3-Phase Bone Scan and WBC Scan and Sulfur Colloid Scan Area of Interest There is insufficient evidence to support the use of 3-phase bone scan, WBC scan, and sulfur colloid scan for evaluation of suspected septic arthritis. Suspected Osteomyelitis, Septic Arthritis 3-Phase Bone Scan and WBC Scan Area of Interest While the literature does not support routine use of 3-phase bone scan and WBC scan for suspected periprosthetic infection, WBC may be performed following a positive bone scan to assess for infection. A 3-phase bone scan can be positive for multiple reasons in the post arthroplasty setting. Trevail et al [34] suggested the addition of WBC scan following a positive arthroplasty is up to 99% specific for infection and 80% sensitive. 3-Phase Bone Scan Area of Interest Bone scintigraphy alone has high sensitivity and low specificity in the evaluation of suspected periprosthetic joint infection [35,36]. A negative 3-phase bone scan suggests low probability of periprosthetic infection [34,37]. Image-Guided Aspiration Area of Interest The use of image-guided joint aspiration is supported to evaluate suspected septic arthritis. Depending on the joint, image guidance may be used to access the joint and confirm intra-articular needle positioning in the event of dry tap. Joint aspiration may be performed under fluoroscopy, US, or, less commonly, CT. The decision of imaging modality should be based on operator expertise and comfort because no modality has been proven superior to others. Laboratory analysis should include cultures, Gram stain, and cell count with differential [31,38,39]. CT Area of Interest CT can be used to evaluate hardware complications including osteolysis adjacent to implanted hardware. The use of metal artifact reduction techniques can improve the detection of joint effusion, soft tissue abscess, and periostitis.
Suspected Osteomyelitis Septic Arthritis or Soft Tissue Infection Excluding Spine and Diabetic Foot PCAs. 3-Phase Bone Scan and WBC Scan and Sulfur Colloid Scan Area of Interest There is insufficient evidence to support the use of 3-phase bone scan, WBC scan, and sulfur colloid scan for evaluation of suspected septic arthritis. Suspected Osteomyelitis, Septic Arthritis 3-Phase Bone Scan and WBC Scan Area of Interest While the literature does not support routine use of 3-phase bone scan and WBC scan for suspected periprosthetic infection, WBC may be performed following a positive bone scan to assess for infection. A 3-phase bone scan can be positive for multiple reasons in the post arthroplasty setting. Trevail et al [34] suggested the addition of WBC scan following a positive arthroplasty is up to 99% specific for infection and 80% sensitive. 3-Phase Bone Scan Area of Interest Bone scintigraphy alone has high sensitivity and low specificity in the evaluation of suspected periprosthetic joint infection [35,36]. A negative 3-phase bone scan suggests low probability of periprosthetic infection [34,37]. Image-Guided Aspiration Area of Interest The use of image-guided joint aspiration is supported to evaluate suspected septic arthritis. Depending on the joint, image guidance may be used to access the joint and confirm intra-articular needle positioning in the event of dry tap. Joint aspiration may be performed under fluoroscopy, US, or, less commonly, CT. The decision of imaging modality should be based on operator expertise and comfort because no modality has been proven superior to others. Laboratory analysis should include cultures, Gram stain, and cell count with differential [31,38,39]. CT Area of Interest CT can be used to evaluate hardware complications including osteolysis adjacent to implanted hardware. The use of metal artifact reduction techniques can improve the detection of joint effusion, soft tissue abscess, and periostitis.