technetium-tc-99m-medronate and Abscess

To demonstrate the combined use of scintigraphy and ultrasonography (US) in differentiating osteomyelitis from bone infarction in sickle cell disease.. Two patients with sickle cell disease were examined with a combination of bone, bone marrow, white blood cell and/or gallium scintigraphy and US.. The scintigraphic studies demonstrated areas of suspected osteomyelitis at the distal femur in both patients and at the proximal right tibia in one of them. US revealed subperiosteal fluid collections in these areas. Aspiration guided by US established the presence of pus at the femur in both instances, which was successfully treated with the US-guided insertion of a drainage catheter and aspiration only, respectively. Thick blood, due to bone infarction, was aspirated at the tibia.. The scintigraphic studies were useful in locating all areas of suspected osteomyelitis. The role of US was to confirm the presence of a subperiosteal fluid collection and to guide aspiration, which can show the distinction between a haematoma and an abscess.

Topics: Abscess; Adult; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Diagnosis, Differential; Female; Gallium Radioisotopes; Hematoma; Humans; Infarction; Male; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Ultrasonography

The emergence of MRI has challenged the long-standing primacy of skeletal scintigraphy in pediatric cases of suspected acute hematogenous osteomyelitis (AHO) with nondiagnostic radiographs. This study evaluated a strategy in which skeletal scintigraphy is the primary and MRI a supplemental test.. We reviewed the records of 213 children (age range, 8 mo-18 y; mean age, 67 mo) with musculoskeletal symptoms and nondiagnostic radiographs who were referred for skeletal scintigraphy because of the possibility of AHO. MRI was performed when diagnostic uncertainty persisted after skeletal scintigraphy or when abscess was suspected.. Diagnosis was made using skeletal scintigraphy without referral for MRI in 179 (84%) of the children, including 79 (92%) of 86 with a final diagnosis of AHO. In no instance was the diagnosis of AHO indicated only by MRI. Treatment and diagnosis were accomplished without referral for MRI in 146 (69%) of all cases and 46 (53%) of the AHO cases. Abscesses that required drainage were found in 3 (6%) of 48 cases of major-long-bone AHO. Each of these 3 had exhibited a slow therapeutic response before MRI. Drainable abscesses were found in 5 (20%) of 25 cases affecting the pelvis, which was the other preponderant location of AHO. These were found with pelvic foci both when MRI was performed at diagnosis and when MRI was performed during treatment.. An imaging strategy in which skeletal scintigraphy is the first test used when AHO is suspected but radiographs are negative remains highly effective. This approach can be most strongly advocated when symptoms are poorly localized or are localized to major long bones. MRI should be performed after skeletal scintigraphy shows major-long-bone AHO if treatment response is slow. Skeletal scintigraphy is also an appropriate first test for suspected radiographically occult pelvic AHO. Because of the association of abscesses with pelvic AHO, however, the use of MRI should be strongly considered after pelvic AHO is detected, and MRI might be substituted diagnostically for skeletal scintigraphy when symptoms are well localized to the pelvis.

Topics: Abscess; Acute Disease; Bone and Bones; Bone Neoplasms; Child, Preschool; Connective Tissue Diseases; Fractures, Bone; Humans; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Abscess; Aged; Aged, 80 and over; Humans; Intervertebral Disc Displacement; Leukocytes; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Abscess; Adult; Bone and Bones; Diagnosis, Differential; Fistula; Humans; Joints; Magnetic Resonance Imaging; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

Topics: Abscess; Data Display; Humans; Image Enhancement; Lumbar Vertebrae; Male; Middle Aged; Preoperative Care; Psoas Abscess; Radiology, Interventional; Radiopharmaceuticals; Spinal Diseases; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Abscess; Adult; Buttocks; Gallium Radioisotopes; Humans; Male; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Tract Infections

Melioidosis is an infectious disease caused by Pseudomonas pseudomallei. It is seldom diagnosed promptly and, if untreated, can lead to an 80-100% mortality rate. Twenty-eight patients with melioidosis were identified over a 6 year period, and their imaging patterns were analysed. Respiratory infections were the commonest form of presentation, frequently shown as diffuse airspace consolidation, and accounted for the highest mortality. Visceral and musculoskeletal infections were associated with chronicity and a high relapse rate. Multifocal splenic abscesses were a common occurrence. Septic arthritis of the knee was frequently seen. The majority of patients had diabetes mellitus and chronic ill-health. An increased awareness of the disease can contribute to its early detection and appropriate treatment.

