Musculoskeletal infection imaging using 99Tcm-ciprofloxacin: preliminary observations

Full text: Clinically available infection imaging techniques employing labelled leukocytes (WBC) and gallium citrate are sensitive for inflammation but often lack specificity for infection. 99Tcm-ciprofloxacin (CIPRO), a labelled broad-spectrum antibiotic, is potentially more specific for infection. We present the CIPRO findings from 13 pts (8 M; 5 F; mean age 58 years) referred with possible current musculoskeletal sepsis. WBC were performed in 10 pts and temporally preceded CIPRO in 7. The average time between scans was 3 days. Eleven of the 13 pts had a prior history of documented infection secondary to trauma or joint surgery. All received antibiotics at some stage prior to CIPRO with 10 on antibiotics at the time of the scan. Final diagnosis of infection (diagnosed in 7 pts) was based on microbiological results from swabs and surgical specimens (7 pts) or the clinical course over the subsequent months (6 pts). CIPRO correctly identified 10/13 pts (77%) as having infection or no infection compared to 6/10 (60%) using WBC (P = N.S.). CIPRO and WBC were concordant in 7/10 pts. Discordant results were due to 1 false-positive CIPRO, 2 false-positive WBC. Scan accuracy in both groups may be affected by the inclusion of a patient with an equivocal diagnosis of infection; and the timing of the scans. Our preliminary observations are: (1) CIPRO is a promising diagnostic agent for musculoskeletal sepsis deserving further evaluation. (2) CIPRO appears at least as accurate as WBC but with significant preparation advantages. (3) Optimal CIPRO scanning time yet to be determined but should be at least 3-4 h post-injection to lessen blood pool effect