pyrophosphate and Osteomyelitis

Technetium-99 (99Tc) pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. Although bone biopsy seems useful in diagnosing osteomyelitis underlying decubitus ulcers, its role in diabetic patients with foot infections is not established. I do not recommend biopsy of foot bones in diabetic patients, since culture of bone biopsy specimens often give unreliable results in these situations because of contamination with ulcer organisms.

Topics: Acute Disease; Bone and Bones; Chronic Disease; Costs and Cost Analysis; Diabetes Complications; Diagnostic Errors; Diphosphates; Foot Diseases; Humans; Osteomyelitis; Radiography; Radionuclide Imaging; Skin Ulcer; Staphylococcal Infections; Technetium; Technetium Tc 99m Pyrophosphate; Wound Infection

Topics: Animals; Calcium Radioisotopes; Diphosphates; Dogs; Extremities; Fractures, Bone; Hormones; Humans; Lymphoscintigraphy; Minerals; Osteomyelitis; Strontium Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Wound Healing; Xenon Radioisotopes

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Lung Neoplasms; Male; Osteomyelitis; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

The radionuclide investigation of skeletal trauma in the past was confined generally to scintimetry and an occasional bone scan. The development of improved radiopharmaceuticals, including 99mTc-labeled compounds with their enhanced sensitivity, and the refinement of imaging devices offering superior resolution and speed have allowed a more detailed assessment of conditions resulting from trauma. Practical approaches to the diagnosis of subtle bone injury resulting in stress fracture, the differentiation between delayed healing and nonunion, and early recognition of avascular necrosis and osteomyelitis are now available. The changing pattern of radionuclide uptake in bone following damage by radiation and other abnormalities as a consequence of trauma also can be easily studied.

Topics: Adolescent; Adult; Athletic Injuries; Calcium Radioisotopes; Child; Diphosphates; Female; Femur Head Necrosis; Fluorine; Fractures, Bone; Fractures, Spontaneous; Fractures, Ununited; Humans; Male; Middle Aged; Myositis Ossificans; Osteomyelitis; Radiation Injuries; Radionuclide Imaging; Radiotherapy; Strontium Radioisotopes; Technetium

Topics: Adult; Child; Diphosphates; Fractures, Bone; Humans; Osteomyelitis; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Injuries; Spinal Neoplasms; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adolescent; Adult; Aged; Chronic Disease; Diagnosis, Differential; Diphosphates; Female; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed

We describe an infrequent case of combined infection of bone, articulation and lung by Staphylococcus aureus, with affectation of all pelvic bones. Studies with 99m Tc pyrophosphate were repeatedly negative, becoming positive following the appearance of radiological signs.

Topics: Adolescent; Bronchopneumonia; Diphosphates; Humans; Male; Osteomyelitis; Pelvic Bones; Radionuclide Imaging; Sacroiliac Joint; Staphylococcal Infections; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray Computed; Ultrasonography

The accuracy of radionuclide angiography and blood-pool imaging using [99mTc]-phosphate to assess skin ulcer perfusion as an indicator of healing capacity was determined in 50 studies performed on 45 patients with nonhealing ulcers of the lower extremities. Two nuclear medicine physicians without clinical bias, graded the perfusion of the ulcer on the images as normal, increased or reduced with respect to the opposite limb. Patients were followed closely with aggressive local wound care for at least 14 days. Of the 31 ulcers which healed, the radionuclide study correctly predicted 30; of the 19 ulcers which did not heal, 14 were correctly predicted. Eight patients had osteomyelitis; four of those healed and four did not. The radionuclide study predicted healing in seven. Excluding those patients with osteomyelitis, the sensitivity for the radionuclide angiogram and blood-pool image in predicting healing was 96%, specificity was 87%, and accuracy was 93%. This technique is a simple, reliable way to predict the microcirculatory adequacy for ulcer healing. Specificity is diminished in the presence of osteomyelitis.

Topics: Aged; Diphosphates; Diphosphonates; Humans; Male; Microcirculation; Middle Aged; Osteomyelitis; Radionuclide Imaging; Skin; Skin Ulcer; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Wound Healing

Fifty seven patients with histologically proven cyst-like lesions of the mandible are reviewed. The importance of combining radiographic with scintigraphic imaging is stressed. These two imaging modalities are complementary in demonstrating both the biological activity and the extent of the lesion. In osteomyelitis the bone scan, which is more sensitive than the radiograph, is also the method of choice in assessing the result of treatment.

Topics: Adolescent; Adult; Aged; Ameloblastoma; Carcinoma, Squamous Cell; Dentigerous Cyst; Diphosphates; Humans; Jaw Cysts; Mandibular Diseases; Mandibular Neoplasms; Middle Aged; Osteomyelitis; Osteosarcoma; Radicular Cyst; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Computerized osteoscintigrams of 54 children with osseous diseases (osteomyelitis, osseous tumors and arthritis) were analysed. 99mTc-pyrophosphate elevated accumulation in inflammatory processes was observed not only in the pathological zone but also in the epiphyses of the affected limb. The accumulation of the radiopharmaceutical agent calculated in several zones of the affected and healthy limbs provides for significant differential diagnosis of acute hematogenic osteomyelitis. In case of bone symmetric involvement by an inflammatory process and in osteomyelitis of the flat bones and the vertebral column the potentialities of the method are limited.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Diphosphates; Extremities; Humans; Infant; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Diphosphates; Disease Models, Animal; Dogs; Female; Leg Injuries; Male; Osteomyelitis; Pentetic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Pyrophosphate

We reviewed the technetium phosphate scans of 280 patients who had been referred with a clinical diagnosis of osteomyelitis in order to establish the diagnostic accuracy of this procedure. Strict criteria were established to define two subgroups: one of patients with proved osteomyelitis and one of patients who definitely did not have osteomyelitis. The scan correctly identified osteomyelitis at fifty-five of sixty-two sites, and was correctly negative in seventy-four of seventy-nine patients without osteomyelitis. The scan correctly distinguished all cases of cellulitis or soft-tissue abscess from osteomyelitis, but identified osteomyelitis in eight of thirty-nine patients with septic arthritis. The phosphate bone scan maintained this accuracy through any duration of symptoms, and performed almost equally well at all skeletal sites and in all age groups.

Topics: Abscess; Adolescent; Bone and Bones; Cellulitis; Child; Child, Preschool; Diagnosis, Differential; Diphosphates; Diphosphonates; Humans; Infant; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Radionuclide joint imaging with the technetium-99m-labeled phosphates is a sensitive technique for the detection of inflammatory articular disease, although it is nonspecific as to the cause of the increased uptake and offers poor resolution in comparison to conventional radiography. There does not appear to be any place for the routine use of joint imaging of the peripheral joints, as there is little evidence that it benefits patient management. Scintigraphy is of benefit in the detection of osteomyelitis, Legg-Perthes' disease, and osteonecrosis, where changes may antedate roentgenologic abnormalities. Technetium-99m-phosphates may have an increasing role in the evaluation of knee and hip prosthetic joint loosening and infection, especially regarding the femoral components. Scintigraphy may be useful in excluding synovitis and allaying concern in selected patients with chronic articular pain in whom a conventional diagnostic evaluation is unrewarding. Attempts have been made to use radionuclide joint imaging to quantitate the degree of synovitis present in individual joints, particularly the sacroiliac joints. To date, reliable methods that distinguish normal from abnormal joints have not been established, although this remains an area of potential usefulness and active research. Scintigraphy with 99mTc-phosphates is useful in the detection of spinal fracture and pseudoarthrosis in individuals with ankylosing spondylitis.

Topics: Adult; Arthritis; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Gallium Radioisotopes; Humans; Joint Diseases; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis; Osteomyelitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spondylitis, Ankylosing; Synovitis; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

To determine the scintigraphic findings in children with distal femoral defects (or subperiosteal desmoids) the authors retrospectively examined 94 sets of radiographs and technetium-99m pyrophosphate bone scans of 54 children. Twenty-four examples of distal femoral defects were identified in 19 children. Only two children demonstrate focally increased uptake of radionuclide in the distal femur. The positive bone scan was caused by osteomyelitis in one of these patients and by metastatic lymphoma in the other. None of the 17 other children with distal femoral defects on radiography had a corresponding focal increase in uptake of radionuclide. The bone scan appears to be a useful method for confirming that a distal femoral defect is benign and, when positive, indicates the presence of other disease.

Topics: Adolescent; Child; Child, Preschool; Diphosphates; Female; Femoral Neoplasms; Femur; Fibroma; Humans; Knee; Lymphoma; Osteomyelitis; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Adult; Chronic Disease; Diphosphates; Humans; Middle Aged; Osteomyelitis; Pentetic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Pyrophosphate; Tibia

Abdominal 99mTc-pyrophosphate (99mTc-PYP) scans were obtained in 15 neonates: 12 with neonatal necrotizing enterocolitis (NEC), two with osteomyelitis, and one with myocarditis. Ten of the babies with NEC had at least one positive scan; of these 10 studies, seven (Group A) showed both diffuse abdominal uptake and localized hepatic activity, two (Group B) showed abdominal uptake and questionable hepatic uptake, and one (Group C) demonstrated diffuse abdominal uptake only. The other two babies with NEC had normal scans (Group D). Pneumatosis intestinalis was unquestionably present in two patients from Group A and one from Group B. Upon resolution of the clinical findings, all NEC patients had normal scans. A patient with myocarditis had hepatic uptake of 99mTC-PYP while the abdominal scan in the two infants with osteomyelitis was normal. These preliminary observations suggest that further study of a relationship between abdominal scan findings and the course of NEC is warranted.

