technetium-tc-99m-medronate and Osteonecrosis

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a well-described clinical condition with consistent radiographic findings. The purpose of this report was to review these findings in an attempt to offer important diagnostic, prognostic, and therapeutic information associated with BRONJ.. The findings of studies assessing the radiographic landmarks on plain films, intraoral films, orthopantograph, computed tomography, magnetic resonance imaging, and nuclear bone scans in patients with BRONJ were analyzed.. The radiographic findings in patients with BRONJ include osteosclerosis, osteolysis, dense woven bone, a thickened lamina dura, subperiosteal bone deposition, and failure of postsurgical remodeling.. Consistent imaging findings are noted in the BRONJ patient. Imaging is an essential part of the clinical assessment of the BRONJ patient and might be an additional tool for tracking the progression of the disease.

Topics: Bone Density Conservation Agents; Diphosphonates; Fluorodeoxyglucose F18; Humans; Jaw Diseases; Magnetic Resonance Imaging; Osteonecrosis; Positron-Emission Tomography; Radiography, Panoramic; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, X-Ray Computed

Is lunate collapse in Kienböck's disease a consequence of spontaneous revascularization, leading to focal osteolysis? A literature review of osteonecrosis in other locations such as the femoral head and bone allografts showed clearly that the loss of mechanical integrity is due to cellular processes which follow the spontaneous restoration of blood supply. We found no evidence in the literature that the lunate has been shown to be avascular at the time of collapse. On the contrary, increased osteoclastic activity has been reported. We excised and reimplanted the lunate in two monkeys, and found spontaneous revascularization, leading to increased osteoblastic activity. Other parts of the bone were destroyed by osteoclasts, leading to collapse. This histological example suggests that it may be possible to make an analogy with osteonecrosis in other locations. Thus, changes on plain radiography may indicate that the bone is revascularized spontaneously. Before performing operative revascularization of the lunate, one should consider that revascularization is a probable cause for collapse.

Topics: Animals; Bone Resorption; Carpal Bones; Neovascularization, Pathologic; Osteochondritis; Osteoclasts; Osteonecrosis; Pilot Projects; Replantation; Saimiri; 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

Theoretically, the bisphosphonates used to treat metastatic bone disease could influence the results of nuclear bone scans which use the structurally similar technetium 99m methylene diphosphonate (99mTc MDP). A prospective clinical study was designed to explore this hypothesis.. Patients with metastatic breast cancer receiving intravenous bisphosphonate (IVBP) therapy who had > or =3 osseous lesions on nuclear bone scan were eligible. A baseline bone scan (number 1) was performed as clinically indicated and IVBP with zoledronic acid was administered within 72 hours. A second bone scan (number 2) was performed within 72 hours of zoledronic acid dosing. Both bone scans were reviewed in a blinded fashion and assessed for changes in the number and intensity of osseous lesions. Ten patients were planned to yield at least 30 lesions.. Ten patients were enrolled. One patient withdrew consent and 1 was excluded due to protocol deviation. Among the 8 patients were 163 assessable osseous lesions. The median time from bone scan number 1 to IVBP was 1 day (range, 1-2 days). The median time from IVBP to bone scan number 2 was 2 days (range, 1-3 days). The paired imaging showed no changes in the total number of bone metastases. One hundred sixty-one lesions were identical in both scans; in 1 patient there were 2 lesions that were discordant, one more intense, the other less intense.. These data do not support the hypothesis that IVBP therapy interferes with bone scan results.

Topics: Adult; Aged; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Infusions, Intravenous; Jaw Diseases; Middle Aged; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Zoledronic Acid

To what extent lateral retinacular release done in total knee arthroplasty compromises patellar viability has been debated. This study is a prospective study to assess patellar viability using Technetium-99m methylene diphosphate (Tc-99m MDP) scintigraphy. Between 2005 and 2006, 59 patients (72 knees) who underwent primary total knee arthroplasty were studied, of which 36 required lateral release. All patients underwent regional bone scan using Tc-99m MDP before and 1 to 3 weeks after the surgery. Two nuclear medicine consultants using both qualitative and quantitative assessment interpreted the scans independently. Fourteen knees with lateral release showed scintigraphic signs of hypovascularity in the early postoperative period that normalized in 8-week postoperative period. This study documents the greater incidence of transient patellar hypovascularity associated with lateral release.

