technetium-tc-99m-medronate and Osteomyelitis

Topics: Arthropathy, Neurogenic; Diabetic Foot; Diagnostic Imaging; Humans; Magnetic Resonance Imaging; Osteomyelitis; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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 the case of a girl with known large right-sided and small left-sided neonatal adrenal haematomas who underwent bone scintigraphy 23 days after birth for suspected osteomyelitis. The radionuclide examination showed uptake of bone tracer around the right-sided haematoma, but no abnormality on the left side.

Topics: Adrenal Gland Diseases; Adrenal Glands; Bone and Bones; Female; Hematoma; Hemorrhage; Humans; Infant, Newborn; Osteomyelitis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ultrasonography; Whole-Body Counting

To demonstrate the combined use of scintigraphy and ultrasonography (US) in differentiating osteomyelitis from bone infarction in sickle cell disease.. Two patients with sickle cell disease were examined with a combination of bone, bone marrow, white blood cell and/or gallium scintigraphy and US.. The scintigraphic studies demonstrated areas of suspected osteomyelitis at the distal femur in both patients and at the proximal right tibia in one of them. US revealed subperiosteal fluid collections in these areas. Aspiration guided by US established the presence of pus at the femur in both instances, which was successfully treated with the US-guided insertion of a drainage catheter and aspiration only, respectively. Thick blood, due to bone infarction, was aspirated at the tibia.. The scintigraphic studies were useful in locating all areas of suspected osteomyelitis. The role of US was to confirm the presence of a subperiosteal fluid collection and to guide aspiration, which can show the distinction between a haematoma and an abscess.

Topics: Abscess; Adult; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Diagnosis, Differential; Female; Gallium Radioisotopes; Hematoma; Humans; Infarction; Male; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Ultrasonography

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

Early and accurate diagnosis of infection or neuropathy of the diabetic foot is the key to successful management. Angiopathy leads to ischemia which, in combination with peripheral neuropathy, predisposes to pedal skin ulceration, the precursor of osteomyelitis. Chronic hyperglycemia promotes production of glycosylated end products which accumulate on endothelial proteins, causing ischemia of the vasa nervorum. When combined with axonal degeneration of the sensory nerves, the result is hypertrophic neuroarthropathy. Should the sympathetic nerve fibers also be damaged, the resultant loss of vasoconstrictive impulses leads to hyperemia and atrophic neuroarthropathy. Plain radiography, although less sensitive than radionuclide, magnetic resonance (MR), and computed tomographic examinations, should be the initial procedure for imaging suspected osteomyelitis in the diabetic patient. If the radiographs are normal but the clinical suspicion of osteomyelitis is strong, a three-phase 99mTc-MDP scan or MR imaging is recommended. An equivocal 99mTc-MDP scan should be followed by MR imaging. To exclude osteomyelitis at a site of neuroarthropathy, a 111In white blood cell scan is preferable. To obtain a specimen of bone for bacteriological studies, percutaneous core biopsy is the procedure of choice, with the entrance of the needle well beyond the edge of the subjacent ulcer.

Topics: Biopsy, Needle; Diabetic Angiopathies; Diabetic Foot; Diabetic Neuropathies; Diagnostic Imaging; Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Osteomyelitis is a serious health problem that results in multiple limb amputations annually. This article reviews the current scintigraphic procedures used in the diagnosis of osteomyelitis and discusses some of the newer radiopharmaceuticals now being developed. The goal is to understand the strengths and weaknesses of each method so that the procedure most effective for specific clinical settings can be selected. In general, the three-phase bone scan is the procedure of choice if the suspected osteomyelitis is not superimposed on another disease that causes increased bone remodeling (i.e., findings on the radiograph are normal). If the suspected osteomyelitis is superimposed on a disease that causes increased bone remodeling, the combined 111In-labeled leukocyte-99mTc bone scan is the procedure of choice in the non-marrow-containing skeleton and the 111In-labeled leukocyte and 99mTc bone marrow scans are the procedures of choice in the marrow-containing skeleton.

Topics: Citrates; Citric Acid; Humans; Indium Radioisotopes; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Radioimmunodetection; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

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

Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In-111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis.

Topics: Adult; Animals; Arthritis, Infectious; Child; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infant; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Nuclear medicine has proven to have a valuable role in the evaluation of osseous metallic implants, particularly with joint prostheses, but can assist with evaluation of other appliances as well. The nuclear arthrogram has become an invaluable adjunct to simultaneously performed radiographic contrast arthrography. This application has been best evaluated in what is one of the most common of orthopedic prosthesis problems, namely, loosening of total hip prostheses. Experience indicates that both sensitivity and specificity of loosening of the femoral component can be increased to over 90% through combined use of nuclear with radiographic contrast arthrography. Furthermore the combination of routine skeletal scintimaging with the nuclear arthrogram adds a significant dimension to precise localizing of the nuclear arthrographics agent In-111 chloride. Nuclear medicine also plays an important role in further evaluating the presence of infection associated with metallic implants with In-111 WBC preparations being superior to Ga-67 as the radiopharmaceutical tracer. Infection has been detected with a sensitivity of 73% and a specificity of 93% in our series using combined In-111 WBC and simultaneous skeletal imaging with conventional Tc-99m MDP. Acute infections are more readily identifiable than chronic in association with prostheses.

Topics: Hip Prosthesis; Humans; Indium Radioisotopes; Leukocytes; Osteomyelitis; Prosthesis Failure; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Diabetic Neuropathies; Diagnosis, Differential; Gallium Radioisotopes; Humans; Indium; Joint Diseases; Leukocytes; Male; Middle Aged; Osteomyelitis; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Lung Neoplasms; Male; Osteomyelitis; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of inflammation. Currently available techniques cannot decisively address this issue. In this respect, antimicrobial peptide Tc-ubiquicidin (UBI) 29-41 scans have been showing interesting results. The aim of this study was to determine the accuracy of Tc-UBI scan in the detection of osteomyelitis and to compare it with Tc-methylene diphosphonate scan and magnetic resonance imaging (MRI).. Twenty patients (mean age=48.90 years) with suspected osteomyelitis were included in this study. After evaluation of each patient through history taking, physical examination, appropriate laboratory tests, and other processes including bone probing, wound culture, and plain film radiography, MRIs, Tc-UBI scans, and Tc-methylene diphosphonate scans were performed. For quantitative analysis, the mean count of abnormal-to-normal (A/N) region was calculated for images acquired at 15, 30, 45, 60, 120, and 240 min to obtain the most favorable time for imaging.. In total, osteomyelitis was detected in the Tc-UBI scans of 17 patients, indicating 100% accuracy, compared with an accuracy of 90% for osteomyelitis detected in three-phase bone scans. The maximum mean A/N was observed at 15 min after intravenous injection (median: 1.91; interquartile range: 1.54-2.94). MRI was performed in 12 cases only with 75% accuracy. In addition, the A/N ratios for the Tc-UBI scans were not significantly different between patients with or without Staphylococcus aureus growth on wound cultures.. For fast imaging with high accuracy, Tc-UBI 29-41 is a suitable choice for the detection of osteomyelitis.

Topics: Adult; Aged; Feasibility Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Peptide Fragments; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Young Adult

Technetium-99m ciprofloxacin (Infecton) has recently become established as a new radiopharmaceutical for the imaging of infection. This study was performed to determine the value of Infecton imaging in demonstrating orthopaedic infection and to compare the results with bone/gallium imaging. Twenty-two patients (12 female, 10 male; mean age 51.7+/-16.8 years) with suspected orthopaedic infective conditions were included in the study. The patients underwent three scintigraphic studies in the following sequence: 740 MBq 99mTc-methylene diphosphonate (MDP) three-phase bone scintigraphy; at least 2 days later, 370 MBq Infecton scan at 1-4 h; and finally, 185 MBq gallium-67 scintigraphy. 67Ga imaging could not be performed on four patients. All images were blindly interpreted by two independent observers. The final diagnosis was made by consensus when the readings were different. Interpretation of the early and late Infecton images was made separately, with visual findings being classified according to a four-grade scale (0, +, ++, +++). Images graded 0 and +, and also those regions which showed a decrease in uptake grade on late images as compared with early images, were classified as negative for infection; grades ++ and +++ were classified as positive. Bone/gallium images were considered positive when the images were spatially incongruent or when gallium uptake was more intense than that of 99mTc-MDP. The diagnosis was confirmed by intraoperative microbiological or histological findings, or by the presence of gross purulence. The sensitivity of Infecton imaging was found to be 85%, the specificity 92% and the accuracy 88%, as compared to figures of 78%, 100% and 90%, respectively, for bone/gallium imaging. Although the two modalities showed a similar clinical yield, the easy availability of Infecton and the short investigation time make Infecton imaging the better option for the detection of orthopaedic infection.

Topics: Arthritis, Infectious; Bone and Bones; Ciprofloxacin; Female; Femur; Gallium Radioisotopes; Hip Joint; Hip Prosthesis; Humans; Knee Joint; Knee Prosthesis; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

The aim of this study was to evaluate the roles of 67Ga-citrate and 99Tcm-methylene diphosphonate (99Tcm-MDP) planar and single photon emission tomographic (SPET) imaging in patients with vertebral osteomyelitis. Thirty patients (22 females, 8 males) aged 62.7 +/- 16.4 years (mean +/- s) were enrolled prospectively between May 1995 and May 1998. The patients had been on antibiotics for 7 +/- 4 weeks prior to the study. Histology was available for all but nine patients with mild infections, who were evaluated by a combination of magnetic resonance imaging (MRI), clinical and laboratory tests. 67Ga-citrate (185 MBq) and three-phase bone (555 MBq 99Tcm-MDP) planar and SPET imaging were performed in all patients, together with MRI as a comparison. In total, 67 infectious foci were detected. Based on histology, there were four cases of severe, 13 cases of moderate and four cases of mild osteomyelitis; nine mild infections were also classified by the combination of MRI, clinical and laboratory results. Combined MRI and 67Ga-citrate SPET correctly classified all patients; MRI detected all 67 infectious foci, whereas 67Ga-citrate SPET identified 54 only. False-negative results were seen with all other modalities, especially in cases of mild and moderate infection. 67Ga-citrate SPET identified unsuspected cases of endocarditis (n = 2), paravertebral abscess (n = 1), subaxillary soft tissue abscess (n = 1) and rib osteomyelitis (n = 1). For 67Ga-citrate SPET, the target-to-background ratio was 2.24 +/- 0.31, 1.76 +/- 0.07 and 1.30 +/- 0.18 for severe, moderate and mild osteomyelitis, respectively. Significant differences were noted between severe and moderate infection (P = 0.0051) and between severe and mild infection (P < 0.0001); that between moderate and mild infection was non-significant. For 99Tcm-MDP planar and SPET imaging, and for planar 67Ga-citrate imaging, there was no correlation with severity. We conclude that 67Ga-citrate SPET is able to identify vertebral osteomyelitis and detect additional sites of infection. It can also aid in determining the severity of infection and, potentially, the response to therapy.

Topics: Aged; Blood Sedimentation; C-Reactive Protein; Citrates; Female; Gallium; Gallium Radioisotopes; Humans; Leukocyte Count; Magnetic Resonance Imaging; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Spine; Technetium Tc 99m Medronate

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

Thirty-seven patients with suspected osteomyelitis in conjunction with diabetic gangrene (N = 14, group 1), arthroplasty (N = 8, group 2), and various diseases (N = 15, group 3) were examined. Three-phase bone scans, followed by granulocyte imaging using I-123 labeled anti-NCA 95 monoclonal antibodies, were performed to evaluate and compare the diagnostic accuracy of both procedures. Final diagnosis was established histologically, bacteriologically, or by both methods either through the clinical course or by long-term follow-up in patients in group 1. Osteomyelitis was proven in 17 out of the 37 patients. Bone and antigranulocyte imaging demonstrated positive results in all patients with osteomyelitis (sensitivity 100% for each method). No signs of skeletal infection were found in 20 patients. Fifteen of these patients had no antigranulocyte antibody accumulation, resulting in 75% specificity. Ten patients without infection had normal three-phase bone imaging results (specificity 50%). Antigranulocyte imaging results were negative in 6 out of 10 patients without osteomyelitis in groups 2 and 3 whose bone imaging results were questionable. However, because of identical bone and granulocyte imaging results, no increase of diagnostic accuracy could be obtained by additional granulocyte imaging in patients with diabetic gangrene. Final diagnoses of false-positive antigranulocyte studies were aseptic osteonecrosis (N = 2), loosening of prostheses, gouty arthritis, and pain after arthrolysis. In summary, antigranulocyte antibody imaging offered high sensitivity and acceptable specificity for the diagnosis of osteomyelitis. Diagnostic accuracy can be improved through the adjuvant use of antigranulocyte imaging for patients with suspected osteomyelitis, especially when radiographic and scintigraphic results are questionable or unreliable.

Topics: Adult; Aged; Algorithms; Bone and Bones; Diabetes Complications; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radioimmunodetection; Sensitivity and Specificity; Surgical Wound Infection; Technetium Tc 99m Medronate

Combat-related extremity injuries are regularly associated with long-term complications such as chronic infection, especially osteomyelitis. Clinical examination and laboratory parameters do not usually allow reliable diagnosis. In contrast, imaging techniques enable constructive assertions to be made about the location and extent of an infection of the peripheral musculoskeletal system. The aim of this study was therefore to determine the diagnostic reliability of three-phase bone scanning and antigranulocyte scintigraphy using Tc-99m-sulesomab (Leukoscan) in the diagnostic clarification of infections associated with combat-related extremity injuries.. Twenty-seven male patients (mean age 33.9 years) with suspected combat-associated infections of the extremities were included in this retrospective analysis. All patients underwent three-phase bone scanning using Tc-99m-HDP followed by antigranulocyte scintigraphy with Tc-99m-sulesomab. In 26 of the 27 patients, a CT scan of affected limb was obtained, where the secondary fusion with single photon emission CT data set was possible. The diagnostic reliability of imaging techniques was validated against microbiological samples obtained during surgery and used as gold standard.. Three-phase bone scanning yielded a positive result in all patients, with 18 scans classified as true positive (TP) and nine scans as false positive (FP). This produced a sensitivity of 100%, a specificity of 0% and a positive predictive value (PPV) of 67%. Antigranulocyte scintigraphy recognised 13 patients as TP, 1 patient as FP, 8 patients as true negative (TN) and 5 patients as false negative (FN), which gave a sensitivity of 72%, a specificity of 88%, a PPV of 93%, a negative predictive value (NPV) of 62% and an accuracy of 78%. CT recognised in 7 cases a TP result, in 3 cases an FP, in 5 cases a TN and in 11 cases an FN result. This produced a sensitivity of 39%, a specificity of 63%, a PPV of 70%, an NPV of 31% and an accuracy of 46%.. Three-phase bone scanning did not deliver any diagnostic benefit, since no result was able to differentiate unequivocally between infection-related and reactive changes. Antigranulocyte scintigraphy using Tc-99m-sulesomab represented a highly suitable technique for diagnostically clarifying combat-related infections of the extremities. It is superior to CT in sensitivity, specificity, PPV, NPV and accuracy.

Topics: Adult; Antibodies, Monoclonal, Murine-Derived; Humans; Infections; Jordan; Libya; Male; Middle Aged; Musculoskeletal Diseases; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Syria; Technetium Tc 99m Medronate; Ukraine; Warfare

This study aimed to evaluate fused images of single-photon emission computed tomography/computed tomography (SPECT/CT), stand-alone whole-body scintigraphy (WBS) and stand-alone CT in the diagnosis of post-traumatic chronic-infected nonunion osteomyelitis (OST) of the lower limb.. The imaging data from 144 patients with known/suspected chronic-infected fracture nonunion in the lower limbs following internal/external fixation between June 2015 and December 2017 were reviewed retrospectively. Technetium-99m-methylene diphosphonate SPECT/CT scans were performed on the patients. For each patient, the diagnosis on the basis of each imaging approach was classified as yes (OST), no (no OST), or equivocal by experienced nuclear medicine physicians and radiologists. An intraoperative bacterial culture experiment was conducted as our gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, κ coefficient, significance level, and agreement level were analyzed.. The diagnosis on the basis of SPECT/CT fused images showed a sensitivity of 91.3%, a specificity of 84.6%, and accuracy of 88.9% compared to that based on WBS, with a sensitivity of 52.2%, a specificity of 15.4%, accuracy of 38.9%, and CT, with a sensitivity of 65.2%, a specificity of 23.1%, accuracy of 50.0%. The fused images can show the precise sites of post-traumatic chronic-infected OST. Considerable agreement (κ 0.679) was found between the SPECT/CT diagnosis and an intraoperative bacterial culture test (WBS, κ 0.218; CT, κ = 0.184).. Technetium-99m-methylene diphosphonate SPECT/CT imaging fusion can improve diagnostic confidence for post-traumatic patients with chronic nonunion OST. This imaging approach can achieve an accurate diagnosis by revealing the precise location and scope of OST with high sensitivity and specificity, which has important implications for surgical guidance by providing the precise location of OST.

Topics: Adult; Aged; Female; Humans; Lower Extremity; Male; Middle Aged; Osteomyelitis; Recurrence; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Young Adult

Bone and joint infections are common diseases in pediatrics. They still are a public health problem in Tunisia. The diagnosis is based on clinical, biological, radiological and skeletal scintigraphy arguments. The purpose of this study is to determine the contribution of triple phase bone scan in the exploration of musculoskeletal pain febrile child.. This was a descriptive and retrospective study. It was conducted over a period of 5 years. It has interested all children explored in nuclear medicine department with suspected acute osteomyelitis (OMA) , osteoarthritis (OA) or septic arthritis (SA) referred from Orthopaedic Infantile service. All these patients had, alongside the conventional radiologic exams, a triple phase bone scan HMDP-Tc99m.. We collected 62 patients. Among the selected diagnoses, there were: 22 OMA, 4 OA, 4 SA. The mean age of the patients was 5.58 years with a male predominance. The main reason for consultation was pain. Fever was ≥ 38° C in 80 % of cases. The preferential localization was the lower limb (93.5 %). The quantitative and qualitative bone scan abnormalities objectified led to a correct diagnosis of: 18 OMA, 3 OA and 2 SA with a respectively estimated sensitivity and specificity of 76.6% and 90.6% in the all population.. Bone scan demonstrates early abnormalities allowing osteoaricular infection diagnosis. It highlights the infection site, and draws a map of the lesions. Currently, imaging modalities differ in their availability, their cost, their input and diagnostic accuracy but they are complementary.

Topics: Acute Disease; Adolescent; Arthritis, Infectious; Child; Child, Preschool; Female; Fever; Hospitalization; Humans; Infant; Male; Osteoarthritis; Osteomyelitis; Pain; Pain Management; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tunisia

Nonosseous uptake in Tc-hydroxymethylene bone scintigraphy should always be evaluated for any possibility of pathological changes. We share interesting images of a 60-year-old woman initially investigated for suspected osteomyelitis of the left femur but found to have an extraosseous uptake in the right hemithorax on bone scintigraphy. Plain chest radiograph followed by contrast-enhanced CT of the thorax revealed the presence of a lung mass in the right lower lobe with no lymphadenopathy. CT-guided biopsy yielded fibrocollagenous tissue, partly lined by benign pneumocytes. The F-FDG-avid lung mass was confirmed to be sclerosing pneumocytoma postlobectomy.

Topics: Female; Fluorodeoxyglucose F18; Humans; Incidental Findings; Middle Aged; Osteomyelitis; Positron Emission Tomography Computed Tomography; Pulmonary Sclerosing Hemangioma; Radiopharmaceuticals; Technetium Tc 99m Medronate

The successful management of infected pelvic pressure ulcer patients (PPUP) depends on the distinction between infections limited to soft tissue (STI) and those with underlying osteomyelitis (OM), which can be difficult to determine clinically. Dual-isotope (DI) comprehensive imaging has excellent accuracy in localizing diabetic foot infection and differentiating OM from STI with SPECT/CT utilization. In this study, we assess the accuracy and confidence of the different DI SPECT/CT imaging steps in PPUP with confirmed diagnoses.. Pelvic flow and blood pool imaging were followed by labeled white blood cell reinjection and Tc-99m hydroxymethylene-diphosphonate bone (bone scan) and In-111-leukocytes (white blood cell scan) DI planar and SPECT/CT (step 1) acquisitions. Tc-99m sulfur colloid (bone marrow scan)/WBCS SPECT/CT (step 2) images were obtained on the following day. DI step 1 planar, step 1 SPECT/CT, step 2 SPECT/CT, and combined step 1/step 2 SPECT/CT were reviewed separately for diagnosis and diagnosis confidence. The final diagnosis was confirmed by culture/pathology in 21 patients and clinical/imaging follow-up in 12 patients.. There were 19 OM patients, three STI patients, and 11 patients with no infection. The final diagnosis agreement to DI combined step 1/step 2 SPECT/CT was higher than DI step 2 or step 1 SPECT/CT alone, or DI step 1 planar, as assessed by λ and error reduction %, respectively. Combined DI step 1/step 2 SPECT/CT was more sensitive than DI step 2 SPECT/CT and more specific than DI step 1 SPECT/CT, and showed higher diagnostic confidence than both imaging techniques.. DI SPECT/CT is highly useful in evaluating PPUP with suspected infection. DI step 1 is more sensitive, whereas step 2 is more specific. Both step 1 and step 2 DI SPECT/CT images are needed to accurately and confidently assess for infection and distinguish OM from STI, which are crucial for optimal management.

