Interest of radiolabelled leukocyte scintigraphy in the diagnosis of osteo-articular infection

The diagnosis of osteo-articular infection, particularly after orthopedic implant surgery, is often difficult to confirm; so, only the combination of clinical, biological and radiological tests can help the clinician to propose, in a strict aseptic procedure, the surgical specimen harvesting which can alone reach the final positive or negative diagnosis of infection. Nevertheless, all those tests don't have enough accuracy in some cases to confirm the necessity to realize a surgical procedure which can present septic risk. So, nuclear imaging has long been recognized as an effective method for helping in management of such patients. Among isotopic procedures, only radiolabelled leukocyte scintigraphy is actually considered as the most accurate method. But, literature review reports heterogeneous studies considering patient characteristics, gold standard for diagnosis, nuclear medicine procedure variety which makes comparison difficult. Indeed, diagnostic performances can be different considering infection after orthopedic surgery, presence of implant or not, acute or chronic process, microbiological gold standard or long clinical follow-up, the combination of different isotopic procedures and their interpretation. So, an evaluation of the radiolabelled leukocyte scintigraphy in each institute seems to be important to answer as well as possible to clinician questions. (author)