technetium-tc-99m-medronate and Pain

Ribbing disease, or multiple diaphyseal sclerosis, is a rare diaphyseal sclerosis of unknown etiology. Patients with this pathology usually present with asymmetric pain limited to the lower extremities. Though all efforts are made to relieve the progressive pain associated with Ribbing disease, no medical or surgical treatments have been established yet. In this case report, we followed up a Ribbing case with sclerotic bone fenestration for 5 years. The radiological changes and the clinical effects are described, and the different Ribbing treatments are then briefly reviewed.

Topics: Adult; Camurati-Engelmann Syndrome; Female; Femur; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Osteoma, Osteoid; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone metastases are responsible for most of the morbidity and mortality associated with solid malignant tumors, occurring in about 65-70% of the patients with advanced breast or prostate cancer. The pathophysiology of skeletal metastasis is a complex process that involves several biologic process leading to cellular invasion, adhesions and stimulation of osteoclasts and osteoblasts with the mediation of several factors including cytokines, serine proteases and tumor-derived factors. The clinical management of pain from bone metastasis, which is mostly due to indirect stimulation of sensory nerve endings by cytokines and other biologically-active compounds released locally in response to the presence of tumor cells in the bone marrow, includes several options that can be used either alone or in varying combinations, such as analgesic drugs, chemo- or hormonal therapy, bisphosponates, external beam radiation therapy, and surgery. Bone-seeking radiopharmaceuticals play an important role in the treatment of pain caused by multiple blastic or mixed-type skeletal lesions; they have in general a favorable toxicity profile and a high rate of overall clinical benefit, although they may differ in terms of duration of pain palliation and suitability for repeat treatments. The palliative effect can be attributed to the radiation targeted to the bone marrow space, and the overall average response ranges between about 45-80%, with complete response in 10-30% of the cases. In selected clinical conditions, radionuclide therapy can also constitute an effective systemic treatment beyond bone pain palliation, and a synergistic anti-tumour effect can be expected by the combination with other agents, such as chemotherapy or bisphosphonates. This review summarizes the current experience with bone-seeking radiopharmaceuticals used for bone pain palliation, focusing on indications, patients' selection, efficacy and toxicity. Finally, the available data on combination therapies showing encouraging results as to potential anti-tumor efficacy are also reviewed.

Topics: Bone Neoplasms; Combined Modality Therapy; Diphosphonates; Drug Therapy, Combination; Etidronic Acid; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Patient Selection; Radioimmunotherapy; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome

A 33 year old female, suffering from HIV infection, presents with diffuse myalgia, generalized muscle weakness and painless dysphagia. An extensive work-up allows to diagnose an HIV-related polymyositis; while well-known, this entity is however rarely observed. Technetium-99m MDP skeletal scintigraphy shows multiple extra-osseous accumulations of the tracer: these observations, as well as the differential diagnoses of muscular involvement during HIV infection, are discussed.

Topics: Adult; Anti-Inflammatory Agents; Biopsy; Deglutition Disorders; Diagnosis, Differential; Female; HIV Infections; Humans; Muscle Weakness; Pain; Polymyositis; Prednisolone; Technetium Tc 99m Medronate

Lutetium-177-labeled ethylenediamine-N,N,N',N'-tetrakis (methylene phosphonic acid) (¹⁷⁷Lu-EDTMP), a beta-emitting bone-seeking therapeutic radiopharmaceutical being assessed as an agent for palliation of bone pain, can emit suitable gamma-photons for scintigraphy. This investigation sought to characterize its optimal conditions for whole-body gamma camera imaging in patients.. Eleven patients with bone metastases underwent whole-body bone scanning using both ⁹⁹mTc-methyl-diphosphonate (⁹⁹mTc-MDP) and ¹⁷⁷Lu-EDTMP (29.4 ± 12.5 MBq/kg BW) utilizing a dual-head camera. For lutetium-177 imaging, two types of collimators, low-energy high-resolution (LEHR) and medium-energy general-purpose (MEGP), and two different peak energies of 113 and 208 keV were used.. The femur-to-muscle uptake ratio (F/M) of ⁹⁹mTc-MDP was 2.69 ± 1.06. For ¹⁷⁷Lu-EDTMP, the significantly highest F/Ms were found at 24 h (12.59 ± 5.73) and 48 h (12.54 ± 5.23) by applying MEGP collimators and collecting the 208 keV photons. In all the combinations of collimator and peak energy, the F/Ms at 24 and 48 h are significantly higher than those at 1 h, except the combination of LEHR collimator and 208 keV peak energy. Lesion-to-normal bone uptake ratios of the ⁹⁹mTc-MDP bone scan and images at the 24 and the 48-h phases of Lu-EDTMP were analyzed. MEGP and 208 keV had significantly higher values in lesion-to-normal bone uptake ratios. The combination of LEHR and 208 keV provided the poorest images.. ¹⁷⁷Lu-EDTMP can provide fine whole-body images with the best results when applying medium-energy collimation and collecting the 208 keV energy photons and alternatively by collecting both 208 and 113 keV photons for higher count statistics. The most appropriate time point for imaging is around 24 h after injection.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Gamma Cameras; Humans; Male; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors; Whole Body Imaging

On the basis of the encouraging results achieved in several clinical trials and its proven therapeutic efficacy, (153)Sm-ethylene diamine tetramethylene phosphonic acid (EDTMP) has become widely used to palliate pain from bone metastases. The results reported in the literature have led the product suppliers (QUADRAMET, Schering) to suggest administering a fixed activity per kilogram (37 MBq/kg). However, considering the observed extreme inter-patient variability of skeletal uptake of (153)Sm-EDTMP, a real therapy optimization would require the individualization of the activity to be administered on a dosimetric basis. This should be planned taking into account the generally accepted 2-Gy dose constraint to the haematopoietic red marrow, the critical organ in palliative treatments with beta-emitting, bone-seeking radiopharmaceuticals.. Seven to 14 days before treatment with (153)Sm-EDTMP, 44 patients underwent (99m)Tc-methylene diphosphonate (MDP) total-body bone scan with two scans (the first within 10 min of injection, the second after 6 h). The percentage bone uptake (Tc(%)) was evaluated as the ratio between total counts at 6 h, adjusted for decay, and total counts at the first scan. Tc(%) was then compared to Sm(%) similarly derived from 10-min and 24-h whole-body scans. Tc(%) and Sm(%) were compared both with and without Brenner's method for soft tissue uptake.. The correlation between Tc(%) and Sm(%) was R (2) = 0.81 and R (2) = 0.88 with and without soft tissue correction, respectively. The difference between their average values was statistically significant (Sm(%) = 64.3 +/- 15.2, Tc(%) = 56.2 +/- 16.0; p = 0.017) with soft tissue correction, while was not statistically significant (Sm(%) = 68.2 +/- 15.5, Tc(%) = 66.9 +/- 14.0; p = 0.670) without soft tissue correction.. The rate of retention of (99m)Tc-MDP in bone provides a reliable estimate of the (153)Sm-EDTMP rate of retention. The proposed method can be usefully adopted for prospective dosimetry seeing its extreme simplicity, and it requires no special investment in terms of human or instrumental resources. This allows an optimization of administered (153)Sm-EDTMP activity.

Topics: Analgesics, Non-Narcotic; Bone Neoplasms; Female; Humans; Leukocyte Count; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Radiometry; Technetium Tc 99m Medronate; Time Factors; Whole Body Imaging

To calculate radiation doses of rhenium-186 ((186)Re) etidronate in painful bone metastases using quantitative bone single-photon emission computed tomography (SPECT) and to determine the threshold dose for predicting pain relief. We also wanted to determine whether technetium-99m ((99m)Tc) methylene diphosphonate (MDP) concentrations predict radiation doses of (186)Re etidronate in painful lesions.. Forty-eight patients with breast and prostate cancer were evaluated. Patients received therapeutic doses of (186)Re etidronate. The area under the pain over time curve (AUPC) was measured for 8 weeks after treatment. Response was calculated as the percentage of change in AUPC. Quantitative bone SPECT (QBS)-measured concentration of (186)Re etidronate was used for calculating radiation doses. Receiver operating characteristics curve analysis determined the radiation dose threshold that best separated responders from nonresponders. SPECT-measured concentration of (186)Re etidronate in the urinary bladder was correlated with its concentration in the voided urine. Concentration of (99m)Tc MDP was compared with radiation doses to painful metastases.. The radiation dose threshold was 2.10 Gy. For a decrease of 50% in the AUPC, the positive predictive value (PPV) of this value was 75% and the negative predictive value (NPV) was 88%. For a decrease in pain of 33%, the PPV was 84% and the NPV was 81%. In prostate cancer patients only, the PPV was 81% and the NPV was 92%. The correlation between in vivo/in vitro measured urine concentration was 0.90. The correlation between (99m)Tc MDP concentration and radiation doses of (186)Re etidronate was 0.92.. QBS-measured radiation doses of (186)Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using (99m)Tc MDP predicts radiation doses delivered by (186)Re etidronate.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Dose-Response Relationship, Radiation; Etidronic Acid; Female; Humans; Male; Middle Aged; Organometallic Compounds; Pain; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Dosage; ROC Curve; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Biokinetics and imaging characteristics of 117mSn(4+)DTPA have been studied in patients with metastatic bone pain.. Seventeen patients with bone pain due to metastasis were given three dose levels: 180 microCi/kg (6.66 MBq/kg), 229 microCi/kg (8.47 MBq/kg) and 285 microCi/kg (10.55 MBq/kg) body weight. Periodic blood and daily urine samples were collected for 14 days to measure percent injected activity retained in blood and that excreted in urine. Simultaneous anterior and posterior view whole-body images were obtained under identical scan settings at 1, 3.5 and 24 hr and on Days 3 and 7 and between 4-6 and 8-10 wk postinjection. The total body retention was calculated using the geometric mean counts.. After intravenous injection, the total body clearance of 117mSn(4+)DTPA shows two components: a soft-tissue component and a bone component. The soft-tissue component accounts for 22.4% of the dose and consists of four subcomponents with an average biologic clearance half-time of 1.45 days (range 0.1-3.2 days). The bone component accounting for the remaining 77.6% of the dose shows no biologic clearance. A mean 22.4% of the dose is excreted in urine in 14 days; 11.4% within 24 hr. The uptake pattern appears similar to that of 99mTc-MDP. Peak uptake is observed in normal bone by 24 hr and metastatic lesions by 3-7 days. Pain palliation was observed with all three doses levels.. Among the four potential bone pain palliation radionuclides, 117mSn(4+)DTPA demonstrates the highest bone uptake and retention. Some biokinetic and radionuclidic features of 117mSn(4+)DTPA are similar to other agents, but many features are different and unique and may make it an ideal bone pain palliation agent. Double-blind comparative studies are needed to determine its exact role in bone pain palliation.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Pain; Palliative Care; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We reviewed three-phase bone scans of the limbs of 7 patients suffering from limb pain suggestive of occupational repetitive strain injury (RSI) and compared them with 13 patients with limb pain due to various aetiologies. Doppler ultrasound measurement of blood flow had been performed in 13 of the 20 patients. The bone scan results showed increased blood flow and pooling (second phase) in the affected limbs of patients with RSI as compared to those with algodystrophy or non-specific limb pain (sensitivity 86%, specificity 85%). Doppler ultrasound also demonstrated increased blood flow to the affected limbs (sensitivity 83%) but failed to differentiate between the different aetiologies of pain (specificity 14%). We conclude that the blood-pool phase of three-phase bone scans can play a potential role in screening RSI patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Cumulative Trauma Disorders; Extremities; Female; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Pain; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Medronate; Ultrasonography

Pancreatic disease can be associated with polyarthritis and panniculitis in a small number of patients, and this triad constitutes PPP syndrome. Early diagnosis is critical as it has high morbidity and mortality. Panniculitis can occur in fat present anywhere in the body. Involvement of fat in bone marrow is relatively uncommon, and radiologic imaging shows osteolytic lesions involving long bones. Here we present a case of acute pancreatitis, referred to our department for evaluation of severe joint pain and multiple bone pain. Tc-MDP scan with SPECT/CT has been done, which showed medullary expansion with heterogenous tracer uptake, that is, moth-eaten appearance.