Topics: Adult; Aged; Aged, 80 and over; Diabetic Foot; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Pelvis; Pressure Ulcer; Radiopharmaceuticals; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Soft Tissue Infections; Technetium Tc 99m Medronate

Magnetic resonance imaging (MRI) is the recommended diagnostic imaging technique for diabetic foot osteomyelitis (DFO), with a reported accuracy of 79%. The gold standard to diagnose osteomyelitis is bone biopsy, with a positive culture and/or histopathology findings consistent with osteomyelitis. The purposes of this study are to assess the accuracy of technetium-99m (Tc-99m) labeled white blood cell (WBC) single-photon emission computed tomography/computed tomography (SPECT/CT) hybrid imaging for diagnosing DFO confirmed by bone biopsy and to compare that to the diagnostic accuracy of an MRI.. The authors performed a retrospective chart review of 166 patients who received a bone biopsy to confirm the diagnosis of a suspected DFO at a large municipal hospital between 2010 and 2013. Patients were selected on the basis of whether they received an MRI or a SPECT/CT. Patients whose scans were not within a clinically relevant time frame of the biopsy were excluded. Imaging results were correlated with probability of osteomyelitis determined by bone biopsy.. For inclusion criteria, 110 patients met the study's criteria: 52 SPECT/CT patients and 58 MRI patients. The sensitivity, specificity, positive predictive value, and negative predictive value of SPECT/CT were 89%, 35%, 74%, and 60%, respectively; the corresponding values for MRI were 87%, 37%, 74%, and 58%, respectively. There were no significant differences in accuracy of diagnosing DFO between imaging techniques.. This data suggests that the diagnostic accuracy of SPECT/CT imaging in DFOs is similar to an MRI.

Topics: Bone and Bones; Humans; Leukocytes; Magnetic Resonance Imaging; Osteomyelitis; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

Early diagnosis and therapeutic monitoring of acute osteomyelitis (AO) is challenging. Here, we use a polyethylene glycol (PEG)ylated chemotactic peptide cinnamoyl-F-(D)L-F-(D)L-F (cFLFLF) conjugated with hydrazinonicotinamide (HYNIC) and labeled with Tc-99m ([(99m)Tc]cFLFLF) to image AO in a rat model and to validate its efficacy in early diagnosis and therapeutic evaluation of AO.. Forty rats were divided into eight groups of five each. Groups A, B, C, G, and H were AO models, and D, E, and F were sham controls. Groups A and D underwent [(99m)Tc]cFLFLF scintigraphy, groups B and E underwent [(99m)Tc]methylene diphosphonate ([(99m)Tc]MDP) bone scan, and groups C and F underwent 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) positron emission tomography (PET)/computed tomography (CT) scan. [(99m)Tc]cFLFLF biodistribution was assessed in group G. The response to antibiotic therapy was evaluated using [(99m)Tc]cFLFLF scintigraphy in group H. Conventional radiographs were obtained following scintigraphy. Ratios of infected or sham-operated tibia to the opposite tibia (T/B) were calculated. Immediately after the imaging studies, infected tibias were excised and underwent histopathological analysis and immunohistochemistry staining.. AO was present in all rats of groups A, B, C, G, and H. Total histological scores were not significantly different among groups A, B, and C (F = 0.34, p = 0.71). The biodistribution results revealed significant uptake and excellent retention of [(99m)Tc]cFLFLF in the infected tibia. [(99m)Tc]cFLFLF scintigraphy and [(99m)Tc]MDP bone scan both detected AO. The mean T/B ratio of [(99m)Tc]cFLFLF scintigraphy 1 h postinjection was 2.09-fold higher than that of [(99m)Tc]MDP bone scan (t = 13.81, p <0.001). The mean T/B ratio of [(18)F]FDG PET/CT scan was not significantly different from the control group F (t = 2.17, p = 0.062). [(99m)Tc]cFLFLF scintigraphy revealed a significant attenuation of inflammation in group H following a 3-week antibiotic treatment, which was verified by histopathological analysis and immunohistochemistry staining.. Our results suggest that the specificity and image quality of [(99m)Tc]cFLFLF are superior to those of the [(99m)Tc]MDP and [(18)F]DFG imaging probes currently used for early diagnosis of AO. Furthermore, [(99m)Tc]cFLFLF was able to effectively evaluate the therapeutic response to antibiotic treatment of AO. Our data suggest that [(99m)Tc]cFLFLF is a promising imaging agent for detection of infectious diseases.

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Fluorodeoxyglucose F18; Humans; Immunohistochemistry; Inflammation; Male; Multimodal Imaging; Neutrophils; Oligopeptides; Organotechnetium Compounds; Osteomyelitis; Peptides; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Staphylococcus aureus; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Topics: Adult; Fluorodeoxyglucose F18; Humans; Leukocyte Count; Lumbar Vertebrae; Male; Osteomyelitis; Positron-Emission Tomography; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate; Thoracic Vertebrae

We report the case of a 56-year-old male with bilateral total knee prostheses suffering from bilateral knee pain mainly on the right side and referred for bone scintigraphy. The medical history of the patient revealed an opening wedge high tibial osteotomy performed nine years earlier, with insertion of two blocks of ceramic made of hydroxyapatite and tricalcium phosphate in a wedge configuration as synthetic bone substitutes. The porous structure of these implants is analogous to the architecture of cancellous bone and permits fibrovascular and bone ingrowth, promoting the healing process. Planar scintigraphy and SPECT/CT showed an intense uptake within those implants in the early phase as well as in the late phase of the bone scan. It also showed bilateral patellofemoral arthritis. A (99m)Tc-labeled antigranulocyte antibody scintigraphy was negative for infection or inflammation. Bilateral patellar resurfacing led to complete symptom regression, confirmed at 10 months follow-up. To the best of our knowledge, this scintigraphic pattern with such a high tracer uptake reflecting bone substitute osteointegration has not yet been published. This should be considered in patients with such bone replacement materials that are increasingly used, in order to avoid false diagnosis of inflammation or infection.

Topics: Arthroplasty, Replacement, Knee; Ceramics; Humans; Hydroxyapatites; Knee Joint; Knee Prosthesis; Male; Middle Aged; Osteomyelitis; Patellofemoral Pain Syndrome; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Early diagnosis of acute hematogenous osteomyelitis (AHO) is crucial for effective management and to reduce the potential risk of lifelong deformities in pediatric patients. Both bone scintigraphy and MRI as current diagnostic imaging claim their high sensitivity in early detection of the disease. We present a 9-year-old girl patient with AHO in the distal right tibia, which was demonstrated on bone scintigraphy while a subsequent MRI on the same day was negative.

Topics: Acute Disease; Ankle; Bone and Bones; Child; Female; Humans; Magnetic Resonance Imaging; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate single photon emission tomography-computed tomography (SPECT-CT) for diagnosis of skull base osteomyelitis (SBO) and to compare this technique with planar bone scintigraphy (BS), SPECT, and CT.. Data from 13 patients with known/suspected SBO were retrospectively analysed. Planar BS and SPECT images were evaluated by an experienced nuclear medicine physician, CT by and experienced radiologist, and SPECT-CT by the nuclear medicine physician and radiologist in consensus. On the basis of diagnostic confidence a score of 1-5 was given, with 1 being definitely osteomyelitis, 2 being probably osteomyelitis, 3 being equivocal, 4 being probably normal, and 5 being definitely normal. ROC analysis areas under the curves (AUC) were calculated. For diagnostic values a score of ≤2 was taken as positive. Clinical/imaging follow-up/microbiology was taken as reference standard.. AUC was largest for SPECT-CT (0.977) followed by SPECT (0.909), CT (0.886), and planar BS (0.614). However, no significant difference was found between the techniques except for borderline significance between planar BS with SPECT-CT (P = 0.071) and CT (P = 0.072). Accuracy was 46% for planar BS, 85% for SPECT, 77% for CT and 92% for SPECT-CT.. SPECT-CT seems to be useful, but not superior to planar BS, SPECT, or CT, for diagnosis of SBO.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Female; Humans; Male; Middle Aged; Observer Variation; Osteomyelitis; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; ROC Curve; Skull Base; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; 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

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: Acute Disease; Artifacts; Bone and Bones; Diagnosis, Differential; Humans; Image Enhancement; Indium Radioisotopes; Leukocytes; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy, Conformal; Technetium Tc 99m Medronate

In this article, we present a rare case of B-cell bone lymphoma in a child with multifocal asymptomatic lesions detected by bone scintigraphy and a chronic clinical history characterized by limping and fever episodes for over a year. Initially, multifocal osteomyelitis was suspected and antibiotic therapy was administered with no clinical improvement. The biopsy of the main lesion in the left distal femur along with bone marrow cytology established the final diagnosis. This rare case illustrates the utility of routinely low cost-effective nuclear medicine studies like whole body bone scan and 99mTc hexamethylpropyleneamine oxime-labeled leukocytes to orientate similar cases to a correct diagnosis.

Topics: Antineoplastic Agents; Bone Neoplasms; Child, Preschool; Diagnosis, Differential; Gait; Humans; Leukocytes; Lymphoma, B-Cell; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Invasive musculoskeletal infections from community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus (CA-SA) are increasingly encountered in children. Imaging is frequently requested in these children for diagnosis and planning of therapeutic interventions.. To appraise the diagnostic efficacy of imaging practices performed for CA-SA osteomyelitis and its complications.. A retrospective review was conducted of the clinical charts and imaging studies of CA-SA osteomyelitis cases since 2001 at a large children's hospital.. Of 199 children diagnosed with CA-SA osteomyelitis, 160 underwent MRI examination and 35 underwent bone scintigraphy. The sensitivity of MRI and bone scintigraphy for CA-SA osteomyelitis was 98% and 53%, respectively. In all discordant cases, MRI was correct compared to bone scintigraphy. Extraosseous complications of CA-SA osteomyelitis detected only by MRI included subperiosteal abscesses (n = 77), pyomyositis (n = 43), septic arthritis (n = 31), and deep venous thrombosis (n = 12).. MRI is the preferred imaging modality for the investigation of pediatric CA-SA musculoskeletal infection because it offers superior sensitivity for osteomyelitis compared to bone scintigraphy and detects extraosseous complications that occur in a substantial proportion of patients.

Topics: Adolescent; Child; Child, Preschool; Community-Acquired Infections; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

(99m)Tc-depreotide is a (99m)Tc-labelled somatostatin analogue, with high affinity for the 2, 3 and 5 subtypes of somatostatin receptors. These particular receptors are over-expressed on the surface of activated leucocytes, which mediate inflammatory response. Based on this property this study tried to investigate whether (99m)Tc-depreotide scintigraphy could be a useful complementary method in the investigation of bone infection and inflammation.. Twenty-three patients, who were investigated for probable osteomyelitis, underwent three-phase bone scintigraphy followed by (99m)Tc-depreotide scintigraphy. Clinical and laboratory findings, complementary imaging procedures, clinical follow-up and bone biopsy established the final diagnosis. (99m)Tc-depreotide scintigraphy was performed 3 h after the intravenous administration of 555-740 MBq of the radiopharmaceutical. Scintigraphic images were, at first, blindly interpreted alone and then in comparative assessment with bone scans.. (99m)Tc-depreotide was positive in 12/12 cases of active osteomyelitis, one case of recent femoral head osteonecrosis and 6/9 rheumatoid arthritis sites. Negative (99m)Tc-depreotide scans were acquired in five cases of 'no-inflammation' (an uncomplicated fracture, an aseptic loosening of prosthesis, an old osteonecrosis, a healed and a successfully treated osteomyelitis), as well as in 14/14 total sites of degenerative arthritis-osteoarthropathy. In five cases (septic arthritis, periodontal and soft tissue infections) (99m)Tc-depreotide was positive, though spatially discordant with bone scintigraphy, delineating precisely the focus of infection.. (99m)Tc-depreotide can be a useful complementary imaging method in the evaluation of bone infection and inflammation. Its combination with three-phase bone scintigraphy seems to be accurate in localizing the infection foci and determining the activity of the inflammatory processes.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Image Enhancement; Male; Middle Aged; Organotechnetium Compounds; Osteitis; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Single-Blind Method; Somatostatin; Technetium Tc 99m Medronate

Our objective in this study was to evaluate whether measurement of quantitative uptake of (99m)Tc-methylene diphosphate (MDP) and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO) white blood cells (WBCs) is useful in detecting osteomyelitis in peripheral bony lesions.. Twenty-four patients (12 men and 12 women; age range, 25-72 y) were referred for imaging because of clinically suspected osteomyelitis. They had a traumatic fracture (n = 10), knee prosthesis (n = 5), hip prosthesis (n = 2), diabetic foot (n = 4), or chronic osteomyelitis (n = 3). Three-phase bone scanning and (99m)Tc-HMPAO WBC studies were performed on all patients within the same week. Regions of interest were drawn over the abnormal bony sites and the contralateral normal sites, and the abnormal-to-normal uptake ratios (A/N ratios) were obtained for both studies.. All patients had abnormal findings on 3-phase bone scanning, whereas 17 (71%) had abnormal findings on (99m)Tc-HMPAO WBC studies, of which 15 were confirmed to be true-positive. In those 15 patients, the mean A/N ratios for (99m)Tc-MDP and (99m)Tc-HMPAO WBC were 3.0 +/- 1.6 (range, 1.3-6.2) and 1.8 +/- 0.3 (range, 1.4-2.2), respectively. In the other 9 patients, whose scan results were clinically confirmed to be true-negative, the mean A/N ratios for (99m)Tc-MDP and (99m)Tc-HMPAO WBC were 2.1 +/- 1.2 and 1.2 +/- 0.2, respectively. In the group with a (99m)Tc-MDP A/N ratio greater than 2 (n = 15), 87% (13/15) had a high (99m)Tc-HMPAO WBC A/N ratio (>1.5), including 2 that were false-positive. In the remaining 2 patients, one with chronic osteomyelitis and the other with a recent hip prosthesis, (99m)Tc-HMPAO WBC ratios were normal. In the group with a bone A/N ratio of less than 2 (n = 9), only 4 patients (44%) were true-positive for acute osteomyelitis.. (99m)Tc-MDP bone scanning alone, with an A/N ratio of more than 2, is useful in detecting osteomyelitis in violated bone except in the case of a recent hip prosthesis or chronic osteomyelitis.

Topics: Adult; Aged; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

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

Topics: Adult; Elbow Joint; Female; Humans; Magnetic Resonance Imaging; Osteomyelitis; Palpation; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Technetium Tc 99m Medronate; Tuberculosis, Osteoarticular

Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical.. We compared the diagnostic values of labelled leucocyte scanning with Tc(99)m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty-one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of > or = grade 3 according to the classification of Wagner.. Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%.. Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.

Topics: Adult; Aged; Biopsy; Blood Sedimentation; Bone and Bones; Bone Marrow; C-Reactive Protein; Diabetic Foot; Female; Humans; Isotope Labeling; Leukocyte Count; Leukocytes; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Arthritis, Infectious; Hip Joint; Humans; Ischium; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Compounds; Technetium Tc 99m Medronate; Tin Compounds

Topics: Adolescent; Bone and Bones; Humans; Male; Osteomyelitis; Pyelonephritis; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Diffuse liver uptake on bone scintigraphy is a rare occurrence with only a few reports in the literature. A case of diffusely increased uptake in a patient with acute hepatitis is presented.

Topics: Aged; Bone and Bones; Hepatitis; Humans; Liver; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Shock, Septic; Technetium Tc 99m Medronate

Functional imaging identifies areas of abnormal bone turnover, providing a useful adjunct in the treatment of osteomyelitis and bone tumors. The low resolution and lack of anatomical detail limit the application of bone scans in craniofacial surgery, however. Multimodality image registration addresses this problem by fusing functional images (single photon emission computed tomography [SPECT]) to high-resolution structural images (computed tomography [CT]) for precise anatomical delineation of bone activity. This article describes a technique for spatial registration of CT and SPECT images to provide precise anatomical delineation of abnormal bone turnover, thereby guiding the extent of resection in the management of craniofacial osteomyelitis. Standard CT and SPECT imaging protocols were used in imaging the skull from the vertex to the mentum. Image data were imported into Analyze (Biomedical Imaging Resource; Mayo Foundation, Rochester, MN) on a dedicated Windows NT (Microsoft Corporation, Redmond, WA) workstation. Using the CT data, the craniofacial skeleton, osteotomy segments, and bone grafts were interactively mapped out. Consecutive axial slices were then reconstructed to form a three-dimensional volume of interest. The CT-derived volume of interest was registered to the technetium Tc 99m-methylene diphosphonate SPECT scan using the Analyze program to provide a fused multimodality image. The imaging technique was used to localize osteomyelitis in a complex craniofacial reconstruction. The fused images guided the extent of resection during surgery, and postoperative microbiological and histological testing confirmed the diagnosis. Multimodality image registration provides a readily available method to relate facial skeletal anatomy and physiology. This technique is valuable in planning and monitoring therapeutic interventions in clinical conditions in which bone turnover is abnormal.

Topics: Adult; Bone Transplantation; Facial Bones; Frontal Bone; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Orbital Diseases; Osteomyelitis; Osteotomy; Patient Care Planning; Radiopharmaceuticals; Surgery, Computer-Assisted; Surgical Wound Infection; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To evaluate use of technetium Tc 99m disodium hydroxymethylene diphosphonate (99m-Tc-HDP) for assessing fracture healing and 99m-Tc-HDP and technetium Tc 99m ciprofloxacin (99m-Tc-CIPRO) for early diagnosis of osteomyelitis in rabbits.. 32 skeletally mature New Zealand White rabbits.. A femoral fracture defect stabilized with bone plates and cortical screws was used. Scintigraphy was performed 4, 8, 12, and 16 weeks after surgery. The 99m-Tc-CIPRO scan was performed 48 hours after the 99m-Tc-HDP scan. The uptake ratio of the experimental limb to the normal limb was calculated by use of multiple regions of interest. Results of radiography performed to determine external callus and lysis grade and percentage defect ossification at 16 weeks were compared with scintigraphy results.. Infected fractures had a higher uptake ratio for 99m-Tc-HDP and 99m-Tc-CIPRO than noninfected fractures. Infected fractures could be differentiated from noninfected fractures late in healing by use of 99m-Tc-HDP. Although 99m-Tc-CIPRO was better than 99m-Tc-HDP for identifying infection, there was a high incidence of false positive and negative results with 99m-Tc-CIPRO. There was an association between 99m-Tc-HDP uptake ratio and callus formation and a good correlation between 99m-Tc-HDP uptake ratio and defect ossification after 4 weeks.. 99m-Tc-HDP and 99m-Tc-CIPRO may be useful for diagnosing osteomyelitis late in fracture healing; however, false positive and false negative results occur. Technetium Tc 99m disodium hydroxymethylene diphosphonate may be useful for evaluating fracture healing.

Topics: Animals; Ciprofloxacin; Female; Femur; Fracture Healing; Organotechnetium Compounds; Osteomyelitis; Rabbits; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Child; Diagnosis, Differential; Female; Humans; Kidney Papillary Necrosis; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinalysis

Bone scanning is frequently used for the assessment of a child with pain around the hip joint. The authors present a child with septic hip arthritis in which a striking abnormality of complete absence of tracer uptake in an extensive region of the proximal femur was demonstrated on bone scintigraphy. Later during the course of his disease, markedly increased tracer uptake was seen along most of the femoral diaphysis with the exception of the avascular proximal bone. These scintigraphic findings represent extensive osteomyelitis of the femur with avascular necrosis of its proximal part.

Topics: Arthritis, Infectious; Child; Femur; Femur Head Necrosis; Hip Joint; Humans; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Staphylococcal Infections; Technetium Tc 99m Medronate

Topics: Bone and Bones; Calcinosis; Connective Tissue; Diagnosis, Differential; Foot; Hand; Humans; Incidental Findings; Infant; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Skin; Technetium Tc 99m Medronate

Topics: Calcium Gluconate; Extravasation of Diagnostic and Therapeutic Materials; False Positive Reactions; Female; Humans; Infant, Newborn; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

In a 15-year-old girl with pain in the right lower abdomen and a 9-year-old boy with pain in the left thigh, an elevated sedimentation rate and C-reactive protein were reason to suspect osteomyelitis. Although no abnormalities could be seen on X-rays, skeletal scintigraphy revealed pathology in Liv-v and the sacroiliac joint, respectively. In the girl, Staphylococcus aureus was cultivated from material obtained by puncture and biopsy. After treatment with antibiotics, rest and gradual mobilisation, the girl retained a scoliosis; the boy was cured without residual complaints or abnormalities. Osteomyelitis of the spine and sacroiliac joint are rare disorders in children. The subtle and non-specific symptoms sometimes make the diagnosis difficult. Conventional X-ray is the primary radiological investigation. Bone scintigraphy (99mTc-oxidronate) is useful in the initial evaluation of children with suspected osteomyelitis. It is sensitive, relatively inexpensive, often does not require sedation and can detect multiple foci of disease. MRI is also highly sensitive and more specific than bone scintigraphy, but it cannot be used as a screening technique when the site of pathology is unclear. MRI is useful when the bone scintigram is inconclusive and in complicated cases for better anatomic details.

Topics: Abdominal Pain; Adolescent; Anti-Bacterial Agents; Child; Diagnosis, Differential; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Osteomyelitis; Prognosis; Radionuclide Imaging; Sacroiliac Joint; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The emergence of MRI has challenged the long-standing primacy of skeletal scintigraphy in pediatric cases of suspected acute hematogenous osteomyelitis (AHO) with nondiagnostic radiographs. This study evaluated a strategy in which skeletal scintigraphy is the primary and MRI a supplemental test.. We reviewed the records of 213 children (age range, 8 mo-18 y; mean age, 67 mo) with musculoskeletal symptoms and nondiagnostic radiographs who were referred for skeletal scintigraphy because of the possibility of AHO. MRI was performed when diagnostic uncertainty persisted after skeletal scintigraphy or when abscess was suspected.. Diagnosis was made using skeletal scintigraphy without referral for MRI in 179 (84%) of the children, including 79 (92%) of 86 with a final diagnosis of AHO. In no instance was the diagnosis of AHO indicated only by MRI. Treatment and diagnosis were accomplished without referral for MRI in 146 (69%) of all cases and 46 (53%) of the AHO cases. Abscesses that required drainage were found in 3 (6%) of 48 cases of major-long-bone AHO. Each of these 3 had exhibited a slow therapeutic response before MRI. Drainable abscesses were found in 5 (20%) of 25 cases affecting the pelvis, which was the other preponderant location of AHO. These were found with pelvic foci both when MRI was performed at diagnosis and when MRI was performed during treatment.. An imaging strategy in which skeletal scintigraphy is the first test used when AHO is suspected but radiographs are negative remains highly effective. This approach can be most strongly advocated when symptoms are poorly localized or are localized to major long bones. MRI should be performed after skeletal scintigraphy shows major-long-bone AHO if treatment response is slow. Skeletal scintigraphy is also an appropriate first test for suspected radiographically occult pelvic AHO. Because of the association of abscesses with pelvic AHO, however, the use of MRI should be strongly considered after pelvic AHO is detected, and MRI might be substituted diagnostically for skeletal scintigraphy when symptoms are well localized to the pelvis.

