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

Topics: Biopsy; Child, Preschool; Chronic Disease; Combined Modality Therapy; Female; Fibula; Humans; Mandible; Mandibular Diseases; Osteomyelitis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Technetium Tc 99m Medronate; Tibia

We report a case of MFH of the mandible in a 16-year-old girl. The mandible is a rare location of MFH of bone, with only 21 cases described in the literature. Clinical, pathologic, and radiologic features are discussed, with special emphasis on the unusual pathologic and radiographic features.

Topics: Adolescent; Biopsy; Chronic Disease; Diagnosis, Differential; Female; Histiocytoma, Benign Fibrous; Humans; Mandible; Mandibular Neoplasms; Radiography, Panoramic; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

On the basis of the findings of nine of our patients and our review of previously reported cases of diffuse sclerosing osteomyelitis and chronic recurrent multifocal osteomyelitis, we discuss the similarity of these two entities. Our nine patients had initially been given diagnoses of diffuse sclerosing osteomyelitis on the basis of their clinicopathologic findings. However, technetium 99m-MDP bone scans performed on four of them revealed multiple bone lesions leading to the diagnosis of chronic recurrent multifocal osteomyelitis. Furthermore, no clear difference between clinical features in the patients with multiple bone lesions and those in the patients with diffuse sclerosing osteomyelitis was found. We conclude that diffuse sclerosing osteomyelitis is an expression of chronic recurrent multifocal osteomyelitis.

Topics: Adult; Aged; Chronic Disease; Female; Humans; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Radionuclide Imaging; Recurrence; Technetium Tc 99m Medronate; Terminology as Topic

Our aim was to evaluate the accuracy of magnetic resonance imaging (MRI) and bone scintigraphy in the diagnosis of mandibular osteomyelitis. Twenty patients with mandibular osteomyelitis were prospectively investigated by conventional radiography, bone scintigrams and MRI. All diagnoses were verified either by surgery or by the clinical course. There was no significant difference between bone scintigraphy and MRI in the detection of osteomyelitis or the assessment of its extent. MRI was significantly better than scintigraphy at detecting the presence and assessing the extent of extraosseous inflammation. We always use MRI to diagnose osteomyelitis. For long-term follow-up of patients with mandibular osteomyelitis, we recommend MRI and bone scintigraphy.

Topics: Acetylmuramyl-Alanyl-Isoglutamine; Adolescent; Adult; Aged; Child; Chronic Disease; Female; Humans; Magnetic Resonance Imaging; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate

Topics: Antibodies, Monoclonal, Murine-Derived; Bone Screws; Chronic Disease; Drug Combinations; Granulocytes; Humans; Image Enhancement; Male; Osteomyelitis; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Single Photon Emission Computed Tomography Computed Tomography; Staphylococcal Infections; Technetium Tc 99m Medronate; Young Adult

Juvenile mandibular chronic osteomyelitis is a rare entity that predominantly affects children and adolescents, but little is known about the factors that contribute to the recurrent course and eventual resolution of this disease. Here, we describe new findings of soft tissue and mandibular nerve canal involvement.. Four patients with mandibular diffuse sclerosing osteomyelitis are presented; all were followed with CT, a few also with MRI and bone scan. We recorded imaging findings of lesion location, pattern of bone formation, presence and evolution of lytic lesions, mandibular nerve, and soft tissue involvement.. In all patients we found enlargement of the mandibular nerve canal and soft tissue changes on CT and MRI (when available). All patients had ground glass bone patterns in conjunction with lamellated/onion skin new periosteal bone formation on CT, and all patients with follow-up CT had change in lytic lesion locations.. Mandibular nerve canal enlargement, soft tissue abnormalities, and change in location of lytic lesions may represent a diagnostic pattern in mandibular diffuse sclerosing osteomyelitis (Garré) that was not previously entirely recognized as such.

