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Diagnosis of Sternal Wound Infection by Technetium-99m-Leukocyte Imaging

Departments of Radiology, Medicine and Surgery, Albany Medical College, Albany, New York

Correspondence: For reprints contact: Jeffrey A. Cooper, MD, Nuclear Medicine, A-72, 47 Scotland Ave., Albany Medical Center, Albany, NY 12208.

ABSTRACT

An imaging study is needed that can detect sternal wound infections and distinguish between superficial and deep sternal wound infection when a clinical diagnosis is uncertain and a decision regarding surgical intervention must be made. We retrospectively reviewed the ^99mTc-leukocyte scans of 29 patients referred to rule out sternal wound infection. The presence or absence of deep or superficial sternal wound infection was determined by microbiology and long-term follow-up. Images obtained 4 and 20 hr after injection were reviewed by two nuclear physicians who were blinded to the clinical history. Findings were categorized as normal or abnormal. Abnormal images were further defined as having intense uptake at 4 and 20 hr, increasing uptake between 4 and 20 hr, or other patterns such as focal cold regions, irregular uptake or "bifid" sternum appearance. The patterns of intense uptake at 4 and 20 hr or increasing uptake between 4 and 20 hr were 100% sensitive and 89% specific for the detection of deep sternal wound infection. The images were also useful for determining the extent of infection. Superficial sternal wound infection could not be reliably detected. The results indicate that ^99mTc-leukocyte imaging is useful for the diagnosis of deep sternal wound infection.

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