Topics: Abscess; Acute Disease; Bone and Bones; Bone Neoplasms; Child, Preschool; Connective Tissue Diseases; Fractures, Bone; Humans; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Abdomen; Aged; Anti-Bacterial Agents; Cervical Vertebrae; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Female; Hemorrhage; Humans; Osteomyelitis; Peritoneal Neoplasms; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

The aim of this prospective study was to assess the role of 99mTc-HMPAO leucocyte scintigraphy combined with a 99mTc-MDP bone scintigraphy in the diagnosis of the diabetic foot infection (HMPAO-Leu/MDP).. 75 diabetic patients with suspected osteomyelitis were included. The HMPAO-Leu/MDP scan was considered to be consistent with osteomyelitis when the HMPAO-Leu uptake was concordant in all the incidences with an MDP bone uptake. A HMPAO-Leu uptake without concordant bone MDP activity was considered as a soft-tissue infection. The results of the HMPAO-Leu/MDP scan were compared to the following diagnostic criteria: bone infection was confirmed by radiological follow-up or bone biopsy; the absence of bone infection was confirmed by clinical (healing of the ulcer without antibiotherapy) and radiological follow up.. According to these criteria, among the 83 ulcers, bone infection was observed in 41 (49.4%): the HMPAO-Leu/MDP scan was positive in 38 cases, including 14 ulcers with normal or doubtful radiographs at inclusion. In the group of 42 ulcers without proven bone infection, the HMPAO-Leu/MDP scan was negative in 41 cases, including 17 lesions with a soft-tissue infection.. With a sensitivity of 92.6%, a specificity of 97.6%, the HMPAO-Leu/MDP scan is a reliable tool for the diagnosis of osteomyelitis in the diabetic foot. Neuroarthropathy did not affect the performances of the HMPAO-Leu/MDP scan. Owing to a high spatial resolution this test is very helpful to differentiate bone infection from soft-tissue infection especially in case of neuroarthropathy.

Topics: Adult; Age of Onset; Aged; Aged, 80 and over; Diabetic Foot; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Ciprofloxacin; Diagnosis, Differential; Female; Femur Head Necrosis; Hip Joint; Humans; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Avascular osteonecrosis can be associated with septic arthritis and osteomyelitis. Combined labeled leukocyte-marrow imaging scintigraphy has demonstrated excellent accuracy for the detection of infection since both tracers accumulate in the bone marrow and only leukocytes accumulate in infection. We report an unusual total absence of 99mTc HMPAO leukocytes/9mTc-sulfur colloid tracer accumulation, not only in the femoral head but also in the acetabulum and hip in hip osteonecrosis secondary to septic arthritis and osteomyelitis.

Topics: Acetabulum; Arthritis, Infectious; Bone Marrow; Chemotaxis, Leukocyte; Female; Femur Head Necrosis; Gallium Radioisotopes; Humans; Leukocytes; Middle Aged; Osteomyelitis; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

To compare a technetium 99m-labeled murine immunoglobulin M monoclonal antigranulocyte antibody that binds to human polymorphonuclear leukocyte CD15 antigens with indium 111 ((111)In)-labeled leukocytes in the diagnosis of appendicular skeletal osteomyelitis.. Twenty-four patients suspected of having infected joint replacement (n = 12), diabetic pedal osteomyelitis (n = 8), or long bone osteomyelitis (n = 4) were imaged 5, 30, 60, and 120 minutes after antibody injection. Following injection, one patient experienced moderate joint pain exacerbation that resolved spontaneously. Patients underwent imaging with (111)In-labeled leukocytes and three-phase bone imaging. All studies were interpreted alone. Images obtained in antibody and (111)In-labeled leukocyte studies were also interpreted with the bone scans. One reader, without knowledge of other study results or final diagnoses, reviewed and interpreted images in a random order. Sensitivity, specificity, and accuracy were calculated for the antibody study at each time point, the (111)In-labeled leukocyte study, the three-phase bone scanning procedure, and dual-tracer studies.. There were 11 cases of osteomyelitis. Bone scintigraphy was sensitive (1.0) but nonspecific (0.38). Images obtained in the 120-minute antibody study were sensitive (0.91), moderately specific (0.69), and comparable to those obtained in the (111)In-labeled leukocyte study (0.91 sensitivity, 0.62 specificity). When interpreted with bone scans, images obtained in the antibody and (111)In-labeled leukocyte studies showed improved sensitivity and specificity (1.0 and 0.85 and 1.0 and 0.77, respectively).. Use of the monoclonal antigranulocyte antibody was comparable to the use of (111)In-labeled leukocytes in the diagnosis of appendicular skeletal osteomyelitis. The combined results of the monoclonal antibody study and bone scanning were more accurate (0.91) for diagnosing this entity than were the results of any of the other studies.

Topics: Aged; Aged, 80 and over; Antibodies, Monoclonal; Female; Granulocytes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

A 30-year-old woman who had a destructive Mycobacterium avium complex infection in the left inguinal fossa affecting the pubic bone underwent three-phase bone scanning to identify other possibly affected sites. Multiple skeletal lesions were seen scattered throughout the vertebral column, sternum, and pelvis. This case is presented to describe a rare extensive metastatic M. avium complex infection in an immunocompromised patient.

Topics: Adult; Biopsy; Female; Humans; Immunocompromised Host; Lumbar Vertebrae; Mycobacterium avium-intracellulare Infection; Osteomyelitis; Pelvis; Radionuclide Imaging; Radiopharmaceuticals; Sternum; Technetium Tc 99m Medronate; Whole-Body Counting

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

We present a rare case of anaplastic large cell lymphoma of the bone in the leg of a child. The patient initially presented with suspected osteomyelitis of the fibula and was treated by antibiotics without apparent success. Thereafter, an open biopsy of the lesion was performed and the correct diagnosis was established. This rare case demonstrates the difficulties that a treating physician meets in establishing the correct diagnosis in a child presenting with limping. A review of the pertinent literature is introduced.

Topics: Bone Neoplasms; Child, Preschool; Gait; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To study the clinical usefulness of granulocyte scintigraphy, eight children with clinical, laboratory and/or radiologic findings strongly suggestive of osteomyelitis were prospectively evaluated. Comparison was made with bone scintigraphy and magnetic resonance imaging. In adults, granulocyte scintigraphy is highly infection specific, although nonspecific findings (i.e. photopenic lesions) may also occur. Granulocyte scintigraphy was positive in one patient, false-negative in two and demonstrated nonspecific photopenic lesions in five children (62%). In conclusion, there appears to be little place for granulocyte scintigraphy in routine investigation of suspected ostoemyelitis in children.

Topics: Antibodies, Monoclonal; Bone and Bones; Child; Child, Preschool; False Negative Reactions; Female; Fever; Granulocytes; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Pain; Prospective Studies; Radiography; Radioisotopes; Radionuclide Imaging; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

Early and accurate diagnosis of osteomyelitis remains a clinical problem. Acute osteomyelitis often occurs in infants and most often is located in the long bones. Radiologic images show changes only in advanced stages of disease. Scintigraphic imaging with (99m)Tc-methylene diphosphonate (MDP), or bone scanning, is much more sensitive in detecting acute osteomyelitis but lacks specificity. We evaluated the performance of (99m)Tc-interleukin-8 (IL-8) in an experimental model of acute osteomyelitis.. Acute pyogenic osteomyelitis was induced in 10 rabbits by inserting sodium morrhuate and Staphylococcus aureus into the medullary cavity of the right femur. The cavity was closed with liquid cement. A sham operation was performed on the left femur. Routine radiographs were obtained just before scintigraphy. Ten days after surgery, the rabbits were divided into 2 groups of 5 animals, received an injection of either 18.5 MBq (111)In-granulocytes or 18.5 MBq (67)Ga-citrate, and were imaged both 24 h after injection and 48 h after injection. On day 12, the rabbits received either 18.5 MBq (99m)Tc-MDP or 18.5 MBq (99m)Tc-IL-8, and serial images were acquired at 0, 1, 2, 4, 8, 12, and 24 h after injection. Uptake in the infected femur was determined by drawing regions of interest. Ratios of infected femur (target) to sham-operated femur (background) (T/Bs) were calculated. After the final images were obtained, the rabbits were killed and the right femur was dissected and analyzed for microbiologic and histopathologic evidence of osteomyelitis.. Acute osteomyelitis developed in 8 of 10 rabbits. All imaging agents correctly detected the acute osteomyelitis in these animals. The extent of infection was optimally visualized with (67)Ga-citrate and delayed bone scanning, whereas diaphyseal photopenia was noted with both (99m)Tc-IL-8 and (111)In-granulocytes. In 1 rabbit with osteomyelitis, imaging results were falsely negative with (111)In-granulocytes and falsely positive with (99m)Tc-MDP. Quantitative analysis of the images revealed that the uptake in the infected region was highest with (67)Ga-citrate (4.9 +/- 0.8 percentage injected dose [%ID]) and (99m)Tc-MDP (4.7 +/- 0.7 %ID), whereas the uptake in the infected area was significantly lower with (99m)Tc-IL-8 (2.2 +/- 0.2 %ID) and (111)In-granulocytes (0.8 +/- 0.2 %ID) (P < 0.0042). In contrast, the T/Bs were significantly higher for (99m)Tc-IL-8 (T/B, 6.2 +/- 0.3 at 4 h after injection) than for (67)Ga-citrate, (99m)Tc-MDP, and (111)In-granulocytes, which had ratios of 1.5 +/- 0.4, 1.9 +/- 0.2, and 1.4 +/- 0.1, respectively (P < 0.0001). Radiography correctly revealed acute osteomyelitis in only 2 of 8 rabbits.. In this rabbit model of osteomyelitis, (99m)Tc-IL-8 clearly revealed the osteomyelitic lesion. Although the absolute uptake in the osteomyelitic area was significantly lower than that obtained with (99m)Tc-MDP and (67)Ga-citrate, the T/Bs were significantly higher for (99m)Tc-IL-8 because of fast background clearance. The ease of preparation, good image quality, and lower radiation burden suggest that (99m)Tc-IL-8 may be a suitable imaging agent for the scintigraphic evaluation of acute osteomyelitis.

Topics: Animals; Female; Femur; Gated Blood-Pool Imaging; Granulocytes; Indium Radioisotopes; Interleukin-8; Organotechnetium Compounds; Osteomyelitis; Rabbits; Radiopharmaceuticals; Receptors, Interleukin; Technetium Tc 99m Medronate

Topics: Aged; Citrates; Gallium; Gallium Radioisotopes; Humans; Male; Mastoid; Osteomyelitis; Otitis Externa; Pseudolymphoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Sinonasal tuberculosis is a rare disease; its association with osteomyelitis of surrounding bone and cervical lymphadenopathy has been reported rarely. In this article, we report a case of sinonasal tuberculosis that was complicated by osteomyelitis of the ethmoid bone and cervical lymphadenopathy. Infection of the bone was demonstrated by biopsy and (99m)Tc-MDP bone single photon emission computed tomography (SPECT), and cervical lymphadenopathy was confirmed by histology. This case will be discussed with specific emphasis on the imaging characteristics.

Topics: Adult; Ethmoid Bone; Ethmoid Sinusitis; Female; Humans; Magnetic Resonance Imaging; Maxillary Sinusitis; Neck; Nose Diseases; Osteomyelitis; Sinusitis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Tuberculosis; Tuberculosis, Lymph Node

Topics: Diagnosis, Differential; Female; Humans; Hyperplasia; Middle Aged; Osteomyelitis; Parathyroid Diseases; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thoracic Vertebrae

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

Topics: Abscess; Aged; Aged, 80 and over; Humans; Intervertebral Disc Displacement; Leukocytes; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Thoracic Vertebrae

The aims of this prospective study were to evaluate the contribution of Tc-99m methylene diphosphonate (MDP), Tc-99m human immune globulin (HIG), and Tc-99m white blood cell (WBC) to the diagnosis of osteomyelitis in the diabetic foot and to evaluate the surgical or medical therapy with Tc-99m HIG and Tc-99m WBC scans.. Twenty patients (15 men, 5 women) with suspected pedal osteomyelitis were included in the study. All patients had type II diabetics. Three- and four-phase bone scintigraphy (3P-MDP, 4P-MDP), early (e) and late (l) HIG, and WBC scans were completed within 1 week in all patients. The lesion-to-background ratios were calculated for early and late images of the feet for all scans and named as the indices. Eight weeks after the end of medical or surgical therapy, Tc-99m HIG and Tc-99m WBC scans were repeated in 10 patients. The difference in indices between 3P-MDP and 4P-MDP for osteomyelitis and indices for osteomyelitis, cellulitis, and inflammation in Tc-99m HIG and Tc-99m WBC in early and late scans were tested for significance.. In 20 patients, 53 lesions were investigated. Among these 53 lesions were 25 sites of proved osteomyelitis, 6 sites of cellulitis, and 22 sites of inflammation confirmed by radiography, microbiologic culture, and clinical evaluation. 4P-MDP was more specific than 3P-MDP for detecting osteomyelitis (50% and 67%, respectively). There was also a significant difference between the mean indices of 3P-MDP and 4P-MDP (P < 0.000). The index values were increased in 4P-MDP scans. There was no significant difference between the indices of early and late Tc-99m HIG scans for inflammation, cellulitis, and osteomyelitis. Early and late Tc-99m WBC scans did not show a significant difference in differentiating osteomyelitis. However, Tc-99m WBC scans could differentiate aseptic inflammation from infection (P < 0.031) in early and late scans. There was a significant difference of index values between pre- and post-treatment Tc-99m HIG and Tc-99m WBC scans. The best combination of scans for detecting osteomyelitis was 4P-MDP with WBC scans, with an accuracy rate of 92%.. These results show that four-phase bone scintigraphy with early Tc-99m WBC scanning is preferred for detecting osteomyelitis of the diabetic foot. To evaluate the response to therapy, Tc-99m WBC scans are the preferred method, but if this is not available, Tc-99m HIG scanning can be used.

Topics: Adult; Aged; Diabetic Foot; Female; Humans; Immunoglobulins; Leukocytes; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Ciprofloxacin; Citrates; False Negative Reactions; Female; Gallium; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Streptococcal Infections; Streptococcus agalactiae; Technetium; Technetium Tc 99m Medronate

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

The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated. A bone scan revealed increased blood flow and blood pool activity, with intense midtibial bony uptake in delayed images. These findings are similar to those of acute osteomyelitis. Biopsy revealed bony metastasis from the patient's breast carcinoma.

Topics: Acute Disease; Biopsy; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diagnosis, Differential; Female; Humans; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Whole-Body Irradiation

Pyomyositis, although uncommon, is being reported with greater frequency in temperate climates. The presentation is similar to a number of infectious processes, and when associated with a traumatic event, the clinical picture may be confused with that of a musculoskeletal injury. This, coupled with an unfamiliarity of the disease, may result in a delay in diagnosis. Early antibiotic therapy may obviate surgery. Progression to the suppurative stage requires surgical drainage along with antibiotics. CT guided drainage may be accomplished in certain cases. In immunocompromised patients, progression to the septicemic stage is associated with high morbidity and mortality.

Topics: Ankle Injuries; Biopsy; Child; Combined Modality Therapy; Compartment Syndromes; Debridement; Decompression, Surgical; Diagnostic Errors; Disease Progression; Emergency Treatment; Female; Humans; Myositis; Nafcillin; Necrosis; Osteomyelitis; Penicillins; Staphylococcal Infections; Suppuration; Technetium Tc 99m Medronate

The purpose of this study was to investigate the potential usefulness of single photon emission computed tomography (SPECT) bone scanning with technetium-99m methylene diphosphonate (Tc-99m MDP) in the diagnosis of idiopathic jaw pain. Unlike planar bone scanning, SPECT uses tomographic technology to provide 3-dimensional images, which are more useful in localizing small lesions.. Twenty patients, each with a diagnosis of chronic idiopathic jaw pain, were compared after SPECT bone scanning with 20 age-matched and gender-matched normal controls. Uptake was identified and compared in sites with previously detected jaw pathoses and jaw pain.. Nineteen of 20 patients with jaw pain evaluated with SPECT had positive scans, in contrast with 12 of 20 control subjects (P <.04). Positive scans were correlated with painful sites in 15 of 20 patients, with the remaining 5 patients demonstrating no uptake in painful locations. Patients with jaw pain demonstrated 37 of 80 mouth quadrants with positive scans, in contrast with 21 of 80 mouth quadrants in the controls (P <.01). Nineteen of 24 painful mouth quadrants had uptake in the pain group. Of the 21 quadrants positive in the controls, 17 were correlated with previously detected jaw pathoses. The sensitivity and specificity for detecting painful sites were 0.79 and 0.68, respectively. The sensitivity and specificity for detecting previously identified pathoses in the jaws of normal controls were 0. 80 and 0.93, respectively.. Patients with idiopathic jaw pain had a significantly greater frequency of positive SPECT bone scans when compared with normal controls. However, the sensitivity and specificity of SPECT bone scans in detecting painful sites were low. These findings suggest that SPECT bone scanning with Tc-99m MDP is not indicated as a routine imaging procedure for the detection of jaw pathoses, but may be considered as a potential research tool in the future study of chronic idiopathic jaw pain.

Topics: Adult; Case-Control Studies; Chi-Square Distribution; Facial Pain; Female; Humans; Jaw Diseases; Male; Middle Aged; Osteomyelitis; Periapical Diseases; Periodontal Diseases; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Two 9-year-old patients with femoral bone lesions were referred to the authors' institution within a few days of each other. Both showed similar radiographic, magnetic resonance imaging, and scintigraphic findings. The radiographs showed osteolytic lesions in the right femoral diaphyses, and gadolinium-DTPA-enhanced magnetic resonance imaging revealed inhomogeneous enhancement. Tc-99m HMDP showed marked linear accumulation with relatively low central uptake in the right femoral shafts, and TI-201 scintigraphy showed considerable uptake corresponding to the area seen with Tc-99m HMDP. Histologic analysis confirmed eosinophilic granuloma in the first patient and Brodie's abscess in the second. The radiographic and scintigraphic findings in Brodie's abscess may be similar to those in eosinophilic granuloma.

Topics: Child; Eosinophilic Granuloma; Female; Femur; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes

Topics: Abscess; Adult; Bone and Bones; Diagnosis, Differential; Fistula; Humans; Joints; Magnetic Resonance Imaging; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

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

Chronic recurrent multifocal osteomyelitis (CRMO) was first described by Giedion in 1972 as a self-limited relapsing noninfectious inflammatory condition usually affecting children and adolescents. The association of CRMO with psoriasis, palmoplantar pustulosis, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) has been described. In this case report, we present a 49-year-old man with CRMO coexisting with Crohn's disease. To our knowledge, this is the first report of CRMO with Crohn's disease without the presence of pustular skin lesions or other features of SAPHO syndrome.

Topics: Adult; Ankle Joint; Crohn Disease; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Pain; Radionuclide Imaging; Recurrence; 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

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

We evaluated radiolabeled liposomes (liposomes labeled both with 99mTc and 111In) for the early detection of osteomyelitis in an experimental model.. Liposomes, containing 5% polyethylene glycol-distearoyl phosphatidylethanolamine with encapsulated glutathione and deferoxamine, were prepared and labeled with 99mTc and 111In by a previously described method. Acute osteomyelitis was induced in male New Zealand rabbits by intramedullary injection of sodium-morrhuate and Staphylococcus aureus in the tibial bone marrow. Serial imaging studies, consisting of radiolabeled liposome imaging (2-4 mCi 99mTc and 75-125 microCi 111In), 99mTc-methylene diphosphonate (MDP) (3-5 mCi) and 67Ga-citrate (500 microCi), were performed starting at the third day after injection. Each radionuclide study was separated by at least 2 days. The animals also underwent radiography of the lower extremities. The animals were then killed and the infected tibia was excised for histopathology.. For interpreting relative efficacy of individual radiopharmaceuticals, only animals showing positive histopathological findings (n = 9) were considered. Radiographs (Days 12, 13) were conclusive for osteomyelitis in only 3 rabbits. Radiolabeled liposome imaging (Days 4-6) showed positivity in 8 cases and was equivocal in 1. Though the lesion could be delineated as early as 8 hr postinjection in the 99MTc window, the best target-to-nontarget ratio (T/NT) of 1.86 +/- 0.19 was obtained at 48 hr in the 111In window. Three-phase 99mTc-MDP scan (Day 7) was positive in only 5 rabbits with 3 hr T/NT of 1.6 +/- 0.23. Galium-67-citrate images (Days 9-11) were positive in 8 cases and equivocal in 1, the mean 48 hr T/NT being 1.74 +/- 0.24. These results show liposomes are better than 99mTc-MDP for imaging bone infection. Given the early localization and better quality of the images, radiolabeled liposomes also exhibited advantages over 67Ga-citrate for detection of acute osteomyelitis.

Topics: Acute Disease; Animals; Citrates; Gallium; Indium Radioisotopes; Liposomes; Male; Osteomyelitis; Rabbits; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

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: Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate

Combined bone scanning and immunoscintigraphy (IS) with 99mTc-monoclonal antigranulocyte antibodies were performed in two patients with suspected reactivation of chronic osteomyelitis of the lower extremity. Because bone scanning and IS were strongly positive, both patients underwent surgical intervention.. Macroscopic findings did not show purulent infection and microbiologic results remained negative, but histology revealed unexpected ectopic bone marrow, explaining the strong uptake on IS. One patient exhibited active hematopoietic bone marrow at the former fracture site of the tibial bone. The second patient presented with interspersed bone marrow in the cortical bone of the femoral diaphysis after several intramedullary surgical procedures.. Unexpected ectopic hematopoietic marrow may occur in the appendicular skeleton after trauma and repeated surgical interventions. The bone marrow shows a physiologic uptake with IS and may be misinterpreted as granulocyte accumulation due to infection. This may lead to false-positive diagnosis in cases of suspected osteomyelitis.

