Scintigraphic imaging of vertebral osteomyelitis with 111In-Biotin

Study Design. Early diagnosis of vertebral infection (hematogenous or postsurgical) is necessary to choose a correct therapy and to minimize dramatic complications. All patients suspected to have vertebral infection underwent radiologic imaging and In-111-Biotin scintigraphy. Objective. Biotin is a growth factor used by many bacteria. The aim of our study is to use In-111-Biotin to diagnose vertebral infections. Summary of Background Data. Magnetic resonance imaging, even if endowed with fairly good sensitivity and specificity, shows some limitations in the study of the onset of pathology and in postsurgical conditions. Conventional scintigraphic imaging, like bone scintigraphy with (99)mTc-MDP, Ga-67-citrate scintigraphy, or Positron Emission Tomography with [F-18] FDG, are limited by relatively low specificity; the use of Streptavidin/ In-111-Biotin scintigraphy, based on aspecific uptake of tracer in the site of infection, shows good results in term of sensibility and specificity but the use of heterologous protein might engender immunogenic reactions. Methods. All patients (pts) (n = 110) of the study underwent In-111-biotin scintigraphy 2 hours after intravenous injection of the tracer, 71 pts were suspected to have hematogenous vertebral infection (Group I) and 39 pts were suspected to have postsurgical infection (Group II). The reference for final diagnosis was either bacterial cultures, histopathologic analysis, and/ or clinical/ imaging follow-up for at least 1 year. Results. In-111-biotin scintigraphy showed a sensitivity of 84% and specificity of 98% in Group I and a sensitivity of 100% and specificity of 84% in Group II. Conclusion. Our results showed that In-111-Biotin scintigraphy possess high diagnostic accuracy. This technique is easy to perform and requires short imaging time-point after intravenous tracer injection. Moreover if In-111-Biotin uptake is due only to high proliferation rate of bacteria presents in site of infection, it will be further investigated to discriminate definitely bacterial from sterile inflammation.