Topics: Adolescent; Child; Child, Preschool; Chronic Disease; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Image Enhancement; Lymph Nodes; Magnetic Resonance Imaging; Male; Mandible; Mandibular Diseases; Mandibular Nerve; Masseter Muscle; Osteogenesis; Osteolysis; Osteomyelitis; Periosteum; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Sclerosis; Technetium Tc 99m Medronate; Tomography, Spiral Computed; Whole Body Imaging

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

To assess the utility of 3-phase bone scintigraphy as a complementary diagnostic method in chronic epicondylitis.. A cross-sectional study.. Hospital outpatient clinic admitting patients with musculoskeletal disorders.. Patients (N=59; 68% women) with unilateral chronic epicondylitis.. Not applicable.. Three-phase bone scintigraphy was performed after an intravenous injection of 550MBq (99m)technetium-labeled hydroxymethyline diphosphonate ((99m)Tc-HDP) in the patients. Blood flow and blood pool phases were graded visually as normative or abnormal. In the bone metabolic phase, the scintigraphic radiograph images were evaluated using a transmission densitometer. The ratio between maximal bone uptake of (99m)Tc-HDP in each epicondyle and the mean of that in the adjacent humerus was used as a bone uptake measure, which was compared with clinical data (pain questionnaire, pain drawing, cubital pain thresholds, muscle strength) and with work ability and lifestyle factors.. The bone uptake of (99m)Tc-HDP of the affected epicondyle was 33% and 17% higher in men and women, respectively, compared with the corresponding healthy epicondyle (P<.001 and P=.007). High bone uptake of (99m)Tc-HDP was associated with better work ability, grip strength, and muscle performance in both sexes but was not correlated with the pain measures. Blood flow phases had a positive correlation with the duration of symptoms and a negative correlation with the bone uptake of (99m)Tc-HDP, grip strength, and work ability.. High bone uptake of (99m)Tc-HDP among patients with chronic epicondylitis was associated with better muscle strength, work ability, and arm function. In chronic cases, a higher degree of bone uptake of (99m)Tc-HDP may thus indicate a healing response in the bone tissue.

Topics: Adult; Biomechanical Phenomena; Chronic Disease; Cross-Sectional Studies; Elbow Joint; Female; Humans; Humerus; Male; Middle Aged; Pain Measurement; Radionuclide Imaging; Radiopharmaceuticals; Statistics, Nonparametric; Technetium Tc 99m Medronate; Tennis Elbow

A 12-year-old Middle Eastern girl presented with abdominal pain, weight loss, and intermittent pain in both thighs. She was initially suspected of Crohn disease, but this diagnosis was excluded after extensive gastromedical evaluation. Plain x-rays of the femora were normal, whereas the initial Tc-99m methylene diphosphonate (MDP) bone scan showed several foci with increased activity in both femurs. MR scan showed excessive periostal inflammatory and mild intramedullary changes in both femurs. A percutaneous bone biopsy demonstrated changes consistent with chronic recurrent multifocal osteomyelitis (CRMO). The patient's symptoms disappeared spontaneously, but reappeared 1.5 years later, which led to a new MDP bone scan that showed normal findings.

Topics: Biopsy; Child; Chronic Disease; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Adolescent; Biopsy; Bone Neoplasms; Chronic Disease; Diagnosis, Differential; Genetic Testing; Humans; In Situ Hybridization, Fluorescence; Joint Diseases; Knee Joint; Male; Pain, Intractable; Positron-Emission Tomography; Sarcoma, Ewing; Technetium Tc 99m Medronate; Thigh; Tomography, X-Ray Computed

The case of a 17-month-old boy with symmetric involvement of both femora in chronic recurrent multifocal osteomyelitis (CRMO) is presented. Imaging showed an extraordinary involvement of both femoral diaphyses and distal metaphyses with extensive lamellar-like periosteal reactions. Diagnosis was based upon laboratory tests, bone scintigraphy, and MRI findings and was proved by open bone biopsy.

