technetium-tc-99m-medronate and Back-Pain

Bone scanning is the most frequent type of radionuclide examination performed. We present a case of reduced uptake on a bone scan thought to be due to etidronate therapy. Other causes of this phenomenon are reviewed.

Topics: Aged; Back Pain; Bone and Bones; Etidronic Acid; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

We evaluated the role of bone scintigraphy in 60 osteoporotic patients with back pain. Thirty-four had scintigraphic evidence of vertebral fracture and were found to have a significantly lower bone density compared to those without fractures (p = 0.01). In only 14 patients was vertebral fracture considered to be the sole cause of pain with 38 having alternative abnormalities, the most common of which was facet joint disease (n = 30). Results of bone scintigraphy influenced a direct change in management in 18 patients and were able to exclude vertebral fracture as a cause of symptoms in 30. In symptomatic osteoporotic patients the bone scan may be helpful in elucidating the etiology of back pain and can impact on patient management.

Topics: Back Pain; Bone Density; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Hybrid SPECT with CT imaging has been used to help elucidate pain generators in patients with axial neck and back pain, identifying potential sites for treatment. Few studies have examined its role in spine surgery and most literature focuses on its use postoperatively. The authors describe the largest series to date of patients with symptomatic spondylosis who underwent preoperative SPECT imaging for surgical planning.. A retrospective medical and imaging record review was conducted to identify patients who underwent SPECT or SPECT/CT studies between January 2014 and May 2018. Patients who underwent spine surgical intervention for spondylosis with primary symptoms of axial neck or back pain and who had evidence of hypermetabolic foci on spinal SPECT imaging were included. Only those patients who subsequently underwent surgery on a spinal level associated with increased radiotracer uptake were included in the analysis. Patient baseline and demographic information, and data pertaining to SPECT imaging, surgical planning, and postoperative care were collected and analyzed.. A total of 23 patients with an average age at surgery of 60.0 ± 11.0 years were included. Fifteen patients (65.2%) were male. A total of 53 spinal levels were treated, with an average of 2.30 levels treated per patient. All patients underwent fusion surgery, either lumbar (n = 14), with interbody fusion most commonly used (64.2%); or cervical (n = 9), with anterior cervical discectomy and fusion (66.6%) being the most common. The average length of hospital stay was 3.45 ± 2.32 days. One patient developed a wound infection postoperatively, requiring readmission. At the 3-month follow-up, 18 patients (78.3%) reported clinical improvement in pain. Eleven patients (47.8%) reported complete symptom resolution at the 6-month follow-up. At 1 year postoperatively, 19 patients (82.6%) reported significant relief of their symptoms following surgery.. This is the largest series to date describing patients with axial neck and back pain who underwent preoperative SPECT imaging and subsequent surgical intervention on the affected spinal levels. The results demonstrate that SPECT imaging may be a useful adjunct to guide surgical planning, resulting in substantial clinical improvement following surgery.

Topics: Aged; Back Pain; Cervical Vertebrae; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Multimodal Imaging; Neck Pain; Postoperative Care; Preoperative Care; Radiopharmaceuticals; Retrospective Studies; Spinal Fusion; Spondylosis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The use of technetium-99m methylene diphosphonate single-photon emission tomography/computed tomography (99mTc-MDP SPECT/CT) of the spine and sacrum has increased over the past years; however, there is little information about the optimal clinical role and true clinical impact of this modality.. All 99mTc-MDP SPECT/CT examinations of the spine and sacrum performed at our large multispecialty institution between 1 January 2008 and 12 April 2012 were identified. The indications, findings, clinical context, and impact on patient management were identified through a retrospective chart review.. Of the 212 99mTc-MDP SPECT/CT examinations of the spine and sacrum identified, 191 (90%) were for pain evaluation, 14 (7%) were to assess infection, and seven (3%) were to evaluate a potential malignancy. The most common specific indication was evaluation of facet joint pain in 70/191 (37%) patients, and the most common finding was facet joint activity in 106/212 (50%) patients. Several findings were reported, although facet joint activity was the most frequent. The other findings included costovertebral joint activity, pars interarticularis defects, an osteoid osteoma, a lumbosacral pseudoarticulation, and a postoperative pseudoarthrosis. A resultant change in clinical management was documented in 168/212 (79%) patients. Ninety-two of the 212 (44%) patients had undergone an MRI of the same region for any indication within ±6 months.. 99mTc-MDP SPECT/CT of the spine and sacrum is most frequently used for the diagnosis and management of pain. It helps identify several potential pain generators, is often used in patients who have a near-contemporaneous MRI, and has an impact on the procedural and/or conservative management in most patients. In addition, several areas in need of future research to establish the optimal clinical role of this modality were identified.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Back Pain; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Sacrum; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Young Adult

