The 111In-granulocyte scan in prosthetic vascular graft infections: imaging technique and results.

Fourteen patients were examined between 3 weeks and 11 years after implantation of an aortobifemoral vascular graft with 111In labelled leukocytes isolated with discontinuous gradient centrifugation. The camera acquisition was performed with a three phase technique (acquisitions at 30 min, 4 h and 24 h p.i.). The presence and extent of a graft or perigraft infection including complicating fistulas could be correctly diagnosed in six of eight patients with surgically proven infections. Leukocyte uptake index was calculated as 1.77 +/- 0.4 (30 min p.i.) and 2.4 +/- 0.7 (24 h p.i.). All infections could be diagnosed by 30 min p.i., fistulas only could be seen 24 h p.i. In two of eight patients, false positive results were observed. These patients suffered from suspected perigraft hematomas and noninfected aortic graft aneurysms. Both had a negative 30 min scan and a slight uptake in the late scans comparable to bone marrow activity. Six patients with fever of unknown origin showed true negative scans. There were no false negative scans. We conclude that only the leukocyte scan can diagnose the presence and the extent, including fistulas, of vascular graft infections. The three phase technique is recommended to localize the blood pool in the 30 min scan and to diagnose complications 24 h p.i. In cases of a negative 30 min scan and positive 4 h and 24 h scans, false positive results should be suspected. All infections have a leukocyte uptake index higher than 1.2.