Topics: Acute Disease; Bone and Bones; Fat Necrosis; Humans; Male; Pain; Pancreatitis; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

The purpose of this study was to assess the incremental value of technetium-99m-methyl diphosphonate (Tc-MDP) single-photon emission computed tomography/computed tomography (SPECT/CT) over Tc-MDP two-phase bone scan (TPBS) in the assessment of the patients with pain following knee arthroplasty.. Tc-MDP TPBS and Tc-MDP SPECT/CT were performed in 49 patients with knee pain after knee arthroplasty. The scans were reviewed by two readers (nuclear medicine physician and musculoskeletal radiologist). Tc-MDP SPECT/CT studies were interpreted in conjunction with TPBS in this retrospective study to identify the pain generator in painful knee prosthesis. The final diagnosis was established based on a combination of histopathological/cytological findings, other imaging findings (e.g. MRI, radiolabelled white scan), clinical decisions, and management outcomes (including subsequent intraoperative findings).. In diagnosing infection or aseptic loosening, a definitive outcome regarding the presence/absence of aseptic loosening or periprosthetic infection was obtained in 41 patients. (a) Sensitivity of Tc-MDP SPECT/CT [100%; 95% confidence interval (CI): 66.4-100%] was higher than Tc-MDP TPBS (88.9%; 95% CI: 51.8-99.7%). (b) Specificity of Tc-MDP SPECT/CT (75%; 95% CI: 53.3-90.2%) was considerably higher than Tc-MDP TPBS (30%; 95% CI: 11.9-54.3%). Alternative diagnoses were identified in 21/49 (43%) patients on Tc-MDP SPECT/CT, which could not be ascertained on Tc-MDP TPBS alone.. Tc-MDP SPECT/CT has better sensitivity and specificity compared with Tc-MDP TPBS in diagnosis of aseptic loosening and periprosthestic infection in patients with painful knee arthroplasty. Tc-MDP SPECT/CT identified alternative causes of pain in 43% of patients, which was not identified by Tc-MDP TPBS.

Topics: Adult; Aged; Arthroplasty, Replacement, Knee; Female; Humans; Knee Prosthesis; Male; Pain; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

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

A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma. Tc-MDP total-body bone scintigraphy was ordered for possible other bony lesions, and only left calcaneus lesion was identified on bone scan. CT scan of the chest revealed a soft tissue mass in the superior aspect of the right lower lobe. Staging FDG PET/CT showed hypermetabolic right lung mass and left calcaneus lesion. She received chemotherapy and local radiation to the left calcaneus metastatic lesion.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Bone Neoplasms; Calcaneus; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Middle Aged; Multimodal Imaging; Pain; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The purpose of this study was to compare the diagnostic performance of SPECT/CT and MRI in patients with ankle and foot pain, with regard to the lesion types.. Fifty consecutive patients with ankle and foot pain, who underwent 99mTc-MDP SPECT/CT and MRI, were retrospectively enrolled in this study. Symptomatic lesions were determined based on clinical examination and response to treatment. On MRI and SPECT/CT, detected lesions were classified as bone, ligament/tendon, and joint lesions. Uptake on SPECT/CT was assessed using a 4-grade system. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SPECT/CT and MRI were evaluated in all detected lesions and each lesion type. Diagnostic value of uptake grade was analyzed using receiver-operating characteristics (ROC) curve analysis, and diagnostic performance was compared using Chi-square or McNemar tests.. In overall lesions, the sensitivity, PPV and NPV of SPECT/CT for symptomatic lesions were 93%, 56%, 91%, and they were 98%, 48%, 95% for MRI. There was no significant difference between SPECT/CT and MRI. However, the specificity of SPECT/CT was significantly higher than that of MRI (48% versus 24%, P = 0.016). Uptake grade on SPECT/CT was significantly higher in symptomatic lesions (P < 0.001), and its area under curve on ROC analysis was 0.787. In the analysis of each lesion type, the specificity of SPECT/CT was poor in joint lesions compared with other lesion types and MRI (P < 0.001, respectively). MRI exhibited lower specificity than SPECT/CT in bone lesions (P = 0.004) and ligament/tendon lesions (P < 0.001).. SPECT/CT has MRI-comparable diagnostic performance for symptomatic lesions in ankle and foot pain patients. SPECT/CT and MRI exhibit different diagnostic specificity in different lesion types. SPECT/CT may be used as a complementary imaging method to MRI for enhancing diagnostic specificity.

Topics: Adolescent; Adult; Aged; Ankle; Ankle Joint; Female; Foot; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pain; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Young Adult

A triple-tracer nuclear medicine study that incorporates (99m)Tc-sulfur colloid, (111)In-labeled leukocytes, and (99m)Tc-methylene diphosphonate can be useful for the diagnosis of aseptic loosening in a patient after total-knee arthroplasty, as demonstrated in this case study. The triple-tracer technique takes less time and is more accurate than a bone scan alone.

Topics: Arthroplasty, Replacement, Knee; Female; Humans; Leukocytes; Middle Aged; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Image fusion software enables technetium(99m)-methylene diphosphonate (Tc(99m)-MDP) bone scan images to be co-registered with CT scan or MRI, allowing greater anatomical discrimination. We examined the role of bone scan images co-registered with CT scan or MRI in the investigation of patients presenting with axial spinal pain and/or limb pain. One hundred and thirty-nine consecutive patients were examined, and thereafter investigated with CT scan, MRI, and/or dynamic plain films. At this point diagnosis (pathology type and anatomical site) and treatment intention were declared. The co-registered Tc(99m)-MDP bone scan images were then studied, after which diagnosis (pathology type and anatomical site) and treatment intention were re-declared. This data were then analysed to determine whether the addition of co-registered bone scan images resulted in any change in diagnosis or treatment intention. The most significant change in diagnosis was pathology type (10%). Anatomical site changed markedly without overlap of the pre and post-isotope fields in 5%, and with overlap in 10%. Treatment intention had a major change in 3.6% and minor change in 8.6%. In the two groups where there was (i) no obvious pathology after full pre-isotope investigation, or (ii) a spinal fusion under suspicion, addition of the bone scan information led to a major change in the pathology and/or anatomical localisation in 18% and 19%, respectively. The addition of co-registered Tc(99m)-MDP bone scan images offers significant diagnostic assistance, particularly in the difficult diagnostic groups where a failed spinal fusion may be the suspected pain generator, or when no pain generator can otherwise be found.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Pain; Prospective Studies; Radionuclide Imaging; Spine; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Young Adult

We report a case of posttransplant distal limb syndrome (PTDLS) representing a rare complication in kidney transplant recipients characterized by a pain syndrome of the distal extremities. A 68-year-old man with a history of kidney transplantation presented with symmetrical and incapacitating pain in the feet and knees and underwent whole-body Tc-methylene diphosphonate (MDP) scintigraphy for further evaluation. Planar scintigraphy demonstrated marked tracer uptake in the distal femoral and tibial epiphyses, and magnetic resonance imaging showed corresponding osteoedema. Tc-MDP scintigraphy is a valuable tool for evaluation of the etiology of musculoskeletal pain and may demonstrate typical findings in case of PTDLS.

