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Use of Tc-99m HMPAO Leukocyte Scans To Evaluate Bone Infection: Incremental Value of Additional SPECT Images

WEON, YOUNG CHEOL M.D.*; YANG, SEOUNG-OH M.D.†; CHOI, YUN YOUNG M.D.‡; SHIN, JUNG WOO M.D.§; RYU, JIN SOOK M.D.§; SHIN, MYUNG JIN M.D.*; LEE, SOO-HO M.D.∥; LEE, HEE KYUNG M.D.§

Original Articles

Purpose: In this study, the diagnostic value of Tc-99m hexamethylpropylene amine oxime (HMPAO) leukocyte scans and the role of additional SPECT in the diagnosis of bone infection were evaluated.

Materials and Methods: The Tc-99m HMPAO leukocyte scans of 37 patients with clinically suspected bone infection were reviewed. The patients were divided into two groups according to the presence of orthopedic implants. Early (4 to 6 hours) and delayed (18 to 20 hours) planar images and early SPECT images were obtained. The final diagnosis of infection was made based on the pathologic, bacteriologic, and surgical data and clinical follow-up.

Results: Group 1 (25 patients with orthopedic implants) included 15 true-positive, 1 false-negative, 7 true-negative, and 2 false-positive results. Group 2 (12 patients without orthopedic implants) included 7 true-positive, 1 false-negative, and 4 true-negative results. The overall sensitivity of the Tc-99m HMPAO leukocyte scan with SPECT to detect bone infection was 92%, with a specificity rate of 85%. (Group 1: sensitivity, 94%; specificity, 78%. Group 2: 88% and 100% sensitivity and specificity, respectively.)

Conclusion: The Tc-99m HMPAO leukocyte scan is useful in the diagnosis of bone infection, regardless of the presence of orthopedic implants. The additional SPECT images may be helpful to localize the site of infection more accurately.

From the Departments of Diagnostic Radiology,* Nuclear Medicine,§ and Orthopedic Surgery,∥ Asan Medical Center, Seoul; Department of Diagnostic Radiology,† Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan; and Department of Nuclear Medicine,‡ Hanyang University Hospital, Seoul, Korea

Received for publication December 14, 1999.

Accepted February 22, 2000.

Correspondence: Seoung-Oh Yang, M.D., Division of Nuclear Medicine, Department of Radiology, Ulsan University Hospital, 290 Cheonha-Dong, Dong-Ku, Ulsan 682-060, Korea. E-mail: soyang@uuh.ulsan.kr

Presented at the 45th Annual Meeting of the Society of Nuclear Medicine, Toronto, Ontario, Canada, June 1998.

© 2000 Lippincott Williams & Wilkins, Inc.