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Usefulness of ^99mTc-Ciprofloxacin (Infecton) Scan in Diagnosis of Chronic Orthopedic Infections: Comparative Study with ^99mTc-HMPAO Leukocyte Scintigraphy

Nuclear Medicine Department and Department of Orthopedics, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; and Nuclear Medicine Department, St. Bartholomew’s Hospital, London, United Kingdom

^99mTc-labeled ciprofloxacin (infecton) has been developed for detecting infectious foci, which localize in high concentrations in living bacteria. Other studies performed with various infections in animals and humans have found that infecton is a promising agent with better specificity for bacterial infections than white blood cell (WBC) scans. In this study, we evaluated the efficacy of infecton scintigraphy for detecting chronic bone and joint infections. Methods: Fifty-six sites with suspected bone or joint infection were examined with ^99mTc-WBC and infecton scans in 51 patients. Of these patients, 21 had prosthetic implant materials. Biochemical, radiologic, and microbiologic data and clinical outcomes also contributed, along with the results from scintigraphic techniques, in determining the presence or absence of infection. Scintigraphic images were produced at 1 and 4 h after injection of 370–400 MBq infecton or 185–200 MBq ^99mTc-hexamethylpropyleneamine oxime (HMPAO)-WBCs. For each patient, there were at least 2 d and at most 7 d between scintigraphic studies. Results: There were 30 true-positive, 4 false-positive, 20 true-negative, and 2 false-negative results with infecton. With ^99mTc-HMPAO-WBCs, the results were 20, 1, 23, and 12, respectively. Values for sensitivity, specificity, and accuracy were 94%, 83%, and 89%, respectively, with the infecton scan and 63%, 96%, and 77%, respectively, with WBC scanning. Differences between the two agents were statistically significant (P < 0.001). Infecton and WBC scan results were in general concordance for 43 of 56 sites (77%). Infecton results for vertebral infections were the most notable findings in this study, despite the limited number of patients with this condition. Infecton scans were positive for hot spots in five of six patients with vertebral osteomyelitis. WBC scans showed photon-deficient areas in four of these same patients and normal distribution in the remaining two patients. Conclusion: Infecton is a useful agent for detecting infectious foci in bones and joints. Moreover, the infecton scan seems to be a more powerful tool in diagnosing vertebral infections than WBC scintigraphy.

Key Words: infection imaging • osteomyelitis • white blood cell scanning

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