Topics: Biopsy; Chronic Disease; Femur; Gadolinium; Humans; Infant; Magnetic Resonance Imaging; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Technetium Tc 99m Medronate; Time Factors; X-Rays

Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event, making its diagnosis difficult. A delayed diagnosis and delayed surgical repair compromise the outcome. In this paper the authors report the case of a chronic contained rupture of an AAA causing spinal destruction, in which diagnosis was difficult because the lesion produced symptoms mimicking those of pyogenic spondylitis.

Topics: Aged; Aneurysm, Ruptured; Aortic Aneurysm, Abdominal; Chronic Disease; Diagnosis, Differential; Humans; Ilium; Intervertebral Disc; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Spondylitis; Suppuration; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adenocarcinoma; Calcinosis; Chronic Disease; Female; Humans; Hypercalcemia; Hyperparathyroidism; Kidney Failure, Chronic; Lung; Lung Neoplasms; Middle Aged; Ossification, Heterotopic; Peritoneal Dialysis, Continuous Ambulatory; Radiopharmaceuticals; Respiratory Function Tests; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

To investigate the clinical significance of bone involvement in chronic rhinosinusitis, 99mTc-MDP bone single photon emission computed tomography (SPECT) was studied in 43 patients diagnosed as having chronic rhinosinusitis. Quantitative isotope uptake indices calculated on SPECT were compared between the patient and a control group, and between patients with a good postoperative outcome and those with a poor outcome. The patient group showed a significantly higher isotope uptake than the control group. The uptake of isotope in the ethmoid sinus areas in patients who had a poor postoperative outcome was significantly higher than those who had a good outcome. Our study suggests that patients with chronic rhinosinusitis have apparent bony involvement, and patients with more severe bone involvement may have a poorer treatment outcome.

Topics: Adult; Chronic Disease; Endoscopy; Female; Humans; Male; Middle Aged; Nasal Bone; Otorhinolaryngologic Surgical Procedures; Rhinitis; Sinusitis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Treatment Outcome

Topics: Chronic Disease; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Proteus Infections; Proteus mirabilis; Radiopharmaceuticals; Soft Tissue Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A patient with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) was evaluated by combined scintigraphy. (99m)Tc HMDP scintigraphy showed accumulation in the sternum and lumbar vertebrae as well as the right mandible, whereas (67)Ga citrate showed an accumulation in the right mandible, but not in the sternum or lumbar vertebrae. These results are consistent with chronic osteomyelitis in the mandible.

Topics: Acquired Hyperostosis Syndrome; Aged; Chronic Disease; Citrates; Gallium; Gallium Radioisotopes; Humans; Lumbar Vertebrae; Male; Mandibular Diseases; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Sternum; Technetium Tc 99m Medronate

The authors present a comparison of the findings for thallium-201 (Tl-201), Tc-99m MAG3 and Tc-99m MDP in subacute and chronic radiation nephritis in a 9-yr-old boy who was treated by radiation therapy for alveolar rhabdomyosarcoma of the left chest wall by a radiation port that partially included the left kidney. Tl-201 imaging three and six months later showed a cortical defect in the left kidney due to radiation nephritis. Tc-99m MDP scan showed increased uptake on both occasions, but more marked in the subacute period than in the chronic period. Tc-99m MAG3 showed decreased concentration and increased cortical retention three months later. Six months after the radiation therapy, a cortical defect corresponding to the cortical area that showed increased parenchymal retention was more prominent in the Tc-99m MAG3 scan. In the present case, Tc-99m MDP, Tl-201 and Tc-99m MAG3 findings may provide useful information for understanding pathophysiological damage in the kidney after radiation.

