technetium-tc-99m-medronate and Acute-Disease

Three-phase bone scintigraphy (TPBS) is an objective diagnostic test for complex regional pain syndrome (CRPS). The diagnostic importance of an increased uptake on the delayed phase has been proven in early CRPS, but that of the vascular and blood pool phases has not. The purpose of this study is to improve the diagnostic strength of the very acute stage of CRPS after stroke through a combined quantitative evaluation of each TPBS phase.. Quantitative TPBS analysis was performed in 26 post-stroke hemiplegic patients with very acute stage of CRPS and in 12 controls with no CRPS after brain lesion. Regions of interest (hands without fingers--carpal bones, metacarpal bones and metacarpopharyngeal joints) were selected and the count ratios of the affected to unaffected sides were calculated.. The maximum values of control in each phase were used as the criteria of positive findings of each TPBS phase. Eleven patients in the vascular phase, 13 in the blood pool phase and 17 in the delayed phase had a higher assumption than the maximum values and a sensitivity of 42.3%, 50% and 65.4%, respectively. Twenty-one of 26 patients were interpreted as abnormal when at least one phase showed a positive finding. As a result, increased sensitivity of 80.8% and identical specificity of 100% were achieved.. These findings suggest that the combination of quantitative evaluation of each TPBS phase can improve the diagnostic strength of the very acute stage of CRPS after stroke.

Topics: Acute Disease; Arthralgia; Bone and Bones; Complex Regional Pain Syndromes; Female; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Outcome Assessment, Health Care; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Stroke; Technetium Tc 99m Medronate

Pancreatic disease can be associated with polyarthritis and panniculitis in a small number of patients, and this triad constitutes PPP syndrome. Early diagnosis is critical as it has high morbidity and mortality. Panniculitis can occur in fat present anywhere in the body. Involvement of fat in bone marrow is relatively uncommon, and radiologic imaging shows osteolytic lesions involving long bones. Here we present a case of acute pancreatitis, referred to our department for evaluation of severe joint pain and multiple bone pain. Tc-MDP scan with SPECT/CT has been done, which showed medullary expansion with heterogenous tracer uptake, that is, moth-eaten appearance.

Topics: Acute Disease; Bone and Bones; Fat Necrosis; Humans; Male; Pain; Pancreatitis; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

Bone and joint infections are common diseases in pediatrics. They still are a public health problem in Tunisia. The diagnosis is based on clinical, biological, radiological and skeletal scintigraphy arguments. The purpose of this study is to determine the contribution of triple phase bone scan in the exploration of musculoskeletal pain febrile child.. This was a descriptive and retrospective study. It was conducted over a period of 5 years. It has interested all children explored in nuclear medicine department with suspected acute osteomyelitis (OMA) , osteoarthritis (OA) or septic arthritis (SA) referred from Orthopaedic Infantile service. All these patients had, alongside the conventional radiologic exams, a triple phase bone scan HMDP-Tc99m.. We collected 62 patients. Among the selected diagnoses, there were: 22 OMA, 4 OA, 4 SA. The mean age of the patients was 5.58 years with a male predominance. The main reason for consultation was pain. Fever was ≥ 38° C in 80 % of cases. The preferential localization was the lower limb (93.5 %). The quantitative and qualitative bone scan abnormalities objectified led to a correct diagnosis of: 18 OMA, 3 OA and 2 SA with a respectively estimated sensitivity and specificity of 76.6% and 90.6% in the all population.. Bone scan demonstrates early abnormalities allowing osteoaricular infection diagnosis. It highlights the infection site, and draws a map of the lesions. Currently, imaging modalities differ in their availability, their cost, their input and diagnostic accuracy but they are complementary.

Topics: Acute Disease; Adolescent; Arthritis, Infectious; Child; Child, Preschool; Female; Fever; Hospitalization; Humans; Infant; Male; Osteoarthritis; Osteomyelitis; Pain; Pain Management; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tunisia

Early diagnosis of acute hematogenous osteomyelitis (AHO) is crucial for effective management and to reduce the potential risk of lifelong deformities in pediatric patients. Both bone scintigraphy and MRI as current diagnostic imaging claim their high sensitivity in early detection of the disease. We present a 9-year-old girl patient with AHO in the distal right tibia, which was demonstrated on bone scintigraphy while a subsequent MRI on the same day was negative.

