Radioimmune Imaging of Diabetic Foot Infection -Tc-99m-Labelled Antigranulocyte Antibody in Combination with Tc-99m-Methylene Diphosphonate Bone Scintigraphy


Abstract: The aim of this study was to evaluate the clinical efficacy of immunoscintigraphy with Tc-99m-labelled antigranulocyte antibody in combination with Tc-99m-methylene-diphosphonate (MDP) bone scanning in diabetic foot infection. The study group comprised 42 Type 2 diabetics with foot infection. Pre- and postprandial blood glucose level, HbA1c, urinary glucose, microalbuminuria, total cholesterol, LDL-cholesterol, HDL-cholesterol, and bacteriological cultures were analyzed. Investigation of transcutaneous oxygen tension, vibration sensation, electromyo-graphy, and Doppler ankle/brachial systolic blood pressure index was carried out. Radiographs centered on the feet were performed. All patients underwent bone scintigraphy with 370 MBq Tc-99m-MDP three hours after injection in 3 projections. Radioimmune planar imunoscintigraphy was performed with 740 MBq Technetium - 99m conjugated with monoclonal antigranulocyte antibody BW 250/183 in the same three projections. Immunoscintigraphy was performed 4 and 24 hours after administration of 740 MBq Tc-99m-MAB BW 250/183 in positive bone scan cases. Final assessment of immunoscintigraphic images based on parallel analysis of isotopic images and final diagnosis revealed 21 true positive cases, 16 true negative cases, 3 false positive cases, and 2 false negative cases. The analysis of diagnostic validity revealed a diagnostic accuracy of 86 %. Immunoscintigraphy with Tc-99m-labelled antigranulocyte antibody in combination with Tc-99m-MDP bone scanning is an efficient method for the early detection of foot bone infection and the precise diagnosis of osteomyelities in diabetics.

Keywords: diabetic foot, infection, immunoscintigraphy, bone scintigraphy

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