The Journal of Bone and Joint Surgery, Vol 69, Issue 9 1353-1360, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
Diagnosis of infection by preoperative scintigraphy with indium-labeled white blood cells
DK Wukich, SH Abreu, JJ Callaghan, D Van Nostrand, CG Savory, DF Eggli, JE Garcia and BH Berrey
Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
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.
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