Topics: Acute Disease; Ankle; Bone and Bones; Child; Female; Humans; Magnetic Resonance Imaging; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Acute Disease; Artifacts; Bone and Bones; Diagnosis, Differential; Humans; Image Enhancement; Indium Radioisotopes; Leukocytes; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Conformal; Technetium Tc 99m Medronate

Topics: Abdomen; Acute Disease; Aged; Diverticulitis, Colonic; Humans; Male; Radiography, Abdominal; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome

Topics: Acute Disease; Bone Neoplasms; Brain Neoplasms; Diagnosis, Differential; Humans; Infarction, Middle Cerebral Artery; Middle Cerebral Artery; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

Calciphylaxis is a rapidly developing, fatal process of vascular calcium deposition with prominent cutaneous manifestation. We treated a long-term haemodialysis patient who developed an analogous disorder limited to the lungs. A 57-year-old man was admitted for initiation of peritoneal dialysis because limited cardiac reserve precluded further haemodialysis. He was treated successfully for pneumonia until hypoxia and progressive hypercalcaemia developed. (99m)Tc-methylene disphosphonate scintigraphy showed diffusely increased pulmonary uptake. Death supervened despite aggressive and successful treatment of hypercalcaemia. Autopsy studies included immunohistochemistry and morphometric studies of bone. Alveolar capillary walls showed diffuse calcium deposition. Both gross and microscopical findings differed from those of typical metastatic calcification in dialysis patients. Immunoreactivity for parathyroid hormone-related protein was present in the lesions. Bone histomorphometry indicated mild osteitis fibrosa. Pneumonia is believed to have caused local synthesis of parathyroid hormone-related protein that, along with high calcium x phosphorus product, contributed to calcium deposition. By analogy with the cutaneous process we termed the deposition "pulmonary calciphylaxis".

Topics: Acute Disease; Calciphylaxis; Fatal Outcome; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Respiratory Insufficiency; Technetium Tc 99m Medronate

We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.

Topics: Acupuncture Therapy; Acute Disease; Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Epidural Abscess; Fever; Gallium Radioisotopes; Humans; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed; Zygapophyseal Joint

Topics: Acute Disease; Aged; Atrial Fibrillation; Female; Hepatitis; Humans; Ischemia; Liver; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated. A bone scan revealed increased blood flow and blood pool activity, with intense midtibial bony uptake in delayed images. These findings are similar to those of acute osteomyelitis. Biopsy revealed bony metastasis from the patient's breast carcinoma.

Topics: Acute Disease; Biopsy; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diagnosis, Differential; Female; Humans; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Whole-Body Irradiation

Topics: Acute Disease; Adult; Arm; Humans; Male; Muscle, Skeletal; Physical Exertion; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Technetium Tc 99m Medronate; Track and Field; Weight Lifting

Tc-99m bone scintigraphy is widely used for evaluation of osseous spread of malignant tumors.. A 60-year-old man had multiple areas of increased uptake on a bone scan in a pattern considered characteristic for extensive metastatic disease. However, a primary neoplasm could not be identified. Finally, acute myelofibrosis--a rare, fatal myeloproliferative syndrome--was diagnosed.. To avoid delays and extensive diagnostic procedures, acute myelofibrosis should be considered in the differential diagnosis of bone scans showing multiple hot spots. In such cases, a diagnosis can be made on an a tissue sample.

