technetium-tc-99m-medronate and Low-Back-Pain

It has been suggested that low back pain (LBP) may arise from lumbosacral transitional vertebral articulation (LSTVA) itself. It is known that bone scintigraphy is a valuable tool for the recognition of pain arising from bone and articular diseases. Therefore we aimed to show planar and SPECT bone scintigraphic findings of LSTVA and compare them with the LBP and X-ray findings. Twenty-eight patients (aged 20-63 years) in whom LSTVA had been identified radiographically were evaluated with planar bone scintigraphy, utilizing 99mTc methylene diphosphonate; and single photon emission computed tomography (SPECT) bone scintigraphy. Eighteen patients had LBP whereas 10 had not. There were 25 type IIA, one type IIB and two type IIIA LSTV articulation. On planar images, normal or non-focal minimally increased uptake superimposed on the upper sacroiliac joint was seen in patients without degenerative changes regardless of LBP whereas SPECT showed non-focal mild increased uptake on the area medial to the upper sacroiliac joint. Planar scans showed normal to non-focal mild, and mild-to-moderately increased uptake whereas SPECT demonstrated focal mild-to-moderately and markedly increased uptake in patients with degenerative changes without LBP and with LBP, respectively. The X-ray results showed an association of LBP degenerative changes, and the SPECT results showed a focal, markedly increased, uptake. We conclude that this focal, markedly increased, uptake may show the metabolically active degenerative changes of LSTV articulation and may help to reveal the pain arising from LSTVA. Therefore we propose that bone scintigraphy may be considered for the evaluation of patients with LBP thought to arise from LSTV articulation.

Topics: Adult; Female; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Male; Middle Aged; Radiography; Radiopharmaceuticals; Reproducibility of Results; Sacrum; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Lumbosacral transitional vertebrae can alter the biomechanics of weight transfer at the affected spinal segment. Low-back pain may result. This study assessed what skeletal scintigraphy reveals about stress associated with a lumbosacral transitional vertebra in young patients with low-back pain.. The study population included 48 patients (30 male, 18 female; age range, 6-19 y; mean age, 15.7 y) with low-back pain and a lumbosacral transitional vertebra. Skeletal scintigraphy was correlated with plain radiographs in all, CT in 12, and MRI in 11.. High uptake was shown at the articulation between the transverse process of a lumbosacral transitional vertebra and the sacrum in 39 (81%) of the patients. In 23 (59%) of the 39 patients with high uptake, this finding was shown only by SPECT. In 13 (81%) of the 16 for which the high uptake was shown by planar imaging, the anterior projection was more valuable than the posterior projection. In 9 (23%) of the 39 patients with high uptake at the transverse-sacral articulation, the lumbosacral transitional vertebra had not been noted in a radiographic report before skeletal scintigraphy but was identified through reevaluation or repetition of radiographs after skeletal scintigraphy. Radiographs showed sclerosis along the transverse-sacral articulation in only 8 (21%) of the 39 patients with high uptake. Findings indicating stress or motion at the joint were shown by CT in 6 (55%) of 11 and by MRI in 5 (63%) of 8 patients with high uptake at the transverse-sacral articulation who underwent these examinations.. Skeletal scintigraphy often indicates stress at the transverse-sacral articulation of young patients with low-back pain and a lumbosacral transitional vertebra. Showing evidence of stress is best accomplished using SPECT. Changes are usually not radiographically evident, but there is a trend for MRI and CT to show findings that imply stress or motion at the articulation. The unique ability of skeletal scintigraphy to provide this physiologic information supports its use in these patients.

Topics: Adolescent; Adult; Child; Female; Humans; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Male; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sacrum; Technetium Tc 99m Medronate

Bone scintigraphy is often utilized to detect the osseous etiology of lower back pain. Here we report a 70-year-old man with lower back pain who was referred a Tc-MDP bone scan to identify possible vertebral compression fracture. The images did not detect any osseous lesion. However, the images revealed photopenic regions in the both kidneys, which were confirmed as renal cysts on the CT images. The patient received laparoscopic unroofing of renal cysts, and his symptoms improved. Our case illustrated that back pain is not always due to osseous etiology, it might be caused by urinary disorder.

Topics: Aged; Humans; Kidney Diseases, Cystic; Low Back Pain; Male; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

To perform a preliminary evaluation of the image quality of pediatric technetium 99m ((99m)Tc) methylene diphosphonate (MDP) bone single photon emission computed tomography (SPECT) by using iterative reconstruction-ordered subset expectation maximization with three-dimensional resolution recovery (OSEM-3D)-and to assess whether any improvements with use of this technique could lead to a reduction in patient dose or a shortening in imaging time.. Institutional advisory board approval was obtained for this investigation. Fifty (99m)Tc-MDP SPECT studies of the spine were evaluated (36 female and 14 male patients; mean age, 15.5 years). Each study was acquired by using a dual-detector camera, with each detector rotating 360°. By using filtered back projection (FBP) and OSEM-3D, images were reconstructed from data generated by both detectors. Likewise, OSEM-3D was used to reconstruct data from a single detector simulating half the administered radiopharmaceutical activity. Two nuclear medicine physicians, blinded to the patient data, reviewed the images for image quality in four different categories by using a four-point scale: artifacts (category 1), lesions (category 2), noise (category 3), and image sharpness (category 4).. Compared with FBP, images reconstructed by using OSEM-3D with one or two detectors showed significant improvement in image quality with regard to lesion detection, noise level, and image sharpness (P < .02, .01, and .001, respectively). With OSEM-3D, no significant differences were observed when either one or two detectors were used.. Improved image quality of skeletal SPECT with either a 50% reduction in radiation dose or a 50% reduction in acquisition time or combination of the two can be achieved by using OSEM-3D.

Topics: Adolescent; Child; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Logistic Models; Low Back Pain; Male; Radiation Dosage; Radiopharmaceuticals; Retrospective Studies; Software; Statistics, Nonparametric; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Young Adult

Case report.. We report malignant pleural mesothelioma (MPM) discovered in a Tc-99m MDP bone scan as a photopenic lesion in a 64-year-old man presenting with low back pain and diagnosed with F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT).. Malignant pleural mesothelioma, an uncommon neoplasm with a poor prognosis, arises from mesothelial cells of the pleura. Typically, the patient presents with either chest pain or symptoms derived from a pleural effusion such as dyspnea, or both. Most cases of MPM are initially detected on chest radiographs and primarily diagnosed with a CT scan.. Case study with bone scan and F-18 FDG PET/CT.. The Tc-99m MDP bone scan showed a photopenic defect occupying the left side of the T11 vertebra and implicated the existence of a tumor. Pathologic analysis of the paraspinal tumor indicated metastatic neoplastic cells, which we initially suspected originated from the gastrointestinal tract. The CT and magnetic resonance imaging showed no additional information about the primary malignancy; therefore, we did an F-18 FDG PET/CT study, which suggested malignant pleural mesothelioma.. The present case highlights both the value of a Tc-99m MDP bone scan when MPM presents, unusually, as low back pain, and the importance of carefully interpreting bone scan images, especially for photopenic defects. It also indicates the usefulness of F-18 FDG PET/CT study in MPM in a difficult histopathological diagnosis.

Topics: Fluorodeoxyglucose F18; Humans; Low Back Pain; Male; Mesothelioma; Middle Aged; Pleural Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In approximately 80-85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP.. To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLBP intensity.. A cross-sectional study of the relationship of self-reported chronic NSLBP intensity to the uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area.. Patients referred for bone scans who were at least 18 years old.. Subject reports of pain intensity and intensity of uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area.. Among subjects who were 65 years or younger, the age-adjusted worst pain intensity accounted for 45% of the variability in the amount of tracer uptake (r = 0.67, P = 0.0006). The association was not significant for those older than 65 years.. Further studies should be conducted on possible mechanisms relating bone nociception to chronic NSLBP in individuals who are 65 years or younger.

