technetium-tc-99m-medronate and Diabetes-Mellitus--Type-1

Topics: Abdominal Muscles; Bone and Bones; Diabetes Mellitus, Type 1; Humans; Injections, Subcutaneous; Insulin; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 19-yr-old woman with juvenile diabetes and protein C deficiency was referred for a bone scan to rule out osteomyelitis of the right tibia. The bone scan did not reveal evidence of osteomyelitis. There was, however, extraskeletal uptake of the 99mTc bone tracer in the anterior abdominal wall confined to the sites of subcutaneous heparin administration. This case is presented because of its interesting scintigraphic findings and to discuss the association of protein C deficiency and heparin administration as a cause of extraskeletal 99mTc bone tracer accumulation.

Topics: Abdominal Muscles; Adult; Anticoagulants; Blood Coagulation Disorders; Diabetes Mellitus, Type 1; Female; Heparin; Humans; Injections, Subcutaneous; Osteomyelitis; Protein C Deficiency; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The noninvasive diagnosis of osteomyelitis of the foot in diabetic patients with currently available radiologic and radionuclide imaging techniques is often difficult. Recently, 111In-labeled leukocyte scintigraphy has been proposed as an attractive alternative. Accordingly, we retrospectively reviewed 51 111In-labeled leukocyte scans, 49 technetium-99m bone scans, and 49 plain radiographs obtained in 51 adults with diabetes in whom osteomyelitis of the foot was suspected. The sensitivity and specificity of these techniques were evaluated in all patients, as well as in a subgroup of 11 patients with neuroarthropathy. Results with 111In-labeled leukocyte scans were also examined in subsets of patients with soft-tissue ulcers (n = 35) and those receiving antibiotics during investigation (n = 20). Confirmation or exclusion of osteomyelitis was made surgically in 28 patients and clinically in 23. Fourteen patients had osteomyelitis. Bone scans were most sensitive (93%) but least specific (43%); plain radiographs were most specific (83%) but least sensitive (43%). 111In-labeled leukocyte scans were both sensitive (79%) and specific (78%), and remained useful in patients with neuroarthropathy, soft-tissue ulcers, and antibiotic treatment. Poor spatial resolution contributed to the false-negative and false-positive 111In-labeled leukocyte scans, suggesting that this technique should not be interpreted independent of other tests. 111In-labeled leukocyte scans are a valuable diagnostic tool for the diagnosis of pedal osteomyelitis in diabetic patients.

Topics: Adult; Aged; Aged, 80 and over; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Foot Diseases; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Radiography; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Diagnosis of osteomyelitis of the foot in diabetic patients may be difficult because of the coexistence of chronic cellulitis, vascular insufficiency, and peripheral neuropathy. This study compared the diagnostic accuracies of plain films, bone scans, and MR imaging studies in diabetic patients with suspicion of osteomyelitis of the foot. Twenty-nine plain radiographs, 20 bone scans, and 30 MR studies were obtained in 24 patients. Twenty-nine bones from 14 patients were pathologically proved either positive (25 bones) or negative (four bones) for osteomyelitis. Another 15 bones (10 patients) studied with MR had no pathologic proof, but the bones healed with only local wound care and/or a short course of oral antibiotics. These patients had trauma, cellulitis, or unhealed ulcers. The sensitivity and specificity of plain films were both 75%. Bone scans had a very low specificity (100% false-positive rate). A negative bone scan should strongly exclude the probability of osteomyelitis. Unlike the findings in previous reports, MR had much higher sensitivity and specificity than bone scans in detecting osteomyelitis in diabetic patients. When the 10 patients without pathologic proof (those who presumably had neuroarthropathy, vascular insufficiency, and/or cellulitis) were included, the sensitivity and specificity of all three techniques decreased. Our experience with this small group of patients suggests that MR is a useful imaging technique for diagnosing osteomyelitis of the foot in diabetic patients.

Topics: Adult; Aged; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Female; Foot; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Diabetes Mellitus, Type 1; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteomyelitis; Otitis Externa; Pseudomonas Infections; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Asymptomatic myocardial disease has been described in relation to longstanding insulin-dependent diabetes mellitus. To detect myocardiopathy in a selected group of 14 patients (aged 21-38 years, duration of diabetes 10-20 years) with insulin-dependent diabetes, we have performed equilibrium gated nuclear angiography with Fourier filtered analysis. These patients had no clinical or echocardiographic signs of cardiac disease. We examined six patients with severe proliferative retinopathy, and eight patients with no signs of retinopathy at fluorescence angiography. The global ejection fraction was within normal limits in all cases. Fourier analysis of scintigraphic data, however, revealed wall motion abnormalities (abnormal amplitude and phase shift) of the left ventricle in all 14 patients, particularly in the anterior and/or septal region. No correlation was found between the degree of wall motion disturbances and prevailing blood glucose or HbA1 concentrations or the presence of retinopathy or autonomic neuropathy. It is concluded that equilibrium gated nuclear angiography in combination with Fourier filtered analysis is a sensitive method of detecting myocardial abnormalities in patients suffering from insulin-dependent diabetes mellitus without cardiac symptoms.

Topics: Adult; Cardiomyopathies; Diabetes Mellitus, Type 1; Diabetic Retinopathy; Female; Fourier Analysis; Heart; Humans; Male; Radionuclide Imaging; Stroke Volume; Technetium Tc 99m Medronate