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Table of Contents
Vol. 17, No. 6, 2008
Issue release date: October 2008
Open Access Gateway
Med Princ Pract 2008;17:447–452
(DOI:10.1159/000151565)

Technetium-99m-Labelled Sulesomab (LeukoScan) in the Evaluation of Soft Tissue Infections

Quigley A.-M. · Gnanasegaran G. · Buscombe J.R. · Hilson A.J.W.
Department of Nuclear Medicine, Royal Free Hospital, London, UK
email Corresponding Author

Abstract

Objective: To perform a retrospective review of all patients receiving technetium-99m (99mTc)-labelled sulesomab over a 4-year period to determine if soft tissue infections can be accurately identified. Methods and Materials: We reviewed the results of 124 99mTc-sulesomab studies performed over a 4-year period. Of these, 34 were performed for undiagnosed fever in which soft tissue infection was suspected to be the main cause. The patients’ clinical notes, microbiology reports and other imaging findings were reviewed to determine the clinical outcome following the scan. The scans were regarded as being true-positives if (i) uptake correlated with the site from which fluid or tissue was obtained and which grew bacteria, and/or (ii) the site of abnormality was reported as having an infection on other imaging or (iii) there was a clinical correlation with the referring clinician’s evaluation of the patient. Planar imaging was performed using standard protocols, together with single-photon emission computed tomography (if required) at 1 and 4 h after injection of 20–30 mCi (740–1,110 MBq) 99mTc-sulesomab. Results: Three patients were unevaluable. In the remaining 31 patients, 21 99mTc-sulesomab studies were regarded as true-positives and 6 patients had true-negative scans. One patient had a false-positive scan (abnormal uptake with negative microbiology) and 3 had false-negative scans (infection confirmed but a negative scan). Conclusion: In suspected soft tissue infection, 99mTc-sulesomab imaging has a sensitivity of 88% with a specificity of 86% and overall accuracy of 87%. 99mTc-sulesomab provides an accurate method of imaging for suspected soft tissue infection, which is also fast and convenient, as cell labelling is not required.


 goto top of outline Key Words

  • Technetium-99m-labelled sulesomab
  • Soft tissue infection
  • LeukoScan

 goto top of outline Abstract

Objective: To perform a retrospective review of all patients receiving technetium-99m (99mTc)-labelled sulesomab over a 4-year period to determine if soft tissue infections can be accurately identified. Methods and Materials: We reviewed the results of 124 99mTc-sulesomab studies performed over a 4-year period. Of these, 34 were performed for undiagnosed fever in which soft tissue infection was suspected to be the main cause. The patients’ clinical notes, microbiology reports and other imaging findings were reviewed to determine the clinical outcome following the scan. The scans were regarded as being true-positives if (i) uptake correlated with the site from which fluid or tissue was obtained and which grew bacteria, and/or (ii) the site of abnormality was reported as having an infection on other imaging or (iii) there was a clinical correlation with the referring clinician’s evaluation of the patient. Planar imaging was performed using standard protocols, together with single-photon emission computed tomography (if required) at 1 and 4 h after injection of 20–30 mCi (740–1,110 MBq) 99mTc-sulesomab. Results: Three patients were unevaluable. In the remaining 31 patients, 21 99mTc-sulesomab studies were regarded as true-positives and 6 patients had true-negative scans. One patient had a false-positive scan (abnormal uptake with negative microbiology) and 3 had false-negative scans (infection confirmed but a negative scan). Conclusion: In suspected soft tissue infection, 99mTc-sulesomab imaging has a sensitivity of 88% with a specificity of 86% and overall accuracy of 87%. 99mTc-sulesomab provides an accurate method of imaging for suspected soft tissue infection, which is also fast and convenient, as cell labelling is not required.

Copyright © 2008 S. Karger AG, Basel


 goto top of outline References
  1. Ryan PJ: Leukoscan for orthopaedic imaging in clinical practice. Nucl Med Commun 2002;23:707–714.
  2. Skehan SJ, White JF, Evans JW, Parry-Jones DR, Solanki CK, Ballinger JR, Chilvers ER, Peters AM: Mechanism of accumulation of 99mTc-sulesomab in inflammation. J Nucl Med 2003;44:11–18.
  3. Becker W: Bone and soft tissue; in Cox PH, Buscombe JR (eds): The Imaging of Infection and Inflammation. Amsterdam, Kluwer, 1998, pp 199–217.
  4. Hakki S, Harwood SJ, Morissey MA, Camblin JG, Laven DL, Webster WB: Comparative study of monoclonal antibody scan in diagnosing orthopaedic infection. Clin Orthop 1997;335:275–285.
  5. Annovazzi AA, Bagni BB, Burroni LC, D’Alessandria CA, Signore AA: Nuclear medicine imaging of inflammatory/infective disorders of the abdomen. Nucl Med Commun 2005;26:657–664.
  6. Love C, Tronco GG, Palestro CJ: Imaging of infection and inflammation with 99mTc-fanolesomab. Q J Nucl Med Mol Imaging 2006;50:113–120.
  7. Sciuk J, Brandau W, Vollet B, Stucker R, Erlemann R, Bartenstein P, Peters PE, Schober O: Comparison of technetium-99m polyclonal human immunoglobulin and technetium-99m monoclonal antibodies for imaging chronic osteomyelitis: first clinical results. Eur J Nucl Med 1991;18:401–407.
  8. Shanthly N, Aruva MR, Zhang K, Mathew B, Thakur ML: 99mTc-Fanolesomab: affinity, pharmacokinetics and preliminary evaluation. Q J Nucl Med Mol Imaging 2006;50:104–112.