The authors present the case of a 17-year-old girl, with pain over lumbar spine area, treated by paediatricians and rehabilitation specialists, discussing diagnostic imaging and laboratory examinations together with clinical observations. Spondylodiscitis was diagnosed after bone scintigraphy with 99mTc-MDP, the course of disease was monitored by immunoscintigraphy amongst other techniques.

Topics: Adolescent; Back Pain; Bone and Bones; Discitis; Female; Humans; Inflammation; Intervertebral Disc; Intervertebral Disc Displacement; Lumbar Vertebrae; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Lesions of fibrous dysplasia involving the spine and scoliosis are thought to be uncommon entities in patients with polyostotic fibrous dysplasia and McCune-Albright syndrome. By examining bone scans of a relatively large cohort of patients with these disorders, we sought to determine the prevalence of spinal involvement and any association with scoliosis.. Sixty-two patients with polyostotic fibrous dysplasia were studied. There were twenty-three male and thirty-nine female patients, and they had a mean age of twenty-five years (range, four to eighty years). Technetium-99m-methylene diphosphonate (MDP) bone scans of the patients were evaluated for evidence of increased uptake in the spine. The presence or absence of scoliosis or a level pelvis and the distribution of other lesions in the skeleton were noted.. Thirty-nine (63%) of sixty-two patients were found to have seventy-six lesions of fibrous dysplasia in the spine. Fifty-four lesions (71%) demonstrated increased uptake in the posterior aspects of the spine. Most lesions were located in the lumbar spine (thirty-two lesions) and the thoracic spine (twenty-seven), with less frequent involvement in the sacrum (ten) and cervical spine (six). Twenty-five (40%) of the sixty-two patients had scoliosis; seventeen had a thoracolumbar curve; six, a lumbar curve; and two, a thoracic curve. Seven patients had curves that could not be accurately measured by bone scanning and, therefore, could not be classified. Thirty patients (48%) had no evidence of scoliosis. Thus, the prevalence of scoliosis in patients with polyostotic fibrous dysplasia was between 40% and 52%. There was a strong correlation between spinal lesions and scoliosis (p < 0.001) and pelvic asymmetry (p < 0.05). Back pain was an uncommon symptom. Two patients had a neurologic abnormality; neither abnormality was related to the location of the lesions or the curve.. Spinal lesions and scoliosis may be more common in patients with polyostotic fibrous dysplasia than has been previously reported. Since there is a strong correlation between a spinal lesion and scoliosis, these patients should be screened clinically for scoliosis.. Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Anthropometry; Back Pain; Cervical Vertebrae; Child; Child, Preschool; Disease Progression; Female; Fibrous Dysplasia, Polyostotic; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Prevalence; Radiopharmaceuticals; Sacrum; Scoliosis; Technetium Tc 99m Medronate; Thoracic Vertebrae

A case of atypical osseous tuberculosis (TB) mimicking multiple secondary metastases on radiologic and nuclear imaging is presented.. To emphasize the contribution of nuclear bone scanning for the assessment of osseous tuberculosis in typical and atypical presentations.. Skeletal locations of TB mostly involve the dorsolumbar spine and diagnosis is often delayed. The presence of multiple TB sites can mimic secondary metastases and biopsy remains the mainstay for final diagnosis.. Clinical symptoms, lab tests, and imaging data are presented. Possible diagnoses are discussed. A review of imaging characteristics in cases of typical and atypical presentations of osseous TB is proposed.. A dorsal spine spondylitis was first diagnosed on a 56-year-old patient presenting neurologic deficit of the left arm. Fine needle aspiration identified bacterial infection but was negative for Mycobacterium tuberculosis. Whole-body bone scan allowed the identification of an asymptomatic sacroiliac lesion, which was accessible to biopsy and gave a final diagnosis.. Nuclear bone scanning should be kept in mind when assessing spinal pain in patients at high risk of TB infection or reactivation.