Topics: Adult; Aged; Antibodies, Monoclonal; Bone Marrow; Choristoma; Diagnosis, Differential; Female; Femoral Fractures; Femur; Hematopoiesis; Humans; Male; Osteomyelitis; Radioimmunodetection; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tibial Fractures

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

When clinical data are insufficient to diagnose infection of bone or joints, nuclear scanning becomes crucial in making an accurate diagnosis. The efficacy of (99m)technetium antigranulocyte monoclonal antibody Fab' fragment (LeukoScan) is prospectively compared with (111)indium white blood cell and (99m)technetium methylene diphosphonate bone scans in 74 patients with suspected musculoskeletal infections. They were grouped according to site of suspected infection: 33 long bones, 23 prosthetic joints, and 18 diabetic feet. Sixty-two of these 74 patients had surgical verification with histopathology or culture. The remaining 12 patients had clinical followup as proof of absence of infection. The overall sensitivity of LeukoScan, (111)indium white blood cell, and (99m)technetium methylene diphosphonate bone scans was 93%, 85% and 92%, respectively. Specificity was 89%, 75% and 52%, and accuracy was 90%, 79% and 74%, respectively. The conclusion from this study is that LeukoScan is more accurate in detecting osteomyelitis, with better sensitivity and specificity in prosthetic joints. Compared with (111)indium white blood cell scans, LeukoScan++ gives superior images, and results are obtained in 1 to 6 hours without biohazard risk from handling blood products.

Topics: Aged; Diabetic Foot; Female; Granulocytes; Humans; Immunoglobulin Fab Fragments; Indium Radioisotopes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Prosthesis-Related Infections; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

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

Indium-111-labeled human nonspecific immunoglobin G (111In-IgG) is one of the newer agents suggested for scintigraphic evaluation of infection and inflammation. In this study, the utility of this agent was studied in routine clinical practice.. A dose of 75 MBq 111In labeled to 2 mg IgG (MacroScint) was administered intravenously in 226 patients with 232 possible foci of infection or inflammation. Imaging was performed 4, 24 and 48 hr postinjection. The results were verified by culture, obtained either surgically (42%) or via puncture (19%) and long-term clinical and roentgenological follow-up (39%). Follow-up data were used in patients of whom the vast majority had a negative work-up, including negative 111In-IgG scintigraphy.. All infected total hip (THA) and total knee arthroplasties, focal osteomyelitis, diabetic foot infections, septic arthritis and soft-tissue infections were detected (61 foci). Only one patient with early, low-grade spondylodiscitis was false negative with 111In-IgG. Since 111In-IgG scintigraphy does not discriminate between infectious and sterile inflammation, careful interpretation is necessary in cementless THA up to 1 yr after insertion, uptake only around the neck of the femoral component of a THA, recent fractures and pseudarthrosis, in which uptake may be caused by sterile inflammation and not by infection (specificity for inflammation 100%, specificity for infection of 77%).. Indium-111-IgG scintigraphy is a very sensitive tool for detection of infectious bone and joint disease. Moreover, when uptake patterns of 111In-IgG, which are characteristic for sterile inflammation, are excluded, infection can be ruled out with a high degree of certainty.

Topics: Arthritis; Arthritis, Infectious; Diabetic Foot; Discitis; Female; Hip Prosthesis; Humans; Immunoglobulin G; Indium Radioisotopes; Knee Prosthesis; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prosthesis-Related Infections; Pseudarthrosis; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Infections; Technetium Tc 99m Medronate

A prospective study of the value of MRI in the diagnosis of osteomyelitis of the mandible with special reference to the suitability of different MR sequences.. In 13 patients, average age 55 years (12-82), with clinical suspicion of osteomyelitis of the mandible, 18 MRI examinations were carried out (STIR, TSE T2, proton and SE T1 weighted scans with and without contrast, slice thickness 3.5 to 6 mm). Image quality of the sequences was evaluated as well as the suitability of the various sequences for showing the lesion, its location and extent. Activity of the osteomyelitis was judged by the degree of contrast uptake and was correlated with 3-phase bone scintigraphy and with histological findings.. In 9 of the 14 cases the findings on MRI and of the scintigraphy agreed with the histology. In two patients the activity of the inflammatory process was exaggerated by the MRI. In another follow-up examination it was slightly underestimated. All lesions were shown to be highly active by the histology were recognized as such by MRI. For the localisation and recognition of the extent of the inflammatory processes STIR sequences and T1 weighted non-enhanced SE sequences proved the most suitable. Contrast medium is essential to evaluate the inflammatory activity.. MRI is a sensitive diagnostic method; it is as good as 3-phase bone scintigraphy in demonstrating osteomyelitis of the mandible and of its activity but is superior for showing the pathological anatomy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Contrast Media; Evaluation Studies as Topic; Female; Gadolinium; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Mandible; Mandibular Diseases; Middle Aged; Organometallic Compounds; Osteomyelitis; Pentetic Acid; Prospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Gallium Radioisotopes; Humans; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tibia; Tuberculosis, Osteoarticular

The study was conducted in order to assess the prevalence of osteomyelitis and the predictive value of radiographic (xR) and combined Tc 99-bone and leukocyte scanning (CS) findings in diabetic foot ulcers that met criteria for hospital admission (FUH). Out of 150 episodes of ulceration managed in an outpatient basis, 33 (in 28 NIDDM patients) requiring admission were evaluated. In all cases plain xR and CS were carried out. Seventeen episodes (51.5%) had a good outcome (healed or improving, at the time of the last follow up). Osteomyelitis was found in 21 episodes and 14 (66.6%) of them required an amputation. In 13 cases where xR showed characteristic radiologic changes of osteomyelitis (11 of them had a positive CS) 11 (84.6%) underwent an amputation. However, when osteomyelitis was diagnosed only by a positive CS, only 3/8 (37.5%) required a toe amputation. Severe peripheral vasculopathy was present in 44% of cases who required amputation and only in 17.6% of those who did not. We conclude that in FU underlying osteomyelitis is frequent and associated to a higher amputation rate than when no bone infection is identified (66.6 vs 17%), even when corrected for vascular status (OR 11, CI 95% 1.65-74.2), with a worse outcome when xR changes are already present.

Topics: Aged; Amputation, Surgical; Angiography; Bone and Bones; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Foot; Female; Humans; Leukocytes; Male; Middle Aged; Osteomyelitis; Prevalence; Radionuclide Imaging; Sensitivity and Specificity; Spain; Technetium Tc 99m Medronate; Toes; Wound Healing

The literature on diffuse sclerosing osteomyelitis of the mandible has included at least two groups of lesions: (1) those from which bacterial infectious agents are rarely isolated (chronic-tendoperiostitis); and (2) those from which bacteria are readily isolated (true diffuse sclerosing osteomyelitis). The latter should be distinguished from secondarily infected florid osseous dysplasia. In this article the features of 16 patients with sclerotic jawbone lesions associated with symptoms of infection are analyzed. Eleven patients showed a large area of sclerosis of the mandible that was not restricted to the alveolar process and was surrounding an infectious focus. The histologic pattern revealed a deposition of reactive bone. These lesions are considered to represent true diffuse sclerosing osteomyelitis. The remaining five patients showed sclerotic lesions restricted to the alveolar process in one or more quadrants of the jaws. Apart from inflammation and reactive changes, histologic pattern revealed a fibroblastic stroma with bone and cementum-like structures that are formed by metaplasia. These lesions are considered to represent secondarily infected florid osseous dysplasia.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Fibrous Dysplasia of Bone; Humans; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Periapical Periodontitis; Pericoronitis; Radiography, Panoramic; Sclerosis; Technetium Tc 99m Medronate

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

Topics: Arthropathy, Neurogenic; Artifacts; Diagnosis, Differential; Humans; Indium Radioisotopes; Leukocytes; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The three-phase bone scan has been shown to be useful in the diagnosis of osteomyelitis, with a high sensitivity and specificity under optimal conditions. However, there are many causes of focally-increased uptake of Tc-99m diphosphonates in the extremities that may mimic infection, especially when there is increase on all three phases. Radiolabeled leukocyte scintigraphy is often performed in this clinical setting, although many pitfalls resulting in false-positive scans still remain. The authors present three cases of gouty arthritis in which skeletal scintigraphy illustrates this lack of specificity. Further causes of increased extremity uptake are reviewed, with attention to those that have been reported to show an increase on all three phases of the bone scan. Additional factors that can improve the specificity of the bone scan are discussed, as are the panoply of more recent scintigraphic approaches aimed at distinguishing infection from aseptic inflammation in the extremity. Unfortunately, no nuclear medicine procedure to date has proven itself to be reliably specific for infection.

Topics: Aged; Arthritis, Gouty; Bone and Bones; Humans; Infections; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The role of magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis in foot infections in diabetics was investigated. The accuracy, sensitivity, and specificity of MRI, plain radiography, and nuclear scanning were determined for diagnosing osteomyelitis, and a cost comparison was made.. Twenty-seven patients with diabetic foot infections were studied prospectively. All patients underwent MRI and plain radiography. Twenty-two patients had technetium bone scans, and 19 patients had Indium scans. Nineteen patients had all four tests performed. Patients with obvious gangrene or a fetid foot were excluded.. The diagnosis of osteomyelitis was established by pathologic specimen (n = 18), bone culture (n = 3), or successful response to medical management (n = 6). Osteomyelitis was confirmed in nine of the pathologic specimens. The diagnostic sensitivity, specificity, and accuracy for MRI was 88%, 100%, and 95%, respectively, for plain radiography it was 22%, 94%, and 70%, respectively, for technetium bone scanning it was 50%, 50%, and 50%, respectively, and for Indium leukocyte scanning it was 33%, 69%, and 58%, respectively. The data were analyzed statistically with the two-tailed Fisher's exact test. MRI was the only test that was statistically significant (p < 0.01).. MRI appeared to be the single best test for the diagnosis of osteomyelitis associated with diabetic foot infections. It had a better diagnostic accuracy than conventional modalities and appeared to be more cost-effective than the frequently used Indium scan.

Topics: Adult; Aged; Aged, 80 and over; Costs and Cost Analysis; Diabetic Foot; Female; Humans; Indium Radioisotopes; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Prospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

One hundred seven combined In-111 WBC/Tc-99m MDP scans performed on 87 patients with a high clinical suspicion of osteomyelitis were retrospectively reviewed. An 86% sensitivity and a 94% specificity for detecting osteomyelitis were found. In addition, patients were grouped into one of five clinical settings for more detailed analysis: diabetic osteoarthropathy, previous arthroplasty, fracture, overlying skin ulcer, and other etiology. Forty-seven studies were performed while patients received antibiotic therapy without loss of sensitivity for detecting osteomyelitis. Results obtained with scintigraphy compared favorably to other imaging and laboratory studies used to detect osteomyelitis. In conclusion, the combined In-111 WBC/Tc-99m MDP scan is a very sensitive and specific method to detect osteomyelitis in patients with concurrent diabetic osteoarthropathy, fracture, postoperative healing, and overlying skin ulcer. Antibiotic treatment does not appear to adversely affect the sensitivity of these scans.

Topics: Anti-Bacterial Agents; Arthroplasty; Bone and Bones; Diabetes Complications; Diagnostic Imaging; Female; Fractures, Bone; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Skin Ulcer; Technetium Tc 99m Medronate

A prospective study of 85 patients with oral cancer, treated with high-dose radiation therapy, was performed to assess the value of magnetic resonance imaging (MRI) and scintigraphy for diagnosis of pathologic changes in the mandible. During postradiotherapeutic monitoring, radiation osteomyelitis occurred in 12 cases, tumor recurrences infiltrating the mandible in five cases, and progressive periodontal disease in nine cases. MRI permitted early diagnosis of radiation osteomyelitis in 11 out of 12 cases; only two cases were false positive. In scintigraphy with 99mTc-HDP, all alterations of the mandible, such as osteoradionecrosis, tumor infiltration, and periodontitis, showed a high uptake, resulting in a sensitivity of up to 100%, but a low specificity of 57%. Scintigraphy permitted assessment of the extension and location of the lesions. Both methods were superior to conventional radiography and clinical examination and should be integrated into a comprehensive follow-up program after radiation therapy.

Topics: Adult; Aged; False Positive Reactions; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Mandible; Mandibular Diseases; Mandibular Neoplasms; Middle Aged; Mouth Neoplasms; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Osteomyelitis; Osteoradionecrosis; Periodontitis; Prospective Studies; Radiation Injuries; Radiation Monitoring; Radiopharmaceuticals; Radiotherapy; Radiotherapy Dosage; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

We reviewed all patients with a clinically infected foot ulcer attending a specialised neuropathic foot clinic. Neuropathy was confirmed by the inability to feel a 5.07 Semmes-Weinstein hair, areflexia and impaired vibration sense, as measured by a biothesiometer. Of 40 patients who attended the clinic over a two-year period, six with ischaemic ulcers were excluded. The remaining 34 had plain radiographs of the foot followed by a 99mTc-MDP bone scan. If the latter was positive, an 111In-labelled WBC scan was performed with planar and/or tomographic dual-isotope studies where appropriate. Bone and WBC scans were performed in 31 patients. In ten, isotope imaging showed infection localised to the soft tissues only and conservative treatment was successful in them all. Eighteen patients were treated surgically with excision of the involved bone, which was sent for culture and histological examination. Dual-isotope scans had a sensitivity of 93% and a specificity of 83%. 99mTc-MDP bone scans with the appropriate In-labelled WBC scans can reliably determine the site and extent of osteomyelitis in the neuropathic diabetic foot.

Topics: Bone and Bones; Diabetic Foot; Diabetic Neuropathies; Humans; Indium Radioisotopes; Leukocytes; Osteomyelitis; Radiography; Radionuclide Imaging; Sensitivity and Specificity; 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

Mycobacterium avium-intracellulare osteomyelitis is an infrequently reported entity, especially in immunocompetent patients. When multifocal, the imaging findings can be confusing, simulating metastatic disease or other bone lesions. An immunocompetent patient with multifocal Mycobacterium avium-intracellulare osteomyelitis is presented who has been followed for 18 years and experienced episodes of exacerbations and further dissemination of her disease, followed by periods of partial remission and clinical quiescence. Bone scintigraphy was very useful in evaluating the extent of involvement and monitoring response to treatment.

Topics: Bone and Bones; Child; Female; Follow-Up Studies; Humans; Mycobacterium avium-intracellulare Infection; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Topics: Costs and Cost Analysis; Humans; Indium Radioisotopes; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The authors present a prospective analysis of Tc-99m MDP and Tc-99m citrate scintigraphy in 29 patients who were clinically suspected of having chronic osteomyelitis. All of the patients showed increased Tc-99m MDP uptake on bone scintigraphy involving the area of concern. However, Tc-99m citrate scintigraphy clearly identified the patients with osteomyelitis (N = 18) confirmed either by biopsy or clinical follow-up. Eleven patients who were free of osteomyelitis showed only minimal radiotracer uptake on Tc-99m citrate scintigraphy. These patients had other benign musculoskeletal diseases that were diagnosed by other imaging modalities. In addition to visually interpreting the scintigraphic images, a semi-quantitative analysis was performed by drawing regions of interest over the areas involved and the normal contralateral side, and patients with osteomyelitis were found to have lesion to nonlesion ratios of greater than 1.70. Because Tc-99m MDP is a nonspecific radiopharmaceutical for the evaluation of bone infection, other imaging agents have been investigated. Tc-99m citrate is a small molecule that makes it suitable to penetrate injured capillaries to the edema fluid known to be present in areas of infection. The authors conclude that Tc-99m citrate is a promising agent for localizing and showing the extent of bone infection that will help the surgeon to determine areas of debridement before surgery.

Topics: Adult; Bone and Bones; Citrates; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

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

A reliable imaging technique is needed for follow-up of patients with temporal and facial osteomyelitis. Clinical outcome in 20 patients with suspected osteomyelitis of the temporal/mastoid, calvarium, and mandible facial bones was evaluated with 30 combined In-WBC/Tc-99m MDP bone single photon emission computed tomographic (SPECT) scans and 27 computed tomographic scans. Simultaneous dual-tracer 25-minute SPECT scans were acquired 18 to 20 hours after radiotracer injection by use of a three-detector system. Diagnosis of the 20 patients (age range, 3 to 74 years) included 8 with facial osteomyelitis, 6 with malignant otitis externa, 3 with mandibular osteomyelitis, and 3 with calvarial osteomyelitis. Diagnosis was confirmed by biopsy/culture results in 18 patients and by endoscopic and clinical evaluation in 2 patients with initial negative scans. Of the 30 In-WBC/MDP scans, 15 were true-positive, 13 true-negative, 1 false-negative, and 1 equivocal. Of a total of 27 CT scans, 9 were true-positive, 5 false-negative, and 1 equivocal in patients with biopsy-proven osteomyelitis. Three computed tomographic scans were false-positive and 1 was equivocal in patients without osteomyelitis, because of concurrent postoperative bone abnormalities. Additionally, 8 computed tomographic scans were true-negative. These results suggest that dual In-WBC/Tc-99m MDP bone SPECT scintigraphy provides an accurate imaging modality for diagnosis and follow-up of temporal and facial osteomyelitis when existing clinical or postoperative bone changes make it difficult to detect active osteomyelitis by computed tomographic scan.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Facial Bones; Female; Humans; Indium Radioisotopes; Infant; Male; Mandibular Diseases; Osteomyelitis; Predictive Value of Tests; Retrospective Studies; Skull; Technetium Tc 99m Medronate; Temporal Bone; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To assess the usefulness of indium-111 white blood cell and technetium-99m methylene diphosphonate bone single photon emission computed tomography (SPECT), computed tomography (CT), and magnetic resonance (MR) imaging in cranial osteomyelitis.. Twenty-six cases (25 patients: 13 male, 12 female; mean age, 55 years) of suspected osteomyelitis were evaluated. Sixteen were postoperative. Final diagnosis was established by means of bone culture in 18 cases and clinical follow-up in eight.. Of 35 CT scans, 10 were true-positive (TP); three false-negative (FN); 13, true-negative (TN); one, false-positive (FP); and eight, equivocal. Of 36 SPECT scans, 19 were TP; 13, TN; one, FP; one, FN; and two, equivocal. Of 11 MR images four were TP; five, TN; and two, FN.. CT is best for differentiation between soft-tissue and bone infection. MR imaging is best for assessment of the calvaria and skull base. SPECT is best for assessment of altered bone and may be the best technique for follow-up.

Topics: Adolescent; Adult; Aged; Biopsy; Cells, Cultured; Female; Follow-Up Studies; Humans; Indium Radioisotopes; Jaw Diseases; Leukocytes; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Retrospective Studies; Sensitivity and Specificity; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to compare Tc-99m nanocolloid scintigraphy with Tc-99m MDP bone imaging in the diagnosis of osteomyelitis and septic arthritis. Overall, 31 Tc-99m MDP bone scans and 39 Tc-99m nanocolloid studies were performed in 34 patients (15 female, 19 male; mean age, 14.88 years +/- 19.00 years) who were suspected of osteomyelitis and/or septic arthritis. The final diagnoses were established by needle aspiration, cultures, radiography, clinical course, and, in some patients, with CT, ultrasonography, and biopsy. The sensitivity, specificity, and accuracy were 100%, 75%, and 92%, respectively for both Tc-99m MDP and Tc-99m nanocolloid scans in detecting osteomyelitis. For septic arthritis, Tc-99m MDP bone imaging showed 100%, 85%, and 94%, and Tc-99m nanocolloid scans showed 90%, 59%, and 76%, sensitivity, specificity, and accuracy, respectively. These results show that, although both scans are in good agreement for osteomyelitis, for septic arthritis nanocolloid is not specific enough to recommend it to be a complementary method to MDP bone scans.

Topics: Adolescent; Arthritis, Infectious; Female; Humans; Male; Osteomyelitis; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

At their initial emergency room presentation, four children were thought to have hip osteomyelitis. Skeletal scintigraphy, however, demonstrated multiple areas of abnormal tracer uptake in the bones in all four, and in three there was abnormal uptake in a soft tissue abdominal mass. The skeletal scintigraphic findings promptly led to the correct diagnosis of neuroblastoma.

Topics: Adrenal Gland Neoplasms; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Hip; Hip Joint; Humans; Infant; Male; Neuroblastoma; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

A 9-year-old girl had a 6-month history of left hip pain. Radiographs of the left hip showed a metaphyseal osteolytic lesion with sclerotic borders in the femoral neck. Tc-99m MDP bone imaging and a Ga-67 scan showed focal areas of increased activity in the left femoral neck. These areas of increased uptake corresponded to a lytic area on x-rays, which was due to a Brodie's abscess. The combination of Tc-99m MDP bone and Ga-67 imaging has been widely used in the confirmation of bone infection, increasing the accuracy in the diagnosis of osteomyelitis. However, nuclear scintigraphy has not been previously reported in the confirmation of a Brodie's abscess.

Topics: Abscess; Child, Preschool; Female; Femur Neck; Gallium Radioisotopes; Humans; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

We report a retrospective study of 94 infants, ages < 4 months, who underwent investigation for possible osteomyelitis during a 9-year period. Of the 30 babies with proven osteomyelitis (radiographic changes or positive bone cultures or positive blood cultures plus a compatible clinical picture), 17 were preterm artificially ventilated babies and 4 were full term infants receiving intensive care. An etiologic organism was isolated from 28: methicillin-susceptible Staphylococcus aureus, 16; methicillin-resistant S. aureus (MRSA), 7; Escherichia coli, 3; and group B Streptococcus, 2. MRSA occurred exclusively in the preterm group. Osteomyelitis was multifocal in 40% and associated with septic arthritis in 47%. The long bones were frequently affected (80%) whereas the flat bones were often sites of clinically silent disease. Twenty-five (83.3%) of the 30 babies with proven osteomyelitis had focal clinical signs or evidence of disseminated staphylococcal disease. Only 10 were febrile. Four of 27 babies investigated because of positive blood cultures for S. aureus but no focal signs had osteomyelitis, as did only 1 of 27 babies with suspected sepsis but no focal signs. The sensitivity of 99mTc bone scanning was 84%, specificity 89%, positive predictive value 79% and negative predictive value 92%. The addition of gallium scanning (in 39 of the 94 infants) improved the respective figures to 90, 97, 93 and 95% and was useful in interpreting equivocal bone scans.

Topics: Arthritis, Infectious; Bone and Bones; Escherichia coli; Escherichia coli Infections; Female; Gallium Radioisotopes; Humans; Infant; Infant, Newborn; Male; Methicillin; Methicillin Resistance; Osteomyelitis; Radiography; Radionuclide Imaging; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Technetium Tc 99m Medronate

Subperiosteal abscess (SA) is a well-known complication of osteomyelitis (OM) in children. The efficiency of treatment of OM with this complication is dependent on early drainage of the abscess. We present a prospective study of 32 children with clinical suspicion of OM. Ultrasonography detected SA in 13 of these children. In nine cases OM with SA was confirmed surgically and in the remaining four other radiographic modalities and/or blood cultures supported the sonographic diagnosis. In the remaining 19 cases, OM without SA was the final diagnosis.

Topics: Abscess; Bone and Bones; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Periosteum; Prospective Studies; Technetium Tc 99m Medronate; Time Factors; Ultrasonography

The ultrasonic findings were reviewed in 13 children in whom pelvic osteomyelitis was diagnosed by a positive 99mtechnetium methylene diphosphonate (MDP) bone scan in conjunction with clinical and laboratory features of osteomyelitis. All patients presented with pain in the region of the hip joint. In six patients the ultrasound study was confined to the hip joint, and all six had normal findings. In seven patients the ultrasound study was extended to include the pelvis. Deep soft tissue swelling was demonstrated in six of these, including a periosseous abscess in one case. Ultrasonography was negative in one patient with a 5-week history, whose pelvic osteomyelitis was resolving at the time of the ultrasound study. Oedema of the obturator internus and externus muscles was observed in osteomyelitis affecting the pubis and ischium, and of the iliacus and/or the gluteus medius muscle in osteomyelitis of the ilium. In children presenting with hip pain who have a normal hip ultrasound study, extension of the ultrasound examination to include these four pelvic muscles may help to identify and document the progression of acute pelvic osteomyelitis.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Osteomyelitis; Pelvic Bones; Predictive Value of Tests; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Ultrasonography

A case of unilateral tibial osteomyelitis in a 20-month-old child after bilateral intraosseous infusion (IOI) needle placement is presented. A review of the indications, potential complications, and scan findings is discussed. This case also shows the lack of significant uptake in the noninfected side, suggesting that a three-phase bone scan is of value in differentiating reactive bone from infected bone in patients with IOI.

Topics: Female; Humans; Infant; Infusions, Intraosseous; Osteomyelitis; Radionuclide Imaging; Shock, Septic; Technetium Tc 99m Medronate; Tibia

Topics: Bone and Bones; Humans; Infant; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

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

The authors present a case report of a young patient with two osteomyelitic foci. Bone scintigraphy showed a rare combination of a cold and a hot spot. Possible problems in the interpretation of the scintigram in patients with pelvic osteomyelitis are discussed.

Topics: Child; Female; Humans; Ilium; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

We prospectively studied 86 children to assess the value and accuracy of isotope bone scanning in the diagnosis of suspected acute haematogenous osteomyelitis and septic arthritis. The patients were scanned because of difficulty in localising the exact site of the pathology. Characteristic scan appearances were found. In osteomyelitis there was increased or decreased uptake extending beyond the confines of the joint capsule; in septic arthritis there was increased or decreased uptake on either side of the joint line, but largely limited to and uniform within the joint capsule. The bone-scan images were correlated with the final diagnosis in 34 sites of septic arthritis and in 62 sites of osteomyelitis. The overall accuracy of the bone scans was 81%. The predictive value for a positive scan to be correct was 100% for a cold scan and 82% for a hot scan. The main reason for a false-positive scan was contiguous soft-tissue infection. The predictive value for a negative scan to be correct was 63%. One reason for a false-negative scan was that the patient was in the transitional phase from cold to hot.

Topics: Adolescent; Arthritis, Infectious; Child; Child, Preschool; False Negative Reactions; False Positive Reactions; Female; Humans; Infant; Male; Osteomyelitis; Predictive Value of Tests; Prospective Studies; Radiography; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate

Early diagnosis of necrotizing external otitis (NEO) includes the use of bone scintigraphy since clinical assessment alone cannot differentiate the necrotizing type of otitis from the severe type of external otitis in which there is no extension to the adjacent bone. Four-hour planar bone scintigraphy may reflect soft-tissue infection, and therefore may not be useful in distinguishing NEO from severe external otitis (SEO). Twenty-four-hour bone scintigraphy using planar or SPECT imaging may better reflect bone uptake and increase the accuracy of the test.. Twenty-six diabetic patients (12 diagnosed NEO; 14 SEO) and 10 nondiabetic (ND) patients were studied. Lesion-to-nonlesion (L/N) count ratios obtained from planar and SPECT imaging at 4 hr, 24 hr and 24 hr/4 hr (24/4) were assessed.. Count ratios obtained from the 4- and 24-hr planar and SPECT images were significantly higher in the NEO patients compared to SEO patients for both planar and SPECT studies (p < 0.001, 0.005). The 24/4 count ratio was also significantly higher in the NEO patients on the planar (p < 0.01) and the SPECT studies (p < 0.001). The ND patients were not different from SEO patients on 4-hr planar, 4- and 24-hr SPECT as well as 24/4-hr planar and SPECT studies. The L/N count ratio threshold yielding the best sensitivity for detecting NEO was 1.05 for the 24/4 SPECT study.. In diabetic patients, an early distinction between NEO and SEO patients can be reliably made by using L/N count ratios on 24/4 or 24-hr SPECT bone scintigraphy.

Topics: Diabetes Complications; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Osteomyelitis; Otitis Externa; Prospective Studies; Pseudomonas Infections; Sensitivity and Specificity; Technetium Tc 99m Medronate; Temporal Bone; Tomography, Emission-Computed, Single-Photon

The field of otolaryngology-head and neck surgery has seen many advances in the treatment and prognosis of malignant external otitis (MEO). However, establishing the resolution of the infection remains problematic. A recent report suggests that indium 111-labeled white blood cell scintigraphy may be a reliable and timely indicator of resolution of infection. We present a case of a false-negative white blood cell scan in a patient with persistent MEO. A discussion of this case and a review of the literature illustrate that there continues to be no "gold standard" for establishing MEO resolution.

Topics: Aged; False Negative Reactions; Humans; Indium Radioisotopes; Leukocytes; Male; Osteomyelitis; Otitis Externa; Radionuclide Imaging; Technetium Tc 99m Medronate; Temporal Bone

To assess the value of fat-suppressed contrast material-enhanced magnetic resonance (MR) imaging in the diagnosis of osteomyelitis.. T1- and T2-weighted MR imaging was performed in 51 cases of suspected osteomyelitis. Nonenhanced and contrast-enhanced T1-weighted fat-suppressed MR images were also obtained. Three-phase bone scan results were available for 30 cases. Complicating clinical factors, including chronic osteomyelitis (n = 26), postoperative state (n = 17), and neuropathic disease of the foot (n = 5), were identified in 73% of cases.. In the diagnosis of osteomyelitis, scintigraphy demonstrated a sensitivity of 61% and specificity of 33%. For nonenhanced MR imaging, sensitivity was 79% and specificity was 53%. For fat-suppressed contrast-enhanced imaging, sensitivity was 88% and specificity was 93%.. In diagnosing osteomyelitis in patients with complicating clinical factors, fat-suppressed contrast-enhanced MR imaging was significantly more sensitive than scintigraphy (P = .04) and significantly more specific than nonenhanced MR imaging (P = .02) or scintigraphy (P = .008).

Topics: Adipose Tissue; Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Marrow; Child; Contrast Media; Diagnosis, Differential; Gadolinium; Humans; Image Enhancement; Magnetic Resonance Imaging; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

The results of combined scintigraphy in which indium-111-labeled leukocytes and technetium-99m methylene diphosphonate were used were compared with the results of cultures of open bone at 102 sites of delayed union or non-union, to determine the effectiveness of this combination as a preoperative indicator of osteomyelitis. There were twenty-five true-positive, fifty-nine true-negative, eleven false-positive, four false-negative, and three indeterminate interpretations, yielding, for the diagnosis of osteomyelitis, a sensitivity of 86 per cent, a specificity of 84 per cent, an accuracy of 82 per cent, a positive predictive value of 69 per cent, and a negative predictive value of 94 per cent. There were few false-negative scans; false-positive results were most likely at a metaphyseal site adjacent to a joint in which there was post-traumatic arthropathy, at the site of a failed arthrodesis, and at the site of an unstable delayed union or non-union.

Topics: Adolescent; Adult; Aged; Child; False Positive Reactions; Female; Femoral Fractures; Fractures, Ununited; Humans; Indium Radioisotopes; Leukocytes; Male; Osteomyelitis; Radionuclide Imaging; Shoulder Fractures; Technetium Tc 99m Medronate; Tibial Fractures

To assess the role of magnetic resonance imaging (MRI) in diagnosing osteomyelitis in diabetic foot infections, 47 diabetic patients with clinical suspicion of osteomyelitis, nonhealing foot ulcer, or soft tissue infection of the foot were examined prospectively by MRI and plain radiographs. Pathological confirmation of diagnosis was obtained in 62 bones from 32 patients. In addition, 14 patients with pathological confirmation of diagnosis underwent technetium-99 MDP triple-phase bone and gallium-67 citrate scans. MRI was significantly more sensitive and accurate (P < .01), with equal specificity in comparison to plain radiographs and technetium and gallium scans. MRI also provided a more detailed and accurate depiction of the anatomy. At early clinical follow-up, complete resection of abnormal bone on an MRI scan correlated with clinical healing. In summary, MRI is indicated when plain radiographs are negative for osteomyelitis or when the extent and accurate depiction of the infective process will facilitate surgical planning.

Topics: Adult; Aged; Aged, 80 and over; Diabetes Complications; Female; Foot Diseases; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Prospective Studies; Technetium Tc 99m Medronate

The authors evaluate the reliability of combined indium-111-labeled white blood cell (WBC) and technetium-99m methylene diphosphonate (MDP) bone scan interpretations at sites of suspected periarticular osteomyelitis with radiographic evidence of adjacent traumatic arthropathy. A review of all orthopedic patients who underwent In-111 WBC-Tc-99m MDP scintigraphy over a 7-year period revealed a subset of 32 such cases that also included results of bone-biopsy cultures. Twenty-eight patients had a history of traumatic intraarticular injury, and four had periarticular fracture malunion or nonunion. Compared with intraoperative culture results, blinded In-111 WBC-Tc-99m MDP scan interpretations included four true-positive, 17 true-negative, and 10 false-positive results, and one false-negative result. The predictive values for positive and negative scans were 28% and 94%, respectively. A high prevalence of false-positive In-111 WBC-Tc-99m MDP scans may occur at periarticular sites of patients with associated traumatic arthropathy. This reduces the specificity of this technique for osteomyelitis, making culture confirmation of positive scans necessary. A negative scan is highly predictive of negative culture results at these sites.

Topics: Adult; Aged; Bone and Bones; False Positive Reactions; Female; Fractures, Bone; Fractures, Ununited; Humans; Indium Radioisotopes; Joints; Leukocytes; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Adult; Female; Hand; Humans; Job Syndrome; Osteomyelitis; Radionuclide Imaging; Synovitis; Technetium Tc 99m Medronate; Time Factors

This article reports on a retrospective study of 32 patients who underwent CT and combined Tc-99m MDP and in-111 WBC SPECT between 1988 and 1991 for post-operative sternal osteomyelitis. Of these 32 patients, 7 patients (Group 1) underwent evaluation for possible sternal osteomyelitis due to persistent fevers, leukocytosis, or changes in the sternal incision; 12 patients (Group 2) had surgically proven osteomyelitis, and in 13 patients (Group 3) there was definite clinical evidence of sternal wound infection (however, surgical specimens of the sternum were not submitted). There was considerable overlap between the CT findings in the soft tissues adjacent to the sternum in Group 1 and Group 2 patients. Severe demineralization was seen in two patients, and erosion of the sternum was seen in five patients with proven osteomyelitis. Combined Tc-99m MDP bone and in-111 WBC SPECT was positive for osteomyelitis in 11 of 12 patients in Group 2. One patient with osteomyelitis had negative scintigraphy; however, this patient had a four-week course of IV antibiotic therapy prior to the study. All seven patients in Group 1 had negative SPECT scans and were treated successfully with oral antibiotics and minimal soft tissue debridement. Three patients in Group 3 had negative SPECT scans and were treated successfully with antibiotics and limited debridement. Ten patients with positive SPECT scans were treated with a combination of antibiotics and aggressive surgical intervention. In conclusion, CT findings in the soft tissues offer little specificity in distinguishing soft tissue inflammation from osteomyelitis of the sternum.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bone and Bones; Humans; Indium Radioisotopes; Leukocytes; Osteomyelitis; Retrospective Studies; Sternum; Surgical Wound Infection; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A case of disseminated North American blastomycosis is described in which the full extent of the multifocal osteomyelitis was depicted by Tc-99m MDP scintigraphy. Skeletal involvement by this disease is not uncommon, yet the utility of bone scintigraphy has not been reported. The efficacy with which the whole body may be examined makes this technique especially appropriate for a hematogenously disseminated and often multifocal form of osteomyelitis where radiographically occult and asymptomatic lesions may be present.

Topics: Blastomycosis; Bone and Bones; Female; Humans; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

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

Despite hyperemia in the blood-pool phase of bone scintigraphy with 99mTc-MDP there was an decreased concentration of the nuclide in a 7-year-old boy with acute osteomyelitis of the femur. In addition to inflammatory destruction of the bone tissue, the other reason for this surprising scintigraphic finding might be a reduced blood flow because of thrombotic occlusion or compression of bone-supplying vessels.

Topics: Acute Disease; Child; Femur; Humans; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

This retrospective study looked at the role of indium 111-labeled white blood cell (111In WBC) scintigraphy in head and neck infections. The efficacy of 111In WBCs was compared to gallium 67 citrate (67Ga) and technetium Tc99m methylene diphosphonate (99mTc MDP) scintigraphy in detecting and monitoring the resolution of infection. For 22 active infections, the sensitivities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 94%, 56%, and 86%, respectively, and the specificities for 111In WBC, 67Ga, and 99mTc MDP scintigraphy were 100%, 43%, and 0%, respectively. For 8 successfully treated infections, all seven 111In WBC studies became negative after therapy, in as short an interval as 1 month. In contrast, all seven 99mTc MDP images remained positive for as long as 6 months after therapy. The seven 67Ga studies had variable results, with four (57%) remaining positive, including two (28%) positive at 6 months after therapy. These results suggest that 111In WBC scintigraphy should be the initial radionuclide imaging tool in detecting active head and neck infections because of its greater accuracy, and its ability to revert to normal much sooner than 67Ga or 99mTc MDP scintigraphs when applied to a subset of patients with resolved infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Female; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Leukocytes; Male; Middle Aged; Osteomyelitis; Otorhinolaryngologic Diseases; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

We evaluated the results of reconstruction of a skeletal defect with use of a vascularized bone graft from the iliac crest or fibula in 160 patients who had been managed consecutively between 1979 and 1989. The indications for the procedure were a skeletal defect including non-union, resulting from resection of a tumor; traumatic bone loss; osteomyelitis; or a congenital anomaly. The average duration of follow-up was forty-two months (range, twelve to 112 months). For the entire series, the rate of union after the primary procedure was 61 per cent and the over-all rate at the latest follow-up examination (including the patients who had a secondary procedure) was 81 per cent. In a subgroup of seventy-six patients who had union after the primary procedure and did not have additional treatment, the average interval until union was six months and the average interval until full activity was sixteen months. The results were more favorable for the patients who had had reconstruction for resection of a tumor (of sixty-nine patients, fifty-six had union), for a congenital anomaly (of six patients, five had union), or for a non-union without infection (of twenty-five patients, twenty-three had union). The results were less satisfactory for patients who had had the reconstruction for bone loss due to osteomyelitis (of sixty patients, forty-six had union). Our data suggest that vascularized bone transfer for the reconstruction of large skeletal defects is a valuable procedure in appropriately selected patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Diseases; Bone Neoplasms; Bone Transplantation; Child; Child, Preschool; Female; Fibula; Follow-Up Studies; Humans; Ilium; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Medronate

In diabetic gangrene, concomitant osteopathy and soft-tissue infection often render laboratory and roentgenographic signs unreliable as indicators of osteomyelitis. In this situation, scintigraphic methods can be helpful.. Relying on the long-term clinical course as the final indicator of presence or absence of osteomyelitis, we prospectively compared in 31 patients three-phase bone scintigraphy with either indium-labeled autologous granulocytes (n = 20) or 123I-labeled antibodies against granulocytes (n = 11).. Three-phase bone scintigraphy and imaging with indium-labeled autologous granulocytes yielded sensitivities and specificities of 95 and 70% for bone scintigraphy and 77 and 100% for granulocyte scintigraphy, respectively. One patient with severe angiopathy and proved osteomyelitis had a negative bone scintigraphy but a positive scintigraphy with labeled antibodies against granulocytes. One patient with aseptic bone necrosis presented with a formally false positive result with both methods.. In contrast to former retrospective studies, three-phase bone scintigraphy compares very well with granulocyte scintigraphy. The care of most patients can be managed with clinical data and this widely available scintigraphic method.

Topics: Bone and Bones; Diabetes Complications; Diabetic Angiopathies; Diagnosis, Differential; Female; Gangrene; Granulocytes; Humans; Indium Radioisotopes; Iodine Radioisotopes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Multifocal osteomyelitis is considered an uncommon complication of acute osteomyelitis. Over a 3-year period, 136 infants and children who had a final diagnosis of acute osteomyelitis were reviewed, and multifocal osteomyelitis was detected in 27 (19%) patients. The major age peak of acute osteomyelitis was between 6 weeks and 3 years (46%). Two age peaks were found for multifocal disease-less than 6 weeks (38%), and 9 to 12 years (44%). Three patients with multifocal disease had septicemia and photon-deficient areas on bone scans. Another adolescent group had nonspecific bone and joint pain that in some cases persisted for more than 3 months and were finally diagnosed as multifocal osteomyelitis. Organisms were isolated in 15/27 (56%). Multifocal osteomyelitis is well recognized in the neonatel age group. However, it occurs more commonly than previously described in older patients. This higher incidence can most likely be attributed to the higher use of the radionuclide bone scan early in the disease and the high sensitivity of the scan for the detection of osteomyelitis.

Topics: Acute Disease; Adolescent; Australia; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Osteomyelitis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Adult; Anemia, Sickle Cell; Bone and Bones; Diagnosis, Differential; Female; Humans; Infarction; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

Osteomyelitis of the foot is a well-known complication of diabetes mellitus. In this study, the validity of 111In-labeled human nonspecific immunoglobulin G (IgG) scintigraphy was studied in 16 diabetic patients with foot ulcers, gangrene or painful Charcot joints. In all patients, plain radiographs, conventional bone scan images and 111In-IgG images were recorded. The results were verified by histologic examination of surgical specimens in patients who did not respond to antibiotic treatment within 2-3 wk (10 lesions) or long-term clinical follow-up of at least 6-mo (16 lesions). On the bone scans, all seven osteomyelitic foci were detected. However, 19 additional foci not due to osteomyelitis were seen. The absence of true-negative bone scans in this study resulted in a specificity of 0%. On the plain radiographs, four of seven osteomyelitis foci were detected; for 111In-IgG scintigraphy, six of seven (sensitivity 57% and 86%, respectively). Plain radiographs correctly ruled out osteomyelitis in 15 of 19 lesions, 111In-IgG scintigraphy in 16 of 19 (specificity 79% and 84%, respectively). All imaging procedures gave false-positive results in penetrating ulcers over the calcaneus in two patients and in one patient with a Charcot joint, most likely due to recent fractures. A false-negative 111In-IgG study was observed in a patient with severe arterial angiopathy. Accurate estimation of probable osteomyelitis was not possible from the results of soft-tissue cultures, since in only 6 of 12 positive cultures, osteomyelitic foci could be proven. Indium-111-IgG scintigraphy can contribute to adequate evaluation of osteomyelitis in diabetic foot complications because it improves specificity when compared to bone scan and radiographic findings and improves sensitivity in comparison to plain radiographs.

Topics: Adult; Aged; Aged, 80 and over; Arthropathy, Neurogenic; Diabetes Complications; Diagnosis, Differential; Female; Foot Diseases; Foot Ulcer; Gangrene; Humans; Immunoglobulin G; Indium Radioisotopes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

The diagnostic accuracy of scintigraphy performed after injection of indium-111-labeled nonspecific human immunoglobulin G (IgG) was studied in 113 patients with 120 foci of suspected infection in bone (52 chronic and eight acute infections), joints (15 localizations), joint prostheses (37 prostheses), and soft tissue of the locomotor system (eight localizations). All patients also underwent standard three-phase scintigraphy after injection of technetium-99m-labeled methylene diphosphonate. A scan obtained with In-111-labeled IgG was considered positive if focal increasing accumulation was noted over time. In 51 patients (45.1%), the results of scintigraphy were verified with intraoperative cultures, and in 21 patients (18.6%), with needle aspiration. The prevalence of infection was 59%; overall sensitivity, 97%; and specificity, 85%. Use of In-111-labeled IgG enabled correct identification of the presence, site, and extent of infection in 69 of 71 proved foci of infection; 41 of 48 negative studies were correct. Only two infections proved with culture were missed; in both patients, the cultures revealed growth of Staphylococcus aureus in low counts.