Topics: Acute Disease; Adrenal Cortex Hormones; Antineoplastic Agents; Biopsy; Bone Neoplasms; Diagnosis, Differential; Fatal Outcome; Humans; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Primary Myelofibrosis; Radionuclide Imaging; Radiopharmaceuticals; Recombinant Proteins; Technetium Tc 99m Medronate

We evaluated radiolabeled liposomes (liposomes labeled both with 99mTc and 111In) for the early detection of osteomyelitis in an experimental model.. Liposomes, containing 5% polyethylene glycol-distearoyl phosphatidylethanolamine with encapsulated glutathione and deferoxamine, were prepared and labeled with 99mTc and 111In by a previously described method. Acute osteomyelitis was induced in male New Zealand rabbits by intramedullary injection of sodium-morrhuate and Staphylococcus aureus in the tibial bone marrow. Serial imaging studies, consisting of radiolabeled liposome imaging (2-4 mCi 99mTc and 75-125 microCi 111In), 99mTc-methylene diphosphonate (MDP) (3-5 mCi) and 67Ga-citrate (500 microCi), were performed starting at the third day after injection. Each radionuclide study was separated by at least 2 days. The animals also underwent radiography of the lower extremities. The animals were then killed and the infected tibia was excised for histopathology.. For interpreting relative efficacy of individual radiopharmaceuticals, only animals showing positive histopathological findings (n = 9) were considered. Radiographs (Days 12, 13) were conclusive for osteomyelitis in only 3 rabbits. Radiolabeled liposome imaging (Days 4-6) showed positivity in 8 cases and was equivocal in 1. Though the lesion could be delineated as early as 8 hr postinjection in the 99MTc window, the best target-to-nontarget ratio (T/NT) of 1.86 +/- 0.19 was obtained at 48 hr in the 111In window. Three-phase 99mTc-MDP scan (Day 7) was positive in only 5 rabbits with 3 hr T/NT of 1.6 +/- 0.23. Galium-67-citrate images (Days 9-11) were positive in 8 cases and equivocal in 1, the mean 48 hr T/NT being 1.74 +/- 0.24. These results show liposomes are better than 99mTc-MDP for imaging bone infection. Given the early localization and better quality of the images, radiolabeled liposomes also exhibited advantages over 67Ga-citrate for detection of acute osteomyelitis.

Topics: Acute Disease; Animals; Citrates; Gallium; Indium Radioisotopes; Liposomes; Male; Osteomyelitis; Rabbits; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

A series of plain radiographs, bone scans, bone marrow scans, and MRIs is reported in a patient with Gaucher disease type I, in whom two episodes of acute bone crisis developed during a 6-year period of follow-up. Acute bone crisis and global indolent bone marrow displacement could both be assessed by bone marrow scintigraphy, whereas MRI could better clarify the corti-comedullary alteration after bone infarction. Thus, MRI and bone marrow scintigraphy could be used as complementary imaging methods in the management of patients with Gaucher disease.

Topics: Acute Disease; Adult; Biopsy; Bone and Bones; Bone Diseases; Bone Marrow; Diagnostic Imaging; Follow-Up Studies; Gaucher Disease; Humans; Infarction; Magnetic Resonance Imaging; Male; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Nonspecific osteomyelitis in children and adolescents can be diagnosed in patients 2 to 16 years old and may present as acute, subacute or chronic. During the last 9 years, 40 pediatric patients (aged 2 to 16 years) affected with extra-axial inflammatory bone lesions were examined. The series of cases was then reviewed. This work was aimed at investigating the role of various imaging modalities: conventional radiology (CR), bone scan with technetium-99 methylene diphosphonate (99mTc-MDP), scintigraphy with technetium-esamethylpropylenaminoxima labelled leukocytes (99mTc-HMPAO), computed tomography (CT) and magnetic resonance imaging (MRI) were used to detect the lesions, to make a differential diagnosis and to assess different disease stages. As for acute osteomyelitis (6 patients), CR showed a lytic lesion, periosteal new bone and soft tissue swelling in 4/6 patients; no abnormalities were demonstrated in the other two. Bone scan, CT and MRI depicted bone involvement. CT and MRI also showed inflammatory lesion spread to surrounding soft tissue. 99mTc-HMPAO scintigraphy was not performed in acute osteomyelitis, because of technical difficulties in performing the exam promptly; thus, the early diagnosis of lesion nature was made with bone biopsy. As for subacute osteomyelitis (23 patients), 99mTc-HMPAO scintigraphy was performed in 8/23 patients and proved to be a highly sensitive method, showing cell clusters and confirming the diagnosis of inflammatory lesion. MRI showed a focal area of intermediate-low signal intensity on T1-weighted sequences, with small focal intralesional areas of low intensity, a low-signal perifocal rim and diffusely low signal of surrounding bone marrow. T2-weighted images showed high signal intensity in both the abscess lesion and bone marrow, the latter probably due to edema. In 5 patients, a paramagnetic contrast agent (Gd-DTPA) was administered during MRI and showed inhomogeneous enhancement of both the inflammatory lesion and surrounding bone marrow. As for chronic osteomyelitis (7 patients), MRI was performed in 5/7 patients. In 4 patients the lesion appeared as a low-signal area on T1-weighted images while T2-weighted images showed an inhomogeneous high-signal area. In the same patients, 99mTc-HMPAO scintigraphy was always positive. In patient 5, the lesion was represented by a low-signal area on both T1 and T2-weighted images, while 99mTc-HMPAO was negative. Therefore, in chronic osteomyelitis, both MRI and 99mTc-HMPAO wer