Topics: Adolescent; Adult; Bone Diseases; Child; Female; Humans; Low Back Pain; Male; Patient Selection; Radiography; Radiopharmaceuticals; Surveys and Questionnaires; Technetium Tc 99m Medronate

We have undertaken a retrospective review of 1017 Tc-methylene diphosphonate (Tc-MDP) skeletal scintigrams performed in patients over 70 years of age in order to identify those with insufficiency fractures.. Patients with the diagnosis of insufficiency fracture then underwent clinical follow-up of 2 years for mortality, which was compared to the national aged-matched population.. One hundred and ninety-four patients were found to have scintigraphic evidence of fractures categorized as insufficiency fractures. Typical H-shaped sacral fractures were present in only 17 (4%) patients. Multiple sites of fracture were observed in 114 patients; the commonest being in the vertebrae. Radiological corroboration was available in 161 patients (83%) and bone scintigraphic findings were concordant with at least one of plain radiograph, computed tomography or magnetic resonance imaging in 107 (55%) patients. Of the 48 patients with insufficiency fracture who had undergone measurement for bone mineral density (BMD), 38 were found to have osteoporosis/osteopenia. Eighty-six patients died during the follow-up period, which was markedly higher than expected in the age-matched population. There was no definite relationship between the mortality in insufficiency fracture and BMD or the number of fractures.. Our findings demonstrate that insufficiency fractures are common in the elderly and generally occur at multiple sites. The typical H-shaped fractures are rare and their absence should not lead to any mistaken diagnosis. The patients with insufficiency fractures appear to have poor survival but this does not appear to have any significant relationship with either BMD or the number of fractures. Finally, insufficiency fracture is an important diagnosis to make because survival may be improved if specific management is used.

Topics: Aged; Aged, 80 and over; Bone Density; Female; Foot; Fractures, Bone; Humans; Low Back Pain; Magnetic Resonance Imaging; Male; Multiple Trauma; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sacrococcygeal Region; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Pyogenic sacroiliitis is a rare cause of hip pain and fever. We aim to report a series of 33 patients with pyogenic sacroiliitis and to investigate the differences among paediatric and adult cases.. Clinical and laboratory data of 33 cases who were admitted to the emergency department with a confirmed discharge diagnosis of pyogenic sacroiliitis between 1996 and 2005 were assessed. All patients were divided into paediatric and adult groups by the age of 15 yr. The features of pyogenic sacroiliitis and clinical outcome were compared among the two groups. Several factors were analysed including gender, age, clinical signs and symptoms, laboratory tests, radiological examinations and scintigraphy.. Among the all included patients, females were attacked more frequently than males (3: 1). One-third of patients had concurrent infections, of which urinary tract infections were the most common (41.6%). Compared with adult patients, paediatric patients tend to have fewer comorbid immunocompromized conditions, fewer concurrent infections, more equality in gender distribution and more presentations of weight bearing difficulty. Staphylococcus aureus was the main blood culture isolate from paediatric patients (80%), but only accounted for half of those from adult patients. Group B streptococcus and Salmonella spp. were not uncommon in the adult patients. Scintigraphic bone scan has the highest sensitivity (93.3%) and remains the image modality of choice. When local abscess formation is suspected, computed tomography or magnetic resonance imaging may be the preferred method used for examination.. This case series should alert the physicians to the possibility of pyogenic sacroiliitis and the difference between paediatric and adult patients.

Topics: Adolescent; Adult; Age Factors; Arthritis, Infectious; Bacteria; Child; Female; Humans; Low Back Pain; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sacroiliac Joint; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Aged, 80 and over; Buttocks; Humans; Low Back Pain; Male; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Topics: Adult; Arm; Bone and Bones; Humans; Incidental Findings; Low Back Pain; Male; Military Personnel; Myofascial Pain Syndromes; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Shoulder Pain; Technetium Tc 99m Medronate

Topics: Acute Kidney Injury; Anti-Inflammatory Agents, Non-Steroidal; Bone and Bones; Diclofenac; Humans; Ibuprofen; Low Back Pain; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Skeletal scintigraphy is an important method for showing evidence of stress injuries affecting the partes interarticulares of young athletes with low back pain. Other etiologies of low back pain may also cause uptake abnormalities in these patients. How often do the results of skeletal scintigraphy support diagnoses other than stress injuries to the partes interarticulares and what are these diagnoses?. We retrospectively reviewed the records of 209 young patients (149 females, 60 males; age range: 8-21 years, mean: 15.7 years) with low back pain and no previously treated vertebral condition who were consecutively referred from a sports medicine clinic to skeletal scintigraphy.. Sites of high uptake supportive of diagnoses other than pars interarticularis stress were shown in 36 (17%) of the 209 patients. Other diagnoses supported by skeletal scintigraphy included stress at the articulation between a transitional vertebra and the sacrum, injuries to the vertebral body ring apophysis, sacral fracture, spinous process injury, and sacroiliac joint stress.. Skeletal scintigraphy shows uptake abnormalities supportive of diagnoses other than pars interarticularis stress in a significant number of young patients with low back pain. The uptake abnormalities shown are usually stress-related in this select population.