Topics: Aged; Bone and Bones; Extremities; Humans; Kidney Transplantation; Male; Pain; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate

Stress injury is a common cause of exercise-induced anterior shin pain. It is important to distinguish between the various causes of stress injury in a timely manner in order to optimize favorable treatment outcomes. Here, we will discuss a case of medial tibial stress syndrome, or shin splints, as one of the causes of shin pain, as well as how to approach shin pain for a successful diagnosis.

Topics: Adolescent; Diagnosis, Differential; Female; Humans; Medial Tibial Stress Syndrome; Pain; Radionuclide Imaging; Radiopharmaceuticals; Running; Technetium Tc 99m Medronate; Tibia

The first metatarsal articulation bears one third of the weight of the forefoot. The hallucal sesamoids are embedded in the flexor hallucis brevis and connected by the intersesamoid ligament and plantar plate. The sesamoid apparatus acts as a pulley to help pull the big toe down against the ground during walking. Repetitive pressure, force, or tension can cause sesamoiditis. If the impact is great enough, the bones can break. Here we present a woman with big toe pain during walking. Our case highlights the role of 99mTc-MDP bone scan in reaching the diagnosis of hallucal sesamoiditis.

Topics: Adult; Female; Humans; Inflammation; Pain; Radionuclide Imaging; Sesamoid Bones; Technetium Tc 99m Medronate

The aim of this study was to examine the relation between pain and bone metastases in a group of patients with prostate or breast cancer that had been referred for bone scintigraphy. Whole-body bone scans, anterior and posterior views obtained with a dual detector gamma camera were studied from 101 consecutive patients who had undergone scintigraphy (600 MBq Tc-99m MDP) because of suspected bone metastatic disease. At the time of the examination, all patients were asked whether they felt any pain or had recently a trauma. This information was correlated with the classifications regarding the presence or absence of bone metastases made by a group of three experienced physicians. In patients with prostate cancer, we found metastases in 47% (18/38) of the patients with pain, but only in 12% (2/17) of the patients without pain (p = 0.01). In patients with breast cancer, on the other hand, metastases were more common in patients without pain (71%; 10/14) than in patients with pain (34%; 11/32) (p = 0.02). In conclusion, a significant relation between pain and skeletal metastases could be found in patients with prostate cancer and a reverse relation in patients with breast cancer.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Pain; Pain Measurement; Predictive Value of Tests; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Surveys and Questionnaires; Sweden; Technetium Tc 99m Medronate

Topics: Adenine; Alkynes; Anti-HIV Agents; Benzoxazines; Cyclopropanes; Deoxycytidine; Drug Therapy, Combination; Emtricitabine; Fanconi Syndrome; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Hypophosphatemia; Middle Aged; Muscle Weakness; Musculoskeletal Diseases; Organophosphonates; Osteomalacia; Pain; Radionuclide Imaging; Radiopharmaceuticals; Substance Abuse, Intravenous; Technetium Tc 99m Medronate; Tenofovir

Foot pain in pediatric patients often presents as a diagnostic challenge. Studies in adults with foot pain have shown that bone scans are valuable diagnostic tools, especially in instances in which clinical evaluation and conventional radiography have failed to provide a clear answer. To our knowledge, no similar investigation has ever been conducted in the pediatric population. The objective of this study was to determine the utility of bone scans as a diagnostic tool for children with foot pain of unclear etiology. Our secondary objective was to determine whether obtaining a bone scan, in fact, alters the treatment plan of such patients. Chart review was done, documenting the prebone scan versus post bone scan diagnosis and treatment plans. We found that bone scans were diagnostically useful in 38 of 49 [77.6%, 66-87, 90% confidence interval (CI)] cases, helping to establish new diagnoses in 31 of 49 (63%, 51-75, 90% CI) cases, and directing the treatment of children with clinically unclear foot pain in 31 of 49 (63%, 51-75, 90% CI) cases. We conclude that children between the age of 2 and 11 years who present with unilateral or bilateral foot pain of unclear clinical etiology, with a normal or inconclusive radiograph and physical examination, and who had no previous magnetic resonance imaging and/or computed tomography scan, may benefit from the use of a bone scan to guide diagnosis and treatment.

Topics: Bone and Bones; Child; Child, Preschool; Female; Foot Diseases; Humans; Male; Pain; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Melorheostosis is an uncommon and rare linear hyperostosis, which can be complicated by soft tissue changes. We present a case of this disorder in the humerus, clinically referred because of carpal tunnel syndrome. Although treatment is usually conservative, in this case, a neurolysis and resection of the sclerotic bone were done with good clinical result.

Topics: Adult; Carpal Tunnel Syndrome; Decompression, Surgical; Denervation; Diagnosis, Differential; Electrodiagnosis; Female; Humans; Humerus; Magnetic Resonance Imaging; Melorheostosis; Osteotomy; Pain; Radiopharmaceuticals; Range of Motion, Articular; Rare Diseases; Technetium Tc 99m Medronate; Treatment Outcome

Quantitative bone SPECT studies have several advantages over qualitative studies for evaluating a temporomandibular joint (TMJ), yet in certain cases additional images are still needed. Accordingly, the current study developed a new easy SPECT quantification method for the bone tracer uptake in a TMJ and evaluated its usefulness and inter-observer variability in patients with TMJ pain.. Sixty-six adult patients (11 males, 55 females) with a mean age of 31 years (range 22-79 years) suffering from TMJ pain were questioned regarding the history of their condition, and then subjected to an oromaxillofacial examination and bone SPECT. New quantitative data for TMJs (TMJ index) were calculated from a formula using TMJ and skull counts.. TMJs with spontaneous pain had higher TMJ indices than those without spontaneous pain (8.87 vs. 6.87, P = 0.032). TMJs with mouth-opening pain or palpatory pain also exhibited higher TMJ indices than those without such pains, although the differences were not statistically significant. Positive TMJs, according to a visual SPECT interpretation, had much higher TMJ indices than the negative ones (8.99 vs. 5.37, P < 0.001). The reference skull count, mean TMJ count and TMJ index obtained using the proposed TMJ quantification method demonstrated an excellent correlation based on two independent observers (r = 0.996, r = 0.993 and r = 0.989, respectively; P < 0.001).. The current results indicate that the proposed quantitative TMJ bone SPECT is easy to perform, plus the resulting TMJ index has a lower inter-observer variability, making it an effective TMJ evaluation method for patients with painful TMJs, and especially useful for serial studies.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Observer Variation; Pain; Radioactive Tracers; Reproducibility of Results; Skull; Technetium Tc 99m Medronate; Temporomandibular Joint; Temporomandibular Joint Disorders; Tomography, Emission-Computed, Single-Photon; Young Adult

Chronic pain is one of the most frequent and distressing symptoms in patients suffering from bone metastases due to malignant disease. Besides pharmacological therapy using analgesics according to the WHO scheme and local surgical or radiotherapeutic treatment options, systemic radionuclide therapy is available, particularly for patients with multilocular metastatic disease. This palliative pain treatment is almost free of severe side effects and is thus indicated as a complementary therapy as part of an interdisciplinary approach in pain treatment. Moreover, preliminary data indicate a favorable cost:utility ratio. Positive clinical effects with marked reduction of pain are described in 70-80% of patients with breast or prostate cancer. However, complete analgesia is uncommon and, thus, most patients require analgesic treatment during the further course of their disease.

