Baba et al [21] performed a retrospective review of the 45 Indium-111-tagged WBC scans that were performed in the aforementioned study by Carter et al in order to evaluate the usefulness of having performed these examinations. Of these, 34/45 (76%) of the studies were determined to be helpful in furthering patient management, even though only half (50%) of the 34 studies were positive, and 8/45 (18%) were considered to be unhelpful in furthering patient management, and 3/45 (6%) were considering to be misleading and led to inappropriate treatment from study results. Uslu et al [22] performed a prospective study involving 15 women with clinically suspected pyogenic pelvic inflammatory disease who underwent Tc-99m-HMPAO (hexamethylpropyleneamine oxime)-tagged WBC scan. All patients had previously undergone another study by either US or CT before the WBC scan. Tc-99m-HMPAO- tagged WBC correctly identified pyogenic pelvic inflammatory disease in all 5 surgically confirmed cases (sensitivity 100%) and incorrectly reported pyogenic pelvic inflammatory disease in 1/10 surgically confirmed negative cases (specificity 90%). Given that the above-mentioned studies are from older literature before the routine use of cross-sectional CT studies, WBC scans are no longer considered useful as the next imaging modality after chest radiograph, given that a WBC scan cannot provide exact anatomic localization in the manner comparable to a CT scan. Therefore, it should only be used after source localization with CT has failed. Sepsis examination is usually appropriate or may be appropriate as the next imaging study. The panel did not agree on recommending CT abdomen and pelvis without IV contrast or CT chest abdomen and pelvis without IV contrast as the next imaging study for this clinical scenario. There is insufficient medical literature to conclude whether or not these patients would benefit from these modalities. Imaging with the mentioned examinations in this patient population is controversial but may be appropriate.
Sepsis. Baba et al [21] performed a retrospective review of the 45 Indium-111-tagged WBC scans that were performed in the aforementioned study by Carter et al in order to evaluate the usefulness of having performed these examinations. Of these, 34/45 (76%) of the studies were determined to be helpful in furthering patient management, even though only half (50%) of the 34 studies were positive, and 8/45 (18%) were considered to be unhelpful in furthering patient management, and 3/45 (6%) were considering to be misleading and led to inappropriate treatment from study results. Uslu et al [22] performed a prospective study involving 15 women with clinically suspected pyogenic pelvic inflammatory disease who underwent Tc-99m-HMPAO (hexamethylpropyleneamine oxime)-tagged WBC scan. All patients had previously undergone another study by either US or CT before the WBC scan. Tc-99m-HMPAO- tagged WBC correctly identified pyogenic pelvic inflammatory disease in all 5 surgically confirmed cases (sensitivity 100%) and incorrectly reported pyogenic pelvic inflammatory disease in 1/10 surgically confirmed negative cases (specificity 90%). Given that the above-mentioned studies are from older literature before the routine use of cross-sectional CT studies, WBC scans are no longer considered useful as the next imaging modality after chest radiograph, given that a WBC scan cannot provide exact anatomic localization in the manner comparable to a CT scan. Therefore, it should only be used after source localization with CT has failed. Sepsis examination is usually appropriate or may be appropriate as the next imaging study. The panel did not agree on recommending CT abdomen and pelvis without IV contrast or CT chest abdomen and pelvis without IV contrast as the next imaging study for this clinical scenario. There is insufficient medical literature to conclude whether or not these patients would benefit from these modalities. Imaging with the mentioned examinations in this patient population is controversial but may be appropriate.