Topics: Africa, Northern; Arm; Back Pain; Biopsy, Fine-Needle; Diabetes Complications; Diagnosis, Differential; Epidural Abscess; False Negative Reactions; Humans; Lumbar Vertebrae; Male; Middle Aged; Mycobacterium tuberculosis; Osteolysis; Paralysis; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Sacroiliac Joint; Sacrum; Spinal Neoplasms; Spondylitis; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tuberculoma; Tuberculosis, Osteoarticular

Topics: Aged; Back Pain; Ciprofloxacin; Discitis; Female; Fever of Unknown Origin; Humans; Lumbar Vertebrae; Organotechnetium Compounds; Radiopharmaceuticals; Sacrum; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Radiography and scintigraphy are used to aid diagnosis of the cause of back pain, but a large variation in appearance and radiopharmaceutical uptake in fully functioning horses make diagnosis difficult.. To describe the range of and compare scintigraphic and radiographic findings in the spinous processes of horses without clinical signs of back problems.. Thirty-three apparently normal riding horses underwent scintigraphic and radiographic examinations of the spinous processes in the thoracolumbar spine. Scintigraphic images were evaluated in a continuous blue, green and red colour scale, and the level of radiopharmaceutical uptake in the spinous processes from T10-L2 was graded into none, mild, moderate or severe increased radiopharmaceutical uptake. Structural changes along the borders of the spinous processes and the width of the interspinous spaces from T10-L2 were recorded.. Only 7 horses had no scintigraphic or radiographic findings. Nine horses had no increased radiopharmaceutical uptake, 17 had no sclerosis, 21 had no radiolucencies and 11 had normal spacing of the spinous processes (>4 mm wide). The majority of findings in 26 horses were located from T13-18 and were mild.. The findings of a wide spectrum of scintigraphic and radiographic changes leads to the conclusion that changes within this range found in affected horses cannot be interpreted as clinically significant.. To determine whether scintigraphy and/or radiography can be used to separate horses with back pain from horses without clinical signs, the results from this study should be compared to the scintigraphic and radiographic findings in horses with clinical signs.

Topics: Analysis of Variance; Animals; Back Pain; Female; Horse Diseases; Horses; Lumbar Vertebrae; Male; Predictive Value of Tests; Radiography; Radionuclide Imaging; Reference Values; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Adult; Back Pain; Diagnostic Errors; Exercise; Humans; Incidental Findings; Male; Organ Specificity; Pectoralis Muscles; Physical Exertion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution

Cervical spinal Ewing's sarcomas are rare and cause problems in diagnosis. We present an unusual case of a primary extraosseous Ewing's sarcoma arising from the spinal cord. An 18-year-old woman with fever, headache and back pain lasting one month was admitted to the hospital. Whole body bone scintigraphy was performed with 1110 MBq technetium-99m methylenediphosphonate. Scintigraphy clearly showed abnormal technetium-99m methylenediphosphonate accumulation in the level of the 5th and 6th cervical vertebrae. Magnetic resonance imaging could also confirm this examination finding. After the scintigraphic study, the patient underwent surgery. Pathological diagnosis of the operation specimen was Ewing's sarcoma.