Topics: Acute Disease; Adolescent; Biopsy; Bone and Bones; Child; Child, Preschool; Chronic Disease; Contrast Media; Female; Gadolinium; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Organometallic Compounds; Organotechnetium Compounds; Osteomyelitis; Oximes; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Magnetic resonance imaging of 14 histopathologically confirmed cases of osteomyelitis of the mandible was retrospectively reviewed. The findings of magnetic resonance imaging were compared with conventional radiography, computed tomography, bone scintigraphy, and histopathologic examinations. All lesions in bone marrow were shown as areas of low (64%) or low-to-intermediate (36%) signal intensity on T1-weighted images, and areas of high (29%), mixed (high and low, 21%; high and intermediate, 36%) or low (14%) signal intensity on T2-weighted images. Histopathologically, high T2-weighted signal intensity areas that showed enhancement after contrast injection corresponded to active infection. These were not collections of pus but were predominantly areas of granulation tissue. Magnetic resonance imaging showed larger areas of abnormality than plain radiography or computed tomography. Bone scintigraphy did not accurately reveal the locations of lesions but showed heterogeneous increased uptake in all patients. MRI was an extremely useful technique for assessing osteomyelitis of the mandible.

Topics: Acute Disease; Adult; Chronic Disease; Female; Fourier Analysis; Humans; Magnetic Resonance Imaging; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Eighty-nine Technetium-99m-MDP scans performed between January 1987 and June 1990 at the Leicester Royal Infirmary were reviewed with regard to the indication, patient outcome and value of the scans in the patients' management. The significant finding was the value of a normal scan in the management of children with chronic pain.

Topics: Acute Disease; Adolescent; Bone and Bones; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Chronic Disease; Humans; Infant; Medical Audit; Osteomyelitis; Pain; Radionuclide Imaging; Sarcoma, Ewing; Synovitis; Technetium Tc 99m Medronate

Radiolabeled granulocyte scintigraphy is a recently introduced technique for detecting osteoarticular infections. Technetium-99m-labeled hexamethylpropylamineoxime (HMPAO), in use since 1986, provides excellent resolution with less radiation exposure than indium-111. Elimination of lymphocytes provides further improvements in image quality and safety, making the technique suitable for use in children. The authors prospectively studied 30 scintigraphies performed with isolated autologous 99mTc-HMPAO-labeled granulocytes to evaluate suspected osteoarticular infection. Image quality was outstanding. In peripheral sites, infection manifested as a focus of increased uptake visible in all three phases (30 min, 3 hours and 18 hours after the injection). Performance was excellent, with 11 true-positive scans, 14 true negative scans, 4 false-positive scans (including two ascribable to recent surgery), and one false-negative scan. Among the 28 evaluable cases, positive predictive value was 85%, negative predictive value was 90%, and sensitivity, specificity, and accuracy were 92%, 88%, and 89%, respectively. The only limitation to routine use of this technique is the need for in vitro granulocyte separation which is time-consuming and requires special precautions to preserve granulocyte function. Nevertheless, these data demonstrate that 99mTc-HMPAO-labeled granulocyte scintigraphy is of value for the detection of osteoarticular infections in patients without chronic inflammatory joint disease.

Topics: Acute Disease; Adolescent; Adult; Aged; Bacterial Infections; Child; Chronic Disease; Extremities; Female; Granulocytes; Humans; Male; Middle Aged; Osteoarthritis; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

A 85-year-old man was admitted with a history of right upper arm pain following trauma. Laboratory studies included an initial CPK level of 5,385 IU/liter. Other laboratory values were GOT, 114 IU/L; LDH, 701 IU/L; myoglobin, 1,100 ng/ml; aldolase, 13.8 IU/L. The patient was presumed to have have rhabdomyolysis. A 99mTc-hydroxy methylene diphosphonate (99mTc-HMDP) scan revealed an increased uptake in the right shoulder area. 99mTc-HMDP scan is a sensitive indicator of local skeletal muscle injury in rhabdomyolysis.

Topics: Acute Disease; Aged; Aged, 80 and over; Arm; Humans; Male; Muscles; Radionuclide Imaging; Rhabdomyolysis; Technetium Tc 99m Medronate

Despite hyperemia in the blood-pool phase of bone scintigraphy with 99mTc-MDP there was an decreased concentration of the nuclide in a 7-year-old boy with acute osteomyelitis of the femur. In addition to inflammatory destruction of the bone tissue, the other reason for this surprising scintigraphic finding might be a reduced blood flow because of thrombotic occlusion or compression of bone-supplying vessels.

Topics: Acute Disease; Child; Femur; Humans; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The authors describe a patient with acute rheumatic fever and polyarthritis in whom scintigraphy unexpectedly identified Tc-99m MDP uptake in the diaphyses of both tibiae. A dramatic rise in antistreptolysin-O titer and rapid resolution of tibial abnormalities paralleled marked articular improvement. Magnetic resonance imaging demonstrated a pattern consistent with marrow edema in the area of abnormal Tc-99m MDP accumulation. This finding has not been previously described in acute rheumatic fever, and it was suspected that the changes in the tibiae resulted from subclinical diaphyseal hyperemia from the inflammatory process observed in the contiguous joints.

Topics: Acute Disease; Adult; Bone Marrow Diseases; Edema; Female; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Rheumatic Fever; Technetium Tc 99m Medronate; Tibia; Time Factors

Multifocal osteomyelitis is considered an uncommon complication of acute osteomyelitis. Over a 3-year period, 136 infants and children who had a final diagnosis of acute osteomyelitis were reviewed, and multifocal osteomyelitis was detected in 27 (19%) patients. The major age peak of acute osteomyelitis was between 6 weeks and 3 years (46%). Two age peaks were found for multifocal disease-less than 6 weeks (38%), and 9 to 12 years (44%). Three patients with multifocal disease had septicemia and photon-deficient areas on bone scans. Another adolescent group had nonspecific bone and joint pain that in some cases persisted for more than 3 months and were finally diagnosed as multifocal osteomyelitis. Organisms were isolated in 15/27 (56%). Multifocal osteomyelitis is well recognized in the neonatel age group. However, it occurs more commonly than previously described in older patients. This higher incidence can most likely be attributed to the higher use of the radionuclide bone scan early in the disease and the high sensitivity of the scan for the detection of osteomyelitis.

Topics: Acute Disease; Adolescent; Australia; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Osteomyelitis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

This article describes a 28-yr-old black man with sickle cell anemia who presented with severe chest pain secondary to acute infarction of the body of the sternum, hypoventilation, and hypoxemia with no evidence of acute chest syndrome. A bone scan performed 5 days after admission revealed increased uptake in the sternum, suggesting sternal infarction. Repeat bone scan performed 2 mo later demonstrated normal concentration in the sternum.