Topics: Adolescent; Adult; Athletic Injuries; Female; Fractures, Stress; Humans; Low Back Pain; Lumbar Vertebrae; Male; Radiopharmaceuticals; Retrospective Studies; Sacrum; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

Muscle and soft-tissue uptake have been described numerous times in the literature in patients undergoing Tc-99m methylene diphosphonate skeletal scintigraphy following trauma. Many of these traumas range from electrical burns, intramuscular injections, sports-related trauma, and overexercising, to actual physical damage resulting in superficial bruising and skin discoloration. In this case the patient presented with continuing low back pain after falling down some stairs. Although the scan was essentially normal for bony trauma, subtle soft-tissue uptake was detected that was enhanced with the addition of single photon emission computed tomographic imaging and surface rendering.

Topics: Accidental Falls; Back Injuries; Female; Humans; Low Back Pain; Middle Aged; Radiopharmaceuticals; Soft Tissue Injuries; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Wounds, Nonpenetrating

Topics: Adult; Female; Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Lumbosacral Region; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sacrum; Technetium Tc 99m Medronate

We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.

Topics: Acupuncture Therapy; Acute Disease; Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Epidural Abscess; Fever; Gallium Radioisotopes; Humans; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed; Zygapophyseal Joint

The authors report the utility of Tc-99m MIBI imaging in Gaucher's disease, which results in the accumulation of glucocerebroside in macrophages. Inflated macrophages, or Gaucher's cells, involve the reticuloendothelial organs.. A 38-year-old man with type I Gaucher's disease, splenectomy, and early bone involvement was examined for a low back "bone crisis." He had a history of total left hip replacement. Results of pelvic radiographs were normal. Magnetic resonance imaging showed complete infiltration of the bone marrow in the lumbar spine and the sacrum. The left iliac bone, the sacrum, and the adjacent part of L5 showed heterogeneously decreased uptake on bone scintigraphs. Hematopoietic bone marrow was absent in these regions and in the left femur. No infection of the prosthesis was revealed with labeled granulocytes.. Avascular necrosis in the left iliac bone was diagnosed, which is a very unusual location. There was no uptake of MIBI in the iliac bones or the femurs.. These findings suggest that MIBI may not be a good tool for the evaluation of medullary infiltration by Gaucher's cells.

Topics: Adult; Bone and Bones; Bone Marrow; Femur; Gaucher Disease; Humans; Ilium; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Sacrum; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Single photon emission computed tomography (SPECT) bone scans of the lumbar spine were evaluated in the management of patients with low back pain and suspected spondylolysis.. Thirty-three patients (mean age, 30 years) with high clinical suspicion of pars interarticularis defects were included in the study. The results of lumbar radiographs and SPECT bone scintigraphy were compared and the influence of these results on patient management was evaluated.. Twenty-six of the 33 patients had abnormal results of lumbar radiographs. Of the 21 patients with radiographs indicating spondylolysis, six had abnormal uptake in the pars regions on bone scintigraphy. One patient with normal results of lumbar radiographs had a SPECT bone scan showing uptake in the region of the pars interarticularis.. SPECT bone scanning of the lumbar spine has a role in the treatment of patients with symptomatic spondylolysis.

Topics: Adult; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Radiography; Radiopharmaceuticals; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 22-year-old woman had a Tc-99m MDP whole-body scan for low back pain. A focal area of increased activity was seen in the skull base in the region of the sella turcica. A computed tomographic examination showed ground-glass opacification of the sphenoid sinus and bony sclerosis along its walls, characteristic of fibrous dysplasia. Monostotic fibrous dysplasia, the more common form compared with the polyostotic variety, occurs in 70% to 80% of all patients with fibrous dysplasia. Monostotic lesions usually involve the ribs, femur, tibia, cranium, maxilla, and mandible. The frontal and sphenoid bones are the cranial bones most commonly involved.

Topics: Adult; Female; Fibrous Dysplasia, Monostotic; Humans; Low Back Pain; Osteosclerosis; Paranasal Sinus Diseases; Radionuclide Imaging; Radiopharmaceuticals; Sella Turcica; Skull Base; Sphenoid Sinus; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In two women aged 85 and 62 years respectively, with pain in the lower back and the hip region, insufficiency fractures of the sacrum were diagnosed. They were treated by bed rest and pain medication with good clinical outcome. Especially in older, postmenopausal women who have been treated for a malignancy (possibly with irradiation of the pelvis), the possibility of sacral insufficiency fractures should be kept in mind. Many unnecessary and sometimes invasive investigations to exclude tumour or metastases can be avoided by adequate diagnostic imaging: first conventional X-ray investigation followed by skeletal scintigraphy. A typical H-shaped pattern of sacral uptake is diagnostic of insufficiency fractures. As this pattern is seen in only approximately 20% of the patients, additional CT will often be necessary. CT can demonstrate the fracture lines and exclude bone destruction or a soft tissue mass. In case CT is not conclusive MRI is indicated.

Topics: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Bed Rest; Diagnosis, Differential; Female; Fractures, Spontaneous; Humans; Low Back Pain; Magnetic Resonance Imaging; Middle Aged; Neoplasms; Osteoporosis; Sacrum; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Treatment Outcome

We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical examination, and plain radiographs and magnetic resonance images were also obtained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities that corresponded with the location and type of clinical symptoms. Twelve subjects had changes in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction. Six out of eight boys and two out of 11 girls had stress reaction (P = 0.043). Restriction of painful activities was recommended to all subjects, restriction of activities and the use of a dynamic low-back brace for the first 3 months was recommended to patients with posterior vertebral arch stress reaction. The self-reported intensity of low-back pain (scale 0-100) among all the patients was 69 +/- 16 (mean +/- SD) at baseline and 18 +/- 21 at the 1-year follow-up (P < 0.0001). In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoiding the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.

Topics: Adolescent; Female; Humans; Low Back Pain; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Prognosis; Prospective Studies; Radiopharmaceuticals; Spinal Injuries; Sports; Technetium Tc 99m Medronate; Time Factors

Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable difficulty is encountered in the vertebral region due to the complexity of structures and the fact that other benign lesions, especially degenerative changes, are very common there. Single-photon emission tomography (SPET) has been reported to be useful in the differentiation of benign from malignant conditions. Here we report our experience with bone SPET in the diagnosis of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecutive patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained. Of teh 174 patients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis of the patients' clinical histories and the findings with other imaging techniques such as magnetic resonance imaging, computed tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic criterion of vertebral metastasis. SPET had a sensitivity of 87%, a specificity of 91%, a positive predictive value of 82%, a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity of 81%, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral metastasis. Except with regard to the negative predictive value, SPET performed statistically better than planar imaging. Only 9/147 (6.4%) lesions involving the vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral metastases and is superior to planar imaging in this respect.

Topics: Aged; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

A 29-yr-old man with several years of back pain was referred for a bone scan. High-resolution regional spot images of the skeleton were obtained following intravenous injection of 20 mCi 99mTc-methylene diphosphonate. Posterior and lateral images of the skull showed focal increased uptake in several regions of the skull. Upon questioning, the patient stated that he had received acupuncture treatment for his back pain several times in the same regions as the increased uptake. The needle placement was confirmed by the patient's acupuncturist. Acupuncture can cause enhanced bone metabolism demonstrated by increased activity on bone scans.

Topics: Acupuncture Therapy; Adult; Bone and Bones; Humans; Low Back Pain; Male; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

A 42-year-old woman presented with intermittent low back and left lower extremity pain. The blood flow and blood pool images of bone scintigraphy showed a large focus of increased activity in the right lower abdomen. Computed tomography showed an enlarged uterus displaced to the right side of the pelvis. At surgery, the uterus was found to be involved with adenomyosis. Three-phase bone scintigraphy consisting of blood flow and blood pool images over the anterior pelvis may be a valuable diagnostic aid in the evaluation of lower back or pelvic pain of a woman.

Topics: Adult; Bone and Bones; Endometriosis; Female; Humans; Low Back Pain; Pelvic Pain; Pelvis; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate; Time Factors; Uterine Diseases

Topics: Bone and Bones; Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Low Back Pain; Neoplasm Recurrence, Local; Radionuclide Imaging; Technetium Tc 99m Medronate