technetium-tc-99m-medronate and Cellulitis

Dynamic bone imaging differs from routine multiphase bone scintigraphy by the use of time-activity curves (TACs) and quantitation of data. TACs were divided into an arterial plus blood pool phase (first 60 s at 1 frame/s) and a subsequent early bone uptake phase (24 min at 1 frame/min). Ratios of normalized integrals, from analogous regions were calculated to determine whether blood flow was abnormal. A key feature of the technique is the monitoring of the flow proximally and distally to the area of involvement. This was of importance in distinguishing between two diseases producing the same degree of local hyperemia. Dynamic bone imaging was applied to the differential diagnosis of arthritis, septic arthritis, cellulitis, osteomyelitis, tumor, avascular necrosis, Charcot joint, Legg-Perthes (LP) disease, and Osteochondritis Dissecans (OCD). Although the method is straightforward, there are technical and clinical factors that may affect interpretation of data. Asymmetries in flow may arise due to injection technique, interfering activity of bladder and/or bowel, vascular abnormalities, AV malformation, and venous backflow. The dynamic study is also sensitive to the effects of various modes of therapy. Consideration must be given to these technical and clinical factors for the avoidance of pitfalls in interpretation of the dynamic study.

Topics: Arthritis; Arthritis, Infectious; Arthropathy, Neurogenic; Bone and Bones; Bone Diseases; Bone Neoplasms; Cellulitis; Diagnosis, Differential; Humans; Legg-Calve-Perthes Disease; Osteochondritis Dissecans; Osteomyelitis; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Diabetic foot infection is the most common etiology of nontraumatic amputation of the lower extremities, and early diagnosis is of great importance in its management. The aim of this prospective study was to evaluate the strength of (99m)Tc-IgG scintigraphy in diagnosis of osteomyelitis of the diabetic foot and to compare (99m)Tc-IgG scintigraphy with (99m)Tc-methylene diphosphonate (MDP) scintigraphy.. A prospective university hospital-based study was performed over 24 mo. Eighteen patients with type II diabetes and foot ulcers (15 men and 3 women; age range, 45-80 y) were referred for imaging because of clinically suspected osteomyelitis. Early (5-h) and late (24-h) (99m)Tc-IgG scanning and 3-phase skeletal scintigraphy were completed for all patients at a 3- to 4-d interval. Regions of interest over the involved bony sites and the contralateral normal sites were drawn, and the abnormal-to-normal ratios were acquired for both (99m)Tc-IgG and (99m)Tc-MDP studies.. From a total of 23 lesions, we observed 10 sites of osteomyelitis, 10 sites of cellulitis, and 3 sites of aseptic inflammation confirmed by MRI, clinical presentation, histopathologic examination, and follow-up evaluation as a gold standard. Both (99m)Tc-IgG and (99m)Tc-MDP scanning showed excellent sensitivity for diagnosis of osteomyelitis, but the specificity was significantly lower (69.2% and 53.8%, respectively). Sensitivity, specificity, and accuracy in the diagnosis of osteomyelitis were, respectively, 100%, 53.8%, 73.9% for (99m)Tc-MDP scanning; 100%, 69.2%, 82.6% for 5-h (99m)Tc-IgG scanning; and 60%, 76.9%, 69.5% for 24-h (99m)Tc-IgG scanning. There was no significant difference between the semiquantitative indices of 5-h and 24-h (99m)Tc-IgG scanning for inflammation, cellulitis, and osteomyelitis.. Although both (99m)Tc-IgG and (99m)Tc-MDP scintigraphy have high sensitivity for the diagnosis of osteomyelitis, the specificity of these studies is poor. For (99m)Tc-IgG scintigraphy, 5-h images appear to be adequate, and there is little benefit to performing additional imaging at 24 h.

Topics: Aged; Aged, 80 and over; Cellulitis; Diabetic Foot; Early Diagnosis; Female; Humans; Immunoglobulin G; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Cellulitis; Diabetic Foot; Foot Bones; Gangrene; Humans; Indium Radioisotopes; Leukocytes; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Medronate; Toes

Topics: Adult; Blood Transfusion; Cellulitis; Female; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Osteomyelitis; Radionuclide Imaging; Spleen; Technetium Tc 99m Medronate

The authors reviewed the three-phase bone scans and radiographs of 24 patients with suspected pedal osteomyelitis who also had histologic confirmation of the diagnosis. Twenty patients had a pedal ulcer, cellulitis, or necrosis. Sensitivity and specificity of bone scanning were 70% and 43% respectively. Sensitivity and specificity of radiography were 70% and 50% respectively. The non-invasive diagnosis of pedal osteomyelitis remains problematic due to the poor specificity of bone scans and radiographs.

