Cold–Hot Mismatch Between Tc-99m HMPAO–Labeled Leukocytes and Tc-99m Ciprofloxacin in Axial Skeleton Infections: A Report of Three Cases

• Published in: Clinical nuclear medicine 1999-11, Vol.24 (11), p.855-855
• Main Authors: AMARAL, HORACIO, MORALES, BARBARA, PRUZZO, ROSSANA, BRITTON, KEITH E
• Format: Article
• Language: English
• Subjects: Adult; Anti-Infective Agents; Biological and medical sciences; Ciprofloxacin; Contrast media. Radiopharmaceuticals; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Leukocytes; Male; Medical sciences; Middle Aged; Miscellaneous. Technology; Osteomyelitis - diagnostic imaging; Pharmacology. Drug treatments; Radionuclide Imaging; Radionuclide investigations; Radiopharmaceuticals; Technetium; Technetium Tc 99m Exametazime
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/00003072-199911000-00007

Radiolabeled leukocyte scintigraphy is a well-established technique for the diagnosis of inflammation and infection with a typical presentation of a hot spot within the abnormal areas. However, in some cases of osteomyelitis of the axial skeleton, a cold defect pattern has been described. Tc-99m ciprofloxacin is a new agent claimed to be specific for imaging sites containing viable bacteria. In this report, we present three cases of proved bacterial infection of the axial skeleton with a mismatch pattern between Tc-99m ciprofloxin and tagged leukocytes. Although Tc-99m–labeled leukocyte scanning showed a cold defect, probably caused by bone marrow replacement, the Tc-99m ciprofloxacin consecutively revealed a hot spot at the site of infection. These data suggest that Tc-99m ciprofloxacin should be a better agent than radiolabeled leukocytes for detecting osteomyelitis of the axial skeleton.