Topics: Child; Chronic Disease; Humans; Kidney; Male; Nephritis; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyosarcoma, Alveolar; Ribs; Technetium Tc 99m Medronate; Technetium Tc 99m Mertiatide; Thallium Radioisotopes

Assessment of disease activity and disease extent in chronic osteomyelitis remains a difficult diagnostic problem. Radiography is not particularly sensitive. Scintigraphic techniques can be more helpful, but the routinely available agents lack specificity (99mTc-methylene diphosphonate [MDP], 67Ga-citrate) or are laborious to prepare (111In-leukocytes). We evaluated the performance of 2 new radiopharmaceuticals, 99mTc-polyethyleneglycol (PEG) liposomes and 99mTc-hydrazinonicotinamide (HYNIC)-immunoglobulin G (IgG), in an experimental model of chronic osteomyelitis.. Chronic osteomyelitis was induced in rabbits by inserting S. aureus into the right reamed and washed femoral canal. The canal was closed with cement. A sham operation was performed on the left femur. Routine radiographs were obtained immediately after surgery and before scintigraphy. Four weeks after surgery, each rabbit was injected with 37 MBq 99mTc-PEG liposomes, 99mTc-HYNIC-IgG, and 99mTc-MDP on 3 consecutive days and imaged up to 4 (MDP) or 22 (liposomes and IgG) h after injection. On day 4, rabbits received either 18 MBq 111In-granulocytes or 67Ga-citrate and were imaged up to 44 h after injection. Uptake in the infected femur was determined by drawing regions of interest. Ratios of infected-to-sham-operated femur were calculated. After the last image, the rabbits were killed, and the left and right femur were scored for microbiologic and histopathologic evidence of osteomyelitis.. 99mTc-PEG liposomes and 99mTc-HYNIC-IgG correctly identified all 6 rabbits with osteomyelitis. 11In-granulocytes and 67Ga-citrate gave equivocal results in 1 infected rabbit. 99mTc-MDP missed 1 case of osteomyelitis. The uptake in the affected region did not differ significantly between the agents, although 99mTc-MDP tended to have higher values (MDP, 4.75 +/- 1.23 percentage injected dose per gram [%ID/g]; 67Ga, 2.05 +/- 0.54 %ID/g; granulocytes, 1.56 +/- 0.83 %ID/g; liposomes, 1.75 +/- 0.76 %ID/g, and IgG, 1.96 +/- 0.27 %ID/g). The ratios of infected-to-normal femur were also not significantly different for the respective radiopharmaceuticals. Radiography visualized only severe osteomyelitis.. In this rabbit model, 99mTc-PEG liposomes and 99mTc-HYNIC-IgG performed at least as well as 111In-granulocytes and 67Ga-citrate in the localization of chronic osteomyelitis. The ease of preparation, the better image quality, and the lower radiation dose suggest that 99mTc-PEG liposomes and 99mTc-HYNIC-IgG might be suitable alternatives for 67Ga-citrate and 111In-granulocytes in the scintigraphic evaluation of osteomyelitis.

Topics: Animals; Chronic Disease; Female; Immunoglobulin G; Liposomes; Osteomyelitis; Polyethylene Glycols; Rabbits; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Bone and Bones; Bone Neoplasms; Calcinosis; Chronic Disease; Female; Humans; Pancreatitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Uterine Cervical Neoplasms

Previous studies have identified focal areas of alveolar tenderness, elevated mucosal temperature, radiographic abnormality, and increased radioisotope uptake or "hot spots" within the quadrant of pain in most patients with chronic, idiopathic facial pain (phantom pain, atypical facial neuralgia, and atypical facial pain).. This retrospective investigation radiographically and microscopically evaluated intramedullary bone in a certain subset of patients with histories of endodontics, extraction, and fixed partial denture placement in an area of "idiopathic" pain.. Patients from 12 of the United States were identified through tissue samples, histories, and radiographs submitted to a national biopsy service. Imaging tests, coagulation tests, and microscopic features were reviewed. Of 38 consecutive idiopathic facial pain patients, 32 were women.. Approximately 90% of subpontic bone demonstrated either ischemic osteonecrosis (68%), chronic osteomyelitis (21%), or a combination (11%). More than 84% of the patients had abnormal radiographic changes in subpontic bone, and 5 of 9 (56%) patients who underwent radioisotope bone scan revealed hot spots in the region. Of the 14 patients who had laboratory testing for coagulation disorders, 71% were positive for thrombophilia, hypofibrinolysis, or both (normal: 2% to 7%). Ten pain-free patients with abnormal subpontic bone on radiographs were also reviewed.. Intraosseous ischemia and chronic inflammation were suggested as a pathoetiologic mechanism for at least some patients with atypical facial pain. These conditions were also offered as an explanation for poor healing of extraction sockets and positive radioisotope scans.

Topics: Adult; Aged; Biopsy; Blood Coagulation Tests; Chronic Disease; Denture, Partial, Fixed; Facial Pain; Female; Fibrinolysis; Humans; Ischemia; Male; Mandible; Mandibular Diseases; Maxilla; Maxillary Diseases; Middle Aged; Neuralgia; Osteomyelitis; Osteonecrosis; Radiography; Radiopharmaceuticals; Retrospective Studies; Root Canal Therapy; Technetium Tc 99m Medronate; Thrombophilia; Tooth Extraction; Wound Healing

Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.

Topics: Chronic Disease; Facial Pain; Humans; Male; Maxillary Diseases; Middle Aged; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate use of positron emission tomography (PET) with 2-(fluorine-18) fluoro-2-deoxy-D-glucose (FDG) in detection of chronic osteomyelitis.. Thirty-one patients suspected to have chronic osteomyelitis in the peripheral (n = 21) or central (n = 10) skeleton were evaluated prospectively with FDG PET. Analysis of the receiver operating characteristic curve was performed. The final diagnosis was made by means of bacteriologic culture of surgical specimens and histopathologic analysis.. FDG PET allowed identification of 17 of 18 patients with osteomyelitis and 12 of 13 without osteomyelitis. There was one false-positive and one equivocal result. The area under the ROC curve was 0.96 for all patients, 1.00 for patients suspected to have osteomyelitis in the peripheral skeleton, and 0.88 for patients suspected to have osteomyelitis in the central skeleton. The overall accuracy of FDG PET was 97% with a high degree of interobserver concordance (kappa = 0.93). The overall sensitivity and specificity were 100% and 92%, respectively.. FDG PET enables noninvasive detection and demonstration of the extent of chronic osteomyelitis with a high degree of accuracy. Especially in the central skeleton within active bone marrow, FDG PET is highly accurate and shows great promise in diagnosis of chronic osteomyelitis.

Topics: Bone and Bones; Chronic Disease; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radioimmunodetection; Radiopharmaceuticals; ROC Curve; Sensitivity and Specificity; Soft Tissue Infections; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Breast Neoplasms; Carcinoma; Chronic Disease; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Mastoid; Mastoiditis; Middle Aged; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

In this study, we describe the importance of the whole-body bone scan in diagnosing the multifocality of chronic recurrent multifocal osteomyelitis (CRMO) and in distinguishing it from unifocal acute hematogenous osteomyelitis.. The medical records and two-phase, whole-body bone scans of 14 patients (mean age 10.5 yr) with the diagnosis of CRMO, were retrospectively reviewed. The diagnosis of CRMO was based on bone biopsy in 9 patients and clinical course/laboratory findings in 5. Bone scans were evaluated for geographic and anatomic locations of their lesions. Correlative radiographs of areas of abnormal uptake were performed to assess the radiographic appearance of the lesions.. The presentation of the disease was localized to one painful, tender and swollen periarticular site 86% of the time. The number of lesions detected by bone scan varied from 1-18 (mean 6). Most lesions were metaphyseal, proximal or distal tibial lesions. Purely sclerotic or mixed (sclerosis and lysis) lesions were found on radiographs. Bilateral lesions were seen in 64% of patients. Biopsies were negative for organisms in all patients and exhibited subacute or chronic histologic changes in most instances. Complications of chronic hyperemia included marked overgrowth (5), diffuse demineralization (1), angular deformity (1) and length discrepancy (1).. The identification of the multifocal configuration of the disease process by two-phase (soft-tissue and delayed) whole-body bone scintigraphy results in appropriate diagnosis and therapy of CRMO. Additional sites for possible bone biopsy become apparent for exclusion of other diagnoses. Supportive (nonsteroidal, anti-inflammatory medication) instead of antimicrobial therapy can be initiated with significant cost savings.

