Efficacy of indigenously developed single vial kit preparation of 99mTc-ciprofloxacin in the detection of bacterial infection: an Indian experience.

Abstract

OBJECTIVE:

To investigate the diagnostic efficacy of indigenously developed single vial kit preparation of Tc-ciprofloxacin (Diagnobact) for the detection of orthopedic infections.

METHODS:

Seventy-seven patients [25 with clinical suspicion of diabetic foot osteomyelitis (DFOM), 25 with orthopedic device-related infection (ODRI) and 27 with tubercular bone infection] underwent three-phase Tc-methylenediphosphonate bone scintigraphy followed by static Tc-ciprofloxacin imaging at 1, 4 and 24 h. Imaging (anterior and posterior views) was performed under a dual-head gamma-camera using a low-energy, high-resolution, parallel-hole collimator. The lesion-to-background ratio (LBR) of the radiotracer was calculated on the static isotime Tc-ciprofloxacin images using semiquantitative analysis. Scintigraphic (Diagnobact) results were compared with the histopathological and/or culture/PCR analysis as a gold standard.

RESULTS:

The mean LBR of the radiotracer (Tc-ciprofloxacin) in the positive scans (n=29; 16 ODRI, 13 DFOM) was > or =2.0 at 1 h postinjection and remained consistent till 24 h. In contrast, the mean LBR in the negative scans (n=21; 12 DFOM, nine ODRI) was < or =1.5 at 1 h and declined significantly (P<0.05) at 24 h. The observed trend in the mean LBR in positive (n=18) and negative (n=9) scans for tubercular osteomyelitis was identical to that seen in the nontubercular bacterial infections.

CONCLUSION:

The management protocol for patients with suspected bony infection may include a three-phase bone scan followed by Tc-ciprofloxacin scan. An LBR of > or =2.0 at 1 h that remained consistent till 24 h on Tc-ciprofloxacin scan is indicative of active bacterial infection. However, resistance to ciprofloxacin at the bacterial cell membrane may be a limitation of this technique.

• Authors: Baljinder Singh, Hejjaji V Sunil, Sarika Sharma, Vikas Prasad, Raghav Kashyap, Anish Bhattacharya, Bhagwant R Mittal, Ashish Taneja, Rajeev Rai, Vijay G Goni, Sameer Aggarwal, Shivinder S Gill, Aseem Bhatnagar, Ajay K Singh
• Journal: Nuclear medicine communications (Nucl Med Commun) Vol. 29 Issue 12 Pg. 1123-9 (Dec 2008) ISSN: 0143-3636 [Print] England
• PMID: 18987535 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Organotechnetium Compounds
• Radioactive Tracers
• Technetium Tc 99m ciprofloxacin
• Ciprofloxacin

Topics

• Adolescent
• Adult
• Bacterial Infections (diagnosis, diagnostic imaging, etiology)
• Bone Diseases, Infectious (diagnosis, diagnostic imaging, etiology)
• Ciprofloxacin (analogs & derivatives)
• Diabetic Foot (diagnostic imaging)
• Diagnosis, Differential
• Female
• Humans
• Image Processing, Computer-Assisted
• India
• Inflammation (diagnosis, diagnostic imaging)
• Male
• Medicine, Traditional
• Middle Aged
• Organotechnetium Compounds
• Orthopedic Fixation Devices (adverse effects)
• Osteomyelitis (diagnostic imaging)
• Radioactive Tracers
• Radionuclide Imaging
• Tuberculosis, Osteoarticular (diagnostic imaging)
• Young Adult