Topics: Acute Disease; Adult; Anemia, Sickle Cell; Chest Pain; Humans; Hypoxia; Infarction; Male; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

A 6-year-old boy presented with an inflammatory syndrome. Because Tc-99m MDP bone scintigraphy revealed increased tracer uptake at the upper pole of the right kidney, further studies were oriented towards a diagnosis of renal or adrenal pathology. I-123 metaiodobenzylguanidine (MIBG) accumulated at the site of the abnormal MDP uptake. The diagnosis of neuroblastoma or allied disorder was excluded on the basis of other investigations and further evaluation, suggesting that the MIBG uptake was a false-positive. Findings on clinical imaging, laboratory findings, Tc-99m DMSA imaging, sonography, and CT scanning were highly suggestive of acute focal pyelonephritis.

Topics: 3-Iodobenzylguanidine; Acute Disease; Child; Humans; Iodine Radioisotopes; Iodobenzenes; Kidney; Male; Pyelonephritis; Radionuclide Imaging; Technetium Tc 99m Medronate

45 children presenting with acute hip pain were prospectively evaluated with conventional radiography, radioisotope bone scan, and magnetic resonance imaging (MRI). The final diagnoses were transient synovitis (n = 17), septic arthritis (n = 2), Legg-Calve-Perthes disease (LCPD, n = 13), epiphyseal dysplasia (n = 2), other conditions (n = 4), and normal findings (n = 7). In the work-up MRI provided more morphologic information than other techniques and enlarged the diagnostic possibilities. It was the only imaging technique able to give an early indication of bone marrow involvement in systemic diseases. For the early diagnosis of LCPD, MRI was as sensitive as isotope bone scan and more precise than conventional radiography. In the follow-up of LCPD patients MRI was not able to indicate the start of revascularisation of the necrotic area, which bone scans showed reliably in six patients: but MRI provided excellent evaluation of the position, form and size of the femoral head and the surrounding soft tissues.

Topics: Acute Disease; Arthritis, Infectious; Child; Child, Preschool; Chondrodysplasia Punctata; Female; Femur Head Necrosis; Hip Joint; Humans; Legg-Calve-Perthes Disease; Magnetic Resonance Imaging; Male; Pain; Prospective Studies; Radionuclide Imaging; Synovitis; Technetium Tc 99m Medronate

Acute myelofibrosis is a rare hematologic malignancy which usually follows a rapidly progressive, fatal course. A case of acute myelofibrosis and severe focal bone pain is described showing bone scan and plain radiograph findings. A biopsy of one of the abnormal bony areas revealed malignant cells, necrosis and fibrosis, and abnormal, exuberant new bone formation, which may account for what is seen on the radiographic and radionuclide studies. The etiology and optimal management of this rare and often rapidly fatal disease remain to be defined.

Topics: Acute Disease; Adult; Humans; Male; Primary Myelofibrosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Brucellosis is an endemic disease in the Middle East. Its incidence in Kuwait has increased during the last 5 years. Bone and joint involvement causes major symptoms and disabilities. Radionuclide bone scans are more sensitive than radiographs in detecting these lesions. The aim of this study is to describe the abnormal patterns detected on bone imaging in acute and chronic brucellosis. Tc-99m MDP bone scans of 56 patients with established diagnosis of brucellosis (19 acute and 37 chronic) were retrospectively analyzed. Bone scans were positive in 8 of 19 patients (42%) with acute brucellosis and in 28 of 37 patients (76%) with chronic brucellosis. Six patterns were observed: involvement of an entire body of one or more vertebrae, especially at the lumbar region (50%); sacroiliitis (41%); focal high uptake at the junction of the upper and lateral margins of the vertebra "Caries sign" (27%); multiple costovertebral joints and costochondral junction involvement (19%); involvement of large joints similar to degenerative osteoarthritis (25%); and focal involvement of long bone (11%).

Topics: Acute Disease; Adult; Back Pain; Bone Diseases; Brucellosis; Chronic Disease; Female; Humans; Joint Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Differentiation of occult skeletal injuries from early acute osteomyelitis in infants and young children is important clinically. The Tc-99m MDP scintigraphic findings in six patients who had occult femoral or tibial fractures were reviewed. The images obtained early (at 1-4 days from the onset of symptoms) shared the common characteristic finding of a subtle but definite, generalized increased uptake of the tracer along the entire length of the injured bone. This pattern of uptake was similar regardless of the type of fracture. These were different from the focal abnormalities that have been observed in early acute osteomyelitis. In the absence of an extensive cellulitis or a vascular occlusive disease, a bone image showing a mild diffuse uniform increased uptake along the entire length of the tibia or femur in infants and young children with lower extremity pain of less than 1 week's duration should suggest the diagnosis of occult skeletal fractures.

