technetium-tc-99m-medronate and Cadaver

Plantar fasciitis is a common cause of foot pain and may be disabling. Although localized injection is painful, anesthetics or corticosteroids can relieve symptoms well. Bone scintigraphy can confirm the diagnosis. We hypothesized that blood-pool abnormalities could provide prognostic information on the response to such injections.. We devised scintigraphic criteria that graded the blood-pool abnormalities as being localized to the plantar enthesis, being localized to half the length of the aponeurosis, or involving the whole aponeurosis. We evaluated 24 patients with an established diagnosis of plantar fasciitis, 8 of whom had bilateral disease, leading to a total of 32 feet injected.. After injection, pain was relieved either completely or nearly completely in 20 feet. The other 12 feet had short-term or no improvement, with persistent pain and loss of function at 4-5 wk after injection. Of the 20 feet responding to injection, 14 had focal hyperemia on blood-pool images and 6 had minimal extension into the proximal third of the plantar soft tissues. No patient with diffuse hyperemia in the plantar fascia had a response (5/12 feet). On the delayed images of the 20 responders, mild inferior calcaneal uptake was seen in 8 feet, moderate uptake in 6, and severe uptake in 6. These groups did not significantly differ (P > 0.05). The blood-pool studies had good reproducibility, with a kappa-value of 0.64.. Critical evaluation of plantar blood-pool images provides prognostic information on the response to localized injection into the enthesis. Reporting such studies is simple and reproducible.

Topics: Adult; Anesthetics, Local; Anti-Inflammatory Agents; Bone and Bones; Bupivacaine; Cadaver; Drug Therapy, Combination; Fasciitis, Plantar; Female; Foot; Humans; Hyperemia; Injections; Male; Methylprednisolone; Middle Aged; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome

Using a rotating gamma camera the normal single photon emission computed tomography (SPECT) anatomy of the skull was defined in eight subjects. The value of SPECT as compared with planar scintigraphy was assessed in 34 patients with known or suspected disease of the skull. Seven patients had normal planar scintigraphy and SPECT. In 12 of 27 patients with bone involvement SPECT and planar scintigraphy showed essentially the same findings. In 15 patients SPECT was superior to planar scintigraphy. In three of these patients SPECT detected lesions while planar scan was normal. In the other 12 patients SPECT showed better anatomic localization and defined the full extent of the lesion. This was most obvious in patients with involvement of sphenoid, petrous, clivus, maxilla, and zygomatic bones. Our findings confirm the potential of SPECT to detect lesions in deep bones that are overlapped by superficial bony structures that cannot be visualized clearly with planar scintigraphy.

Topics: Bone Diseases; Cadaver; Evaluation Studies as Topic; Humans; Skull; Skull Fractures; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed