title: Diagnostic value of ⁹⁹mTc-HMPAO-labeled leukocytes scintigraphy in suspicion of post-sternotomy mediastinitis relapse.
abstract: BACKGROUND
  The diagnostic value of radiolabeled white blood cells (WBCs) scintigraphy in mediastinitis is well established, but data in the specific context of relapse are lacking. The present study aimed at evaluation of the diagnostic value of WBCs scintigraphy in suspicion of mediastinitis relapse after prior surgical revision.
  
  
  RESULTS
  Multiple planar incidences of the chest were acquired 4 and 20 hours after injection of labeled WBC in 43 patients. In case of non-conclusive scintigraphy, a second scan was performed 2-3 weeks after the first one. The diagnosis of infection was based on positive bacteriological results; otherwise patients were followed up for at least 1 year. Out of 39 analyzable patients, 17 (44%) were diagnosed with mediastinitis relapse. After the first scan, 32 of 39 were correctly classified, 2 were false positive, and 5 were not conclusive. After completion of an additional scan in the latter 5 patients, 36 of 39 were correctly classified and 3 were false positive (100% sensitivity, 86% specificity, 85% positive predictive value, and 100% negative predictive value).
  
  
  CONCLUSIONS
  In the specific context of suspicion of mediastinitis relapse, the optimal diagnostic value was achieved by repeating the scan when the first one was not conclusive. In this context, a negative WBC scintigraphy was able to rule out infection, with potential major impact on therapeutic management in patients with poor clinical status.
authors.affiliation: Department of Nuclear Medicine, Bichat Hospital, Assistance Publique Hôpitaux de Paris (APHP) and DHU FIRE, 46 rue Henri Huchard 75018, Paris, France. francois.rouzet@bch.aphp.fr
authors.forename: François
authors.initials: F
authors.lastname: Rouzet
authors.forename: Claire
authors.initials: C
authors.lastname: de Labriolle-Vaylet
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Anne
authors.initials: A
authors.lastname: Hitzel
authors.forename: Khadija
authors.initials: K
authors.lastname: Benali
authors.forename: Rachida
authors.initials: R
authors.lastname: Lebtahi
authors.forename: Dominique
authors.initials: D
authors.lastname: Le Guludec
mesh_terms: D000368:Aged; D001706:Biopsy; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007962:Leukocytes / Q000528:radiation effects*; D008297:Male; D008480:Mediastinitis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D056346:Sternotomy; D019690:Technetium Tc 99m Exametazime
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime