
- Groningen Research Institute of Pharmacy, Pharmacotherapy, Epidemiology & Economics, University of Groningen, Groningen, the Netherlands; GE Healthcare Radiopharmacy Zwolle, Zwolle, the Netherlands.
| | - Daniëlle Koopman
- Department of Nuclear Medicine, Isala Hospital, Zwolle, the Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Pieter L Jager
- Department of Nuclear Medicine, Isala Hospital, Zwolle, the Netherlands
| | - Jos G W Kosterink
- Groningen Research Institute of Pharmacy, Pharmacotherapy, Epidemiology & Economics, University of Groningen, Groningen, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Eugène van Puijenbroek
- Groningen Research Institute of Pharmacy, Pharmacotherapy, Epidemiology & Economics, University of Groningen, Groningen, the Netherlands; Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, the Netherlands
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Galletti F, Cammaroto G, Galletti B, Quartuccio N, Di Mauro F, Baldari S. Technetium-99m (⁹⁹mTc)-labelled sulesomab in the management of malignant external otitis: is there any role? Eur Arch Otorhinolaryngol 2015; 272:1377-82. [PMID: 24534898 DOI: 10.1007/s00405-014-2938-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/06/2014] [Indexed: 02/07/2023]
Abstract
We report two cases of malignant external otitis (MEO) evaluated with Technetium-99m((99m)Tc)-labelled sulesomab. Two patients affected by MEO are presented, together with a literature review. Both patients were studied with clinical examination, ear discharge culture, radiological imaging, blood exams, (99m)Tc Sulesomab, and treated with antibiotic therapy. (99m)Tc-Sulesomab would appear to be an useful tool for diagnosis and follow-up of MEO, highlighting the site and extension of the inflammatory process, and evaluating course and treatment efficacy. (99m)Tc-Sulesomab shows promise as a rapid, effective and safe imaging agent for treatment response evaluation and follow-up of patients with MEO. Further studies are warranted to validate the inclusion of (99m)Tc-Sulesomab scan in the imaging follow-up of patients with MEO.
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Affiliation(s)
- Francesco Galletti
- Department of Otorhinolaryngology, University of Messina, Messina, Italy,
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The use of nuclear imaging for the diagnosis of periprosthetic infection after knee and hip arthroplasties. Nucl Med Commun 2015; 36:305-11. [DOI: 10.1097/mnm.0000000000000266] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Inflammation. THE PATHOPHYSIOLOGIC BASIS OF NUCLEAR MEDICINE 2015. [PMCID: PMC7123337 DOI: 10.1007/978-3-319-06112-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inflammation was described as early as 3000 BC in an Egyptian papyrus [1] and is still a common problem despite continuous advancements in prevention and treatment methods. The delineation of the site and extent of inflammation are crucial to the clinical management of infection and for monitoring the response to therapy [2].
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Ouyang Z, Li H, Liu X, Zhai Z, Li X. Prosthesis infection: diagnosis after total joint arthroplasty with three-phase bone scintigraphy. Ann Nucl Med 2014; 28:994-1003. [DOI: 10.1007/s12149-014-0899-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/11/2014] [Indexed: 01/29/2023]
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Xing D, Ma X, Ma J, Wang J, Chen Y, Yang Y. Use of anti-granulocyte scintigraphy with 99mTc-labeled monoclonal antibodies for the diagnosis of periprosthetic infection in patients after total joint arthroplasty: a diagnostic meta-analysis. PLoS One 2013; 8:e69857. [PMID: 23922825 PMCID: PMC3724677 DOI: 10.1371/journal.pone.0069857] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/12/2013] [Indexed: 02/07/2023] Open
Abstract
The accurate diagnosis of periprosthetic joint infections (PJI) is crucial for therapy and the prevention of complications. No diagnostic test of PJI is 100% accurate. The aim of this study was to assess the use of anti-granulocyte scintigraphy using 99 mTc-labeled monoclonal antibodies to diagnose PJI after total joint arthroplasty. A systematic search of all relevant studies published through January 2013 was conducted using the MEDLINE, EMBASE, OVID, and ScienceDirect databases. Observational studies that assessed the accuracy of the anti-granulocyte scintigraphy with monoclonal antibodies or antibody fragments labeled with technetium 99 m in diagnosis for PJI and provided data on specificity and sensitivity were identified. Standard methods recommended for meta-analysis of diagnostic accuracy were used. Nineteen studies were eligible for inclusion. The results demonstrated that the area under the summary receiver operator curve was 0.88, and the diagnostic accuracy (Q*) was 0.81. Additionally, the diagnostic odds ratio (DOR) was 18.76 with a corresponding 95% confidence interval of 10.45–33.68. The pooled sensitivity and specificity of the diagnostic method for the diagnosis of PJI were 83% and 79%, respectively, while the pooled positive likelihood ratio (PLR) was 3.56, and the negative likelihood ratio (NLR) was 0.26. Anti-granulocyte scintigraphy using 99 mTc-labeled monoclonal antibodies has a reasonable role in the diagnosis of PJI after total joint arthroplasty. Due to the limitations of the present meta-analysis, additional high-quality original studies are required to confirm the predictive value.
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Affiliation(s)
- Dan Xing
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
- Department of Orthopaedics, Tianjin Gongan Hospital, Tianjin, China
| | - XinLong Ma
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
- * E-mail: (XLM); (JXM)
| | - JianXiong Ma
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
- * E-mail: (XLM); (JXM)
| | - Jie Wang
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Chen
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
| | - Yang Yang
- Department of Orthopaedics Institute, Tianjin Hospital, Tianjin, China
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