 goto top of outline Author Contacts

Dr. J.R. Buscombe
Nuclear Medicine Department, Royal Free Hospital
Pond Street
London NW3 2QG (UK)
Tel. +44 20 7830 2470, Fax +44 20 7472 6202, E-Mail j.buscombe@medsch.ucl.ac.uk


 goto top of outline Article Information

Received: August 26, 2007
Revised: November 13, 2007
Published online: October 03, 2008
Number of Print Pages : 6
Number of Figures : 5, Number of Tables : 1, Number of References : 8


 goto top of outline Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 17, No. 6, Year 2008 (Cover Date: October 2008)

Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011–7571 (Print), eISSN: 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: To perform a retrospective review of all patients receiving technetium-99m (99mTc)-labelled sulesomab over a 4-year period to determine if soft tissue infections can be accurately identified. Methods and Materials: We reviewed the results of 124 99mTc-sulesomab studies performed over a 4-year period. Of these, 34 were performed for undiagnosed fever in which soft tissue infection was suspected to be the main cause. The patients’ clinical notes, microbiology reports and other imaging findings were reviewed to determine the clinical outcome following the scan. The scans were regarded as being true-positives if (i) uptake correlated with the site from which fluid or tissue was obtained and which grew bacteria, and/or (ii) the site of abnormality was reported as having an infection on other imaging or (iii) there was a clinical correlation with the referring clinician’s evaluation of the patient. Planar imaging was performed using standard protocols, together with single-photon emission computed tomography (if required) at 1 and 4 h after injection of 20–30 mCi (740–1,110 MBq) 99mTc-sulesomab. Results: Three patients were unevaluable. In the remaining 31 patients, 21 99mTc-sulesomab studies were regarded as true-positives and 6 patients had true-negative scans. One patient had a false-positive scan (abnormal uptake with negative microbiology) and 3 had false-negative scans (infection confirmed but a negative scan). Conclusion: In suspected soft tissue infection, 99mTc-sulesomab imaging has a sensitivity of 88% with a specificity of 86% and overall accuracy of 87%. 99mTc-sulesomab provides an accurate method of imaging for suspected soft tissue infection, which is also fast and convenient, as cell labelling is not required.



 goto top of outline Author Contacts

Dr. J.R. Buscombe
Nuclear Medicine Department, Royal Free Hospital
Pond Street
London NW3 2QG (UK)
Tel. +44 20 7830 2470, Fax +44 20 7472 6202, E-Mail j.buscombe@medsch.ucl.ac.uk


 goto top of outline Article Information

Received: August 26, 2007
Revised: November 13, 2007
Published online: October 03, 2008
Number of Print Pages : 6
Number of Figures : 5, Number of Tables : 1, Number of References : 8


 goto top of outline Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 17, No. 6, Year 2008 (Cover Date: October 2008)

Journal Editor: Owunwanne A. (Kuwait)
ISSN: 1011–7571 (Print), eISSN: 1423–0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Ryan PJ: Leukoscan for orthopaedic imaging in clinical practice. Nucl Med Commun 2002;23:707–714.
  2. Skehan SJ, White JF, Evans JW, Parry-Jones DR, Solanki CK, Ballinger JR, Chilvers ER, Peters AM: Mechanism of accumulation of 99mTc-sulesomab in inflammation. J Nucl Med 2003;44:11–18.
  3. Becker W: Bone and soft tissue; in Cox PH, Buscombe JR (eds): The Imaging of Infection and Inflammation. Amsterdam, Kluwer, 1998, pp 199–217.
  4. Hakki S, Harwood SJ, Morissey MA, Camblin JG, Laven DL, Webster WB: Comparative study of monoclonal antibody scan in diagnosing orthopaedic infection. Clin Orthop 1997;335:275–285.
  5. Annovazzi AA, Bagni BB, Burroni LC, D’Alessandria CA, Signore AA: Nuclear medicine imaging of inflammatory/infective disorders of the abdomen. Nucl Med Commun 2005;26:657–664.
  6. Love C, Tronco GG, Palestro CJ: Imaging of infection and inflammation with 99mTc-fanolesomab. Q J Nucl Med Mol Imaging 2006;50:113–120.
  7. Sciuk J, Brandau W, Vollet B, Stucker R, Erlemann R, Bartenstein P, Peters PE, Schober O: Comparison of technetium-99m polyclonal human immunoglobulin and technetium-99m monoclonal antibodies for imaging chronic osteomyelitis: first clinical results. Eur J Nucl Med 1991;18:401–407.
  8. Shanthly N, Aruva MR, Zhang K, Mathew B, Thakur ML: 99mTc-Fanolesomab: affinity, pharmacokinetics and preliminary evaluation. Q J Nucl Med Mol Imaging 2006;50:104–112.