Topics: Adolescent; Back Pain; Cervical Vertebrae; Female; Fever of Unknown Origin; Headache; Humans; Neoplasms, Unknown Primary; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma, Ewing; Spinal Neoplasms; Technetium Tc 99m Medronate

Six hunting dogs were investigated after showing signs of diffuse back pain. In three of the dogs, prodromal signs included coughing. Swelling in the dorsal lumbar region was noted in four of the dogs, but in two there was no visible or palpable swelling. Initial radiographs of the lumbar region were normal in two of the dogs and showed mild to moderate ventral periosteal reactions in the L1 to L4 region in the remaining four. On ultrasonography and magnetic resonance imaging, changes were seen in the sublumbar muscles (e.g., abnormal echogenicity and increased signal intensity) in five dogs examined. Exploratory surgery revealed plant material foreign bodies in the sublumbar muscles in the L1 to L4 region in five of the six dogs. The concurrent infections were caused predominantly by anaerobic bacteria common to the mucous membranes of the oropharyngeal and respiratory tracts. All dogs recovered, with restored hunting ability. The mean follow-up period was five years (range 1.3 to 7.8 years). It is proposed that the plant parts were inhaled, and then migrated along either diaphragmatic crus to lodge in the sublumbar muscles.

Topics: Animals; Back Pain; Behavior, Animal; Cough; Dog Diseases; Dogs; Female; Follow-Up Studies; Foreign Bodies; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Plant Structures; Prognosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Ultrasonography

Topics: Adolescent; Athletic Injuries; Back Pain; Fractures, Stress; Humans; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae

A prospective study was performed to compare the results of quantitative radionuclide bone scanning with those of sacroiliac joint anesthetic block in patients with unilateral low back pain. Thirty-four subjects, forming the control group, underwent quantitative radionuclide bone scanning of the sacroiliac joints. The normal values in sacroiliac uptake difference were taken to be between -1.7% and +6.2%. Thirty-two patients with chronic unilateral low back pain underwent sacroiliac bone scanning and sacroiliac joint block. Six of the seven patients with increased uptake > 6.2% on the painful side had at least 75% pain reduction in response to the block. The sensitivity, specificity, and positive and negative predictive values of the quantitative bone scanning in the unilateral mechanical sacroiliac joint syndrome were 46.1%, 89.5%, 85.7%, and 72%, respectively.

Topics: Adolescent; Adult; Aged; Back Pain; Female; Humans; Male; Middle Aged; Nerve Block; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sacroiliac Joint; Syndrome; Technetium Tc 99m Medronate

Topics: Adult; Back Pain; Female; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Spina Bifida Occulta; Spine; Technetium Tc 99m Medronate

Acquisitions of 360 degrees are usually performed for bone single photon emission computed tomography (SPECT). However, the spine is a peripheral and median structure, it therefore seemed interesting to compare the 360 degrees and the posterior 180 degrees SPECT images. In a phantom study and in 25 adult patients, the 360 degrees SPECT images were compared with the posterior 180 degrees images obtained during the same acquisition: the posterior 180 degrees images are at least equivalent to the 360 degrees images. With a reduction in the examination time, SPECT could become easier to perform, especially in patients suffering from back pain.

Topics: Adult; Aged; Aged, 80 and over; Back Pain; Female; Follow-Up Studies; Gamma Cameras; Humans; Male; Middle Aged; Models, Structural; Osteitis Deformans; Spinal Diseases; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Despite the frequency with which whiplash injuries present to accident and emergency (A&E) departments, there lacks an objective investigation to define the severity of the initial injury or the morbidity that may ensue. Following reports on the effectiveness of isotope bone scanning for soft tissue and ligament injuries a study was undertaken of isotope scanning of whiplash injuries. The objectives of the study were to isolate the anatomic site of the injury and to quantify the severity of the injury with relation to the concentration of isotope uptake and subsequent morbidity.

Topics: Adolescent; Adult; Back Pain; Evaluation Studies as Topic; Female; Headache; Humans; Male; Middle Aged; Neck; Neck Injuries; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Whiplash Injuries

To assess the value of magnetic resonance imaging (MRI) in the investigation of patients with suspected but nonproven vertebral metastases 45 consecutive patients referred in a 6 month period with known primary malignancy and back pain in whom an isotope bone scan was reported as equivocal were studied. All patients had abnormal isotope uptake localized to the spine. Twelve patients were shown to have bony metastases on plain X-ray. In the remainder, where X-rays showed normal or benign appearance, MRI of the spine was offered. Twenty-four patients underwent MRI examination which showed vertebral metastases in 11 cases. Magnetic resonance imaging is shown to be a useful, noninvasive, complementary investigation for evaluation of patients known to have malignant disease and suspected of having vertebral metastases on bone scintigraphy.