Topics: Aged; Bone Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Neoplasms; Pain; Prostatic Neoplasms; Radiography; Radioisotopes; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Cysts, Aneurysmal; Bone Neoplasms; Bone Transplantation; Chondroblastoma; Diagnosis, Differential; Femur; Hip; Humans; Magnetic Resonance Imaging; Male; Pain; Radiopharmaceuticals; Synovitis, Pigmented Villonodular; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome; Whole Body Imaging

The role of whole-body Tc-MDP bone scanning in the management of vertebral compression fractures with kyphoplasty has not been clearly established.. To determine the accuracy of bone scanning in patient selection, planning treatment and predicting response to kyphoplasty.. Retrospective chart reviews were undertaken of all kyphoplasties performed by the same orthopaedic surgeon between June 2000 and June 2004. All patients who underwent plain radiographs (X-ray) of the spine and bone scanning within 4 weeks of treatment were included. Response to treatment was assessed via a questionnaire administered to the patient 3 weeks after intervention and concomitant objective assessment. Response was graded as excellent, intermediate or poor. Each bone scan was reviewed by two nuclear physicians blinded to the initial scan results, level of treatment and therapeutic response. The readers were asked to indicate the level(s) to be treated according to the bone scan findings. Sites of chronic fractures were also recorded.. Sixty-six procedures on 60 patients fulfilled the selection criteria. Fifty-three patients were managed by X-ray and bone scanning (A) and seven were managed by X-ray only (B). There was a significant difference in the rates of sub-optimal results between (A) and (B) (11/53 vs. 7/7, P=0.0001). There was also a significant difference in chronic fracture rates between patients with excellent outcome and those with sub-optimal results (3/42 vs. 7/11, P=0.0002). A high rate of incorrect level selection (3/7) was found in (B). In 12 patients (20%) X-ray showed multiple fractures but the bone scanning demonstrated only one level of acute disease.. Bone scanning is an excellent predictor of response to kyphoplasty and decreases the number of vertebrae to be treated as suggested by X-ray. Preoperative bone scanning is recommended to avoid incorrect selection of treatment level. Even when the appropriate level has been selected an incomplete response can be expected if additional chronic fracture is seen on bone scanning. In the event of unexpected incomplete response, re-evaluation with bone scanning may demonstrate new disease amenable to therapy.

Topics: Aged; Female; Fractures, Compression; Humans; Male; Outcome Assessment, Health Care; Pain; Prognosis; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Vertebroplasty

Plantar fasciitis is a common cause of foot pain and may be disabling. Although localized injection is painful, anesthetics or corticosteroids can relieve symptoms well. Bone scintigraphy can confirm the diagnosis. We hypothesized that blood-pool abnormalities could provide prognostic information on the response to such injections.. We devised scintigraphic criteria that graded the blood-pool abnormalities as being localized to the plantar enthesis, being localized to half the length of the aponeurosis, or involving the whole aponeurosis. We evaluated 24 patients with an established diagnosis of plantar fasciitis, 8 of whom had bilateral disease, leading to a total of 32 feet injected.. After injection, pain was relieved either completely or nearly completely in 20 feet. The other 12 feet had short-term or no improvement, with persistent pain and loss of function at 4-5 wk after injection. Of the 20 feet responding to injection, 14 had focal hyperemia on blood-pool images and 6 had minimal extension into the proximal third of the plantar soft tissues. No patient with diffuse hyperemia in the plantar fascia had a response (5/12 feet). On the delayed images of the 20 responders, mild inferior calcaneal uptake was seen in 8 feet, moderate uptake in 6, and severe uptake in 6. These groups did not significantly differ (P > 0.05). The blood-pool studies had good reproducibility, with a kappa-value of 0.64.. Critical evaluation of plantar blood-pool images provides prognostic information on the response to localized injection into the enthesis. Reporting such studies is simple and reproducible.

Topics: Adult; Anesthetics, Local; Anti-Inflammatory Agents; Bone and Bones; Bupivacaine; Cadaver; Drug Therapy, Combination; Fasciitis, Plantar; Female; Foot; Humans; Hyperemia; Injections; Male; Methylprednisolone; Middle Aged; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome

A bone island represents a focus of mature compact bone within the cancellous bone, and it can be diagnosed based on characteristic clinical and radiologic features. The lesion is typically asymptomatic with a preference for the pelvis, femur, and other long bones. On radiographs, the lesion appears as an ovoid, round or oblong homogeneously dense and sclerotic focus in the cancellous bone. The characteristic features of this lesion are radiating bony streaks, known as thorny radiations or pseudopodia. Most bone islands are small, and the majority of these lesions measure from 0.1 to 2.0 cm. A giant bone island, defined as having a diameter greater than 2 cm, has been rarely reported in the English-language literature. We report here on a case of a giant bone island that measured 10 x 1.7 x 1 cm in the diaphysis of the right tibia in a 31-year-old man who complained of right lower leg pain for 3 weeks.

Topics: Adult; Biopsy; Bone Diseases; Curettage; Diagnosis, Differential; Diaphyses; Humans; Leg Injuries; Magnetic Resonance Imaging; Male; Pain; Pain Management; Radiographic Image Enhancement; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Technetium Tc 99m Medronate; Tibia

Topics: Erdheim-Chester Disease; Humans; Leg Bones; Male; Middle Aged; Pain; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The most common cause of recurring childhood musculoskeletal pain is termed "growing pains" (GP). The etiology and pathogenesis are unknown. There is an increased prevalence of migraine headaches in families with children with GP. This fact, and the sudden onset and severity of GP episodes, has led to speculation that GP may have a vascular component. Therefore, we investigated whether GP are associated with vascular perfusion changes, measured by technetium-99 methylene diphosphate (MDP) bone scintigraphy. Eleven patients with GP who underwent technetium-99 MDP bone scans were compared to 12 children who underwent bone scans for other indications. The uptake in the blood pool phase, static images, and blood pool phase/static image ratio were measured in the right mid-tibia region (painful among patients with GP) and right mid-femur (non-painful). Student's t-test was used to compare these measurements at painful and painless regions among GP children, and to compare children with or without GP. There were no significant differences between children with GP and without GP in the blood pool, static images, and blood pool/static images in all localities. There were also no significant differences among patients with GP between painful regions and non-painful regions. We conclude that GP are not associated with vascular perfusion changes in painful regions as opposed to migraine headaches.