Topics: Bone and Bones; Child; Chronic Disease; Female; Humans; Male; Osteomyelitis; Radiopharmaceuticals; Recurrence; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Child; Chronic Disease; Female; Humans; Magnetic Resonance Imaging; Mandibular Diseases; Osteomyelitis; Radiopharmaceuticals; Recurrence; Technetium Tc 99m Medronate; Tomography, Emission-Computed

A case of chronic recurrent multifocal osteomyelitis in a 14-year-old girl is presented. The disease had an initial aggressive osteolytic appearance involving both the maxilla and the mandible. Conservative treatment with minimal surgical intervention has been successful in this case during a 2-year follow-up period. The value of magnetic resonance imaging and bone scintigraphy in this case and the cause of chronic recurrent multifocal osteomyelitis is discussed.

Topics: Adolescent; Bone Regeneration; Chronic Disease; Female; Humans; Jaw Diseases; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Recurrence; Technetium Tc 99m Medronate

Topics: Abdominal Muscles; Adolescent; Chronic Disease; Cumulative Trauma Disorders; Humans; Leg; Male; Martial Arts; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Chronic Disease; Frontal Sinus; Frontal Sinusitis; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To evaluate the diagnostic value of technetium-99m d, l-hexamethylpropylene amine oxime (HMPAO) labelled leucocytes in combination with a 99mTc-methylene diphosphonate (MDP) bone scan in the detection of chronic osteomyelitis, we retrospectively reviewed 55 patients. Prior to the 99mTc-d,l-HMPAO labelled leucocyte scan, all patients underwent a 99mTc-MDP bone scan. The correct diagnosis was confirmed by long-term clinical follow-up (n=29) or by bacteriological cultures (n=26). We found an overall sensitivity of 94%, a specificity of 91% and an accuracy of 92% for 99mTc-d,l-HMPAO labelled leucocyte scintigraphy in the diagnosis of chronic osteomyelitis. When the patients were divided into three groups according to the location of the infection, our study results showed a sensitivity and specificity for the central location (containing active bone marrow) of 94% and 100% respectively; for the peripheral location (hands and feet) both parameters were 100%, and for the middle location (all sites between the central and the peripheral location) the values were 92% and 81% respectively. Specificity and accuracy were significantly lower in the middle location than in the central and peripheral locations. The results of our study confirm that a 99mTc-d,l-HMPAO labelled leucocyte scan in combination with an 99mTc-MDP bone scan is a reliable way to diagnose chronic osteomyelitis, except for vertebral osteomyelitis.

Topics: Case-Control Studies; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

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

Our purpose was to assess the role of MRI in evaluating the musculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the pubic ring was performed in 11 young athletes (soccer players) with long-standing groin pain. MR findings were compared with plain films and isotope examination (bone scan Tc 99M). Abnormal MRI findings included a broadened and irregular symphysis with a characteristic pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior pubic ramus at a distance from the symphysis. Positive findings were also observed on plain films and on nuclear medicine studies. However, the imaging findings in the superior public ramus of the symphysis was located considerably more laterally on MRI. MRI is a valuable method for evaluating discrete and ambiguous pelvic pain in athletes, particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing pain localized laterally in the groin.

Topics: Adolescent; Adult; Bone Diseases; Chronic Disease; Humans; Inguinal Canal; Joint Diseases; Ligaments; Magnetic Resonance Imaging; Male; Pain; Pelvic Bones; Pubic Bone; Pubic Symphysis; Radiography; Radionuclide Imaging; Soccer; Technetium Tc 99m Medronate

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

To determine whether quantitative bone scintigraphy (QBS) with single-energy photon emission computed tomography (SPECT) can help predict which patients with chronic renal disease will show bone mineral density (BMD) loss.. In 18 patients, the percentage of injected dose of technetium-99m methylene diphosphonate per cubic centimeter of bone was measured with QBS SPECT in the lumbar vertebrae and femoral neck. The differences in BMD over an average of 20 months were measured and compared with SPECT measurements. QBS values were also compared with serum bone turnover markers.. There was a negative correlation (r = -.54, P < .05 for the lumbar spine and r = -.60, P < .01 for the femoral neck) between QBS values and bone loss. Positive and negative predictive values, sensitivity, and specificity of QBS for bone loss in the lumbar spine were 78%, 71%, 78%, and 71%, respectively, and in the femoral neck, 82%, 100%, 100%, and 78%, respectively. Differences between predictive values of serum bone turnover markers were not statistically significant.. QBS with SPECT enabled prediction of rapid bone loss in patients with renal disease.

Topics: Absorptiometry, Photon; Aged; Alkaline Phosphatase; Biomarkers; Bone Density; Calcium; Chronic Disease; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Femur Neck; Follow-Up Studies; Forecasting; Humans; Kidney Failure, Chronic; Lumbar Vertebrae; Male; Middle Aged; Osteocalcin; Parathyroid Hormone; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

We studied the results of bone scans in 50 consecutive patients with symptomatic, unilateral, chronic anterior cruciate ligament (ACL) tears. All patients had failed conservative therapy and underwent radionuclide imaging of the knee prior to arthroscopic ACL reconstruction. The scintigraphic activity in each of the three knee compartments was quantitatively scaled from 1 (normal scintigraphic activity) to 4 (marked activity). Quantitative activity in each of the three compartments was correlated with plain radiographic, arthroscopic, and clinical findings. All but four of the scans (92%) showed abnormal scintigraphic activity. The quantitative activity was highest overall in the medial compartment (2.9), followed by the lateral (2.4) and patellofemoral compartments (1.9). In the subgroup of patients with normal menisci (10 patients), most of the abnormal activity was in the lateral compartment (2.9), implying that when the medial meniscus remains competent in the presence of a torn ACL, there is increased stress on the lateral compartment. There was little correlation with scintigraphy and roentgenographic changes, except in the presence of moderate or severe radiographic degenerative arthritis. Similarly, there was little correlation between increased scintigraphic activity and chondromalacia. These results provide a baseline for future studies that use scintigraphic imaging in monitoring restoration of bone homeostasis following ACL reconstruction.

Topics: Adolescent; Adult; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Arthroscopy; Cartilage Diseases; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Injury Severity Score; Male; Osteoarthritis; Preoperative Care; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Wounds and Injuries

Thirty-five patients each with a tentative diagnosis of osteomyelitis of the mandible were examined with 99Tcm-labeled phosphorus compounds. The scintigraphic findings were compared with the radiographic features and related to disease stages to evaluate the diagnostic potential of bone scintigraphy in different disease stages. The scintigraphy was valuable to exclude bone tissue involvement in some patients with clinical signs and symptoms similar to those of osteomyelitis and with equivocal radiographic findings. In 13 patients with chronic osteomyelitis, scintigraphy revealed a larger extent of the lesion than the radiography. In lesions with permeated bone destructions with penetration of the cortex, the uptake of 99Tcm was higher than in lesions with a motheaten or sclerotic appearance. This study supports the view that 99Tcm-bone scintigraphy is a useful tool at various stages of osteomyelitis, that is, in its early detection, in the treatment or biopsy planning, and in the evaluation of the efficacy of treatment.

Topics: Adolescent; Adult; Chronic Disease; Female; Humans; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Radiography, Panoramic; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Twelve patients with longstanding constipation were examined by isotope proctography. Radio-labelled potato mash was inserted rectally to provoke the urge to defaecate and expulsive manoeuvres were recorded using a Gamma-camera. The method illustrated dynamic alterations in the anorectal angles (ARA) which became more acute on 'squeezing', less so on coughing and more obtuse on straining, and maximally so on evacuation. The pelvic floor (PF) movements were consistently upwards on squeezing, less so on coughing, downwards on straining, and maximally so on evacuation. A useful addition was the measurement of the completeness of evacuation and the time involved. The results were comparable to radiological videoproctography (P < 0.01), but the isotope method gave greater discrimination for both ARA and PF movement changes. It also allowed correlations to be made between the pelvic floor descent (P < 0.05) and anorectal angle changes (P < 0.01) with rectal evacuation.

Topics: Adult; Anal Canal; Chronic Disease; Constipation; Defecation; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Rectum; Technetium Tc 99m Medronate

Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. The three-phase bone scan is therefore very useful in diagnosing PF and in distinguishing it from other etiologies of the painful heel syndrome.

Topics: Adult; Chronic Disease; Fasciitis; Female; Heel; Humans; Male; Middle Aged; Pain; Prospective Studies; 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

We evaluated the relative contribution of transmission computed tomograms (CT), plain radiographs, and bone/gallium scans in the diagnosis of 27 patients with suspected active chronic osteomyelitis. All patients were imaged with all modalities and had surgical proof of the presence or absence of disease. At surgery, osteomyelitis was shown to be active in 20 patients, 15 of whom had sequestra, and inactive in the remaining seven. CT depicted all 15 sequestra, but was falsely positive in three patients, all of whom had bone remodeling only and had negative bone/gallium scintiscans. Plain radiographs had a limited value; they detected sequestra, which was the only findings to indicate the presence of active disease, in 5 patients out of the 15 with surgical proof thereof. The authors conclude that, considering the shortcoming of other modalities with regard to depicting sequestra, scintigraphy is helpful in confirming the presence or absence of active disease and therefore in preventing unnecessary surgery.

Topics: Adult; Chronic Disease; Citrates; Citric Acid; Female; Humans; Male; Osteomyelitis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Use of single photon emission computerized tomography (SPECT) with Tc 99m HDP for localization of an active sequestrum in a case of chronic head and neck osteomyelitis is described. Correlation with x-ray computed tomography (CT) for anatomy was helpful for surgical debridement. The potential of the complementary roles of SPECT and CT in chronic head and neck osteomyelitis for assessing sequestrum activity and anatomy prior to surgery is discussed.

Topics: Adult; Chronic Disease; Debridement; Female; Humans; Maxilla; Maxillary Diseases; Neck; Osteomyelitis; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

Chronic recurrent multifocal osteomyelitis was first described in 1972 and to date 33 cases have been reported, all but one from outside the United States. This unusual osteomyelitis is characteristically recurrent and multifocal with a predilection for the metaphyses. Cultures are persistently negative and antibiotics do not appear to affect the course of the disease, which may be as long as 15 years. Females are affected twice as frequently as males and half the cases are less than ten years old. Antistreptolysin 0 titers are elevated in a quarter of the patients, and there may be a history of previous throat infection. There is an association with pustulosis palmoplantaris. We present two additional cases from the United States.

Topics: Child; Chronic Disease; Female; Humans; Osteomyelitis; Radiography; Radionuclide Imaging; Recurrence; Technetium Tc 99m Medronate

The usefulness of indium-111 white blood cell scintigraphy in the diagnosis of subacute or chronic bone infection was examined in 21 orthopedic patients. In-111 WBC imaging was compared with gallium-67 and technetium-99m methylene diphosphonate skeletal scintigraphy and bone radiography, all studies being performed within 1 week. In-111 WBC scintigraphy showed no definite advantage over Ga-67 scintigraphy in the identification of chronic bone infection. The two tests had the same sensitivity (80%) and similar specificity (In-111 WBC 75%, Ga-67 83%; difference not significant). Bone radiography had a sensitivity of 60% and a specificity of 67%. A negative Tc-99m MDP bone scintigram ruled out infection (sensitivity 100%), but because of low specificity (25%), final evaluation required performance of Ga-67 or In-111 WBC scintigraphy.

Topics: Adult; Aged; Bone Diseases; Chronic Disease; Diphosphonates; Gallium Radioisotopes; Humans; Indium; Infections; Leukocytes; Middle Aged; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; 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

Topics: Adolescent; Adult; Bone and Bones; Chronic Disease; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Female; Humans; Male; Middle Aged; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Uremia