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

Pott's disease is an uncommon extrapulmonary form of tuberculosis. Delay in diagnosis and management may cause serious complications. The authors describe Pott's disease incidentally detected on Tc-99m MDP bone and Ga-67 imaging in a patient with diabetes. Tc-99m MDP bone scintigraphy showed intensely increased uptake in the lower cervical spine and lumbosacral regions. Ga-67 scintigraphy revealed intensely increased uptake corresponding to the areas noted on Tc-99m MDP bone scintigraphy. Magnetic resonance imaging showed destructive lesions in the C5-C6 and L5-S1 intervertebral discs with destruction of adjacent end plates. Biopsy of the lumbosacral area was guided by computed tomography, and histologic examination of the bone specimen showed caseation, giant cells, and acid-fast bacilli. Posterior decompression and posterolateral spinal fusion with bone grafts were performed. Antituberculous chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. The patient showed remarkable relief of symptoms during a period of 9 months of therapy. Both Tc-99m MDP bone and Ga-67 imaging can offer the convenience of screening the entire body to detect multiple sites of Pott's disease.

Topics: Cervical Vertebrae; Citrates; Diabetes Complications; Diabetes Mellitus; Diagnosis, Differential; Female; Gallium; Humans; Hypertension; Incidental Findings; Low Back Pain; Lumbosacral Region; Middle Aged; Muscle Weakness; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tuberculosis, Spinal; Whole-Body Counting

Topics: Animals; Diabetes Mellitus; Dissection; Humans; Myocardial Revascularization; Regional Blood Flow; Sternum; Technetium Tc 99m Medronate

Qualitative technetium Tc 99m bone scintigraphy using phosphate compounds and gallium 67 scintigraphy were described as a helpful means in diagnosing necrotizing external otitis (NEO). They were, however, claimed to be nonspecific. Quantitative Tc 99m methylene diphosphonate bone scintigraphy and gallium 67 scintigraphy were performed in eight patients with NEO and in 20 patients with severe external otitis, in order to prove usefulness of scintigraphy in the diagnosis of NEO. Ratios of lesion to nonlesion for bone scintigraphy were 1.67 +/- 0.16 in patients with NEO and 1.08 +/- 0.09 in patients with severe external otitis, and for gallium 67 scintigraphy they were 1.35 +/- 0.24 in NEO patients and 1.05 +/- 0.03 in patients with severe external otitis. There was no difference in uptake between diabetic patients with severe external otitis and nondiabetic patients. The scintigraphic studies were also evaluated using a qualitative scoring method (scores 0 to +4), according to the intensity of the radiopharmaceutical uptake. This method was found to be inferior in the diagnosis of NEO compared with the quantitative method. We conclude that lesion-to-nonlesion ratios greater than 1.5 and 1.3 on bone and gallium 67 scintigraphy, respectively, are indicative of NEO. Quantitative bone scintigraphy, which is quicker to perform, may be used as a single imaging modality for the diagnosis of NEO.

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Diabetes Mellitus; Diagnosis, Differential; Female; Gallium Radioisotopes; Granulation Tissue; Humans; Male; Middle Aged; Necrosis; Observer Variation; Otitis Externa; Prospective Studies; Pseudomonas Infections; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Temporal Bone

Scintigraphic techniques for detecting bone infection can be misleading in neuroarthropathy (Charcot joint). Three patients showed strongly positive three phase bone and 67Ga imaging despite absence of osteitis. Indium labelled white cell imaging provided the correct information on each patient. The findings have important implications for the investigation of diabetic patients with suspected bone infection.

Topics: Adult; Aged; Arthropathy, Neurogenic; Diabetes Complications; Diabetes Mellitus; Female; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteitis; Radionuclide Imaging; Technetium Tc 99m Medronate