Sequential technetium-99m HMDP-gallium-67 citrate imaging for the evaluation of infection in the painful prosthesis.

In order to evaluate the clinical utility of sequential technetium-99m HMDP-gallium-67 scanning in patients with painful orthopedic prosthesis, a retrospective review was made of 154 sequential scans performed in 130 patients. Criteria for a positive study included spatially incongruent gallium-technetium uptake or gallium uptake that was congruent but more intense than technetium. Images were interpreted as negative if gallium was congruent and less intense than technetium. Sixty-six patients underwent surgery (31 infected, 35 aseptic), and 64 were evaluated clinically (3 infected, 61 aseptic). The combined results of the surgical and nonsurgical patients yielded a sensitivity of 66%, a specificity of 81%, and an accuracy of 77%. In this series, the technetium-gallium scan combination has proven to be helpful but more recent techniques such as indium-111-labeled leukocytes may prove to be superior to sequential technetium-gallium imaging.