We prospectively compared sequential technetium-gallium imaging with
indium-labeled-leukocyte imaging in fifty patients with suspected low-grade
musculoskeletal sepsis. Adequate images and follow-up examinations were
obtained for forty-two patients. The presence or absence of low-grade
sepsis was confirmed by histological and bacteriological examinations of
tissue specimens taken at surgery in thirty of the forty-two patients. In
these thirty patients, the sensitivity of sequential Tc-Ga imaging was 48
per cent, the specificity was 86 per cent, and the accuracy was 57 per
cent, whereas the sensitivity of the indium-labeled-leukocyte technique was
83 per cent, the specificity was 86 per cent, and the accuracy was 83 per
cent. When the additional twelve patients for whom surgery was deemed
unnecessary were considered, the sensitivity of sequential Tc-Ga imaging
was 50 per cent, the specificity was 78 per cent, and the accuracy was 62
per cent, as compared with a sensitivity of 83 per cent, a specificity of
94 per cent, and an accuracy of 88 per cent with the
indium-labeled-leukocyte method. In patients with a prosthesis the
indium-labeled-leukocyte image was 94 per cent accurate, compared with 75
per cent accuracy for sequential Tc-Ga imaging. Statistical analysis of
these data demonstrated that the indium-labeled-leukocyte technique was
superior to sequential Tc-Ga imaging in detecting areas of low-grade
musculoskeletal sepsis.