Clinical feasibility of two-step streptavidin/111In-biotin scintigraphy in patients with suspected vertebral osteomyelitis.

Abstract

PURPOSE:

Streptavidin accumulates at sites of inflammation and infection as a result of increased capillary permeability. In addition to being utilised by bacteria for their own growth, biotin forms a stable, high-affinity non-covalent complex with avidin. The objective of this investigation was to determine the diagnostic performance of two-step streptavidin/111In-biotin imaging for evaluating patients with suspected vertebral osteomyelitis.

METHODS:

We evaluated 55 consecutive patients with suspected vertebral osteomyelitis (34 women and 21 men aged 27-86 years), within 2 weeks after the onset of clinical symptoms. Thirty-two of the patients underwent magnetic resonance imaging (MRI) and 24, computed tomography (CT). DTPA-conjugated biotin was radiolabelled by incubating 500 microg of DTPA-biotin with 111 MBq of 111In-chloride. Two-step scintigraphy was performed by first infusing 3 mg streptavidin intravenously, followed 4 h later by 111In-biotin. Imaging was begun 60 min later.

RESULTS:

Streptavidin/111In-biotin scintigraphy was positive in 32/34 patients with spinal infection (94.12% sensitivity). The study was negative in 19/21 patients without infection (95.24% specificity). The corresponding results for MRI and CT were 54.17% and 35.29% (sensitivity), and 75% and 57.14% (specificity), respectively. All statistical parameters of diagnostic performance (Youden's J index, kappa measure of agreement with correct classification, accuracy, sensitivity, specificity, positive likelihood and negative likelihood) were clearly better for streptavidin/111In-biotin scintigraphy than for either MRI or CT.

CONCLUSION:

Streptavidin/111In-biotin scintigraphy is highly sensitive and specific for detecting vertebral osteomyelitis in the first 2 weeks after the onset of clinical symptoms, and is potentially very useful for guiding clinical decisions on instituting appropriate therapy.

• Authors: Elena Lazzeri, Ernest K J Pauwels, Paola A Erba, Duccio Volterrani, Mario Manca, Lisa Bodei, Donatella Trippi, Antonio Bottoni, Renza Cristofani, Vincenzo Consoli, Christopher J Palestro, Giuliano Mariani
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 31 Issue 11 Pg. 1505-11 (Nov 2004) ISSN: 1619-7070 [Print] Germany
• PMID: 15241627 (Publication Type: Clinical Trial, Journal Article, Validation Study)

Chemical References

• DTPA-bis-biotin
• Biotin
• Pentetic Acid

Topics

• Adult
• Aged
• Aged, 80 and over
• Biotin (analogs & derivatives)
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Osteomyelitis (diagnosis, diagnostic imaging)
• Pentetic Acid (analogs & derivatives)
• Radionuclide Imaging
• Reproducibility of Results
• Sensitivity and Specificity
• Spine (diagnostic imaging)
• Spondylitis (diagnosis, diagnostic imaging)