Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells

J Bone Joint Surg Am. 1987 Dec;69(9):1353-60.

Abstract

Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Bacterial Infections / diagnostic imaging*
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Humans
  • Hydroxyquinolines*
  • Indium Radioisotopes*
  • Leukocytes*
  • Male
  • Middle Aged
  • Organometallic Compounds*
  • Osteomyelitis / diagnostic imaging*
  • Oxyquinoline* / analogs & derivatives
  • Preoperative Care
  • Radionuclide Imaging
  • Technetium Tc 99m Medronate

Substances

  • Hydroxyquinolines
  • Indium Radioisotopes
  • Organometallic Compounds
  • indium oxine
  • Oxyquinoline
  • Technetium Tc 99m Medronate