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- W2038930907 abstract "The diagnosis of osteomyelitis in patients with diabetic foot is difficult both clinically and radiologically. An early diagnosis is crucial to optimize therapeutic strategy. Among the diagnostic methods currently used, scintigraphy with ex-vivo labelled white blood cells is the gold standard, but cannot be performed in all centers; therefore 67Gallium citrate (67Ga) imaging in combination with a bone scintigraphy is still widely used. The results of imaging 24 diabetic patients with 31 suspected osteomyelitic lesions using the antigranulocyte Fab' fragment (Sulesomab or LeukoScan® or immunoscintigraphy) were prospectively compared with results from the bone scan coupled with 67Ga. The diagnosis of osteomyelitis was confirmed by either biopsy or follow-up, radiological imaging and clinical outcome. Sulesomab correctly identified 12 of 18 osteomyelitic lesions while 67Ga was able to detect only 8 of 18. Therefore the sensitivity is 67% for Sulesomab and 44% for 67Ga. Among the 13 non-osteomyelitic lesions imaging with Sulesomab was able to rule out infection in 11 cases and 67Ga in 10 cases. The specificity is therefore 85% for Sulesomab and 77% for 67Ga. Image interpretation for Sulesomab in this group of patients is occasionally suboptimal when imaging is performed at 3 hours post injection. High vascular background in the early images may obscure infection especially in small bones. Practically, scintigraphy with Sulesomab is fast and simple due to ease of labeling, no ex-vivo handling of blood, low radiation and provides rapid diagnosis. The diagnosis of osteomyelitis obtained by the antibody fragment scintigraphy influences the management (guided biopsy) and therapy. In several patients, imaging with Sulesomab was able to rule out osteomyelitis, helping to avoid useless antibiotic therapy and its associated side effects. Comparaison du LeukoScan® (Sulesomab) et du Gallium-67 pour le diagnostic d'ostéite en cas de pied diabétique Le diagnostic d'ostéite du pied chez les patients diabétiques est difficile tant cliniquement que radiologiquement. Un diagnostic précoce permet pourtant de guider le choix thérapeutique. Parmi les examens que la médecine nucléaire propose, la scintigraphie au Leucocytes marqués ex vivo est la méthode de choix mais ne peut facilement être pratiquée par l'ensemble des services de médecine nucléaire. Nous avons voulu comparer les performances de la scintigraphie osseuse couplée au Gallium (67Ga) à celles du LeukoScan® (Sulesomab, fragment Fab' d'anticorps murin anti-granulocytaire) dont le marquage au 99mTc est simple et réalisable en routine clinique. Vingt-quatre patients diabétiques totalisant 31 lésions suspectes d'ostéite ont été inclus dans cette étude prospective. Le diagnostic d'ostéite a été obtenu grâce à la biopsie ou au suivi radiologique et clinique. Le Sulesomab a identifié correctement 67 % (12/18) des foyers d'ostéite alors que le 67Ga n'en a montré que 44 % (8/18). Parmi les 13 lésions sans ostéite, le Sulesomab a permis d'exclure l'infection dans 11 cas et le 67Ga dans 10 cas. Les sensibilités sont de 67 % pour le Sulesomab et 44 % pour le 67Ga et les spécificités sont respectivement de 85 % et 77 %. L'interprétation des images du Sulesomab est parfois suboptimale sur les clichés obtenus trois heures après l'injection en raison du bruit de fond vasculaire toujours présent, qui ne permet pas toujours, surtout au niveau des petites structures osseuses, de différencier l'infection osseuse de celle des tissus mous avoisinants. En pratique, le Sulesomab est un traceur intéressant pour sa facilité d'emploi, sa faible irradiation et sa rapidité de diagnostic. Le diagnostic précoce de l'ostéite posé grâce à l'examen peut influencer la prise en charge (en guidant le biopsie) et le choix thérapeutique du clinicien, ce qui permet dans certains cas d'exclure une ostéite et d'éviter ainsi une antibiothérapie inutile et parfois même délétère." @default.
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- W2038930907 date "2005-04-01" @default.
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- W2038930907 title "Comparison between Leukoscan® (Sulesomab) and Gallium-67 for the diagnosis of osteomyelitis in the diabetic foot" @default.
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- W2038930907 doi "https://doi.org/10.1016/s1262-3636(07)70178-7" @default.
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