Topics: Acute Disease; Diagnosis, Differential; Female; Femoral Fractures; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors

Tc-99m MDP three-phase bone imaging demonstrated the acute hyperemic inflammatory soft tissue phase of radiation injury to the hand in a patient receiving radiation therapy to bone lesions of multiple myeloma.

Topics: Acute Disease; Adult; Hand; Humans; Hyperemia; Inflammation; Male; Radionuclide Imaging; Radiotherapy; Technetium Tc 99m Medronate

Topics: Acute Disease; Bone and Bones; Female; Humans; Middle Aged; Myositis; Radionuclide Imaging; Rhabdomyolysis; Technetium Tc 99m Medronate

A noninvasive radionuclide technique to visualize ischemic small intestine was evaluated. Vascular ligation of 20-30 cm ileum was done in rabbits. After induction of ischemia, technetium (99mTc) methylene diphosphonate (TMDP) was injected IV at intervals up to 24 hours. Images were recorded 1 and 3 hours after injection of radioisotope and showed preferential (9:1) uptake by ischemic bowel. Positive scans were present in all animals up to 4 hours and in 75% at 10-12 hours, but in none 24 hours after induction of ischemia. Nonocclusive intestinal ischemia was simulated in 4 dogs by infusing norepinephrine into a jejunal mesenteric arterial branch. After 1 hour, an IV bolus of TMDP was injected and images recorded at intervals up to 3 hours. Selective uptake of isotope by the ischemic segment was observed in all animals. Angiography confirmed that isotope uptake was confined to the infused segment. These studies show that occlusive intestinal ischemia can be detected, by radionuclide imaging up to 12 hours, and nonocclusive (low flow) ischemia for at least 4 hours, after onset.

Topics: Acute Disease; Animals; Arterial Occlusive Diseases; Disease Models, Animal; Dogs; Evaluation Studies as Topic; Ileum; Ischemia; Jejunum; Rabbits; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Nine children over 20 months of age had acute osteomyelitis of the epiphysis of a long bone. The clinical features varied, but all of the patients had pain at the infected site and an elevated erythrocyte sedimentation rate. The distal femur was involved in seven cases, the proximal tibia in two, and the proximal humerus in one. In two patients there was a contiguous metaphyseal lesion, while the other seven patients (eight sites) had lesions limited to the epiphysis. Bone scintigraphy clearly identified the infected sites in all seven patients in whom it was performed, and allowed an early diagnosis in four cases. Radiographs showed a lytic lesion of the epiphysis that corresponded to the scintigraphic findings in all cases. The vascular supply to the epiphysis and the microscopic structure of the epiphyseal venous sinusoids provide locations that favor lodgement of blood-borne organisms. The epiphysis of the child should be recognized as another site of hematogenous osteomyelitis.

Topics: Acute Disease; Blood Sedimentation; Child; Child, Preschool; Diphosphonates; Epiphyses; Female; Femur; Humans; Infant; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Early detection of an inflammatory process involving bone and joints is very important in children with extremity pain. We reviewed the efficacy and pitfalls of three-phase bone scans in 100 consecutive children with acute extremity pain. Sixty-one of the subjects showed abnormalities on bone scans. The sensitivity and specificity of three-phase bone scans for acute osteomyelitis were 84% and 97%, respectively. Sensitivity and specificity for both acute septic joint and cellulitis were 93% and 100%, respectively. Pitfalls in interpretation of three-phase bone scans include simulation of infection by fracture and obscuration of osteomyelitis by septic arthritis, prior antibiotic treatment, and the occasional "cold" defect due to ischemia.