Topics: Back Pain; Humans; Magnetic Resonance Imaging; Prospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate

In patients with chronic low back pain, bone scintigraphy with single photon emission computed tomography (SPECT) of the lumbar spine allows identification of lesions not seen with planar imaging. In this study, findings from radiography, computed tomography (CT), and bone scintigraphy with SPECT in 34 patients with chronic back pain were examined to determine the nature and clinical relevance of the lesions. Twenty-seven patients had lesions at SPECT, of whom 24 (89%) had abnormalities at CT and 18 (67%) had abnormalities at radiography. SPECT allowed identification of 54 lesions, of which only 20 (37%) were detected with planar imaging. Forty-three (80%) SPECT lesions were located at the site of an abnormality also seen at CT and 20 (37%) at the site of an abnormality also seen at radiography. It was concluded that bone SPECT provides diagnostic information in chronic low back pain that is not available with radiography or planar imaging. The majority of lesions seen at SPECT corresponded to identifiable disease at CT.

Topics: Adult; Back Pain; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Osteoarthritis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Of 753 adult patients undergoing SPECT and planar bone scintigraphy for the evaluation of low back pain, 43 (6%) showed either unilateral or bilateral increased sacroiliac joint (SIJ) uptake. Five of the 58 abnormal joints were only identified with SPECT (9%), whereas 20 of the 58 abnormal joints were much more convincingly demonstrated by SPECT (34%). Fifteen of the 43 patients with increased SIJ uptake had undergone prior lumbar laminectomy and/or spinal fusion. Such spinal surgery can increase impact loading on the SIJ, leading to mechanical overload and sacroiliitis. Degenerative joint disease, trauma, or other benign pathology accounted for the remaining patients with increased SIJ uptake. The authors conclude that for patients with a history of lumbar spinal fusion and/or laminectomy, increased SIJ uptake usually is caused by altered spinal mechanics rather than malignancy or infection.

Topics: Adult; Aged; Aged, 80 and over; Back Pain; Female; Humans; Laminectomy; Male; Middle Aged; Retrospective Studies; Sacroiliac Joint; Spinal Fusion; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

For many years it has been known that the sensitivity of bone scanning to the presence of destructive bony lesions favors its use in screening for bone metastases and osteomyelitis. More recently bone scanning has been routinely employed in evaluating benign skeletal pathology that may be the cause of low back pain. Bone scanning can play an important part in (1) identifying the cause of pain, (2) clarifying the significance of radiographic findings, and (3) evaluating the results of spinal surgery. This expansion of the role of nuclear medicine in diagnosing and managing low back pain is based in part upon novel diagnostic applications of 99mTc-methylene diphosphonate, a radiopharmaceutical that has been available for over 15 years. Equally important for this development, however, has been the recent availability of SPECT, a tomographic imaging technique that can be used to display the spine in a series of 6- to 8-mm thick sections. Slightly more than one-half of newly purchased gamma cameras are rotating systems suitable for bone SPECT studies. Thus, many community hospitals can now perform state-of-the-art bone scans for low back pain.

Topics: Adult; Back Pain; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Low back pain is the most frequent rheumatologic manifestation of brucellosis. The diagnosis of brucellar sacroiliitis is hampered by the poor specificity of the clinical data and the poor sensitivity of the radiologic data. In this report, we show that scintigraphy not only increases the sensitivity but also allows an earlier diagnosis of disease and permits the detection of osteoarticular brucellar involvement in areas adjacent to the sacroiliac joint.

