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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

View larger version (84K): [in a new window]   FIGURE 1. 99mTc-HMPAO-WBC (A) and infecton (B) diagnostic images of 42-y-old man with chronic osteomyelitis in right leg after traumatic fracture, produced at 1 and 4 h after injection and at 1, 4, and 24 h after injection, respectively. Images show concordant results. Note increased synovial activity in knees even on contralateral healthy side in infecton images.

View larger version (74K): [in a new window]   FIGURE 2. 99mTc-HMPAO-WBC (A) and infecton (B) images at 1 and 4 h after injection of 31-y-old man with pain in left hip 2 y after hip orthopedic surgery. Hip injury was sustained in traffic accident. Infecton images show marked abnormality of left hip, which was reported as soft-tissue abscess without osteomyelitis.

View larger version (70K): [in a new window]   FIGURE 3. (A) 99mTc-HMPAO-WBC images show focal tracer accumulation in distal tip of left hip endoprosthesis but no abnormal findings in right femora, where fixation nail is present, in 77-y-old man who underwent orthopedic surgery 1 y previously. (B) Infecton scans confirm abnormality in distal end of left hip prosthesis and also show pronounced focal accumulation of tracer in area of right femoral fixation nail. Biopsy results confirmed osteomyelitis on both sides.

View larger version (117K): [in a new window]   FIGURE 4. Infecton image (upper right) shows increased focal activity concordant with results of MDP scans (lower left), whereas 99mTc-HMPAO-WBC scan revealed cold lesion on same area (upper left) in 60-y-old man with history of suspected spondylodiscitis and pain on dorsal vertebra 12.

View larger version (89K): [in a new window]   FIGURE 5. Series of infecton images of 62-y-old man with severe lower back pain caused by spondylodiskitis on lumbar vertebrae 2 and 3. Initial image (A) revealed marked increase in activity in that area, with lesion-to-background ratio of 1:66. One month after intense antibiotic therapy, dramatic improvement was observed; however, infecton images (B) still showed increased activity in same area but relatively decreased density of lesion (lesion-to-background ratio, 1:24).