Topics: Aged; Aged, 80 and over; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Female; Fractures, Bone; Humans; Ischemia; Knee Joint; Knee Prosthesis; Male; Middle Aged; Osteoarthritis, Knee; Osteonecrosis; Patella; Prospective Studies; Radionuclide Imaging; Risk Factors; Technetium Tc 99m Medronate; Treatment Outcome

A series of 19 patients, who were clinically suspected of developing avascular necrosis of bone following fracture, were entered into a pilot study comparing the use of bone marrow scintigraphy with conventional skeletal scintigraphy. Two-phase bone scintigraphy, using 600 MBq of 99Tcm-HMDP, and perfusion and late-phase nanocolloid scintigraphy, using 370 MBq of 99Tcm-nanocolloid, were performed on each patient. In both methods, photon deficiency at the site of interest was taken to indicate avascularity. The perfusion phase of both methods was found to be unhelpful. Agreement between methods was obtained in 18 patients (95%). Six patients had abnormal nanocolloid scans, one of which was normal on the conventional bone scintigram. The remaining 13 patients had no evidence to suggest avascularity in either method. Three of the patients with abnormal scans have had hip replacement surgery following which avascularity of the femoral head was confirmed. 99Tcm-nanocolloid scintigraphy is thus shown to be a very sensitive method of demonstrating avascularity of bone following trauma.

Topics: Adult; Aged; Bone and Bones; Bone Marrow; Female; Femoral Neck Fractures; Femur Head Necrosis; Humans; Male; Middle Aged; Osteonecrosis; Pilot Projects; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

Endovenous bisphosphonate therapy seems associated with osteonecrosis of the jaw. The aim of this study was to evaluate the additional diagnostic value of hybrid SPECT/CT in 99mTc-methylene diphosphonate 3-phase bone scintigraphy of osteonecrosis of the jaw in bisphosphonate-treated patients.. We studied 15 patients (12 women and 3 men) with extraoral tumors affected by lytic bone metastases and multiple myeloma. All patients were previously treated with intravenous bisphosphonates (zoledronic acid) for 1-3 y, were negative for dental disease at clinical examination, and had suspected osteonecrosis of the jaw. All 15 patients underwent panoramic x-ray orthopantomography, CT or MRI (or both), microbiologic examination, 3-phase bone scintigraphy, and SPECT/CT of the maxillary region.. Three-phase bone-scintigraphy showed increased perfusion and an increased blood pool in 9 of 12 and 10 of 12 patients, respectively; at the metabolic phase, SPECT was positive in all patients and showed abnormal hyperactivity in the maxilla of 2 patients, in the mandible of 9 patients, and in both the mandible and the maxilla of 4 patients. Hybrid SPECT/CT was of particular value in 8 of 15 patients, allowing discrimination of the osteonecrotic core from nearby hyperactivity due to viable bone. Whole-body scintigraphy showed remote and multiple metastases in all patients. Orthopantomography showed nonspecific bone rarefaction in all patients but was not able to aid diagnosis of osteonecrosis of the jaw. CT and MRI showed anomalies in all symptomatic patients: CT was helpful in evaluating both cortical and trabecular bone aspects, and MRI was able to detect soft-tissue involvement but not cortical bone destruction.. In appropriately selected oncology patients treated with bisphosphonates, an increased uptake of 99mTc-methylene diphosphonate in maxillary bones may suggest probable osteonecrosis of the jaw. In such cases, SPECT/CT may be of value in increasing the diagnostic accuracy of bone scanning, providing a precise functional anatomic correlation for the definition of the extent of disease.

Topics: Aged; Aged, 80 and over; Diphosphonates; Female; Humans; Jaw; Magnetic Resonance Imaging; Male; Middle Aged; Osteonecrosis; Radiography, Panoramic; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Aged; Aged, 80 and over; Diphosphonates; Female; Humans; Jaw; Magnetic Resonance Imaging; Male; Middle Aged; Osteonecrosis; Radiography, Panoramic; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Bone scintigraphy has been advocated as a useful diagnostic tool for patients with suspected osteonecrosis or in screening for multifocal disease. We evaluated the sensitivity of bone scanning relative to magnetic resonance imaging (MRI) in the diagnosis of osteonecrosis.. Forty-eight patients presented with suspected osteonecrosis of the shoulder, hip, knee, or ankle. All patients underwent simultaneous (< 3 months apart) bone scans and MRI studies as part of diagnostic investigations. Histological confirmation of osteonecrosis was obtained for all suspected lesions. The diagnostic result for each imaging modality was then assessed and compared.. All 163 (100%) histologically confirmed lesions were identified by MRI, while only 91 lesions (56%) were identified by bone scan. There was complete congruency of bone scans with MR images in only 38% of patients (18/48). Bone scanning identified 72% of lesions (47/65) in oligofocal patients (< or = 2 joints involved) compared with 45% of the lesions (44/98) in multifocal patients (> or = 3 joints involved). Sensitivity of lesions was highest for the knee and hip and lower for the shoulder and ankle. Larger and later-stage lesions had a higher bone scan sensitivity.. Our results demonstrated the low sensitivity of bone scintigraphy for diagnosing symptomatic osteonecrosis. It is least sensitive for early-stage lesions where it might be most useful to diagnose the disease. Our study also confirms that this test is less sensitive for joints other than the hip and is also not useful as a screening tool. Our study does not support the use of bone scans as a diagnostic or screening tool for osteonecrosis.

Topics: Adult; Aged; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteonecrosis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Arthralgia; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Osteonecrosis; Radiopharmaceuticals; Talus; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

It is important to recognize osteonecrosis of the jaws in patients treated with bisphosphonates because an early diagnosis can make a significant difference to the outcome of the disease. The aim of this study is to describe the radiological features of bisphosphonate osteonecrosis (BON) in order to aid its prompt recognition.. A conventional radiograph, a computed tomograph (CT), a magnetic resonance image (MRI) and a 99Tc(m)-MDP 3-phase bone scan were carried out for 11 patients with BON. The main imaging findings of osteonecrosis are described.. Conventional radiography and CT displayed osteolytic lesions with the involvement of cortical bone. MRI demonstrated the characteristic features of osteonecrosis and the oedema of soft tissues. Both CT and MRI were very useful in defining the extent of the lesions. 99Tc(m)-MDP three-phase bone scan was the most sensitive tool to detect the osteonecrosis at an early stage.. 99Tc(m)-MDP three-phase bone scans who could be used as a screening test to detect subclinical osteonecrosis in patients who have received bisphosphonates. CT scans and MRI are useful in defining the features and extent of osteolytic lesions.

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Bone Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Jaw Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Osteonecrosis; Radiography, Panoramic; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Zoledronic Acid

Topics: Adult; Arthralgia; Female; Humans; Metacarpus; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Femur; Humans; Male; Middle Aged; Osteonecrosis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

In patients with non-traumatic osteonecrosis of the femoral head (ONFH), the shoulder is one of the major affected sites secondary to the proximal and distal femur in cases of multiple osteonecrosis. The present study attempted to investigate whether technetium bone scintigraphy is useful for screening of non-traumatic osteonecrosis of the shoulder (ONS).. A total of 170 shoulder joints in 85 patients with ONFH were evaluated by bone scintigraphy and the findings compared with those of magnetic resonance imaging (MRI). The MR diagnosis was used as the gold standard.. Based on the diagnosis by MRI, ONS was detected in 43 shoulders of 27 patients (25%). All necrotic lesions were located in the humeral head. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of bone scintigraphy for ONS detection were 65%, 81%, 77%, 54% and 87%, respectively. When the necrotic angle of the lesions on the mid-coronal MRI was more than 40 degrees, the sensitivity of bone scintigraphy for ONS detection increased to 88% (21/24 shoulders).. Bone scintigraphy may be useful for demonstrating medium or large ONS lesions on screening of patients with ONFH.

Topics: Adolescent; Adult; Aged; Alcoholism; Female; Femur Head Necrosis; Glucocorticoids; Humans; Humerus; Male; Middle Aged; Osteonecrosis; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Shoulder Joint; Technetium Tc 99m Medronate

To determine whether technetium bone scintigraphy (BS) is useful for screening of non-traumatic osteonecrosis of the knee (ONK), which was a major affected site, secondary to the femoral head, among multiple osteonecrosis, in patients with non-traumatic osteonecrosis of the femoral head (ONFH).. A total of 214 knee joints in 107 patients with ONFH were evaluated by BS and a comparison made with magnetic resonance imaging (MRI). ONK was classified into five sites, including the femoral condyles (ONFC), distal femoral metaphysis (ONFM), tibial plateau (ONTP), proximal tibial metaphysis (ONTM), and patella (ONP).. Based on the diagnosis by MRI, ONK was detected in 103 knees of 62 patients (48%). ONFC was most common (86 knees, 40%), ONFM (15%), followed by ONTM (10%), ONP (3%), and ONTP (0.9%). Sensitivity, specificity, and accuracy of BS for ONFC detection were 63%, 71%, and 68%, respectively. When the ONFC lesions on the coronal views of MRI were large or medium sized and occupied two thirds, or the entire anteroposterior joint surface on the sagittal views, the sensitivity of BS for ONFC detection increased to 89% (34/38 knees). The sensitivity of BS for ONFM, ONTM, and ONP detection was 3%, 0%, and 0%, respectively, but these lesions showed a low likelihood of collapse.. BS is useful for screening large ONK in patients with ONFH given that 89% of patients with ONFC who had a high risk of collapse of the knee were identified.

Topics: Adolescent; Adult; Aged; Female; Femur Head Necrosis; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Adult; Behcet Syndrome; Bone and Bones; Humans; Male; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

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

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

This study documented the previously reported lower sensitivity of routine planar three-phase bone scintigraphy (BS) performed using a high-resolution parallel-hole collimator compared with MRI to diagnose nontraumatic avascular necrosis of the hip (AVN).. Six observers reviewed 143 bone scintigrams obtained in patients with nontraumatic hip pain (n = 120) or a control group (n = 23). All patients had a standard radiograph and MRI within 2 months of the BS. Of 280 hips, 148 (53%) were painful on the day of the examination. The osteonecrosis group (AVN) consisted of 93 instances of AVN in 58 patients. Although it departs from the clinical situation, this method evaluated the intrinsic performance of the imaging method. The data were analyzed using a receiver operating characteristic method.. For the six observers, the A(z) values were 0.65, 0.67, 0.66, 0.67, 0.73, and 0.79, respectively, and 0.66, 0.71, 0.75, 0.81, 0.81, 0.82, and 0.84 after removing hip diseases other than AVN through data manipulation. Bone marrow edema, as seen on MRI, was the most frequently reported misleading sign in false-positive diagnoses, especially in the early or late phases of the disease. False-negative diagnoses misclassified the scans as "asymptomatic hips" in 28 of 30 cases. Twenty-two of 30 scans appeared normal, but these AVN lesions were small (<25%) and were discovered by chance on MRIs that displayed bilateral involvement associated with radiographic evidence (stage 0 or 1). Thirteen of 20 patients were followed for 3 or more years, and only one worsened.. BS is not indicated to diagnose possible contralateral AVN if the hip is asymptomatic. This study emphasizes the results from the literature; if indicated, a radionuclide hip investigation requires the use of a pin-hole collimator, a SPECT study with scatter correction and iterative reconstruction algorithms, or both.

Topics: Adult; Case-Control Studies; Female; Hip; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Osteonecrosis; Pain Measurement; Radiography; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate

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

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

Topics: Adrenal Cortex Hormones; Adult; Anemia, Hemolytic; Female; Femur Head Necrosis; Humans; Humerus; Knee Joint; Lupus Erythematosus, Systemic; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Shoulder Joint; Technetium Tc 99m Medronate

The clinical, radiographic and scintigraphic findings in 12 patients diagnosed with osteonecrosis of the tibial plateau (10 of the medial and two of the lateral plateau) were analysed. The disease presented suddenly in most of the patients, as acute pain in the lateral side of the knee, with no major traumatic antecedents. X-ray findings were varied and non-specific, and hence of little value for initial diagnosis. On the other hand, scintigraphic findings were very useful for diagnostic purposes in all cases. All the patients were over 55 years of age and 11 out of 12 were women. The most frequent location of the disease was the medial tibial plateau; however, two cases involved the lateral plateau and two involved both plateaux. Seven patients were subjected to full knee arthroplasty, four to valgising osteotomy and one to grafting. The patients' diagnoses were considerably delayed (by more than 6 months), which affected their treatment and prognosis.

Topics: Aged; Female; Humans; Knee Joint; Male; Middle Aged; Osteonecrosis; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tibia

Based on the data by Armas et al, avascular necrosis, a not uncommon treatment-associated complication in patients with lymphoma, it should be easily distinguishable from osseous lymphomatous involvement in patients with Ga-67 avid lymphoma. In avascular necrosis, Ga-67 uptake will be either absent, decreased, or normal, whereas in lymphoma Ga-67 uptake will be increased. The authors present a patient with Hodgkin's disease who had new foci of simultaneously increased Ga-67 and Tc-99m MDP uptake because of avascular necrosis as proven by biopsy and long-term follow-up. The authors hypothesize that a possible-explanation for the discrepancy between this patient report and the series by Armas et al may be that increased Ga-67 is a delayed phenomenon related to healing.

Topics: Adult; Antineoplastic Agents; Biopsy; Bone Marrow Transplantation; Bone Neoplasms; Combined Modality Therapy; Diagnosis, Differential; Femur; Follow-Up Studies; Gallium Radioisotopes; Hodgkin Disease; Humans; Male; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Wound Healing

Aseptic loosening is the most common problem of hip arthroplasties, limiting its long term success. We report a study of pulsed electromagnetic field (PEMF) treatment in 24 patients with this complication. At the end of treatment, six months and one year later, pain and hip movements improved significantly with the exception of flexion and extension. There was significant improvement in both isotope scans and ultrasonography, but not in plain X-ray. The decreased pain and improved function suggest that PEMF is effective in improving symptoms of patients with loose hip replacement. No improvement, however, can be expected in patients with severe pain due to gross loosening.

Topics: Adult; Aged; Bone and Bones; Calcification, Physiologic; Electric Stimulation Therapy; Electromagnetic Fields; Female; Follow-Up Studies; Hip Prosthesis; Humans; Male; Middle Aged; Osteonecrosis; Prospective Studies; Prosthesis Failure; Radionuclide Imaging; Range of Motion, Articular; Technetium Tc 99m Medronate; Ultrasonography

Quantitative bone scanning of the hip was carried out in 50 patients, 45 with unilateral disorders, and 5 with no symptoms and normal radiographs. The uptake ratio of the involved femoral head was calculated in the perfusion and static phases. In the patients with no symptoms the difference in the uptake ratio between the right and left hips averaged less than 0.02 in both phases. In 5 patients with a unilateral endoprosthesis the average was 0.52 in the perfusion and 0.34 in the static phase. In 10 patients with intertrochanteric fractures, 9 with undisplaced femoral neck fractures and 7 with osteoarthritis, each uptake ratio averaged more than 1.1 in both phases. In 9 patients with displaced femoral neck fractures, the mean ratio was 0.76 in the perfusion and 0.92 in the static phase. In 5 patients with avascular necrosis the ratio was 0.82 in the perfusion and 1.57 in the static phase. Quantification of uptake in both phases provides objective data reflecting bone blood flow and metabolism in various disorders of the hip.

Topics: Adult; Aged; Aged, 80 and over; Female; Femoral Neck Fractures; Femur Head; Hip Fractures; Humans; Male; Middle Aged; Osteoarthritis; Osteonecrosis; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate

We compared MR imaging with scintigraphy and CT in eight patients with spontaneous osteonecrosis of the knee. The histological changes accounting for the MR signal abnormalities were evaluated.. Eight patients with spontaneous osteonecrosis of the knee joint underwent MR imaging before and after i.v. administration of Gd-DTPA. Nuclear scintigraphy was performed in all 8 patients, three patients also had CT scans of the knee area. Histologic correlation was available in three patients.. Increased radionuclide uptake was observed in all patients. In one patient, however, scintigraphy showed increased radionuclide uptake consistent with osteonecrosis only in the medial femoral condyle, while MR imaging demonstrated osteonecrosis both in the medial as well as the lateral femoral condyles. MR demonstrated areas of low signal intensity on precontrast T1-weighted images in the femoral condyle in all patients. All these areas showed high signal intensity on T2-weighted images. On postcontrast T1-weighted images, signal intensity increase was either homogeneous throughout the lesion or it was seen at the periphery of the lesion in a band-like pattern. Histologically, the areas of high signal intensity on T2-weighted and on postcontrast T1-weighted images corresponded to granulation tissue.. MR imaging detects granulation tissue adjacent to the necrotic zone. Using morphological and signal intensity criteria, MR imaging can be utilised to differentiate spontaneous osteonecrosis of the knee from osteochondritis dissecans, degenerative osteoarthritis, and other conditions affecting the knee joint.

Topics: Aged; Aged, 80 and over; Contrast Media; Evaluation Studies as Topic; Female; Gadolinium; Gadolinium DTPA; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Osteonecrosis; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 37-year-old woman entered our hospital because of bilateral knee pain. Tc-99m HMDP bone scintigram demonstrated increased activity in the bilateral patellae and cold lesion in the center and left lateral segments of the left patellae, so-called doughnut pattern. Trephine biopsy was performed to prove bilateral idiopathic asepct osteonecrosis of the patellae. The knee pain subsided and a bone scan 5 months later demonstrated increased activity in the bilateral patellae more widely than initial scan. We report the usefulness of Tc-99m HMDP bone scintigraphy to observe a reparative phase of idiopathic asepct osteonecrosis of the patellae.

Topics: Adult; Female; Humans; Osteonecrosis; Patella; Radionuclide Imaging; Technetium Tc 99m Medronate

Thirty-two patients in whom Legg-Perthes disease apparently involved only one hip were examined with venography, measurement of intraosseous and intra-articular pressures, arthrography, and dynamic triphasic bone-imaging with 99mTc methylene diphosphonate. The arterial flow of blood in the affected femoral head was slightly decreased, but the difference from that on the normal side was not statistically significant. However, there was marked disturbance of the venous drainage in the diseased hip, elevated intraosseous pressure in the affected femoral neck, and increased intra-articular pressure in the involved hip compared with the normal side. An animal model was then created in twenty immature dogs, venous drainage was obstructed, and intraosseous pressure of the femoral head and neck was elevated by injection of four milliliters of semiliquid silicone into the femoral neck. In eleven of the dogs, areas of avascular necrosis resembling those associated with Legg-Perthes disease developed in the femoral head.

Topics: Adolescent; Animals; Arthrography; Child; Child, Preschool; Disease Models, Animal; Dogs; Female; Femur Head; Femur Neck; Hip Joint; Humans; Legg-Calve-Perthes Disease; Male; Osteonecrosis; Phlebography; Pressure; Radionuclide Imaging; Technetium Tc 99m Medronate; Venous Pressure

During the past 4 years, three-phase bone scintigraphy using 99mTc-MDP has been studied in 68 patients suffering from hemi-lateral hip-joint disorders. We were impressed on abnormal uptake of the shaft of femur on the involved side. 99mTc-MDP uptake in the shaft of femur is compared with between involved leg and normal leg of 68 cases with hemi-lateral hip-joint disorders (76 examinations). We excluded cases of osteomyelitis, cases of malignant tumor, and post-operative cases. In early images, the 99mTc-MDP uptake is not always increased in involved side. But in delayed images, there are no patients whose normal side's 99mTc-MDP uptake is increased. The 99mTc-MDP uptake in early image is not related only with blood flow of the thigh but with the amount of soft tissue of the thigh. And the 99mTc-MDP uptake in delayed image is related with disuse osteoporosis.

Topics: Adult; Aged; Child; Female; Femur; Hip Dislocation; Hip Fractures; Humans; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis, Hip; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Three-phase scintimetry with 99mTc MDP was analyzed in 40 patients with a clinical history of spontaneous onset of knee pain and a focal static isotope uptake in the femoral condyle indicating osteonecrosis. A strong correlation was found between pool-phase ratios and the static ratios. The pool-phase study did not add to the information obtained from the flow phase and static studies. There was a characteristic change of the pattern of the early flow-phase curves with the duration since the onset of symptoms indicating hyperemia early in the disease. A persistent high flow-phase and static-uptake ratio 6-12 months after the onset of symptoms correlated positively with a poor clinical and radiographic outcome. The 10 patients with a good prognosis had, as a group, a more rapid decrease in isotope uptake after 6 months. There was a positive correlation between a high static uptake ratio and the size of the lesion, and subsequently with the clinical and radiographic outcome. 30 patients developed arthrosis and/or severe clinical symptoms. Five of the 10 patients who did not develop arthrosis never developed radiographic evidence of osteonecrosis.

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Knee Joint; Male; Middle Aged; Osteonecrosis; Prognosis; Radionuclide Imaging; Remission, Spontaneous; 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

Osteonecrosis or aseptic necrosis is well-recognised in certain sites. We report two patients, both with predisposing factors, who developed avascular necrosis of the hemipelvis which was bilateral in one case. In each patient the diagnosis was not suspected clinically. In the initial phase, bone scintigraphy showed diminished uptake in the hemipelvis when plain radiographs were normal. Follow-up scans showed evidence of revascularisation. This is an unusual site for osteonecrosis, though there appears to be an underlying anatomical basis for its occurrence.

Topics: Adult; Female; Humans; Osteonecrosis; Pelvic Bones; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Bone and Bones; Decompression Sickness; Female; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Osteonecrosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Two girls, aged 11 and 7 years, with myelomeningocele had osteonecrosis in the lateral tibial epiphysis and in the medial femoral condyle, respectively. Both girls suffered from sensory impairment of the affected area and presented with warmth and swelling of the knee. No signs of infection were found. The necroses seen in radiographs were confirmed by biopsy and 99mTc-MDP scintigraphy. The lesions showed only little tendency to heal, and rather severe growth disturbances developed despite treatment in long leg calipers. One of the girls was unable to walk because of the loss of muscular power during the long period of bracing.

Topics: Child; Female; Femur; Humans; Meningocele; Osteonecrosis; Technetium Tc 99m Medronate; Tibia

Two patients with Freiberg's infraction of the second metatarsal are presented. The scintigraphic pattern of a photopenic defect with hyperactive collar is demonstrated as evidence of the existence of avascular necrosis or infarction in this entity. The photopenia was appreciated only on pinhole collimator images in our first patient. The later revascularization phase of avascular necrosis with diffuse increase in uptake is demonstrated scintigraphically in the second patient.

Topics: Adolescent; Child; Female; Foot Diseases; Humans; Hyperemia; Metatarsus; Osteochondritis; Osteonecrosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

The cemented hip arthroplasty is one of the most successful orthopedic operations. However, the results do deteriorate with time because of mechanical loosening. Some hips with obviously loose prosthetic components are not painful. This discrepancy between symptoms and radiographic evidence of loosening has caused uncertainty about the diagnostic criteria that should be applied. This uncertainty has in turn led to confusion about the basic cause of loosening. The aims of this presentation were to find a favorable definition of loosening and to investigate the etiology of mechanical loosening of the cemented hip prosthesis. The diagnostic criteria of contrast and radionuclide arthrography, bone scintigraphy, and roentgen stereophotogrammetric analysis (RSA) were evaluated in 14 symptomatic hip arthroplasties examined by these methods. Loosening was found to be best defined as migration; regardless of diagnostic criterion, all loose prosthetic components were migrating, but no nonmigrating component was loose. The development of the radiolucent zone was analyzed in a simple model consisting of 6 cases of giant-cell tumor of bone successfully treated by curettage and cementing. In locations where the cement filling adjacent to cancellous bone was concave, a considerably wider zone developed. There was a positive correlation between the width of the zone and the volume of cement. The radiolucent zone in this model could be explained by heat injury during the polymerization of bone cement. The pattern of migration of the components in 20 cemented hip prostheses was studied with RSA and with conventional radiography over a period of 2 years postoperatively. Eleven acetabular and three femoral components migrated. After an initial 4-month period of rapid migration, most components migrated slowly. The initial rapid migration could be accounted for by the resorption of a layer of necrotic bone following heat injury during the polymerization. The less frequent migration of the metallic femoral component as compared with the polyethylene acetabular component could be explained by the metal acting as a heat sink. Radiographic examination was found to be unsatisfactory as a means of detecting mechanical loosening during the first 2 postoperative years. RSA, on the other hand, was capable of revealing migration as early as 4 months postoperatively. Migration of the components in 16 hip prostheses was studied with RSA for 1 year postoperatively following randomized use

Topics: Acetabulum; Bone Cements; Bone Resorption; Equipment Failure; Femur; Hip; Hip Joint; Hip Prosthesis; Hot Temperature; Humans; Osteonecrosis; Photogrammetry; Prosthesis Failure; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Viscosity

Topics: Adolescent; Adult; Aged; Arthritis, Rheumatoid; Bone Diseases; Bone Neoplasms; Calcinosis; Female; Humans; Male; Middle Aged; Osteonecrosis; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

Avascular necrosis of bone (AVN) may cripple a patient who has had a successful renal transplant. The authors have attempted to gain more knowledge of this condition by undertaking a prospective survey to determine as accurately as possible the incidence of AVN in renal transplant patients. Routine six-month whole body bone scans were performed with 99mTechnetium Methylene Diphosphonate in 42 consecutive surviving renal transplant patients. The survey started in 1978-79, and patients were followed for a minimum of two years and a maximum of three years. As a result, seven were found to have AVN that would have remained undetected in two of the patients if routine whole body bone scanning had not been conducted. Despite a reduction in steroid dosage in recent years, the incidence of AVN in the authors' patients remains high at 17%. Bone scan appearances in renal transplant patients were classified and subdivided into four groups. By linking bone scans and radiographic and postmortem appearances of the femoral head, one very early case of AVN was detected. Routine bone scanning provided a more accurate estimation of the incidence of fractures in renal transplant patients (12%).

Topics: Adolescent; Adult; Aged; Bone and Bones; Child; Diphosphonates; Female; Femur Head Necrosis; Follow-Up Studies; Humans; Kidney Transplantation; Male; Middle Aged; Osteonecrosis; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

A prospective study of bone scanning for detection of ischemic necrosis of bone (INB) was performed in 36 patients (97% female, age range 16-36 yrs.) with systemic lupus erythematosis (SLE). Since the hips, knees, and shoulders are usually affected by INB in patients with SLE, 300 K converging collimator images of these joints were obtained on film and in digital format 2 to 3 hours after the injection of 20 mCi (740 MBq) of Tc-99m methylene diphosphonate. All patients underwent radiography of the joints, and 10 had intraosseous pressure determinations in the marrow space of affected joints (n = 31) for independent assessment of INB. Scans showed abnormally increased joint activity in 28 of the 36 patients. A total of 97 joints showed abnormalities, 19% in the hips, 34% in the knees, and 47% in the shoulders. Twenty-four of 27 joints with elevated bone marrow pressure (BMP) had abnormal scans (sensitivity = 89%), and scans were abnormal in 2 of 4 joints with normal pressures (specificity = 50%). The positive predictive value of the scans compared with BMP measurements was 92% (24/26). Eleven of 27 joints with abnormal BMP had abnormal radiographs, a sensitivity of 41%.

Topics: Adolescent; Adult; Aged; Arthrography; Diphosphonates; Female; Femur Head Necrosis; Humans; Joints; Male; Middle Aged; Osteonecrosis; Prednisone; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Bone scintigraphy is a very useful technique for detection of aseptic necrosis. We have used this diagnostic tool in a patient to detect aseptic necrosis of the talus, a common complication stemming from foot injuries. The scintigraphic pattern is rather typical and antedates any other radiographic changes. This technique appears to be very useful for diagnosis and follow-up of aseptic necrosis occurring during talar injuries.

Topics: Adult; Diphosphonates; Humans; Male; Osteonecrosis; Prognosis; Radionuclide Imaging; Talus; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Diphosphonates; Etidronic Acid; Female; Femur; Humans; Kidney Transplantation; Knee; Methylprednisolone; Organotechnetium Compounds; Osteonecrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate