Inability of 99mTc-Ciprofloxacin Scintigraphy to Discriminate Between Septic and Sterile Osteoarticular Diseases

Inability of ^99mTc-Ciprofloxacin Scintigraphy to Discriminate Between Septic and Sterile Osteoarticular Diseases

Laure Sarda, MD¹^,2, Anne-Claude Crémieux, MD, PhD³, Yves Lebellec, MD⁴, Alain Meulemans, PhD², Rachida Lebtahi, MD, PhD², Gilles Hayem, MD, PhD⁵, Rémi Génin, MD², Nicolas Delahaye, MD², Denis Huten, MD⁴ and Dominique Le Guludec, MD, PhD²

¹ Service Hospitalier Frédéric Joliot, Commissariat à l’Energie Atomique/Direction des Sciences du Vivant/Département de Recherche Médicale, Orsay, France
² Nuclear Medicine Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
³ Internal Medicine Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
⁴ Orthopedic Surgery Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
⁵ Rheumatology Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

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FIGURE 1. Anterior and posterior whole-body ^99mTc-ciprofloxacin images 4 h after injection.

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FIGURE 2. 1-, 4-, and 24-h images of negative and positive ^99mTc-ciprofloxacin findings. (A) Negative findings (patient 3 with aseptic loosening of left hip prosthesis). (B) Positive findings (patient 9). Increased ^99mTc-ciprofloxacin uptake is seen at seat of fracture (right tibia) on all images.

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FIGURE 3. Examples of ^99mTc-ciprofloxacin scintigraphy in prosthetic hips. (A) Patient 13, with infected right prosthetic hip and extensive soft-tissue infection (surgical findings of inflamed cutaneous scar and pus in muscles), shows activity in periprosthetic femur and soft tissues. (B) Patient 7, with aseptic loosening of total right-hip replacement (histologic intraoperative findings of reactive inflammation to metallosis), shows activity around prosthetic femoral neck, in periprosthetic femur, and in socket.

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FIGURE 4. Examples of ^99mTc-ciprofloxacin scintigraphy in prosthetic knees. (A) Patient 26, with infected right prosthetic knee, shows activity in synovial cavity and periprosthetic tibia. (B) Patient 27, with aseptic total right-knee replacement, shows activity in synovial cavity, periprosthetic tibia, and femur. Both patients show mild but significant ^99mTc-ciprofloxacin activity in left knee arthrosis.