Topics: Arthritis, Infectious; Humans; Immunoglobulins, Intravenous; Indium Radioisotopes; Joint Prosthesis; Osteomyelitis; Prevalence; Prosthesis-Related Infections; Radioimmunodetection; Sensitivity and Specificity; Staphylococcal Infections; Technetium Tc 99m Medronate

Fifty consecutive occult limping toddlers were prospectively evaluated by acute triphase 99mTc MDP scintigraphy (TTS) at Arkansas Children's Hospital from 1984 through 1989. Only patients with a limp that could not be diagnosed by an orthopaedist were included. TTS proved essential in localizing the lesion in 27 patients (54%). With only two false negatives and one false positive, this test was shown to be highly sensitive, specific, efficient, and predictive, especially as compared with temperature, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and plain radiography. Because no infections were missed by TTS, patients with a normal TTS could be safely observed as outpatients, saving thousands of health care dollars in this small series.

Topics: Arthritis, Infectious; Child, Preschool; Female; Humans; Infant; Leg Injuries; Male; Movement Disorders; Observer Variation; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

61 patients with clinical findings suspicious for an osteomyelitis were examined by MRI between January 1985 and November 1989. All results were verified either by surgery or by the clinical course. MRI criteria of a musculoskeletal infection were: decreased signal intensity of the lesions on short TR, short TE images and increased signal to intensity on long TR, long TE images when compared to the intensity of normal bone marrow, adipose tissue and muscles. 35 of 61 patients had been examined by 99mTc-MDP three phase bone scans prior to the MRI examination. Sensitivity and specificity of the MRI examinations were superior to those of bone scans. We therefore recommend MRI examinations as the method of choice in the diagnosis of the early musculoskeletal infections and in all chronic complicated cases.

Topics: Bone and Bones; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Female; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

We compared the ability of magnetic resonance imaging (MRI) using a 0.064 T permanent magnet, three-phase bone scanning, and indium-labeled white blood cell (111In-WBC) scanning, to diagnose osteomyelitis. Twenty-three patients underwent biopsy. All patients were examined at presentation with all three modalities. Sensitivities for each modality were calculated using biopsy as a gold standard. The results were 72% for MRI, 68% for bone scan, and 45% for 111In-WBC. Specificities were not calculated because of lack of negative biopsies. MRI was as sensitive as bone scanning in the diagnosis of osteomyelitis. All modalities had lower than previously reported sensitivities for imaging osteomyelitis.

Topics: Biopsy; Bone and Bones; Evaluation Studies as Topic; Humans; Indium Radioisotopes; Leukocytes; Magnetic Resonance Imaging; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Scintigraphy was used after injection of technetium-99m methylene diphosphonate (MDP) and indium-111-labeled white blood cells (WBCs) to assess for the presence of osteomyelitis in 97 patients who had undergone prior surgical procedures. Thirty-four patients with abnormal In-111-labeled WBC patterns underwent restudy with Tc-99m albumin colloid (AC). Scintigraphic findings were considered positive for osteomyelitis whenever localization of In-111-labeled WBCs exceeded Tc-99m AC activity in extent or focal intensity (discordant pattern). Ten of 12 patients with culture-proved osteomyelitis had discordant patterns; two had false-negative (concordant) patterns. The cases of 20 of 22 patients without infection who were considered to have osteomyelitis on the basis of patterns of In-111-labeled WBCs and Tc-99m MDP were reclassified correctly on the basis of concordant patterns of In-111-labeled WBCs and Tc-99m AC. Radiocolloid images improved the overall scintigraphic specificity for osteomyelitis from 59% without bone marrow imaging to 92%; sensitivity decreased from 94% to 88%.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Marrow; Diagnostic Errors; Female; Fractures, Ununited; Humans; Indium Radioisotopes; Joint Prosthesis; Leukocytes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; 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

To evaluate the usefulness of 111In-leukocyte scintigraphy for identifying osteomyelitis in the presence of soft-tissue infection, we prospectively studied 45 bone sites adjacent to soft-tissue infection in patients with abnormal findings on radiographs and 99mTc bone scans that were suggestive of osteomyelitis. 111In-leukocyte scans were analyzed in terms of the intensity of abnormal uptake and its location relative to bone. The diagnosis of osteomyelitis was established from results of percutaneous bone biopsy culture (n = 35), histologic examination of surgical specimens (n = 8), and clinical follow-up (n = 2). Osteomyelitis was present at 22 sites, including 16 of 18 sites with increased leukocyte uptake in bone, resulting in a sensitivity of 73%, specificity of 91%, and positive predictive value of 89% for this finding. Osteomyelitis was present at four of 17 sites with predominantly soft-tissue localization of leukocyte activity in the region of bone, none of seven sites with normal leukocyte scans, and two of three sites with diminished leukocyte uptake in bone. Although not helpful in distinguishing infectious from noninfectious bone abnormalities, 3- and especially 24-hr bone scans viewed in conjunction with leukocyte studies provided important correlation to aid in estimating the location of focal abnormal leukocyte uptake. The finding of soft-tissue infection with increased uptake of labeled leukocytes that extends to involve adjacent bone strongly suggests concurrent osteomyelitis. When the presence of abnormal leukocyte uptake in bone is uncertain, additional imaging and possibly biopsy may be required to establish or exclude the diagnosis of osteomyelitis.

Topics: Adult; Aged; Bacterial Infections; Biopsy, Needle; Connective Tissue Diseases; Diagnosis, Differential; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Prospective Studies; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Seventy-six 111In-labeled leukocyte images performed on 71 patients with possible vertebral osteomyelitis were reviewed. Twenty-eight cases of vertebral osteomyelitis were diagnosed. Vertebral labeled leukocyte activity was normal in 2, increased in 11, and decreased in 15 cases of osteomyelitis. The median duration of symptoms was significantly longer in patients with osteomyelitis and decreased vertebral activity than in patients with osteomyelitis and increased activity (3 mo versus 2 wk; p = 0.019). No significant relationship between the duration of antibiotic therapy and the appearance of vertebral osteomyelitis on leukocyte images was identified (p = 0.62). Increased vertebral activity was highly specific (98%) for osteomyelitis but relatively insensitive (39%). Decreased activity was neither sensitive (54%) nor specific (52%). Seven patients with clinically resolved infection underwent follow-up imaging. Of four patients who initially presented with increased activity, one had normal and three had decreased vertebral activity on follow up studies. All three patients with decreased activity initially had decreased activity on follow-up. Using increased or decreased activity as criteria for infection, the accuracy of leukocyte imaging for diagnosing vertebral osteomyelitis was 66%, similar to that of 99mTc bone imaging (63%) in our population. Leukocyte imaging did however provide important information about extraosseous infection in 12 of the patients studied.

Topics: Bacterial Infections; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Spinal Diseases; Technetium Tc 99m Medronate

Bone scans in two patients with Gaucher's disease were reported as consistent with Gaucher's-associated osseous crises. A bone-radiogallium subtraction study was also initially negative in each individual (although it later became positive in one). At surgery both patients were seen to have osteomyelitis. These two cases point out the difficulty in attempting to diagnose osteomyelitis in the presence of Gaucher's bone disease. A possible role for MRI in such instances was mentioned. Also noted was clinical reluctance to accept a diagnosis of osteomyelitis (positive bone-radiogallium subtraction study) in an afebrile Gaucher's patient.

Topics: Adult; Diagnosis, Differential; Female; Femur; Gallium Radioisotopes; Gaucher Disease; Humans; Magnetic Resonance Imaging; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

To investigate the utility of indium-111-chloride (111In-Cl) imaging in detecting osteomyelitis complicating surgical or fracture sites, the proximal tibia of 11 dogs were experimentally infected with Staphylococcus aureus after creation of a cortical defect. The contralateral limb served as a sham-operated control. Animals were serially imaged by radiography, three-phase technetium-99m-methylene diphosphonate (99mTc-MDP) scintigraphy, and 111In-Cl scintigraphy. There was a significant difference between infected (1.93) and noninfected (1.32) limb's tibia/femur count density ratios on 24-hr (p = 0.0001) and 72-hr (p = 0.0001) 111In-Cl images. A smaller difference was found for 99mTc-MDP bone-phase tibia/femur ratios (p = 0.0199). Using receiver operator characteristic analysis of tibia/femur ratios, a sensitivity of 61%, specificity of 88%, and positive (75%) and negative (79%) predictive values were determined for the 24-hr 111In-Cl images. Indium-111-chloride was superior to 99mTc-MDP in differentiating infected and noninfected operative sites.

Topics: Animals; Dogs; Femur; Indium; Indium Radioisotopes; Osteomyelitis; Radionuclide Imaging; Sensitivity and Specificity; Staphylococcal Infections; Technetium Tc 99m Medronate; Tibia; Wound Infection

The clinical information and imaging data from 27 patients with hematogenous pyogenic vertebral osteomyelitis were reviewed. All patients had roentgenographic and magnetic resonance imaging examinations. Seventeen patients had computed tomograms; 17 had technetium Tc 99m medronate bone scans; and seven had gallium citrate Ga 67 scans. Magnetic resonance imaging, when used as a part of the initial radiologic evaluation, detected abnormalities consistent with osteomyelitis in all 27 patients. Magnetic resonance imaging also demonstrated paravertebral and/or epidural extension of infection in 14 patients, including seven patients who had neurologic signs of lower-extremity weakness. Roentgenograms, computed tomograms, technetium bone scans, and gallium scans had findings suggestive of the diagnosis in 48%, 65%, 71%, and 86% of the patients, respectively. We recommend magnetic resonance imaging as an important and perhaps critical imaging modality for detection of pyogenic vertebral osteomyelitis.

Topics: Evaluation Studies as Topic; Female; Gallium Radioisotopes; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Staphylococcal Infections; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

Sternal osteomyelitis complicating infection of vascular access for hemodialysis is exceedingly rare and presents serious diagnostic and therapeutic difficulties. Two hemodialysis patients with sternal osteomyelitis following vascular access infection are reported. Factors favoring sternal location of the infection included previous chest trauma in the first patient and difficult insertion of a dialysis subclavian catheter in the second patient. Indium oxine, gallium, and three-way bone scans were instrumental in establishing diagnosis and in documenting cure by prolonged antibiotic courses. Sternal scans should be performed in dialysis patients with vascular access infections and signs of sternal disease.

Topics: Aged; Bacterial Infections; Catheterization, Central Venous; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Renal Dialysis; Sternum; Technetium Tc 99m Medronate

Topics: Adult; Citrates; Citric Acid; Gallium; Humans; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Abscess; Cervical Vertebrae; Gallium Radioisotopes; Humans; Male; Middle Aged; Nafcillin; Osteomyelitis; Radionuclide Imaging; Staphylococcal Infections; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Diagnosis, Differential; Hodgkin Disease; Humans; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

We studied the occurrence, magnitude, and kinetics of bacteremia and the resultant osteomyelitis and septic arthritis in an avian model of Staphylococcus aureus infection. Thirty-day-old male broiler chicks were inoculated i.v. with 10(5), 10(6), or 10(7) cfu of strain Duntravis, a beta-hemolytic, coagulase-producing, capsular type 8 isolate from the synovial fluid of a 2-year-old black boy. Bacteremia occurred in 80%, 90%, and 100% of animals inoculated with 10(5), 10(6), or 10(7) cfu, respectively. The magnitude of bacteremia in surviving, bacteremic animals increased for 96 hours after inoculation and then decreased after a plateau phase. Osteomyelitis and septic arthritis occurred only in chicks that were continuously bacteremic. The occurrence of osteomyelitis was uniform among continuously bacteremic animals and developed 1 to 23 hours after inoculation. Chickens are susceptible to systemic infections with S. aureus. Bacteremia, osteomyelitis, and septic arthritis may be induced in healthy chickens without prior manipulations that depress their resistance.

Topics: Animals; Bone and Bones; Chickens; Disease Models, Animal; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Sepsis; Staphylococcal Infections; Technetium Tc 99m Medronate; Time Factors

We evaluated the monoclonal antibody MAb, BW 250/183, which is easy to label with Tc-99m, with respect to its clinical application for the detection of inflammatory processes in bone and joint diseases. This monoclonal antibody is a murine immunoglobulin (IgG1 isotype), directed against NCA 95 (nonspecific cross-reacting antigen), which is also present on the surface of neutrophil granulocytes. We investigated patients with acute (n = 9) and chronic (n = 3) osteomyelitis, with coxitis (n = 3) and coxarthrosis (n = 2), with septic hip prosthesis (n = 8) and loosening hip prosthesis (n = 14), with low back pain (n = 4), with spondylitis (n = 5) and with postoperative spondylodiscitis (n = 9). With reference to the total number of patients examined in this study we found 29 true positive results, 22 true negative results, 4 false negative results and 2 false positive results. This gives a sensitivity of 88% and a specificity of 92%. The lesions were already visualized within 4 to 6 hours, but 24 hour pictures are desirable. SPECT pictures are mandatory in patients with diseases of the hip or of the spine because sensitivity is considerably improved thereby.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Arthritis, Infectious; Bone Diseases; Discitis; Female; Humans; Inflammation; Joint Diseases; Male; Middle Aged; Osteoarthritis, Hip; Osteomyelitis; Prosthesis Failure; Radionuclide Imaging; Spondylitis; Technetium Tc 99m Medronate

The utility of indium-111-(111In) labeled immunoglobulin G (IgG) to detect infection of bone and adjacent tissues was investigated. Proof of infection was obtained by cultures taken at surgery. All 32 patients showed focally increased uptake on the technetium-99m- (99mTc) methylene diphosphonate (MDP) skeletal scintigraphies. Labeled immunoglobulin correctly identified presence, location, extent and soft-tissue involvement of the suspected inflammatory site. In these patients, focally increasing accumulation was noted over 48 hr. Discrimination between infection and sterile inflammatory lesions was not possible. Two fractures, 6-mo-old, and an aseptic loosening of a total-hip prosthesis were not visualized. Side effects after the immunoglobulin administration were not observed. Radiolabeled immunoglobulin is a new and safe radiopharmaceutical for the investigation of infectious bone and joint disease. The sensitivity of this agent appears at least as high as that of labeled leukocytes. However, labeled immunoglobulin can easily be prepared in every nuclear medicine department.

Topics: Arthritis, Infectious; Bacterial Infections; Discitis; Female; Humans; Immunoglobulin G; Indium Radioisotopes; Male; Middle Aged; Osteomyelitis; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Arthritis, Infectious; Bacterial Infections; Focal Infection; Humans; Immunoglobulin G; Indium Radioisotopes; Leukocytes; Organotechnetium Compounds; Osteomyelitis; Oximes; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

The bone scans of 25 patients with a clinical diagnosis of diabetic osteoarthropathy (Charcot joint) of the ankle and foot were analysed using the technique of dynamic bone imaging. The analysis of time-activity curves generated over the Charcot joint, the contralateral joint and the bone above the Charcot joint, produces characteristic patterns that are distinguishable from the ones observed for osteomyelitis. Recently it has been shown that the significance of dynamic bone imaging resides in its correlation to physiological and morphological components of bone. The difference in the blood supply to the long bones has been suggested as an explanation for the difference in time-activity curve patterns.

Topics: Arthropathy, Neurogenic; Diagnosis, Differential; Humans; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Fourteen patients (16 sites) with clinical and/or radiographic evidence of neuropathic osteoarthropathy (Charcot joints) were evaluated with combined indium-111-leukocyte (111In-WBC) and technetium-99m-methylene diphosphonate (99mTc-MDP) bone imaging for suspected osteomyelitis. Magnetic resonance (MR) images were obtained in seven patients. Using a positive bone culture as the criterion for the presence of osteomyelitis, there were four true-positive studies, six true-negative sites, and one false-negative 111In-WBC study. Five of 16 sites (31%) had false-positive 111In-WBC uptake at noninfected sites. There were four true-positive and three false-positive MR studies. All false-positives showed at least moderately abnormal findings by both techniques at sites of rapidly progressing osteoarthropathy of recent onset. In this preliminary study, both techniques appear to be sensitive for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of 111In-WBC/99mTc-MDP and MR images at sites of rapidly progressing, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis.

Topics: Adult; Aged; Arthropathy, Neurogenic; False Positive Reactions; Female; Humans; Indium Radioisotopes; Leukocytes; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

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

The Klebsiella pneumoniae bacillus is a rare cause of acute hematogenous osteomyelitis of long bones. Bony involvement usually develops from a bacteremia associated with a Klebsiella pulmonary or urinary tract infection. Diabetes mellitus, alcoholism, or cirrhosis are predisposing conditions to the development of this form of osteomyelitis. A case report follows in which two sites of Klebsiella osteomyelitis were demonstrated by three-phase bone imaging in a patient with both diabetes and alcoholism.

Topics: Adult; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Forty-nine patients with 50 fracture nonunions 4-48 months after injury underwent technetium-99m methylene diphosphonate (99mTc-MDP) scintigraphy on day 1, combined 99mTc-MDP and indium-111 leukocyte (111In-WBC) scintigraphy on day 2, and gallium-67 (67Ga) scintigraphy on day 3. The results were compared to evaluate the relative abilities of these scintigraphic techniques to detect osteomyelitis. Nine patients had clinical evidence of infection at the time of imaging, and 40 patients (41 fractures) did not. Open-biopsy cultures were performed at all fracture sites and were positive at 21 (42%) of the 50 sites. Combined 99mTc-MDP/111In-WBC images were interpreted with the use of two criteria. A positive study by the first criterion required 111In-WBC localization in the region of the nonunion fracture. A positive study by the second criterion required 111In-WBC localization in bone at the fracture site. The first criterion yielded a sensitivity of 84%, specificity of 72%, and accuracy of 74%; the specificity improved to 97% with an accuracy of 88% when the second criterion was used. Ten (25%) of the 40 patients thought not to have osteomyelitis by clinical criteria at the time of imaging had true-positive 99mTc-MDP/111In-WBC studies by biopsy culture results. Gallium-67 studies were interpreted as nondiagnostic if localization of radioisotope at fracture sites was equal to that with 99mTc-MDP, positive if 67Ga localization was greater than that of 99mTc-MDP, and negative if it was less than that of 99mTc-MDP. Twenty-one 67Ga studies were interpreted as nondiagnostic; 11 (52%) of the 21 had culture-positive fracture sites. The accuracy of 67Ga/99mTc-MDP imaging was 39%. Combined 99mTc-MDP/111In-WBC imaging is useful in the detection of osteomyelitis at fracture nonunion sites and improves the specificity of 111In-WBC imaging by differentiating inflammation/infection in adjacent soft tissue from osteomyelitis at the fracture site. Gallium-67 with 99mTc-MDP imaging is not sufficiently reliable in this clinical setting to be useful as an indicator for osteomyelitis.

Topics: Adult; Aged; Female; Femoral Fractures; Fractures, Ununited; Gallium Radioisotopes; Humans; Humeral Fractures; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

To determine whether imaging techniques can differentiate osteomyelitis from bone infarction in sickle cell disorders, 39 sets of bone scans (BS) and bone marrow scans (BMS) were performed on 31 patients with sickling disorders and bone pain. In addition, three patients who had either a BS or a BMS were included. Results were analyzed according to whether scans were performed three days or less (Period 1), four to six days (Period 2), or seven or more days (Period 3) after the onset of pain. Regardless of the period, all but five BMS for 34 episodes of assumed infarction showed decreased uptake. BS findings varied depending on the time interval, with none of the ten in Period 1 showing increased uptake, but all 11 in Period 3 showing increased uptake. However, in Period 2, about half of the 13 BS showed increased uptake. All three patients with osteomyelitis in Period 3 had increased uptake on BS. The BMS done in one of these patients showed decreased uptake. Three patients with cellulitis had normal BS and BMS. One patient with septic arthritis had normal BMS, but slightly increased uptake on BS. Although typical imaging patterns are present in early and late infarction (Periods 1 and 3), the patterns for late infarction may not differ from those of advanced osteomyelitis. Therefore, imaging studies are only of value in differentiating infarction from osteomyelitis when both BS and BMS are performed soon after the appearance of symptoms.

Topics: Adolescent; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infarction; Male; Osteomyelitis; Radionuclide Imaging; 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

The authors report a case of sickle cell anemia associated osteomyelitis where the Tc-99m white blood cell imaging was negative, and bone imaging showed increased uptake in the region in question. The reasons for the possible false-negative image are discussed.

Topics: Anemia, Sickle Cell; False Negative Reactions; Female; Femur; Humans; Leukocytes; Middle Aged; Osteomyelitis; Radionuclide Imaging; Salmonella Infections; Technetium; Technetium Tc 99m Medronate

Six diabetic patients with roentgenographic finding of osteomyelitis, osteoarthropathy, or both, had combined leukocyte and bone imaging. Bone images demonstrated increased activity in all cases, including three without osteomyelitis. Leukocyte images, however, showed increased activity in only the three cases of osteomyelitis. There was minimal or no activity in the other three cases where osteoarthropathy was ultimately believed to be the basis of the roentgenographic and bone imaging changes.

Topics: Arthropathy, Neurogenic; Bone and Bones; Diabetic Neuropathies; Female; Foot Diseases; Humans; Indium Radioisotopes; Isotope Labeling; Leukocytes; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Seventy-seven diabetic patients with suspected osteomyelitis of the foot were evaluated by three-phase bone scintigraphy (TPBS), indium 111-labeled white blood cell scintigraphy (WBCS), roentgenography, or some combination thereof. Retrospective analysis after clinical and pathologic follow-up indicated that the sensitivity of TPBS alone in the diagnosis of osteomyelitis was 100%, with a specificity of only 38% and an accuracy of 63%; the sensitivity of WBCS alone was 100%, with a specificity of 78% and an accuracy of 87%; and the combination of TPBS and WBCS yielded a sensitivity of 100%, with a specificity of 79% and an accuracy of 87%. Roentgenography yielded a sensitivity of 69%, with a specificity of 82% and an accuracy of 76%. The results of this study demonstrate that WBCS is superior to TPBS in the diagnosis of osteomyelitis in the diabetic foot, and TPBS adds little when viewed in conjunction with WBCS. Based on our observations and because of the high prevalence of neuropathic joint disease and other causes of false-positive bone scans, we believe that WBCS alone is adequate for evaluation of suspected pedal osteomyelitis in diabetic patients, particularly when the suspected lesion is located in the tarsometatarsal region in contrast to the toe region (7% vs 44% specificity and 28% vs 69% accuracy, respectively, for TPBS in these two regions, compared with 100% vs 68% specificity and 100% vs 80% accuracy, respectively, for WBCS in the same two regions).

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Diabetes Complications; Female; Follow-Up Studies; Foot Diseases; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; 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

Topics: Adolescent; Adult; Aged; Bone Transplantation; Humans; Middle Aged; Osteomyelitis; Prognosis; Radionuclide Imaging; 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

Solitary abnormalities located within the spine from 75 bone images with Tc-99m MDP were reviewed. For the sake of convenience, patients were grouped in three classes of age: 15-50, 51-65, and 66-90 years. In 67 cases, the diagnosis was apparent from clinical studies, x-ray examinations, or biopsies. In eight cases, no diagnosis could be made. The maximum percentage of lesion sites were within the lumbar spine (45 cases). Metastatic lesions were the most common solitary abnormalities within the spine (29.3%). Osteoporosis was second (24%) with the maximum percentage in age group 66-99 years (83%) with a greater female predominance (67%).

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate

It is difficult to diagnose osteomyelitis in the presence of neurotrophic osteoarthropathy. We performed combined [99mTc]MDP bone scans and indium-111 (111In) leukocyte studies on 35 patients who had radiographic evidence of neuropathic foot disease and clinically suspected osteomyelitis. The [111In]leukocyte study determined if there was an infection and the bone scan provided the anatomic landmarks so that the infection could be localized to the bone or the adjacent soft tissue. Seventeen patients had osteomyelitis and all showed increased [111In]leukocyte activity localized to the bone, giving a sensitivity of 100%. Among the 18 patients without osteomyelitis, eight had no accumulation of [111In]leukocytes, seven had the [111In]leukocyte activity correctly localized to the soft tissue, two had [111In]leukocyte activity mistakenly attributed to the bone, and one had [111In]leukocyte accumulation in a proven neuroma which was mistakenly attributed to bone. These three false-positive results for osteomyelitis reduced the specificity to 83%. Considering only the 27 patients with a positive [111In]leukocyte study, the combined bone scan and [111In]leukocyte study correctly localized the infection to the soft tissues or bone in 89%. Uninfected neurotrophic osteoarthropathy does not accumulate [111In]leukocytes. We found the combined bone scan and [111In] leukocyte study useful for the detection and localization of infection to soft tissue or bone in patients with neuropathic foot disease.

Topics: Adult; Aged; Bone and Bones; Diabetic Neuropathies; Female; Foot Diseases; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; 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

The osteoarticular complications of drepanocytosis-thalassemia (DT) include: 1) bone infarction, or avascular necrosis (AVN), common at all ages; 2) acute septic arthritis and hematogenous osteomyelitis, that usually affect infants and children. Early diagnosis and treatment of the osteoarticular infectious complications is imperative, to maximize the chances of a favorable outcome, and to prevent the sequelae, ie pathological fractures, chronic osteomyelitis. Early roentgenographic features of involved areas are similar in acute osteomyelitis and in AVN--both of which cause painful bone crises, so as to make osteomyelitis (OM) a diagnostic challenge. Four cases of DT are reported. The patients, 17 to 37 years old, presented with bone infarcts. One of them (the youngest) had also multiple osteomyelitis of long bones. The 99m-Tc-MDP bone scans, performed only on the youngest patient, affected by OM, revealed increased uptake in both AVN and in OM locations, without differential diagnostic features. After a review of the literature, a diagnostic protocol is suggested, based on 99m-Tc colloid marrow scintigraphy for the early differential diagnosis between acute OM (normal or slightly-increased uptake), chronic OM (markedly increased uptake), and AVN (decreased uptake). Furthermore, MR imaging is stressed as the most promising tool, in the next future, for this kind of differential diagnosis.

Topics: Adolescent; Adult; Anemia, Sickle Cell; Arthritis, Infectious; Bone and Bones; Diagnosis, Differential; Humans; Infarction; Joint Diseases; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thalassemia; Tomography, X-Ray Computed

A case of greatly increased blood flow in the region of a fracture with malunion of the left femur, both in the flow and immediate blood pool studies during three phase bone imaging, is presented. The sluggish left femoral artery flow resulted from the greatly increased regional perfusion and is similar to the findings in acute osteomyelitis. The sluggish left femoral artery flow and greatly increased regional perfusion of the site is probably best explained as a regional "neurovascular flush" resulting from the pain caused by the malunion of the fracture and/or hyperemia in the area of the malunion responding to inflammation.

Topics: Aged; Diagnosis, Differential; Femoral Fractures; Fractures, Ununited; Humans; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Since indium-111 white blood cell (In-111 WBC) scintigraphy is often used to evaluate for osteomyelitis in bone fractures, it is important to know if noninfected fractures have In-111 WBC uptake. Twenty-seven noninfected closed fracture sites in 19 patients were prospectively evaluated with technetium-99m methylene diphosphonate bone scintigraphy and In-111 WBC scintigraphy. In-111 WBC uptake was present in 41% of the 27 sites. In the 11 positive sites, the In-111 WBC uptake was 1+ (definite but minimal) in 55%, 2+ (moderate) in 36%, and 3+ (marked) in 9%. The visual intensity of the radioactive uptake on In-111 WBC scintigrams relative to that on bone scintigrams was less in 82%, equal in 9%, and greater in 9%. The visual size of the area of uptake on In-111 WBC scintigrams and bone scintigrams was smaller in 36%, equal in 55%, and greater in 9%. Factors that may help distinction of In-111 WBC uptake due to fracture alone from infection associated with fracture are discussed.

Topics: Adult; Aged; Fractures, Closed; Humans; Indium Radioisotopes; Leukocytes; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

Differentiation of occult skeletal injuries from early acute osteomyelitis in infants and young children is important clinically. The Tc-99m MDP scintigraphic findings in six patients who had occult femoral or tibial fractures were reviewed. The images obtained early (at 1-4 days from the onset of symptoms) shared the common characteristic finding of a subtle but definite, generalized increased uptake of the tracer along the entire length of the injured bone. This pattern of uptake was similar regardless of the type of fracture. These were different from the focal abnormalities that have been observed in early acute osteomyelitis. In the absence of an extensive cellulitis or a vascular occlusive disease, a bone image showing a mild diffuse uniform increased uptake along the entire length of the tibia or femur in infants and young children with lower extremity pain of less than 1 week's duration should suggest the diagnosis of occult skeletal fractures.

Topics: Acute Disease; Diagnosis, Differential; Female; Femoral Fractures; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors

Topics: Adolescent; Ankle Joint; Arthritis, Infectious; Child; Child, Preschool; Diagnosis, Differential; Female; Gallium Radioisotopes; Humans; Infant; Infant, Newborn; Knee Joint; Leg; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

Scintigraphy with indium-labeled white blood cells has been reported to be sensitive and specific in the diagnosis of low-grade sepsis of the musculoskeletal system. We reviewed the records of fifty patients who had suspected osteomyelitis or suspected infection about a total joint prosthesis and who underwent scintigraphy with technetium-99m methylene diphosphonate and scintigraphy with indium-111 oxine-labeled white blood cells before an open surgical procedure. Any patient who received preoperative antibiotics was not included in the study. For all of the patients, gram-stain examination of smears, evaluation of a culture of material from the operative site, and histological examination were done. The patients were divided into two groups. Group I was composed of twenty-four patients, each of whom had a prosthesis in place and complained of pain. Group II was composed of twenty-six patients for whom a diagnosis of chronic osteomyelitis had to be considered. With the indium scans alone, there was only one false-negative result (in Group II), but there were eighteen false-positive results (eight patients in Group II and ten patients in Group I). Although scintigraphy with indium-labeled white blood cells is quite sensitive, it is not specific in detecting chronic osteomyelitis; a negative scan should be considered highly suggestive that osteomyelitis is not present. Specificity can be increased by interpreting the indium scan in conjunction with the technetium scan.

Topics: Adult; Aged; Bacterial Infections; False Negative Reactions; False Positive Reactions; Female; Humans; Hydroxyquinolines; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Preoperative Care; Radionuclide Imaging; Technetium Tc 99m Medronate

Six cases of osteomyelitis due to Coccidioides immitis are presented. The cases reported demonstrate the importance of performing both bone and gallium imaging to avoid missing the osseous coccidioidal lesions.

Topics: Adult; Coccidioidomycosis; Follow-Up Studies; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The lesion-to-nonlesion 24 hour/4 hour ratio of technetium-99m methylene diphosphonate (MDP) uptake was used to distinguish osteomyelitis from increased bone uptake caused by adjacent soft-tissue infection. In a prospective study, this ratio was measured in 38 patients with 41 sites of increased uptake that were suspected to be osteomyelitis. The mean ratio was 1.18 +/- 0.18 in patients with proved osteomyelitis, which was significantly higher (P less than .001) than that in patients with increased uptake resulting from soft-tissue infection (0.98 +/- 0.05). On the basis of a receiver operating characteristic curve, a ratio of 1.06 was selected as the cutoff for differentiating osteomyelitis from soft-tissue infection. This method resulted in a sensitivity of 82%, a specificity of 92%, and an accuracy of 85%, and it appears to be more reliable than three- and four-phase scintigraphy, which are subjective and nonquantitative techniques.

Topics: Adolescent; Adult; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infections; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Review of three-phase bone imaging results in three patients with gangrene of the toes showed a unique pattern of absent perfusion and absent bony and soft-tissue uptake. In one of these patients, characteristic bone imaging findings were present before clear-cut clinical presentation. In our experience, the finding of absent uptake in a particular clinical setting is highly specific for gangrene.

Topics: Aged; Bone and Bones; Diagnosis, Differential; Female; Gangrene; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Toes

To determine the impact of radiographic findings on the interpretation of bone and gallium scans of patients with active osteomyelitis, the authors reviewed the medical records and radiologic examinations of 104 patients. The only diagnostic finding of active disease on radiographs was the presence of a sequestrum (three patients). Other findings--such as erosion, soft-tissue swelling, and periosteal reaction--proved nonspecific and did not differentiate active from inactive disease. Furthermore, these findings did not significantly change the sensitivity or specificity of the bone and gallium scans, either in detecting or in excluding the presence of active disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; False Negative Reactions; False Positive Reactions; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Nine cases of suspected craniotomy flap osteomyelitis evaluated by combined bone and gallium scanning are presented. In six cases, the clinical data were inconclusive and evaluation by radionuclide imaging provided an accurate negative diagnosis. The other three cases considered positive by this technique were proven infected at subsequent exploration and flap removal. The use of radionuclide bone and gallium imaging should be considered in cases of possible craniotomy flap osteomyelitis.

Topics: Adolescent; Adult; Aged; Craniotomy; Female; Gallium Radioisotopes; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Surgical Wound Infection; 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

Hematogenous pyogenic vertebral osteomyelitis (HPVO) continues to be a diagnostic problem for clinicians due to nonspecific presentation of the disease (1,2). We reviewed our experience of the last 10 years to determine the diagnostic usefulness of radionuclide bone studies in this disease. We found 15 patients whose primary diagnosis was HPVO. Of the 15 patients, 12 had [99mTc]MDP bone scans which were all positive. Five of the 12 patients had positive [67Ga]citrate scans and one patient with chronic active HPVO had negative 67Ga and [111In]WBC bone images. At the same time, three patients' spine x-rays and one patient's CT scan of the vertebra were normal. Additionally, in three patients spine x-rays were interpreted as consistent with degenerative joint disease that contributed to the delay of the diagnosis. We conclude that when HPVO is suspected an abnormal [99mTc]MDP bone image increases the probability of the disease, even if the x-rays and CT scans of the spine are normal. An abnormal 67Ga image following an abnormal 99mTc bone image increases the specificity of the diagnosis. Normal [99mTc]MDP and [67Ga]citrate bone images of the vertebra virtually exclude the diagnosis of HPVO.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Spinal Diseases; 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

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

Topics: Bone and Bones; Female; Humans; Middle Aged; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Venous Insufficiency

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

This retrospective study was done to determine the value of combined bone (technetium-99m methylene-diphosphonate) and gallium-67 citrate imaging in selected children with complicated clinical situations. Thirty-one children were evaluated for suspected osteomyelitis by bone scan followed within 4 days by a gallium scan. These 31 children represented a subpopulation in whom the Tc-99m scan is known to be potentially unreliable in diagnosing acute osteomyelitis. Eight children had acute osteomyelitis by strict criteria, while 23 did not. The bone scan successfully identified five of the eight with osteomyelitis but was positive in ten of the other 23. The gallium scan correctly identified all eight with osteomyelitis but was positive in seven of the other 23. The gallium scan was significantly less specific when the suspected lesion was in the extremities compared with central locations; causes of false-positive gallium scans included fracture and juvenile rheumatoid arthritis. Combined gallium and bone scanning increased accuracy of the scintigraphic diagnosis of acute osteomyelitis. Both tests may, however, be abnormal in conditions other than osteomyelitis. These findings emphasize the importance of correlating all imaging studies in detection of osteomyelitis.

Topics: Adolescent; Arthritis, Rheumatoid; Child; Child, Preschool; Fractures, Bone; Gallium Radioisotopes; Humans; Infant; Infant, Newborn; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The accuracy of radionuclide angiography and blood-pool imaging using [99mTc]-phosphate to assess skin ulcer perfusion as an indicator of healing capacity was determined in 50 studies performed on 45 patients with nonhealing ulcers of the lower extremities. Two nuclear medicine physicians without clinical bias, graded the perfusion of the ulcer on the images as normal, increased or reduced with respect to the opposite limb. Patients were followed closely with aggressive local wound care for at least 14 days. Of the 31 ulcers which healed, the radionuclide study correctly predicted 30; of the 19 ulcers which did not heal, 14 were correctly predicted. Eight patients had osteomyelitis; four of those healed and four did not. The radionuclide study predicted healing in seven. Excluding those patients with osteomyelitis, the sensitivity for the radionuclide angiogram and blood-pool image in predicting healing was 96%, specificity was 87%, and accuracy was 93%. This technique is a simple, reliable way to predict the microcirculatory adequacy for ulcer healing. Specificity is diminished in the presence of osteomyelitis.

Topics: Aged; Diphosphates; Diphosphonates; Humans; Male; Microcirculation; Middle Aged; Osteomyelitis; Radionuclide Imaging; Skin; Skin Ulcer; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Wound Healing

Simultaneous digital acquisition of [67Ga] and [99mTc]MDP images, and subsequent division of the first by the second to produce a parametric ratio image (G/T), is employed to characterize the relative localization of the two radiopharmaceuticals in early rabbit tibia Staphloccocus aureus osteomyelitis and fracture repair. Images obtained during the first 48 hr of each condition show preferential 67Ga accumulation probably reflecting an initial inflammatory response while G/T images at 5-7 days show predominance of the bone-seeking scan agent, which may indicate that the dominant process is osteoblastic repair.

Topics: Animals; Diphosphonates; Gallium Radioisotopes; Osteoblasts; Osteomyelitis; Rabbits; Radionuclide Imaging; Staphylococcal Infections; Technetium; Technetium Tc 99m Medronate; Tibial Fractures; Time Factors; Wound Healing

Twenty-four patients with a history of post-traumatic fracture nonunion underwent sequential 99mTc and 67Ga citrate scintigraphy in an attempt to differentiate between posttraumatic fracture nonunion and nonunion complicated by subclinical osteomyelitis. Neither technetium nor gallium studies alone nor in combination, with or without clinical correlation, could help delineate between fracture nonunion and nonunion complicated by subclinical osteomyelitis because of the increased technetium and gallium radioisotope uptake associated with the nonunion site.

Topics: Adolescent; Adult; Aged; Diphosphonates; Female; Fractures, Ununited; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Nine children over 20 months of age had acute osteomyelitis of the epiphysis of a long bone. The clinical features varied, but all of the patients had pain at the infected site and an elevated erythrocyte sedimentation rate. The distal femur was involved in seven cases, the proximal tibia in two, and the proximal humerus in one. In two patients there was a contiguous metaphyseal lesion, while the other seven patients (eight sites) had lesions limited to the epiphysis. Bone scintigraphy clearly identified the infected sites in all seven patients in whom it was performed, and allowed an early diagnosis in four cases. Radiographs showed a lytic lesion of the epiphysis that corresponded to the scintigraphic findings in all cases. The vascular supply to the epiphysis and the microscopic structure of the epiphyseal venous sinusoids provide locations that favor lodgement of blood-borne organisms. The epiphysis of the child should be recognized as another site of hematogenous osteomyelitis.

Topics: Acute Disease; Blood Sedimentation; Child; Child, Preschool; Diphosphonates; Epiphyses; Female; Femur; Humans; Infant; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The delayed images of the four-phase 99mTc phosphonate bone scan are compared with the delayed images of the three-phase study in patients with diabetes mellitus and/or peripheral vascular disease and suspected osteomyelitis. Three-phase bone imaging includes an immediate postinjection radionuclide angiogram, a blood-pool image, and delayed static images to 7 hr. The four-phase study adds a 24-hr static image. The scan is positive for osteomyelitis if images show progressively increasing lesion to background activity ratios over time. The results of analyzing 21 three- and four-phase bone scans in 17 patients were correlated with clinical course, cultures, and/or x-rays, gallium scans, and CT scans. The accuracy of four-phase bone imaging for diagnosing osteomyelitis was 85%; for three phase, 80%. Sensitivity for four phase was 80%; specificity was 87%. Sensitivity for three phase was 100%; specificity was 73%. Since overall accuracy of the four-phase study is slightly better than three phase, in these patients with diabetes mellitus and/or peripheral vascular disease, the addition of a 24-hr image, creating a four-phase bone scan, is recommended.

Topics: Diabetic Angiopathies; Diphosphonates; Humans; Leg; Leg Ulcer; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Venous Insufficiency

A case of pubic osteomyelitis in a child is presented. A well localized hyperactive area on a Tc-99m MDP bone scan provided the correct diagnosis. This scintigraphic localization of osteomyelitis seldom has been reported.

Topics: Child; Diphosphonates; Female; Humans; Osteomyelitis; Pubic Bone; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Bone scans from 43 children referred with hip pain of uncertain cause were reviewed. The bone scan was abnormal in 36 patients: normal in 7. In 12 the findings were diagnostic: osteomyelitis, osteoid osteoma, osteomyelitis with septic arthritis, Perthes' Disease and juvenile chronic arthritis. Twenty-four patients had abnormal scans including diffuse peri-articular increase and of these 18 had transient synovitis. Immobilisation and trauma accounted for the remainder. Isotope bone scans have been found to be a valuable investigation in children presenting with hip pain or limp, where the x-rays may appear normal or nondiagnostic.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Hip Joint; Humans; Infant; Male; Osteoma, Osteoid; Osteomyelitis; Radionuclide Imaging; Synovitis; Technetium; Technetium Tc 99m Medronate

Thirty-seven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance (MR), radiography, and radionuclide studies. These findings were correlated with the final clinical, microbiologic, or histologic diagnoses. Based on the results of these latter studies, 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. The MR appearance of vertebral osteomyelitis in this study was characteristic, and MR was as accurate and sensitive as radionuclide scanning in the detection of osteomyelitis.

Topics: Adult; Aged; Diphosphonates; Female; Follow-Up Studies; Gallium Radioisotopes; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radiography; Spinal Diseases; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

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 prospectively compared sequential technetium-gallium imaging with indium-labeled-leukocyte imaging in fifty patients with suspected low-grade musculoskeletal sepsis. Adequate images and follow-up examinations were obtained for forty-two patients. The presence or absence of low-grade sepsis was confirmed by histological and bacteriological examinations of tissue specimens taken at surgery in thirty of the forty-two patients. In these thirty patients, the sensitivity of sequential Tc-Ga imaging was 48 per cent, the specificity was 86 per cent, and the accuracy was 57 per cent, whereas the sensitivity of the indium-labeled-leukocyte technique was 83 per cent, the specificity was 86 per cent, and the accuracy was 83 per cent. When the additional twelve patients for whom surgery was deemed unnecessary were considered, the sensitivity of sequential Tc-Ga imaging was 50 per cent, the specificity was 78 per cent, and the accuracy was 62 per cent, as compared with a sensitivity of 83 per cent, a specificity of 94 per cent, and an accuracy of 88 per cent with the indium-labeled-leukocyte method. In patients with a prosthesis the indium-labeled-leukocyte image was 94 per cent accurate, compared with 75 per cent accuracy for sequential Tc-Ga imaging. Statistical analysis of these data demonstrated that the indium-labeled-leukocyte technique was superior to sequential Tc-Ga imaging in detecting areas of low-grade musculoskeletal sepsis.

Topics: Adolescent; Adult; Aged; Diphosphonates; Female; Gallium Radioisotopes; Humans; Hydroxyquinolines; Indium; Isotope Labeling; Leukocytes; Male; Middle Aged; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Prospective Studies; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Incidence of non-tuberculous vertebral osteomyelitis has been increasing significantly over the past 15 years. Its prompt diagnosis remains difficult. Presented here are five cases of vertebral osteomyelitis studied clinically, with laboratory studies, radiographically, and with Tc-99m bone and In-111 labeled white blood cells (In-111 WBC) scintigrams. Three of the cases are described in detail. The In-111 WBC studies were not found useful in detecting the infection in four out of the five patients. Reasons for these false negative results are discussed. Clinical, etiopathogenic and radiographic characteristics of vertebral osteomyelitis are also presented.

Topics: Adult; Aged; Female; Humans; Indium; Klebsiella pneumoniae; Leukocytes; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Pseudomonas aeruginosa; Radionuclide Imaging; Spinal Diseases; Staphylococcus aureus; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

Bone scans or bone marrow scans or both were obtained during 42 episodes of bone pain in 40 children with sickle cell disease, and the usefulness of these procedures was compared. On the basis of the subsequent clinical course, a diagnosis of bone infarction was made in 34 episodes, and osteomyelitis in eight. Among 22 patients with bone infarction, uptake on bone scan was increased in 14, decreased in three, and normal in five. Seven of eight patients with osteomyelitis had increased uptake on bone scan; one had normal uptake. In contrast, marrow scan uptake was markedly decreased in 15 of 16 patients with bone infarction, and was normal in five of five patients with osteomyelitis. Thus, decreased uptake on bone marrow scan in a patient with sickle cell disease and bone pain almost invariably indicates infarction, whereas normal uptake strongly suggests the diagnosis of osteomyelitis. We found marrow scans more useful than bone scans for this differential diagnosis.

Topics: Adolescent; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infarction; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

In 87 patients with proved diagnosis and a normal or pathologic bone scan (BS) in addition a bone marrow scan (BMS) was performed using a 99mtechnetium-labelled microcolloid. The analysis of scintigraphic findings included those obtained by other investigations shows that in these selected patients a false normal or false positive interpretation would have been resulted in 18% performing the BS only. Both methods BS and BMS were capable of diagnosing the correct stage of disease in all patients. The results indicate an augmentation of diagnostic facilities by the BMS in diseases affecting bone or bone marrow.

Topics: Adult; Bone and Bones; Bone Diseases; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Hodgkin Disease; Humans; Lung Neoplasms; Male; Middle Aged; Myeloproliferative Disorders; Osteomyelitis; Osteosarcoma; Plasmacytoma; 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

An early differential diagnosis between bone infarction and osteomyelitis in sickle cell patients is practically impossible using routine laboratory methods. Twenty radioisotope studies in sickle cell patients during vaso-occlusive crises, were analyzed. A three stage process can be described. In the first stage a decreased uptake can be demonstrated by Tc 99m methylene diphosphonate (MDP) bone scanning. In osteomyelitis, an increased uptake area is usually seen at this early stage, corresponding to increased uptake in Ga-67 citrate scanning. At the second stage, approximately a week later, normal uptake can be seen. Two to four weeks later an area of increased uptake is recorded that corresponds to the healing process, stage three. We recommend therefore Tc 99m MDP bone scanning in the early stages if clinical signs and symptoms suggest a vaso occlusive crisis or osteomyelitis in a sickle cell patient. This study can be followed by a Ga-67 citrate scintigraphy in doubtful cases. Later studies should be used for the assessment of the healing process. Two illustrative case reports are included.

Topics: Anemia, Sickle Cell; Bone and Bones; Child; Child, Preschool; Diagnosis, Differential; Diphosphonates; Female; Humans; Infarction; Lumbar Vertebrae; Male; Osteomyelitis; Radionuclide Imaging; Sickle Cell Trait; Technetium; Technetium Tc 99m Medronate; Tibia

An animal study was performed to assess the effect on the Tc-99m phosphate bone scintigram of injury by needle aspiration or drill hole to metaphyseal and diaphyseal areas in immature and mature bones. Results showed that in 12 immature rabbits such trauma to metaphyseal regions had no effect on the bone image. Similar metaphyseal trauma in two mature dogs showed definite abnormalities on the bone image, but in one mature rabbit, no abnormality could be identified by scintigram. Diaphyseal trauma always gave a definitely abnormal bone image. Extrapolation of these results to humans should be cautious, but it suggests that needling or drilling in metaphyseal regions in neonates or young children probably does not affect later bone images.

Topics: Age Factors; Animals; Biopsy, Needle; Bone and Bones; Bone Development; Diphosphonates; Dogs; False Negative Reactions; Growth Plate; Osteomyelitis; Rabbits; Radionuclide Imaging; Salter-Harris Fractures; Technetium; Technetium Tc 99m Medronate; Tibia; Time Factors

Topics: Diphosphonates; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis; Technetium; Technetium Tc 99m Medronate; Tuberculosis, Osteoarticular

Topics: Aged; Candidiasis; Diphosphonates; Humans; Intervertebral Disc; Lumbar Vertebrae; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Spondylitis; Technetium; Technetium Tc 99m Medronate

Osteomyelitis of the mandible is one of the most intractable inflammations occurring in the oral cavity. However, the recent increased incidence of subacute cases of this disease resulting probably from inappropriate use of antibiotics caused difficulties in diagnosis and management of this disease. By means of diagnostic imaging using 99mTc-MDP and 67Ga citrate, we obtained useful information for evaluation of the expansion of lesional involvement and the degree of progression, and also for prediction of the prognosis in six cases of osteomyelitis which presented different patterns of morbidity.

Topics: Adult; Anti-Bacterial Agents; Combined Modality Therapy; Diphosphonates; Female; Gallium Radioisotopes; Humans; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Twenty-eight pressure sores were evaluated prospectively. Osteomyelitis was reported histologically in nine of 28 bones and pressure-related changes were reported in 14 bones. Roentgenograms suggested the presence of osteomyelitis in four instances of histologically proved osteomyelitis. Technetium Tc 99m medronate bone scans were highly sensitive, showing increased uptake in all cases of osteomyelitis; however, increased uptake also occurred commonly in uninfected bones due to pressure-related changes or other noninfectious causes. Cultures of bone biopsy samples usually disclosed anaerobic bacteria, gram-negative bacilli, or both. The diagnosis of osteomyelitis must be considered if a pressure sore does not respond to local therapy. If the technetium Tc 99m medronate uptake is increased in the involved area, or roentgenographic findings are abnormal, the diagnosis can only be made with certainty by histologic examination of bone. Antibacterial treatment should be selected based on the results of bone culture.

Topics: Adult; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Biopsy; Bone and Bones; Diphosphonates; Humans; Male; Osteomyelitis; Pressure Ulcer; Prospective Studies; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Two patients with infantile cortical hyperostosis (Caffey's disease) are presented in whom radionuclide imaging with 99mTc-MDP and 67Gallium-citrate was performed to eliminate multifocal osteomyelitis as a diagnosis. The scintigraphic appearance of this relatively uncommon disease of children was similar to that obtained in multifocal osteomyelitis; all osseous lesions showed a marked uptake of both radiotracers. However, the distribution of abnormalities (mandible, scapulae) and the degree of extension (mainly diaphyseal) of the lesions are important characteristics in the scintigraphic differential diagnosis but bone radiographs are best used in making the diagnosis.

Topics: Aspirin; Diagnosis, Differential; Diphosphonates; Female; Gallium Radioisotopes; Humans; Hyperostosis, Cortical, Congenital; Infant; Infant, Newborn; Infant, Premature, Diseases; Mandible; Osteomyelitis; Radiography; Radionuclide Imaging; Scapula; Technetium; Technetium Tc 99m Medronate; Tibia

5 consecutive patients with osteoid osteoma were examined with bone scintigraphy and 67Ga scintigraphy. In 2 cases a 'three-phase' bone scintigraphy was performed. Scintigraphic features included obvious 67Ga uptake and diffusely increased accumulation on blood pool images. Thus, osteoid osteoma may possess the same scintigraphic characteristics as osteomyelitis.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Diagnosis, Differential; Diphosphonates; Extremities; Gallium Radioisotopes; Humans; Osteoma, Osteoid; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Twenty rabbits with chronic osteomyelitis of the tibia were treated for eight weeks and then scanned with Tc-99m MDP and Ga-67 citrate. All were sacrificed and bacteriologic cultures of the tibia were obtained. All rabbits had positive Tc-99m MDP scans at the end of treatment despite thirteen cures of osteomyelitis. Eight had negative gallium scans and negative cultures. Five of the twelve positive gallium scans had negative cultures, while seven had positive cultures. Tc-99m MDP alone is not sensitive enough to be useful in predicting the cure of osteomyelitis, and combining Tc-99m MDP and Ga-67 citrate scintigrams offers no additional information over the Ga-67 citrate scintigram alone in follow-up of osteomyelitis.

Topics: Animals; Diphosphonates; Gallium Radioisotopes; Osteomyelitis; Rabbits; Radionuclide Imaging; Staphylococcal Infections; Technetium; Technetium Tc 99m Medronate

A positive 99mTc-methylene diphosphonate bone scan was obtained in a case of pelvic osteomyelitis in a 15-year-old girl. An 111In-labelled leucocyte scan confirmed the presence of pus, gave a more accurate anatomical location than was obtained by the bone scan, and enabled the most suitable surgical route to be selected.

Topics: Adolescent; Bone and Bones; Diphosphonates; Female; Gallium Radioisotopes; Humans; Indium; Leukocytes; Osteomyelitis; Pelvic Bones; Radioisotopes; Radionuclide Imaging; Suppuration; Technetium; Technetium Tc 99m Medronate

Using both Tc-99m methylene diphosphonate and gallium-67 citrate, images of the lower extremities in New Zealand white rabbits were obtained on sequential days after inoculation of tibias with Staphylococcus aureus. Gallium-67 scintigraphy was positive earlier in the course of infection than Tc-99m MDP scintigraphy. In addition to 4-hr Ga-67 scintigrams, 24-hr and 48-hr scintigrams were obtained, contributing substantially to interpretation. However, 72-hr Ga-67 scintigrams contributed little additional information.

Topics: Animals; Diphosphonates; Extremities; Gallium Radioisotopes; Osteomyelitis; Rabbits; Radionuclide Imaging; Staphylococcal Infections; Technetium; Technetium Tc 99m Medronate; Time Factors

Computerized tomography (CT) was performed in 19 patients with spinal cord injury (SCI) who had large pressure sores and in whom other complications were suspected. CT detected the depth, extent, and degree of undermining of the edges of the pressure sores in 19 of 27 lesions. Conventional radiography detected four cases of pelvic osteomyelitis. CT detected eight additional cases of pelvic osteomyelitis, as well as eight clinically unsuspected peripelvic and intrapelvic abscesses. Technetium-99m bone scanning was not very helpful because of localization in chronic proliferative changes of bone and widespread foci of myositis ossificans, as well as in osteomyelitis. Gallium-67 scanning detected only one of six abscesses. It was not very helpful because of confusion of abscess and osteomyelitis with intense soft tissue swelling and cellulitis, which are often associated with pressure sores in patients with chronic SCI. CT was found to be, by far, the modality of choice for detection of pelvic osteomyelitis and abscess in patients with SCI.

Topics: Abscess; Adolescent; Adult; Biopsy, Needle; Diphosphonates; Gallium Radioisotopes; Humans; Osteomyelitis; Pelvic Bones; Pressure Ulcer; Spinal Cord Injuries; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Two cases of unilateral septic sacro-iliitis are reported. Importance of the anterior view of sacroiliac joints on the radionuclide bone scan is stressed. Limitation of the posterior view in evaluation of sacroiliac joints may lead to misdiagnosis and false negative results in unilateral sacro-illiac disease.

Topics: Adolescent; Adult; Arthritis, Infectious; Diphosphonates; Female; Humans; Male; Osteomyelitis; Radionuclide Imaging; Sacroiliac Joint; Staphylococcal Infections; Streptococcal Infections; Streptococcus pneumoniae; Technetium; 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

Radionuclide joint imaging with the technetium-99m-labeled phosphates is a sensitive technique for the detection of inflammatory articular disease, although it is nonspecific as to the cause of the increased uptake and offers poor resolution in comparison to conventional radiography. There does not appear to be any place for the routine use of joint imaging of the peripheral joints, as there is little evidence that it benefits patient management. Scintigraphy is of benefit in the detection of osteomyelitis, Legg-Perthes' disease, and osteonecrosis, where changes may antedate roentgenologic abnormalities. Technetium-99m-phosphates may have an increasing role in the evaluation of knee and hip prosthetic joint loosening and infection, especially regarding the femoral components. Scintigraphy may be useful in excluding synovitis and allaying concern in selected patients with chronic articular pain in whom a conventional diagnostic evaluation is unrewarding. Attempts have been made to use radionuclide joint imaging to quantitate the degree of synovitis present in individual joints, particularly the sacroiliac joints. To date, reliable methods that distinguish normal from abnormal joints have not been established, although this remains an area of potential usefulness and active research. Scintigraphy with 99mTc-phosphates is useful in the detection of spinal fracture and pseudoarthrosis in individuals with ankylosing spondylitis.

Topics: Adult; Arthritis; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Gallium Radioisotopes; Humans; Joint Diseases; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis; Osteomyelitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spondylitis, Ankylosing; Synovitis; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

We have reviewed the three-phase bone scans, radiographs, and histologic findings of 39 diabetic patients with serious foot problems. The sensitivity and specificity of bone scans were 83% and 75%, respectively, for osteomyelitis of the small bones of the foot. The positive and negative predictive values were 87% and 69%, respectively. The radiographs were less sensitive (62%) and less specific (69%), with predictive values of 80% (positive) and 47% (negative).

Topics: Arthropathy, Neurogenic; Diabetes Complications; Diagnosis, Differential; Diphosphonates; Evaluation Studies as Topic; False Negative Reactions; Foot; Humans; Osteomyelitis; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Technology, Radiologic

Topics: Adolescent; Diphosphonates; Female; Gallium Radioisotopes; Humans; Osteomyelitis; Pseudomonas Infections; Radionuclide Imaging; Sacroiliac Joint; Technetium; Technetium Tc 99m Medronate

Topics: Diabetic Neuropathies; Diagnosis, Differential; Diphosphonates; Foot Diseases; Gallium Radioisotopes; Humans; Osteomyelitis; Radionuclide Imaging; Skin Ulcer; Technetium; Technetium Tc 99m Medronate

Tc-99m labeled dimethyl-amino-diphosphonate (DMAD) was compared with methylene diphosphonate (MDP) in five healthy volunteers and 28 patients with a variety of bony afflictions. Although the normal bone uptake of DMAD is less than MDP, the lesion-to-normal bone ratio is significantly higher with DMAD. All 71 lesions detected with MDP were also seen with DMAD. However, 10 lesions were disclosed with DMAD that were not seen with MDP. These lesions tended to have low grade concentrations of the radiopharmaceutical and were detected with DMAD by virtue of the lower normal bone uptake rather than higher lesion uptake.

Topics: Adult; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Humans; Kidney Neoplasms; Lung Neoplasms; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Osteitis Deformans; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A computer macro-program was developed for standardized, semiquantitative measurement of radiotracer uptake. The method uses profiles of selectable length, width, and inclination according to the anatomical structures of the pathological and the corresponding healthy region. The ratio of the two curves is calculated automatically and shown as an 'uptake curve'. The essential use of osteoscintimetry is in the follow-up examination if small changes of regional uptake have to be identified. The profile-technique rather than the ROI-technique was selected, because the main benefit of the profile-technique is that the results of follow-up examinations are comparable to previous examinations with a standard deviation of +/-5%.

Topics: Adolescent; Adult; Bone Diseases; Child; Child, Preschool; Computers; Diphosphonates; Humans; Infant; Male; Methods; Osteitis; Osteomyelitis; Radionuclide Imaging; Syndrome; Technetium; Technetium Tc 99m Medronate; Tuberculosis, Osteoarticular

Topics: Anemia, Sickle Cell; Bone and Bones; Child; Diagnosis, Differential; Diphosphonates; Female; Humans; Infarction; Male; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The usefulness of radionuclear scanning in the treatment of 18 patients with necrotizing progressive "malignant" external otitis is discussed. A Tc 99-m bone scan, a valuable test since results are positive in early cases of osteomyelitis of the temporal bone and base of skull, showed increased uptake in all 18 patients. In 6 patients, Ga-67 citrate scans were obtained at the start of therapy and at 5-6 week intervals thereafter. The serial gallium scans were useful in evaluating the effectiveness of therapy since the uptake decrease with control of infection.

Topics: Aged; Diabetes Complications; Diphosphonates; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Necrosis; Osteomyelitis; Otitis Externa; Pseudomonas Infections; Radionuclide Imaging; Skull; Technetium; Technetium Tc 99m Medronate; Temporal Bone

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

Based on experience with 22 cases of neonatal osteomyelitis in 10 years, the authors suggest these patients can be divided into two groups depending on severity of disease. Premature infants requiring umbilical catheterization and severely ill full-term infants constitute a high-risk group; signs are more overt, multifocal infection and joint involvement more frequent, and severe skeletal deformities more common. The patients in the low-risk group had much milder disease but also presented more difficulty in diagnosis because of the vagueness of the presenting signs. Radiographic examination is essential for diagnosis and follow-up of osteomyelitis, particularly limb deformities. Bone scans should be reserved for situations in which the clinical and radiographic findings are equivocal.

Topics: Diphosphonates; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Osteomyelitis; Polyphosphates; Risk; Staphylococcal Infections; Technetium; Technetium Compounds; Technetium Tc 99m Medronate

Two cases of acute hematogenous osteomyelitis of the rib are presented. In one case the etiologic agent was Staphylococcus aureus coagulase-positive and in the other it was Bacteroides corrodens. Although an uncommon disease, hematogenous osteomyelitis should be considered in the differential diagnosis of destructive lesions of the rib. Anaerobic and aerobic cultures should be obtained for bacteriologic analysis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteroides Infections; Diagnosis, Differential; Diphosphonates; Eikenella corrodens; Humans; Male; Osteomyelitis; Ribs; Staphylococcal Infections; Technetium; Technetium Tc 99m Medronate

Acute osteomyelitis was induced in 18 rabbits after direct injection of a solution of Staphylococcus aureus culture into a proximal tibial metaphysis. Serial plain radiographs and radionuclide studies with indium-111 oxide labeled while blood cells and technetium-99m methylene diphosphonate were performed over the next 4 weeks. Visual and quantitative analysis by measuring the isotope activity of 111In and 99mTc over the infected tibias as compared with the opposite bones revealed that the white blood cell scans were positive in 15 (83%) of the 18 rabbits during the first week after injection of the microorganism. During the same period, the 99mTc bone scans were positive in only 22% of the animals (p less than 0.005). In the animals that survived, both white blood cell and bone scans were positive during the second week, and thereafter, the bone scans revealed consistently higher activity than was observed with white blood cell scans. Computed tomography performed in six rabbits revealed an increased attenuation coefficient of the medullary cavities in the infected bones of four animals during the first week and of one more during the second week. Plain radiographs became positive after the 12th day. Results indicate that in patients with suspected acute osteomyelitis, white blood cell scans and probably computed tomography can detect the disease earlier than 99mTc bone scans and plain radiographs.

Topics: Animals; Diphosphonates; Hindlimb; Hydroxyquinolines; Indium; Leukocytes; Organometallic Compounds; Osteomyelitis; Oxyquinoline; Rabbits; Radionuclide Imaging; Staphylococcus aureus; Technetium; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed

The results of skeletal scintigraphy with Tc-99m-medronate of five children, in whom bone or joint infection was suspected, are presented. They illustrate that the demonstration of areas of diminished radionuclide accumulation may be of considerable assistance in establishing a diagnosis.

Topics: Arthritis, Infectious; Bone and Bones; Child; Child, Preschool; Diphosphonates; Female; Hip Joint; Humans; Hyperemia; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Staphylococcal Infections; Staphylococcus aureus; Technetium; Technetium Tc 99m Medronate

Increased patellar uptake on bone scans is seen quite commonly but the possible or probable etiologies of this finding have not been previously well described. A review of 100 consecutive bone scans showed that the incidence of bilateral "hot" patellae is 15%. Identified etiologies include osteoarthritic degenerative disease (35%), fracture, possible metastatic disease, bursitis, Paget's disease, and osteomyelitis. The value of careful history, physical examination, and radiographs is stressed.

Topics: Adult; Arthritis, Infectious; Bone and Bones; Bursitis; Diphosphonates; Female; Humans; Male; Middle Aged; Osteitis Deformans; Osteoarthritis; Osteomyelitis; Patella; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Thirty-nine bone scans were performed in children (1 week - 14 years of age), with symptoms and signs of acute osteomyelitis. All but two scintigrams were obtained within the first week of the disease. Nine scans showed locally increased isotope accumulation. The diagnosis of osteomyelitis was later confirmed by radiological examination or by positive cultures. Twenty-nine scans were reported negative. Nevertheless, four patients developed characteristic radiological signs of osteomyelitis. In one of these four cases a decreased uptake ("cold" lesion) in the scintigram was over-looked. In spite of surgical drainage the patient developed chronic osteomyelitis. It is concluded that bone scanning is a valuable adjunct in the early diagnosis of osteomyelitis. A negative scintigram, however, does not exclude this diagnosis. A "cold" lesion may indicate a high pressure abscess and a risk for sequestrum formation. Prompt surgical drainage is advocated when such lesions are encountered in the scintigram.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Bone and Bones; Child; Child, Preschool; Diagnosis, Differential; Diphosphonates; Female; Humans; Infant; Infant, Newborn; Male; Osteomyelitis; Radionuclide Imaging; Sepsis; Technetium; Technetium Tc 99m Medronate

For the scintigraphic diagnosis of bone disease 99mTechnetium MDP has been shown to be of great value. In acute haematogenous pelvic ostemyelitis scintigraphy is one of the most important early diagnostic aids. The rare and difficult diagnosis with an initial negative X-ray can be confirmed by a high uptake on scintigraphy. Through early selected antibiotic therapy in high doses the development of radiologic changes were prevented which is shown in the two reported cases with acute haematogenous osteomyelitis in the iliosacral joint.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Arthritis, Infectious; Diphosphonates; Humans; Ilium; Male; Osteomyelitis; Radionuclide Imaging; Sacrum; Staphylococcal Infections; 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

Topics: Adolescent; Diagnosis, Differential; Diphosphonates; Humans; Male; Osteomyelitis; Radionuclide Imaging; Stress, Mechanical; Technetium; Technetium Tc 99m Medronate; Tibial Fractures