Topics: Abscess; Adult; Aged; Diagnostic Imaging; Female; Humans; Lung Diseases; Magnetic Resonance Imaging; Male; Melioidosis; Middle Aged; Pneumonia, Bacterial; Radionuclide Imaging; Retrospective Studies; Splenic Diseases; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

A 9-year-old girl had a 6-month history of left hip pain. Radiographs of the left hip showed a metaphyseal osteolytic lesion with sclerotic borders in the femoral neck. Tc-99m MDP bone imaging and a Ga-67 scan showed focal areas of increased activity in the left femoral neck. These areas of increased uptake corresponded to a lytic area on x-rays, which was due to a Brodie's abscess. The combination of Tc-99m MDP bone and Ga-67 imaging has been widely used in the confirmation of bone infection, increasing the accuracy in the diagnosis of osteomyelitis. However, nuclear scintigraphy has not been previously reported in the confirmation of a Brodie's abscess.

Topics: Abscess; Child, Preschool; Female; Femur Neck; Gallium Radioisotopes; Humans; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Abscess; Aged; Buttocks; Female; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Tuberculosis

Subperiosteal abscess (SA) is a well-known complication of osteomyelitis (OM) in children. The efficiency of treatment of OM with this complication is dependent on early drainage of the abscess. We present a prospective study of 32 children with clinical suspicion of OM. Ultrasonography detected SA in 13 of these children. In nine cases OM with SA was confirmed surgically and in the remaining four other radiographic modalities and/or blood cultures supported the sonographic diagnosis. In the remaining 19 cases, OM without SA was the final diagnosis.

Topics: Abscess; Bone and Bones; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Periosteum; Prospective Studies; Technetium Tc 99m Medronate; Time Factors; Ultrasonography

Although many radiopharmaceuticals are "targeted" for specific tissues or organs, they may be incorporated into nonspecific sites to the extent that they are readily diffusible. There may be local hyperemia with "leaky" neovascularity or capillaries and perhaps also diminished lymphatic or venous removal from the affected area. Two cases are reported in which abscesses were visualized serendipitously. One was visualized on a Tc-99m MDP bone scan following nephrectomy, the other on a patient with a pelvic abscess and nonvisualized left kidney but with enhancement of the rim of a large pelvic abscess.

Topics: Abscess; Adult; Bone and Bones; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Kidney; Organotechnetium Compounds; Pelvis; Radionuclide Imaging; Sugar Acids; Technetium Tc 99m Medronate; Technetium Tc 99m Pentetate

Topics: Abscess; Cervical Vertebrae; Gallium Radioisotopes; Humans; Male; Middle Aged; Nafcillin; Osteomyelitis; Radionuclide Imaging; Staphylococcal Infections; Technetium Tc 99m Medronate

Acute osteomyelitis, soft-tissue infection, or both were experimentally produced in 38 New Zealand white rabbits, and three-phase technetium-99m methylene diphosphonate, gallium-67, and magnetic resonance (MR) images were obtained 7 or 14 days after infection. There was no significant difference between radionuclide studies and MR images in the detection of osteomyelitis, but MR imaging was significantly more sensitive (100% vs. 69%; P less than .01) in the detection of soft-tissue infection. In addition, cellulitis could not be distinguished from soft-tissue abscess on radionuclide studies, whereas MR imaging was 92% accurate in depicting soft-tissue abscesses. Further research is necessary to determine how to relate these findings to true human clinical situations.

Topics: Abscess; Animals; Cellulitis; Gallium Radioisotopes; Magnetic Resonance Imaging; Osteomyelitis; Rabbits; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Abscess; Foot Diseases; Humans; Kidney Diseases; Middle Aged; Radionuclide Imaging; Skin Ulcer; Technetium Tc 99m Medronate

Computerized tomography (CT) was performed in 19 patients with spinal cord injury (SCI) who had large pressure sores and in whom other complications were suspected. CT detected the depth, extent, and degree of undermining of the edges of the pressure sores in 19 of 27 lesions. Conventional radiography detected four cases of pelvic osteomyelitis. CT detected eight additional cases of pelvic osteomyelitis, as well as eight clinically unsuspected peripelvic and intrapelvic abscesses. Technetium-99m bone scanning was not very helpful because of localization in chronic proliferative changes of bone and widespread foci of myositis ossificans, as well as in osteomyelitis. Gallium-67 scanning detected only one of six abscesses. It was not very helpful because of confusion of abscess and osteomyelitis with intense soft tissue swelling and cellulitis, which are often associated with pressure sores in patients with chronic SCI. CT was found to be, by far, the modality of choice for detection of pelvic osteomyelitis and abscess in patients with SCI.

Topics: Abscess; Adolescent; Adult; Biopsy, Needle; Diphosphonates; Gallium Radioisotopes; Humans; Osteomyelitis; Pelvic Bones; Pressure Ulcer; Spinal Cord Injuries; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

Topics: Abscess; Bone and Bones; Child, Preschool; Diagnosis, Differential; Diphosphonates; Female; Gallium Radioisotopes; Humans; Leg; Muscles; Myositis; Neoplasms; Radionuclide Imaging; Staphylococcal Infections; Technetium; Technetium Tc 99m Medronate