technetium-tc-99m-medronate and Arthralgia

The purpose was to evaluate the intra- and inter-observer reliability of combined quantitative 3D-volumetric single-photon emission computed tomography (SPECT)/CT analysis including size, intensity and localisation of tracer uptake regions and total knee arthroplasty (TKA) position.. Tc-99m-HDP-SPECT/CT of 100 knees after TKA were prospectively analysed. The anatomical areas represented by a previously validated localisation scheme were 3D-volumetrically analysed. The maximum intensity was recorded for each anatomical area. Ratios between the respective value and the mid-shaft of the femur as the reference were calculated. Femoral and tibial TKA position (varus-valgus, flexion-extension, internal rotation- external rotation) were determined on 3D-CT. Two consultant radiologists/nuclear medicine physicians interpreted the SPECT/CTs twice with a 2-week interval. The inter- and intra-observer reliability was determined (ICCs). Kappa values were calculated for the area with the highest tracer uptake between the observers.. The measurements of tracer uptake intensity showed excellent inter- and intra-observer reliabilities for all regions (tibia, femur and patella). Only the tibial shaft area showed ICCs <0.89. The kappa values were almost perfect (0.856, p < 0.001; 95 % CI 0.778, 0.922). For measurements of the TKA position, there was strong agreement within and between the readings of the two observers; the ICCs for the orientation of TKA components for inter- and intra-observer reliability were nearly perfect (ICCs >0.84).. This combined 3D-volumetric standardised method of analysing the location, size and the intensity of SPECT/CT tracer uptake regions ("hotspots") and the determination of the TKA position was highly reliable and represents a novel promising approach to biomechanics.

Topics: Adult; Arthralgia; Arthroplasty, Replacement, Knee; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Knee Joint; Male; Multimodal Imaging; Observer Variation; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

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

This study attempted to compare the radiopharmaceutical uptake findings of planar bone scintigraphy (BS) and single photon emission computed tomography (SPECT)/computed tomography (CT) performed on knee joints.. The uptake grades assessed visually on the planar images differed significantly from the uptake grades on SPECT/CT images in all areas of the knee (all p < 0.001), and SPECT/CT imaging revealed a larger number of uptake lesions than those noted in planar imaging for each patient (3.3 ± 2.0 vs 2.4 ± 2.3, p < 0.0001). In all regions of the knee, all of the quantitative values, including uptake counts obtained from the planar image as well as the maximum SUV (SUVmax) and mean SUV (SUVmean) obtained from SPECT/CT, showed statistically higher values as their visual grades increased (all p < 0.001). However, when analyzed for each area, only the SUVmax showed a significant difference by grade in all knee regions. Quantitative uptake values obtained from planar images were moderately correlated with SUVs of SPECT/CT images (r = 0.58 for SUVmean and r = 0.53 for SUVmax, all p < 0.001) in the total knee regions. Looking at each area, there was a significant but low correlation between the uptake counts of the planar images and the SUVs on SPECT/CT in the right lateral tibial region (r = 0.45 for SUVmean, r = 0.31 for SUVmax, all p < 0.001).. In assessing knee joints, the findings of planar images and SPECT/CT images differ both visually and quantitatively, and more lesions can be found in SPECT/CT than in the planar images. The SUVmax could be a reliable value to evaluate knee joint uptake activity.

Topics: Arthralgia; Bone and Bones; Femur; Humans; Knee Joint; Patella; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Tibia