Topics: Acute Disease; Adolescent; Arthritis, Infectious; Bone and Bones; Cellulitis; Child; Child, Preschool; Extremities; Female; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of massive hepatic necrosis has been found to have intense, diffuse accumulation of Tc-99m HMDP in the liver. A review of three similar cases revealed that diffuse intense uptake of bone-scanning agents is a grave prognostic sign.

Topics: Acute Disease; Adult; Bone and Bones; Humans; Liver; Male; Necrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Studies with gallium-67 and three-phase bone imaging (TPBS), though very sensitive, are not very specific in evaluating suspected osteomyelitis (OM) that is superimposed upon other diseases causing increased bone turnover. A total of 57 patients with suspected OM were studied; this included 48 with increased bone turnover. All of the patients were studied with granulocytes labeled with In-111 acetylacetone (In-111 GRAN), TPBS and 29 of these patients had Ga-67 studies as well. In-111 GRAN had a sensitivity of 100% in acute OM and 60% in chronic OM, with a specificity of 96%. Gallium-67 was excellent in ruling out OM when the study was normal, or in ruling in OM when the relative uptake of Ga-67 exceeded the uptake of Tc-99m MDP, or when the Ga-67 in bone had a different distribution from the TPBS. Unfortunately, these criteria were met in only 28% of our subjects. We conclude that when added to TPBS, the In-111 GRAN study plays an important role in detecting complicating OM.

Topics: Acute Disease; Adolescent; Adult; Aged; Arthritis; Bone and Bones; Chronic Disease; Diphosphonates; Female; Fractures, Bone; Gallium Radioisotopes; Granulocytes; Humans; Indium; Male; Middle Aged; Osteomyelitis; Prostheses and Implants; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Thirty-nine bone scans were performed in children (1 week - 14 years of age), with symptoms and signs of acute osteomyelitis. All but two scintigrams were obtained within the first week of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative. Nevertheless, four patients developed characteristic radiological signs of osteomyelitis. In one of these four cases a decreased uptake ("cold" lesion) in the scintigram was over-looked. In spite of surgical drainage the patient developed chronic osteomyelitis. It is concluded that bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram, however, does not exclude this diagnosis. A "cold" lesion may indicate a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Bone and Bones; Child; Child, Preschool; Diagnosis, Differential; Diphosphonates; Female; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Sepsis; Technetium; Technetium Tc 99m Medronate

A clinical comparison between a new bone seeking radiopharmaceutical, Tc-99m hydroxymethylene diphosphonate (TcHMDP) and the standard agent, Tc-99m pyrophosphate (TcPPi), was performed in 18 patients with acute myocardial infarction. Each patient was imaged initially with either TcHMDP or TcPPi, and imaged 24 hr later with the other tracer. All 18 patients had images positive for acute myocardial infarction with TcPPi, whereas 16 of 18 patients (89%) had positive studies with TcHMDP. The TcPPi images were graded significantly superior to those obtained with TcHMDP in 61% of the patients, and they were equal in 33%. In only one patient (6%) was TcHMDP better. The results indicate that compared with TcHMDP, TcPPi not only has a superior sensitivity for acute myocardial infarction but also has a significantly increased intensity of uptake in positive areas. TcPPi remains the agent of choice for myocardial infarct imaging.

Topics: Acute Disease; Diphosphates; Diphosphonates; Heart; Humans; Myocardial Infarction; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Technetium-99m hydroxymethylene diphosphonate (Tc-99M HMDP) is a new diphosphonate skeletal imaging agent. Animal studies show that Tc-99m HMDP has a higher uptake on bone and a more rapid clearance from the blood than any of the three technetium-labeled bone imaging agents in current use: Tc-99m methylene diphosphonate (DMP), Tc-99 (1-hydroxyethylidene) diphosphonate (HEDP), and Tc-99m pyrophosphate (PPi). On the basis of these animal studies, Tc-99m HMDP is a highly promising candidate for skeletal imaging.

Topics: Acute Disease; Animals; Bone and Bones; Diphosphates; Diphosphonates; Dogs; Etidronic Acid; Guinea Pigs; Injections, Intravenous; Myocardial Infarction; Organotechnetium Compounds; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors; Tissue Distribution