Topics: Adolescent; Body Height; Bone and Bones; Case-Control Studies; Child; Child, Preschool; Cohort Studies; Female; Growth; Humans; Male; Pain; Probability; Radionuclide Imaging; Reference Values; Regional Blood Flow; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Adult; Anaphylaxis; Angioedema; Diagnosis, Differential; Drug Hypersensitivity; Female; Humans; Incidental Findings; Lidocaine; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Diagnosis, Differential; Fibula; Fractures, Stress; Humans; Male; Myositis Ossificans; Pain; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ultrasonography

Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.

Topics: Adenoma; Bone and Bones; Fatal Outcome; Female; Humans; Hyperparathyroidism; Middle Aged; Pain; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Arthritis; Bone and Bones; Female; Follow-Up Studies; Humans; Male; Middle Aged; Musculoskeletal Diseases; Pain; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Adult; Clavicle; Employee Discipline; Humans; Male; Military Personnel; Muscle, Skeletal; Pain; Physical Exertion; Punishment; Radionuclide Imaging; Radiopharmaceuticals; Renal Insufficiency; Rhabdomyolysis; Technetium Tc 99m Medronate; Thigh; Tissue Distribution; Whole-Body Counting

Pulmonary involvement secondary to Waldenstrom's macroglobulinemia (WMG) is described in a 40-year-old male by incidental findings on a bone scan. He was examined for right leg pain, and bone scan revealed unexpected pulmonary uptake of Tc-99m MDP. CT scan of the thorax revealed pleural effusion and slightly disseminated micronoduler density increase in the right lung and parenchymal infiltration in the left lung. Transdermal lung biopsy demonstrated diffuse infiltration of lymphoplasmocytoids. Reporting the presence of pulmonary involvement is important because it may prevent morbidity from pulmonary dysfunction.

Topics: Adult; Bone and Bones; Humans; Incidental Findings; Leg; Lung; Lung Diseases; Male; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Waldenstrom Macroglobulinemia; Whole-Body Counting

A 17-year-old woman presented with pain over the sacral region. Plain radiographs of the sacrum demonstrated a bony deformity of the sacrococcygeal region in the shape of a scimitar. Magnetic resonance imaging showed a cystic mass of the presacral region which appeared to be continuous with the dural sac. An anteroposterior view myelogram revealed caudal elongation of the dural sac, and on the lateral view it was recognized as an anterior meningocele. At surgery, we confirmed a connection between the presacral mass and the rectum. In light of the combination of a sacral bony deformity, presacral mass including meningocele, and mass-rectum connection, we made the diagnosis of the Currarino triad, which is a rare complex of congenital caudal anomalies. The patient underwent excision of the presacral mass. Histologic examination of the resected specimen revealed features of an epidermoid cyst.

Topics: Abnormalities, Multiple; Adolescent; Anal Canal; Contrast Media; Epidermal Cyst; Female; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Meningocele; Myelography; Pain; Sacrum; Staphylococcal Infections; Syndrome; 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

The incidence of bone metastases in soft tissue sarcoma (STS) patients seems to be low but has not been studied separately. In this study, the authors aimed to determine the value of routine radionuclide bone scanning in preoperative staging of STS patients.. Preoperative bone scans were evaluated retrospectively in 109 consecutive patients (median age, 44 years; range, 1-86) with intermediate or high grade STS. Scans were scored in 3 categories: 1, metastases very likely; 2, equivocal; and 3, normal or benign lesions.. Category 1 scans were found in 8 of 109 patients (7%); in all 8 patients, bone metastases were confirmed. Six of these eight patients reported pain, and all had additional lung, bone marrow, or lymph node metastases. The highest rate (17%) was found in the rhabdomyosarcoma subgroup (n = 18). Category 2 (equivocal) scans were present in 12 of 109 patients (11%), in all of which bone metastases were excluded through additional investigations. Category 3 (normal) scans were found in 81%. Bone metastases were at least as frequent as lung metastases (4%) and were the single site of systemic disease in 4%. The rate of bone metastases was 55% in patients with bone pain versus 2% in patients without pain.. Bone metastases in primary STS patients are rare (7%) yet in this study at least as frequent as lung metastases. The low rate in asymptomatic patients versus the high rate in symptomatic patients supports the use of bone scanning in symptomatic patients only. The yield of routine bone scanning is low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Pain; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Rhabdomyosarcoma; Sarcoma; Technetium Tc 99m Medronate

A 59-year-old man with prostate cancer and pain from multiple bone metastases was treated with 1,424 MBq (38.5 mCi) rhenium-186 hydroxyethylidene diphosphonate (Re-186 HEDP). In addition, he had nonsteroidal antiandrogen, progestagen, and an analog-luteinizing hormone. Neither chemotherapy nor external-beam radiotherapy was administered. Bisphosponate therapy was stopped 4 weeks before the administration of Re-186 HEDP. The Tc-99m HMDP whole-body scan obtained 6 weeks after therapy showed the same results as before therapy. However, 1 year after therapy, a significant reduction of the mass of the metastases was visible on bone scan. The bone scan index decreased from 34 before therapy to 10 after 1 year. The patient described significant pain relief and stopped his analgesic intake 3 weeks after therapy.

Topics: Bone Neoplasms; Etidronic Acid; Humans; Male; Middle Aged; Organometallic Compounds; Pain; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone and Bones; Humans; Male; Osteitis; Pain; Pubic Bone; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Varicocele

Topics: Adult; Bone Remodeling; Female; Fractures, Bone; Humans; Pain; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Tarsal Bones; Technetium Tc 99m Medronate

A 26-year-old man with a previous history of external twin bursitis was remitted to our Department for a bone scintigraphy. Before the study, the patient performed an elevated number of intense sprints. Bone scintigraphy showed a bilaterally increased activity in both anterior rectum muscles suggesting rhabdomyolysis. Biochemical studies and MRT confirmed the diagnosis.