Topics: Back Pain; Brucellosis; Diagnosis, Differential; Humans; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

The accumulation of 99mTc-methylene diphosphonate (99mTc-MDP) and 99mTc-dicarboxypropane diphosphonate (99mTc-DPD) in sacroiliac (si) joints was evaluated as a function of imaging time in 22 control patients and 5 patients with sacroiliitis. The controls were injected with either 99mTc-DPD or 99mTc-MDP (12 and 10 patients, respectively) and the patients with sacroiliitis with both agents within 5 days. Both the anterior and posterior views of the si joints were taken. The sacroiliac joint-to-sacrum (SI/S) ratio was calculated with the region of interest method. No statistically significant differences between these bone-seeking agents were found in the SI/S ratios of the control or the diseased patients. A clear overlap of indices (mean +/- SD) was found between the control patients and the patients with sacroiliitis. When the inflamed si joint was divided into three small adjacent areas and the SI/S ratios calculated for these areas, a statistically significant (P less than 0.001) increase in the SI/S ratio was noticed when compared with the SI/S ratio of the whole joint. Comparison of control patients and patients with sacroiliitis showed the most significant differences in the anterior views as well as in the P value: P less than 0.001 in all patients injected with 99mTc-DPD and in most patients injected with 99mTc-MDP. In the posterior views, the significance was less marked. In every case, the inflamed part of the si joint was visible in the anterior views. The background subtraction had the greatest effect on the SI/S ratio of anterior images, but in the posterior views no significance was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Arthritis; Back Pain; Diphosphonates; Humans; Organotechnetium Compounds; Radionuclide Imaging; Sacroiliac Joint; Technetium Tc 99m Medronate; Time Factors

A case is reported of acute renal failure occurring after prolonged abdominal aortic bypass surgery in an overweight 69-year-old male patient. Preoperative serum creatinine concentration was normal. Surgery lasted for 6 h, and infrarenal aortic cross-clamping 2 1/2 h. The patient complained of important lumbar pain immediately after the operation. In the same time, oliguria and acute renal failure also developed (creatinine: 464 mumol.l-1; urea: 13 mmol.l-1). Rhabdomyolysis caused by the kidney-bridge was confirmed by the elevated blood creatine phosphokinase levels (16,000 IU.l-1 on the second postoperative day). A 99 m-Technetium methylene-diphosphonate imaging on the 10th postoperative day exhibited diffuse fixation in the paravertebral lumbar and thoracic muscles, extending from Th8 to L3. The acute renal failure regressed completely after haemodialysis.

Topics: Acute Kidney Injury; Aged; Back Pain; Beds; Blood Vessel Prosthesis; Humans; Intraoperative Complications; Lumbosacral Region; Male; Posture; Radionuclide Imaging; Rhabdomyolysis; 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

We studied 20 women who were at risk for osteoporosis (postmenopausal, or on dialysis, or on steroids), who presented with severe back pain. Patients underwent a dual photon (153Gd) densitometry study of the L2-L4 vertebrae, as well as an emission bone scan (99mTc-MDP). The dual photon method revealed abnormal results (20% or more below the mean expected value) in 13/20 patients (65%), and below the "fracture threshold" in 15/20 (75%). The emission bone scan delineated abnormal foci of uptake in 15/19 (79%). We conclude that women at risk for osteoporosis, who present with severe back pain, are likely to have a positive bone scan due to compression fracture or other derangements related to bone demineralization.

Topics: Adult; Aged; Aging; Back Pain; Bone and Bones; Female; Gadolinium; Humans; Middle Aged; Osteoporosis; Radioisotopes; Radionuclide Imaging; Risk Factors; Technetium Tc 99m Medronate

In 66 patients with back pain and suspected spondylolysis, the results of bone scintigraphy have been correlated with operative findings and clinical follow-up. Although bone scintigraphy is of little value for primary diagnosis, it helps to distinguish between those patients with established non-union of the defect, and those in whom healing is still progressing and who may benefit from immobilisation. We also found that increased uptake on the contralateral side to a unilateral spondylolysis is suggestive of impending fracture.

