Clinical validation of the avidin/indium-111 biotin approach for imaging infection/inflammation in orthopaedic patients

• Published in: European journal of nuclear medicine 1999-06, Vol.26 (6), p.606-614
• Main Authors: LAZZERI, E, MANCA, M, MOLEA, N, MARCHETTI, S, CONSOLI, V, BODEI, L, BIANCHI, R, CHINOL, M, PAGANELLI, G, MARIANI, G
• Format: Article
• Language: English
• Subjects: Avidin; Biological and medical sciences; Biotin; Discitis - diagnostic imaging; Diseases of the osteoarticular system; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Osteomyelitis - diagnostic imaging; Predictive Value of Tests; Prosthesis-Related Infections - diagnostic imaging; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Exametazime
• ISSN: 0340-6997; 1619-7070; 1619-7089
• DOI: 10.1007/s002590050428

We report here the results of a validation study of the avidin/indium-111 biotin approach in patients with skeletal lesions. This study involved 54 patients with orthopaedic conditions: 20 patients with intermediate suspected osteomyelitis of the trunk, 19 patients with infection/inflammation of prosthetic joint replacements, and 15 patients with suspected osteomyelitis of appendicular bones. Avidin (3 mg) was injected as an i.v. bolus, followed 4 h later by 111In-biotin; imaging was acquired 30 min and 16-18 h after administration of 111In-biotin. Technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocyte scintigraphy was performed in 39/54 patients. The overall sensitivity of the avidin/111In-biotin scan was 97.7% (versus 88.9% for 99mTc-HMPAO leucocyte scintigraphy). While the diagnostic performance of avidin/111In-biotin scintigraphy was similar to that of 99mTc-HMPAO leucocyte scintigraphy in patients with prosthetic joint replacements or osteomyelitis of appendicular bones, the avidin/111In-biotin approach clearly performed better than 99mTc-HMPAO leucocyte scintigraphy in patients with suspected osteomyelitis of the trunk (100% sensitivity, specificity and accuracy versus 50% sensitivity, 100% specificity and 66.7% accuracy for 99mTc-HMPAO-leucocyte scintigraphy). These results demonstrate the feasibility of the avidin/111In-biotin approach for imaging sites of infection/inflammation in the clinical setting. Although no systematic advantages of avidin/111In-biotin scintigraphy were found versus 99mTc-HMPAO leucocyte scintigraphy, the newer scintigraphic method is more practicable and involves lower biological risk for the operators.