Topics: Adult; Bone and Bones; Humans; Joint Diseases; Magnetic Resonance Imaging; Male; Muscular Diseases; Pain; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyolysis; Running; Technetium Tc 99m Medronate

Adult-onset Still's disease (AOSD) is an acute systemic inflammatory disorder of unknown origin. We report a patient whose AOSD presented with the commonly accepted diagnostic clinical signs and laboratory parameters. The painful joints distinctly demonstrated increased uptake of 99mTc-methylene diphosphonate in scintigraphy and areas of increased gadolinium-enhanced signal in MRI. Biopsies indicated bone marrow edema. AOSD in association with bone marrow edema had not been previously demonstrated. AOSD is often diagnosed after a considerable delay, bone scintigraphy, and magnetic resonance imaging may offer new imaging techniques for early diagnosis and successful therapy in follow-up examinations.

Topics: Adult; Bone and Bones; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Pain; Radionuclide Imaging; Radiopharmaceuticals; Still's Disease, Adult-Onset; Technetium Tc 99m Medronate; Tissue Distribution

A 78-year-old patient with prostate cancer and osseous metastases had a pain symptomatic. In the Urology he was treated with antiandrogenes. The outcome of the bone scintigraphy showed a super bone scan with normalization after antiandrogene-therapy which seemed to be a sign of remission, before he showed a progressive form with multiple osseous metastases. Pain could not be treated with non steroidal antiphlogistics and opiates, so the indication for treatment with Rhenium-186-HEDP was given in this case.

Topics: Aged; Androgen Antagonists; Bone Neoplasms; Disease Progression; Follow-Up Studies; Humans; Male; Pain; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

Bone scintigraphy is requested as part of the investigation of foot pain, but its contribution to clinical management has not been comprehensively documented. Previously published data are limited; the most comprehensive series identified scintigraphic abnormalities in patients with primarily orthopaedic problems and a control group was not included (Maurice HD et al. J Bone Joint Surg 1987;69B:448 52). The aim of this study was to evaluate whether bone scintigraphy may be useful in different clinical circumstances indicated by referral request details. Regions of scintigraphic abnormality were scored and compared with clinical details drawn from case notes of 60 patients with foot pain. The commonest clinical indications for scans were: confirmation of the clinical suspicion of plantar fasciitis, documentation of the extent of inflammatory arthritis and location of focal pathology. A group of 30 asymptomatic, age- and sex-matched controls were also studied. In 14 out of 19 symptomatic feet in the plantar fasciitis group, focal uptake at the medial calcaneal tubercle was present, confirming the diagnosis. In patients with non-specific, diffuse foot pain, the bone scan identified focal abnormalities in 11 out of 14 cases, thus directing the clinician to the site of pathology. Scintigraphy also proved useful in mapping local inflammatory disease. Technetium-99m methylene diphosphonate image abnormalities occurred in the control group most commonly in the midfoot (16 regions in 13 subjects) and first metatarsophalangeal joint (19 regions in 14 subjects).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthritis; Bone and Bones; Female; Foot Diseases; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Organ and tissue uptake and retention of Sn-117m(4+)DTPA were studied in a human subject treated for metastatic bone pain, and the results were compared with the biodistribution studies in five normal mice. The explanted organs from a patient who received a therapy dose of 18.6 mCi (688.2 MBq) Sn-117m(4+)DTPA and who died 47 days later were imaged with a gamma-camera, and tissue samples were counted and also autoradiographed. Bone, muscle, liver, fat, lungs, kidneys, spleen, heart and pancreas tissue samples were assayed in a well counter for radioactivity. Regions of interest were drawn over bone and major organs to calculate and quantify clearance times using three in vivo Sn-117m(4+)DTPA whole-body scintigrams acquired at 1, 24 and 168 h after injection. Five normal mice injected with the same batch of Sn-117m(4+)DTPA as used for the human subject were sacrificed at 24 h, and tissue samples were collected and assayed for radioactivity for comparison with the human data. For the human subject, whole-body retention at 47 days postinjection was 81% of the injected dose, and the rest (19%) was excreted in urine. Of the whole-body retained activity at 47 days, 82.4% was in bone, 7.8% in the muscle and 1.5% in the liver, and the rest was distributed among other tissues. Gamma-ray scintigrams and electron autoradiographs of coronal slices of the thoracolumbar vertebral body showed heterogeneous metastatic involvement with normal bone between metastatic lesions. There was nonuniform distribution of radioactivity even within a single vertebral body, indicating normal bone between metastatic lesions. Lesion-to-nonlesion ratios ranged from 3 to 5. However, the osteoid-to-marrow cavity deposition ratio, from the microautoradiographs, was 11:1. The peak uptake in the human bone was seen at 137 h with no biological clearance. Soft tissues showed peak uptake at 1 h and exhibited three compartmental clearance components. Whole-body retention in normal mice was 38.7% of the injected dose at 24 h and the rest was excreted. At 24 h postinjection, bone in mice showed 84.2% of the whole-body retention, muscle 1.7% and liver 1.4%, and the rest was distributed in other soft tissues. Percent distribution of the retained dose among bone, muscle, liver and other soft tissues is very similar between mice and a human subject. To calculate precise radiation absorbed doses from bone pain palliation radionuclides, it is necessary to take into account soft-tissue uptake and retention

Topics: Adenocarcinoma; Animals; Bone Neoplasms; Humans; Kidney; Liver; Male; Mice; Mice, Inbred BALB C; Middle Aged; Pain; Pentetic Acid; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tin Radioisotopes; Tissue Distribution; Urinary Bladder

We describe a new technique, known as coregistration imaging, which superimposes 99mTc isotope bone scans on to plain radiographs. We used the technique selectively in cases in which the nuclear medicine physician, who reported the isotope scan, had difficulty in localising the anatomical site of the abnormality. In the forefoot, coregistration of isotope scans did not help to localise pathology; the scan alone gave sufficient detail. In 17 patients with pain in the hind- and midfoot, isotope scanning identified eight sites of abnormality in those with normal radiographs. In those with more than one abnormality on plain radiographs the isotope scan eliminated 12 sites of suspicion. Coregistration of the images significantly increased the certainty of localisation of disease (p < 0.001). We recommend the selective use of coregistration scanning as a useful technique for investigating patients with pain in the foot and ankle.

