DETECTION OF AORTIC GRAFT INFECTION WITH LEUKOCYTES LABELED WITH TECHNETIUM 99M HEXAMETAZIME

Purpose. To reduce the rates of morbidity and mortality in aortic graft infection, a new diagnostic approach is needed to help identify low-grade stages, specifically when there are minimal or no clinical signs of overt infection. The aim of this study was to evaluate the role of technetium 99m-hexametazime white blood cell scanning (Tc-99m scanning) in detecting aortic graft infection, particularly in the low-grade stages. Methods and Results: Thirty-seven patients with suspected aortic graft infection were categorized into three groups according to their signs and symptoms on readmission. Ten patients (group A) had advanced graft infections that were correctly diagnosed by use of computed tomography (CT) scanning and Tc-99m scanning and confirmed by intraoperative findings and culture results. Eighteen patients (group B) had nonspecific signs and symptoms of graft infection. Patients only underwent CT and Tc-99m scanning for graft infection after standard clinical work-ups failed to reveal disease processes that accounted for the clinical symptoms. In this group of patients Tc-99m scanning identified four cases of low-grade graft infection, which was confirmed by intraoperative findings and graft cultures. None of these four cases was confirmed by results of CT scanning. On an average 18-month follow-up in patients who did not undergo surgery graft infections developed. Nine patients (group C) had anastomotic aneurysms; CT scanning and Tc-99m scanning correctly diagnosed five patients as being infected. The result of Tc-99m scanning was false-positive in one patient. Conclusions: The diagnostic accuracy of Tc-99m scanning in patients who did not have specific signs of graft infection (groups B and C) was 100% for sensitivity, 94.4% for specificity, 90% for the positive predictive value, and 100% for the negative predictive value. Tc-99m scanning seems to be a useful diagnostic technique for detecting aortic graft infection, particularly in low-grade stages.