Topics: Adult; Aged; Cellulitis; Diagnosis, Differential; Female; Foot Diseases; Humans; Male; Middle Aged; Osteomyelitis; Osteonecrosis; Radiography; Radionuclide Imaging; Retrospective Studies; Skin Ulcer; Technetium Tc 99m Medronate

In a retrospective review, 485 patients with suspected osteomyelitis were studied. Of these, 453 patients were studied with both bone and indium-111 leukocyte scanning (173 sequentially and 280 simultaneously). The ability to determine that the infection was in bone rather than in adjacent soft tissue was greater with simultaneous bone scan and In-111 leukocyte studies than with sequential studies. The locations of suspected osteomyelitis were divided into central (containing active bone marrow), peripheral (hands and feet), and middle (between central and peripheral). Specificity remained high (about 90%) regardless of the location. Overall sensitivity was significantly lower in the central location than in the peripheral or middle location. Determination of whether the In-111 leukocyte activity was in bone or adjacent soft tissue was also more difficult when the infection was in the central location. For acute osteomyelitis, sensitivity was high regardless of the location. For chronic osteomyelitis, sensitivity was lower in the central location.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Cellulitis; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

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

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

The scintigraphic manifestations of cellulitis consist of a diffuse increase in activity in the affected soft tissues without a focal increase in activity in the bone. The radionuclide images in two children with Group A streptococcal cellulitis were atypical, as no increased activity was noted in the soft tissues. The false-negative radionuclide images in these children is attributed to the marked amount of edema present at the sites of infection.

Topics: Bone and Bones; Cellulitis; Child, Preschool; False Negative Reactions; Female; Humans; Radionuclide Imaging; Streptococcal Infections; Streptococcus pyogenes; Technetium Tc 99m Medronate

Whole bone activity on skeletal scintigraphy in children, although nonspecific, is uncommon and was caused by unusual presentations of osteomyelitis in two of eight patients. Soft tissue pathology, including cellulitis and vascular obstruction, was causative in four of eight cases. Whole bone activity was seen in two children with trauma due presumably, to subperiosteal hematoma formation and strongly supported the diagnosis of child abuse.

Topics: Adolescent; Bone and Bones; Cellulitis; Child; Child Abuse; Child, Preschool; Extremities; Female; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thrombophlebitis

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

We reviewed the technetium phosphate scans of 280 patients who had been referred with a clinical diagnosis of osteomyelitis in order to establish the diagnostic accuracy of this procedure. Strict criteria were established to define two subgroups: one of patients with proved osteomyelitis and one of patients who definitely did not have osteomyelitis. The scan correctly identified osteomyelitis at fifty-five of sixty-two sites, and was correctly negative in seventy-four of seventy-nine patients without osteomyelitis. The scan correctly distinguished all cases of cellulitis or soft-tissue abscess from osteomyelitis, but identified osteomyelitis in eight of thirty-nine patients with septic arthritis. The phosphate bone scan maintained this accuracy through any duration of symptoms, and performed almost equally well at all skeletal sites and in all age groups.

Topics: Abscess; Adolescent; Bone and Bones; Cellulitis; Child; Child, Preschool; Diagnosis, Differential; Diphosphates; Diphosphonates; Humans; Infant; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

A quantitative analysis of the results obtained by sequential 99mTc methylene diphosphonate (MDP) and 67Ga-citrate (Ga) imaging to disclose and distinguish infections in bone, synovium and adjacent soft tissue is reported. There were 129 patients with proved or probable osteomyelitis, septic arthritis and cellulitis, and 94 patients who were eventually shown to be free of sepsis, but not necessarily free of some other nonseptic affliction. Of the 159 patients referred with a presumptive clinical diagnosis of osteomyelitis 94 were eventually shown to be free of infection. The results of this group by sequential imaging were true positive 0.72, true negative 0.86 and accuracy 0.80 when low-grade Ga uptakes, which were similar in distribution to MDP, were excluded. In 26 patients with septic arthritis, the true-positive fraction for combined MDP and Ga was 0.84. The true-positive fraction for Ga in 38 patients with cellulitis was 0.79.

Topics: Arthritis, Infectious; Cellulitis; Diagnosis, Differential; Diphosphonates; False Negative Reactions; False Positive Reactions; Gallium Radioisotopes; Humans; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Three-phase skeletal scintigraphy, consisting of a radionuclide angiogram, an immediate postinjection "blood-pool" image, and 2--3 hr delayed images, was performed on 98 patients with suspected osteomyelitis. This procedure was evaluated by first interpreting only the delayed images, next the combination of "blood-pool" and delayed images, and finally the three-phase study. There was no change in the sensitivity (12/13 = 0.92) for detecting osteomyelitis, but the false-positive rate for osteomyelitis decreased from 0.25 (21/85) to 0.06 (5/85). In 21 of 64 patients (33%) with abnormal studies, the "blood-pool" image and/or the radionuclide angiogram led to a more accurate scintigraphic diagnosis. In 12 patients (19%) the "blood pool" alone was enough to achieve the correct final diagnosis and was used most often to identify noninfectious skeletal disease. In 9 patients (14%) the radionuclide angiogram was required for an accurate interpretation and was considered essential most often in cases of soft-tissue infection. Both radionuclide angiography and "blood-pool" imaging appear to augment the specificity of skeletal scintigraphy in patients with suspected osteomyelitis.

Topics: Adolescent; Adult; Aged; Arthritis, Infectious; Bone and Bones; Cellulitis; Child; Child, Preschool; Diphosphonates; False Positive Reactions; Female; Humans; Infant; Male; Methods; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate