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Osteomyelitis: Antigranulocyte Scintigraphy with ^99mTc Radiolabeled Monoclonal Antibodies for Diagnosis—Meta-Analysis¹

¹ From the Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology (E.E.P., H.D.K., J.P.A.I.), and Department of Nuclear Medicine (A.D.F.), University Hospital of Ioannina School of Medicine, University Campus, Ioannina, Epirus 45110, Greece; and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass (J.P.A.I.). Received November 2, 2006; revision requested January 3, 2007; revision received February 3; final version accepted March 25. Address correspondence to J.P.A.I. (e-mail: jioannid{at}cc.uoi.gr).

Purpose: To perform a meta-analysis of the sensitivity and specificity of antigranulocyte scintigraphy with monoclonal antibodies (MoAbs) in the diagnosis of osteomyelitis across different patient groups and clinical settings.

Materials and Methods: MEDLINE and EMBASE searches were conducted. Data on the diagnostic performance of antigranulocyte scintigraphy with MoAbs were combined. Weighted sensitivities and specificities were estimated by using a random-effects model that incorporated between-study heterogeneity and by constructing summary receiver operating characteristic (ROC) curves. The weighted positive and negative likelihood ratios (LRs) across studies were estimated. Data syntheses were performed for all patients and for various subgroups. The reference standard used in each individual study was accepted.

Results: Nineteen nonoverlapping studies with a total of 714 examinations and reference standards of cell culture, histologic examination, clinical follow-up, and radiologic examination were eligible. The independent random-effects summary estimates of sensitivity and specificity were 81% (95% confidence interval [CI]: 70%, 88%) and 77% (95% CI: 66%, 86%), respectively, with statistically significant between-study heterogeneity (exact P < .001 for both metrics). In the summary ROC curve, a sensitivity of 81% corresponded to a specificity of 86%, and a specificity of 77% corresponded to a sensitivity of 87%. The weighted positive LR was 3.02 (95% CI: 2.07, 4.42), and the weighted negative LR was 0.26 (95% CI: 0.17, 0.39), with statistically significant between-study heterogeneity (exact P < .001 for both metrics). Sensitivity was better for peripheral than for axial skeleton lesions (87% vs 53%).

Conclusion: Antigranulocyte scintigraphy with MoAbs has a sensitivity of 81% and a specificity of 77% in the diagnosis of osteomyelitis.

© RSNA, 2007