Topics: Adolescent; Adult; Back Pain; Child; Female; Humans; Lumbar Vertebrae; Male; Radiography; Radionuclide Imaging; Spondylolisthesis; Spondylolysis; Technetium Tc 99m Medronate

Bone and gallium scintigraphy were performed as part of the diagnostic workup of a 21-yr-old woman who presented at our institution with a history of progressively worsening low back pain over a 1-wk period of time. The angiographic phase of the bone scan demonstrated a well-defined radionuclide blush within the pelvis just cephalad to the urinary bladder with persistent hyperemia noted in the blood-pool image. We attribute these findings to a uterine blush secondary to the pronounced uterine muscular hyperplasia, hyperemia, and edema that accompany pregnancy. Gallium scintigraphy demonstrated intense bilateral breast accumulation of the imaging agent in a typical doughnut pattern which is commonly found in the prelactating and lactating breast. Also demonstrated was apparent gallium accumulation in the placenta. This case is presented to emphasize the radionuclide findings that occur during pregnancy, particularly the incidental finding of radionuclide blush during the angiographic phase of a radionuclide scintigraphy which should alert the nuclear physician to the possibility of pregnancy in a woman of childbearing age.

Topics: Adult; Back Pain; Bone and Bones; Breast; Female; Fetus; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Hyperemia; Placenta; Pregnancy; Pregnancy Trimester, Second; Radiation Dosage; Radionuclide Imaging; Technetium Tc 99m Medronate; Uterus

This study looks retrospectively at 113 patients with low back pain referred by orthopaedic surgeons for bone scanning. 79 scans (70%) were reported normal and 34 scans (30%) abnormal. 61 out of the 79 patients with normal scans were diagnosed and managed as "chronic back strain". Negative bone scans were also encountered in 3 patients with degenerative disease, 3 with prolapsed intervertebral disc and one with spondylolysis. In those patients with positive scans, a varied range of diagnoses was encountered, the main ones being bone metastases, previous trauma, osteomyelitis and degenerative disease. The scan was shown to be helpful in deciding on the presence or absence of pathology, and in identifying the sites of involvement, but not the nature of the disease. A higher likelihood of positivity is seen in the more elderly patients as well as those below 20 years of age. In interpreting the scan, the clinical context is important e.g. a history of trauma, previous surgery or of malignant disease. The bone scan may be normal in disc prolapse and in degenerative disease of the spine.

Topics: Adolescent; Adult; Aged; Back Pain; Child; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Radionuclide Imaging; Spinal Diseases; Spondylolysis; Technetium Tc 99m Medronate

Three-phase radionuclide bone (TPB) imaging was performed on 238 patients with sports-related injuries. A wide variety of lesions was encountered, but the most frequent lesions seen were stress fractures of the lower part of the leg at the junction of the middle and distal thirds of the posterior tibial cortex (42 of 79 lesions). There were no differences in the type, location, or distribution of lesions between males and females or between competitive and noncompetitive athletes. In 110 cases, bone stress lesions were often diagnosed when radiographs were normal, whereas subacute or chronic soft-tissue abnormalities had few specific scintigraphic features. TPB imaging provides significant early diagnostic information about bone stress lesions. Normal examination results (53 cases) exclude underlying osseous pathologic conditions.

Topics: Adolescent; Adult; Aged; Athletic Injuries; Back Pain; Bone and Bones; Child; Connective Tissue Diseases; Diphosphonates; Female; Fibula; Follow-Up Studies; Foot Injuries; Fractures, Bone; Hip Fractures; Humans; Leg Injuries; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sports; Technetium; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors

Topics: Adolescent; Back Pain; Bone and Bones; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Ureter

This is the first report in the nuclear medicine literature of the scintigraphic appearance of the piriformis muscle syndrome. This syndrome previously has been thought to be a purely clinical diagnosis and imaging modalities have been ignored. However, its confusing clinical presentation can lead to unnecessary surgical exploration. This case is presented to illustrate the characteristic scintigraphic pattern and suggest the role of nuclear medicine scanning in establishing the diagnosis.

Topics: Adult; Back Pain; Diphosphonates; Humans; Male; Muscles; Radionuclide Imaging; Sciatica; Syndrome; Technetium; Technetium Tc 99m Medronate

Our experience, in a group of 25 patients with chronic low back pain, shows that nuclear imaging of the spine with 99mTc-methylene diphosphonate is of no benefit in predicting the sites at which intraarticular facet blocks may be successful.

Topics: Adolescent; Adult; Aged; Back Pain; Diphosphonates; Female; Humans; Injections, Intra-Articular; Joints; Lumbar Vertebrae; Male; Middle Aged; Nerve Block; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate