Comparative Study of Monoclonal Antibody Scan in Diagnosing Orthopaedic Infection

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Abstract
When clinical data are insufficient to diagnose infection of bone or joints, nuclear scanning becomes crucial in making an accurate diagnosis. The efficacy of 99mtechnetium antigranulocyte monoclonal antibody Fab' fragment (LeukoScan) is prospectively compared with 111indium white blood cell and 99mtechnetium methylene diphosphonate bone scans in 74 patients with suspected musculoskeletal infections. They were grouped according to site of suspected infection: 33 long bones, 23 prosthetic joints, and 18 diabetic feet. Sixty-two of these 74 patients had surgical verification with histopathology or culture. The remaining 12 patients had clinical followup as proof of absence of infection. The overall sensitivity of LeukoScan, 111indium white blood cell, and 99mtechnetium methylene diphosphonate bone scans was 93%, 85% and 92%, respectively. Specificity was 89%, 75% and 52%, and accuracy was 90%, 79% and 74%, respectively. The conclusion from this study is that LeukoScan is more accurate in detecting osteomyelitis, with better sensitivity and specificity in prosthetic joints. Compared with 111indium white blood cell scans, LeukoScan gives superior images, and results are obtained in 1 to 6 hours without biohazard risk from handling blood products.