Both osteoarthritis and impingement syndrome are the disorders commonly observed in sports medicine. However, failure in pain alleviation by surgical intervention introduces challenges in the diagnosis and decision-making for orthopedists. Hybrid single photon emission computed tomography/computed tomography (SPECT/CT) provides both functional and structural information of ankle pathology. The purpose of this retrospective study was to evaluate whether bone tracer uptake by ankle SPECT/CT is related to the lesion type and visual analog scale (VAS) pain score for patients with osteoarthritis and bony impingement. Fifty individuals with chronic ankle pain who underwent pretreatment ankle SPECT/CT were included in the current study. The median follow-up period was 2.5 (range 1.8 to 3.2) years. The lesion types were categorized by the positions of anatomical changes and bone tracer uptake. The VAS pain score was recorded 2 weeks before and 1.5 year after surgical intervention. Twenty-nine (58%) of 50 patients had osseous impingement. Among them, 16 (55.2%), 4 (13.8%), and 9 (31%) patients had anterior, posterior, and both types of ankle impingement, respectively. The uptake grade of bone tracer was significantly related to the lesion type of ankle impingement (p < .001). The VAS pain score was significantly correlated with bone tracer uptake before treatment (p < .001). Bone tracer uptake was related to the lesion type of impingement detected by SPECT/CT and was confirmed by surgical findings. The VAS pain score was significantly correlated with the bone tracer uptake. Preoperative ankle SPECT/CT may be helpful to clinically correlate the VAS pain score in the pre- and postsurgical periods for patients with osteoarthritis and bony impingement syndrome.

Topics: Adult; Aged; Aged, 80 and over; Ankle Joint; Arthralgia; Female; Fluorodeoxyglucose F18; Humans; Joint Diseases; Male; Middle Aged; Osteoarthritis; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Visual Analog Scale; Young Adult

The study aims to evaluate whether bone scintigraphy is effective in diagnosing temporomandibular joint (TMJ) osteoarthritis (OA) in juvenile patients. A retrospective study was conducted with 356 consecutive patients with TMJ-OA who were clinically assessed according to the Research Diagnostic Criteria for Temporomandibular Disorders. Patients were assigned to three groups based on their ages: Group 1: aged 12-16 years; Group 2: aged 17-19 years; and Group 3: aged 20 years. Additionally, we performed qualitative and quantitative analyses of bone scintigraphy images for the TMJ uptake ratio of the involved joint. The diagnostic rate of TMJ-OA (

Topics: Adolescent; Arthralgia; Child; Cone-Beam Computed Tomography; Female; Humans; Male; Osteoarthritis; Pain Measurement; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

To assess the relationship of subchondral bone tracer uptake (BTU) on SPECT/CT and meniscal pathologies on MRI in patients with painful knees.. Twenty-five patients who had MRI and SPECT/CT within 3 months without knee surgery or grade ≥3 cartilage lesions were prospectively included. Maximum values of each subchondral femorotibial area were quantified and a ratio was calculated in relation to a femoral shaft reference region, which represented the BTU background activity. Meniscal lesions were graded (intact/degeneration/tear) and meniscal extrusion (no/yes) was assessed using MRI by two musculoskeletal radiologists blinded to the SPECT/CT findings. One-tailed Spearman correlations served for statistics (p < 0.05).. Knees with meniscal degeneration or tear showed a significantly higher BTU in the medial femorotibial compartment (p = 0.045) when compared to intact menisci. Meniscal degeneration was associated with an increased BTU in the lateral femorotibial compartment; however, this was not statistically significant (p = 0.143). Patients with an extruded meniscus showed significantly higher BTU compared to a non-extruded meniscus (p < 0.020).. Medial femorotibial BTU in SPECT/CT was associated with meniscal pathologies. Highest BTU was found in patients with meniscal tears. SPECT/CT appears to be a useful imaging modality to identify patients with overloading or early osteoarthritis.. • Meniscal degeneration and tears correlate significantly with increased BTU using SPECT/CT. • Medial meniscus extrusion is associated with an increased BTU in SPECT/CT. • SPECT/CT allows detection of overloading and early osteoarthritis.

Topics: Adult; Aged; Arthralgia; Female; Follow-Up Studies; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Menisci, Tibial; Meniscus; Middle Aged; Osteoarthritis, Knee; Positron Emission Tomography Computed Tomography; Prospective Studies; Radiopharmaceuticals; ROC Curve; Technetium Tc 99m Medronate; Young Adult

As patellar tracking and loading is influenced by tibial tuberosity and trochlear groove (TT-TG) distance, patellar height, thickness and tilt as well as TKA component position, it was our hypothesis that these parameters significantly correlate with patellar BTU intensity and localization in SPECT/CT. The purpose of the study was to investigate whether TKA component position as well as the height, thickness and tilt of the unresurfaced patella influences the intensity and the distribution pattern of BTU in SPECT/CT.. A total of 62 consecutive patients who underwent primary TKA without patellar resurfacing were prospectively included. Demographic data such as age, gender, side and type of primary TKA were noted. All patients underwent clinical and radiological examination in a specialized knee clinic, including standardized radiographs (anterior-posterior and lateral weight bearing, patellar skyline view) and Tc-99m-HDP-SPECT/CT before, 12 and 24 months after TKA. SPECT/CT images were analysed on 3D reconstructed images. Rotational, sagittal and coronal position of the tibial and femoral TKA components was assessed using a previously validated analysis software. Measurements of BTU including intensity and anatomical distribution pattern were also performed from 3D data. The patellar height, thickness and tilt were measured, and the distance between TT and TG was measured using axial CT images. Univariate analysis was performed to identify any correlations between BTU and TKA component position and patellar measurements (p < 0.05).. The highest median BTU was measured in the superior posterior parts of the patella. A statistically significant correlation was found between valgus alignment of the femoral TKA and increased BTU at the lateral patellar regions (p < 0.05). External rotation of the tibial TKA correlated with increased BTU at the lateral superior joint adjacent part (p < 0.05). No correlation was found between the tibial TKA position (varus-valgus, anterior and posterior slope), TT-TG distance, patellar height and patellar BTU values.. A significant correlation of increased patellar BTU was found with femoral valgus TKA alignment. These findings highlight the importance of femoral TKA position in coronal plane with regard to post-operative patellar tracking. Moreover, these facts might explain anterior knee pain in unhappy TKA with femoral valgus alignment.. Diagnostic study, Level II.

Topics: Adult; Aged; Aged, 80 and over; Arthralgia; Arthroplasty, Replacement, Knee; Female; Femur; Humans; Imaging, Three-Dimensional; Knee Joint; Male; Middle Aged; Patella; Postoperative Complications; Rotation; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Tibia

In this study, we aimed to evaluate the contribution of single-photon emission computerized tomography/computed tomography (SPECT/CT) to three-phase planar bone scintigraphy/SPECT in the assessment of aseptic and septic prosthesis loosening in patients with painful hip and knee prostheses.. Fifty patients who had undergone arthroplasties (20 hips and 30 knees) and were suspected to have complications and had undergone revision surgery were included in this study. Technetium-99m methylene diphosphonate three-phase bone scintigraphy and SPECT/CT were performed at the region of prostheses in all patients. Planar bone/SPECT and SPECT/CT images were separately assessed by two nuclear medicine physicians. SPECT/CT findings were compared with the findings of planar images/SPECT. Both planar bone scan/SPECT and SPECT/CT findings were divided into three groups: aseptic loosening, septic loosening, and miscellaneous. In all patients, scintigraphic diagnosis was confirmed by surgical findings.. SPECT/CT changed the diagnosis and treatment plan in 8/50 (16%) patients. SPECT/CT was significantly better than planar scan/SPECT imaging for the diagnosis of aseptic and septic loosening in both joints (κ value: 0.477 for planar scan/SPECT; κ value: 0.717 for SPECT/CT). Moreover, both planar scan/SPECT and SPECT/CT were statistically successful in knee prostheses than in hip prostheses (κ value: 0.271 vs. 0.579 for planar/SPECT; κ value: 0.579 vs. 0.80 for SPECT/CT). For the hip, SPECT/CT was successful on the acetabular component than on the femoral component. For the knee, the results of SPECT/CT were similar for the femoral and tibial components.. SPECT/CT increases diagnostic accuracy in the evaluation of aseptic and septic loosening in hip and knee prostheses compared with three-phase bone scintigraphy/SPECT.

Topics: Adult; Aged; Aged, 80 and over; Arthralgia; Bone and Bones; Female; Hip Prosthesis; Humans; Knee Prosthesis; Male; Middle Aged; Multimodal Imaging; Prosthesis Failure; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The objective of this study was to evaluate the usefulness of bone scan procedures for the diagnosis of temporomandibular joint (TMJ) osteoarthritis.. From February 2009 to June 2009, 22 patients (4 males and 18 females) from Seoul National University Bundang Hospital, Republic of Korea, were diagnosed with TMJ disorder. They were examined by clinical examination, plain radiograph and bone scan and were categorized into three groups: normal, internal derangement and osteoarthritis. TMJ uptake ratios and asymmetrical indices were calculated.. There were no significant differences in uptake ratios associated with pain and bone change. However, significant results were obtained when comparing uptake ratios between the osteoarthritis and non-osteoarthritis groups.. It was concluded from this study that bone scans may help to diagnose osteoarthritis when increased uptake ratios are observed.

Topics: Adolescent; Adult; Aged; Arthralgia; Facial Pain; Female; Humans; Image Processing, Computer-Assisted; Joint Dislocations; Male; Middle Aged; Osteoarthritis; Parietal Bone; Physical Examination; Radiography, Panoramic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint Disorders; Young Adult

The objective of this study was to correlate chronic medial knee pain at rest and during exercise with bone scintigraphic uptake, bone marrow edema pattern (BMEP), cartilage lesions, meniscal tears, and collateral ligament pathologies on magnetic resonance MR imaging (MRI).. Fifty consecutive patients with chronic medial knee pain seen at our institute were included in our study. Pain level at rest and during exercise was assessed using a visual analog scale (VAS). On MR images, BMEP volume was measured, and the integrity of femoro-tibial cartilage, medial meniscus, and medial collateral ligament (MCL) were assessed. Semiquantitative scintigraphic tracer uptake was measured. Multivariate linear regression analysis was performed.. At the day of examination, 40 patients reported medial knee pain at rest, 49 when climbing stairs (at rest mean VAS 33 mm, range 0-80 mm; climbing stairs mean VAS, 60 mm, range 20-100 mm). Bone scintigraphy showed increased tracer uptake in 36 patients (uptake factor, average 3.7, range 2.4-18.0). MRI showed BMEP in 31 studies (mean volume, 4,070 mm(3); range, 1,200-39,200 mm(3)). All patients with BMEP had abnormal bone scintigraphy. Ten percent of patients with pain at rest and 8% of patients with pain during exercise showed no BMEP but tracer uptake in scintigraphy. Tracer uptake and signal change around MCL predicted pain at rest significantly (tracer uptake p = 0.004; MCL signal changes p = 0.002). Only MCL signal changes predicted pain during exercise significantly (p = 0.001).. In chronic medial knee pain, increased tracer uptake in bone scintigraphy is more sensitive for medial knee pain than BMEP on MRI. Pain levels at rest and during exercise correlate with signal changes in and around the MCL.

Topics: Adult; Aged; Arthralgia; Chronic Disease; Exercise Test; Female; Humans; Knee Injuries; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Rest; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Arthralgia; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Osteonecrosis; Radiopharmaceuticals; Talus; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Aged; Arthralgia; Bone and Bones; Female; Humans; Joints; Radionuclide Imaging; Radiopharmaceuticals; Schnitzler Syndrome; Technetium Tc 99m Medronate

To study the clinical hand findings in Behçet's disease (BD) and to observe scintigraphic changes of these areas.. Fifty-seven randomly selected BD patients and the patients in the control group (N=40) were evaluated by two blind rheumatologists. The hands were examined for the presence of pain, tenderness, swelling, effusion, erythema, warmth, range of motion and limitation of motion, deformities and muscle atrophy. Then scintigraphic examination of the hands was performed. Control hand scintigrams were obtained from 40 age- and sex-matched patients and were examined by the same two observers.. Thirty-two of the 57 patients (56.1%) showed Behçet's clinical hand findings. Terminal phalangeal pulp atrophy was observed in 17 (29.81%), rheumatoid-like hand findings were observed in 16 (28.1%), dorsal interosseos atrophy was observed in 12 (20.05%) and erythema over the digits was observed in 12 (20.05%). Twenty-four patients (42.1%) had scintigraphic involvement. The disease duration was observed to be an important factor for hand findings (P=0.040) and scintigraphic involvement (P=0.011).. High prevalence of hand involvement in BD and its relationship with disease duration is demonstrated. Hand involvement tends to be overlooked and careful examination is required in the evaluation of BD. The scintigraphic involvement detected in hands requires special consideration, too.

Topics: Adolescent; Adult; Arthralgia; Atrophy; Behcet Syndrome; Edema; Erythema; Female; Finger Joint; Follow-Up Studies; Hand Deformities, Acquired; Humans; Male; Middle Aged; Observer Variation; Prevalence; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Medronate

Topics: Arthralgia; Bone Diseases, Metabolic; Bone Neoplasms; Diagnosis, Differential; Erdheim-Chester Disease; Female; Hip Joint; Humans; Middle Aged; Muscle Neoplasms; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 25-year-old woman presented with a disturbance in the opening of her mouth 5 months before admission. On admission, painful swelling of the right preauricular region was revealed. Computed tomography (CT) demonstrated a soft tissue density mass around the right condylar process of the mandible. Tc-99m hydroxymethylene diphosphonate (HMDP) bone scintigraphy and Ga-67 citrate scintigraphy showed avid uptake in the mass. The tumor was histologically identified as an osteoblastic osteosarcoma of the right mandible. There are few reports of Ga-67 citrate scintigraphy findings of osteoblastic osteosarcoma of the mandible. The accumulation patterns on Tc-99m HMDP bone scintigraphy and Ga-67 citrate scintigraphy are possibly characteristic of osteoblastic osteosarcoma of the mandible.

Topics: Adult; Arthralgia; Citrates; Female; Gallium; Humans; Mandibular Neoplasms; Osteoblastoma; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint

A 34-year-old male was seen with severe right hip pain, rapidly worsening in 1 to 2 weeks, with no history of trauma. There was no fever and laboratory studies were normal. Bone scan showed markedly increased uptake in the femoral head. Magnetic resonance imaging showed bone marrow edema. The patient became asymptomatic with conservative therapy, confirmed by returning toward normal on bone scintigraphy 5 months later. He was readmitted 4 months later because the patient developed similar symptoms on the opposite side. A bone scan showed demineralization of the left femoral head. He recovered on conservative therapy and there was a normal bone scan one year after the initial admission.

Topics: Adult; Arthralgia; Disease Progression; Hip Joint; Humans; Male; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors

Topics: Adult; Arthralgia; Female; Humans; Metacarpus; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We report about an 18-year-old man, suffering from acne on his face and trunk and complaining about indefinite bone pains--without any trauma. SAPHO-syndrome was diagnosed which consists of synovitis, acne, pustulosis, hyperostosis and osteitis. Five types of this syndrome can be differentiated: spondarthritis hyperostotica pustulo-psoriatica, chronic recurrent multifocal osteomyelitis, inflammatory chest wall syndrome, isolated sternocostoclavicular hyperostosis, and the combined form of acne-associated spondarthritis and chronic recurrent osteomyelitis. Although the sapho-syndrome is very rare, it should be considered a possible diagnosis in the case of indefinite bone pains in combination with acne, pustulosis and hyperostosis.

Topics: Acne Vulgaris; Acquired Hyperostosis Syndrome; Adolescent; Arthralgia; Clavicle; Diagnosis, Differential; Humans; Male; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Arthralgia; Arthritis; Bone and Bones; Female; Humans; Kidney; Kidney Diseases, Cystic; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Arthralgia; Cystadenoma; Female; Hip Joint; Humans; Ovarian Neoplasms; Pelvis; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Medronate; Ultrasonography

Sarcoidosis is rarely recognized as an osseous manifestations alone. Patients with osseous involvement usually have a chronic multivisceral form of the disease. The authors report a case of osseous sarcoidosis without other visceral involvement. A bone scan was requested to evaluate the extent of the bone involvement and explore buttocks pain.

Topics: Arthralgia; Bone Diseases; Buttocks; Chronic Disease; Foot Diseases; Hand; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Sacroiliac Joint; Sarcoidosis; Technetium Tc 99m Medronate