Topics: Abdomen; Diphosphates; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Liver; Male; Myocarditis; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Scintigraphy is a non-invasive technically simple tool for diagnostic in the head and neck. Using nuclides with a short life time the irradiation of the skeleton is less than 1 rd. Scintigraphy in addition to X-ray examination is useful in diagnosis and surveillance of different osteoplastic tumors (like osteoma, osteoplastoma, cementoma, meningioma) and in systemic diseases of the bones (fibrotic dysplasia, Morbus Paget). Concerning inflammatory diseases osteomyelitis is the main indication for scintigraphy, but it is as well usefull in the diagnosis of complications of inflammatory diseases of the sinuses, like mucocelia or non resorbed antibiotics which provoked an inflammatory reaction of the mucosa. There is no indication for scintigraphy regarding its low specificity in common acute or chronic sinusitis.

Topics: Adult; Aged; Bone Neoplasms; Diagnosis, Differential; Diphosphates; Diphosphonates; Female; Head and Neck Neoplasms; Humans; Male; Middle Aged; Osteolysis; Osteoma; Osteomyelitis; Radionuclide Imaging; Sinusitis; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray

Topics: Adult; Arthropathy, Neurogenic; Diabetic Neuropathies; Diphosphates; False Positive Reactions; Gallium; Gallium Radioisotopes; Humans; Male; Osteomyelitis; Radionuclide Imaging

Fifty-nine patients with suspected osteomyelitis were referred to the Nuclear Medicine Service for bone scanning during a twelve month period. The bone scan correctly identified abnormal sites in 18 of 19 patients with osteomyelitis (sensitivity of 95%) while the radiograph detected only 6 of 19 (sensitivity of 32%). In this clinical setting, the bone scans and radiographs had specificities of 92% and 89% respectively. Technetium-99m phosphate radiopharmaceuticals are superior to the previously used isotopes of fluorine and strontium in that they are readily available, can be imaged with conventional instruments, and allow high quality scans to be completed within 4 h. Routine bone scanning should be performed in patients presenting with suspected osteomyelitis and normal radiographs. The scan can be helpful in confirming or excluding the clinical suspicion and can lead to a more rapid institution of appropriate treatment.

Topics: Acute Disease; Adolescent; Adult; Aged; Bone and Bones; Child; Child, Preschool; Diphosphates; Female; Humans; Infant; Male; Middle Aged; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium

Topics: Acute Disease; Diphosphates; Humans; Osteomyelitis; Radionuclide Imaging; Technetium

A gallium-67/technetium-99m subtraction technique was used with a variable weighting factor. That is, each image was separately set to 100%. Varying amounts of the Tc-99m images were subtracted from those of Ga-67. A total of 95 patients who had radiogallium scanning for suspected inflammatory disease were studied by the subtraction technique. Thirty of these patients had abnormal Tc-99m pyrophosphate bone scans, while 20 had abnormal radiogallium abdominal foci; 45 had defects in liver, spleen, or kidney images. The subtraction technique with variable weighting was highly successful in enhancing hot-spot visibility, and in providing information as to the anatomic location of the defect.

Topics: Abscess; Adult; Arthritis, Infectious; Citrates; Computers; Diphosphates; Female; Gallium Radioisotopes; Humans; Inflammation; Kidney Diseases; Liver Abscess; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Splenic Diseases; Technetium

Six children (7 to 16 years of age) with pelvic osteomyelitis are described. Sites of involvement included the pubis in three patients, the ilium in two patients, and the ischium in one patient. All were right-sided. Each patient presented with a history of fever and an abnormal gait. In four, the point tenderness indicated the site of bony involvement. All patients had pain on abduction but free passive range of motion of the hip. Soft tissue swelling was present on admission pelvic roentgenograms in five patients. Intravenous pyelogram revealed deviation of the bladder toward the midline in each of four patients studied. Roentgenographic changes typical of osteomyelitis developed in four patients ten days to ten weeks after onset of symptoms. In four patients in whom an organism was identified, Staphylococcus aureus was isolated from blood and/or bone. All isolates were methicillin-sensitive and two were penicillin-sensitive. Purulent material was drained from three of the five patients who underwent surgical exploration of the pelvis. All patients received parenteral antistaphylococcal therapy for 3 to 5 1/2 weeks (mean, 4 weeks). Oral antibiotics were given to five patients for an additional 3 to 14 weeks. All patients recovered completely.

Topics: Adolescent; Child; Diphosphates; Female; Humans; Male; Osteomyelitis; Pelvic Bones; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In osteomyelitis, bone-scan findings precede the appearance of bone changes on radiographs. In cases where focal ischemia occurs, the earliest scan finding may be a "cold" area that later becomes "hot" as active periostitis develops.

Topics: Diphosphates; Femur; Humans; Infant; Male; Osteomyelitis; Radionuclide Imaging; Technetium