Topics: Female; Foot Bones; Humans; Image Processing, Computer-Assisted; Middle Aged; Pain; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We report an interesting case of osteomalacia in which flare response was seen during therapy. The first 99mTc-methylene diphosphonate bone scan showed increased bilateral and symmetric uptake in the ribs, clavicles and iliac bones. Thoracic CT showed symmetric radiolucent seams (Looser's zones) in both ribs, which were pathognomonic of osteomalacia. After initiation of therapy with vitamin D, the patient's subjective symptoms gradually were relieved. On a second bone scan 4 mo. after initiation of therapy, the hot spots in the ribs remained unchanged. Uptake in the bilateral clavicles had become more intense, and new hot spots were recognized in the right lower ribs and left tibia. A third bone scan after 10 mo. demonstrated an obvious decrease in the number and intensity of the hot spots. Increased uptakes in the second scan were thought to be a flare response caused by therapy.

Topics: Aged; Bone and Bones; Follow-Up Studies; Gastrectomy; Humans; Malabsorption Syndromes; Male; Osteomalacia; Pain; Radionuclide Imaging; Radiopharmaceuticals; Stomach Neoplasms; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed; Vitamin D

Takayasu's arteritis (TA) is a vasculitis of large and medium sized arteries. Involvement of bone in TA is very rare. We report a case of young woman who presented with multiple painful bone lesions which were identified as periostitis with new bone formation associated with TA. Our case is unique in that bony involvement in TA could occur independent of vascular stenosis.

Topics: Adult; Female; Forearm; Humans; Leg; Pain; Periostitis; Radionuclide Imaging; Radius; Takayasu Arteritis; Technetium Tc 99m Medronate; Tibia; Ulna

Lutetium-177 (177Lu) has both beta particle emissions for a therapeutic effect and gamma emissions for imaging. This study was undertaken to synthesize and evaluate 177Lu-EDTMP (ethylenediaminetetramethylene phosphonic acid) as a therapeutic radiopharmaceutical for the palliation of pain from bone metastases. Chelation of 177Lu to EDTMP was obtained by heating for 30 min in boiling water at pH 8.8, resulting in a radiochemical yield of over 99%. The compound was stable for 20 days without any appreciable dissociation. Biodistribution studies in normal rats indicated selective bone accumulation, showing faster blood clearance, higher bone uptake and higher bone-to-soft tissue ratios than 99Tcm-MDP. In conclusion, 177Lu-EDTMP has favourable biological and physical characteristics for the palliative treatment of painful bone metastases.

Topics: Animals; Beta Particles; Bone and Bones; Bone Neoplasms; Femur; Gamma Rays; Humans; Lutetium; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Radiopharmaceuticals; Rats; Rats, Wistar; Technetium Tc 99m Medronate; Time Factors; Tissue Distribution

I present 10 cases of spongious bone injury of the femoral head induced by physical stress. All patients were young military recruits who complained of hip pain from weight bearing which had started during physical exertion. Increased uptake in a radionuclide bone scan was regarded as the criterion for stress osteopathy. 7 hips were radiographically normal. In 3 cases a subcortical lateral cystic lesion of the femoral head was observed. MRI was performed in 6 cases. A decreased signal intensity in T1-weighted images in 5 cases and high signals in T2-weighted and IR signals (2 patients) indicated bone marrow edema. A lateral osteophyte of the femoral head developed in 1 case during 8 years' follow-up. After a median of 6 years, 9 patients still had occasional slight hip pain.

Topics: Adult; Femur Head; Follow-Up Studies; Fractures, Stress; Hip Fractures; Humans; Magnetic Resonance Imaging; Male; Military Personnel; Pain; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Weight-Bearing

There is no consensus on the optimum mode of imaging in patients with painful shoulder lesions. There is a particular paucity of scintigraphic data. As a result, the strengths and weaknesses of scintigraphy cannot be adequately compared to other imaging techniques used in shoulder imaging. This study evaluated whether specific patterns of scintigraphic abnormality could be detected in patients with painful shoulders seen in rheumatological practice using 99mTc-methylene diphosphonate (MDP).. Scintigraphic abnormalities were recorded in consecutive patients presenting to a rheumatology clinic with unilateral shoulder pain. Patients were subdivided according to patterns of clinical abnormality consistent with a working diagnosis of a lesion located in the subacromial region, adhesive capsulitis (frozen shoulder) or a lesion likely to be located in the glenohumeral joint. Patterns of radiopharmaceutical distribution in different regions of the shoulder were evaluated in the light of clinical data and the results of shoulder radiographs.. Technetium-99m-MDP scans were abnormal in 19 of 24 (79%) patients, and radiographs were abnormal in 8 of 24 (33%) patients. Distinct patterns of 99mTc-MDP image abnormality were identified: an increase in 99mTc-MDP uptake in the coracoid, acromion and medial humeral head on anterior planar images, together with an absence of posterior planar image abnormality, frequently occurred in association with a working diagnosis of a lesion located in the subacromial region. Posterior planar 99mTc-MDP image abnormalities always occurred in patients with clinical features consistent with a diagnosis of adhesive capsulitis. There was an 85% agreement between two observers' scores when 99mTc-MDP distribution in specific shoulder regions was graded.. Distinct patterns of 99mTc-MDP distribution may be associated with clinically-distinct patterns of abnormality in patients with painful shoulder lesions. Further studies to elucidate a role for 99mTc-MDP scintigraphy in this patient group are warranted.

Topics: Humans; Joint Diseases; Pain; Radionuclide Imaging; Radiopharmaceuticals; Shoulder Joint; Technetium Tc 99m Medronate

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Remission Induction; Strontium Radioisotopes; Technetium Tc 99m Medronate; Terminal Care; Thyroid Neoplasms

Topics: Abdominal Muscles; Adolescent; Chronic Disease; Cumulative Trauma Disorders; Humans; Leg; Male; Martial Arts; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone scintigraphy was performed in a 69-year-old male patient with adult T-cell leukemia suffering from right lower limb pain. Numerous sites of increased uptake were seen in the skull, left clavicle, bilateral humeri, bilateral radii and right femur and tibia. Bone radiographs showed multiple osteolytic lesions, most of which corresponded to the abnormal deposits on the bone scans with 740 MBq of 99mTc-hydroxymethylene diphosphonate. This pattern is rarely reported, but bone involvement of adult T-cell leukemia is not uncommon. Bone involvement was remarkable on the appendicular skeleton when compared with common metastatic bone tumors. Bone scintigraphy may be useful in detecting bone involvement in adult T-cell leukemia.

Topics: Aged; Bone and Bones; Humans; Leukemia, T-Cell; Male; Osteolysis; Pain; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution; Tomography, Emission-Computed

The three-phase bone scan is finding increasing utility in acute and chronic pain syndromes in sports medicine settings. This useful technique may have significant clinical application in assessing the increasing numbers of patients with exercise induced lower leg or medial tibial pain. The authors present a case of exertional lower leg pain or medial tibial pain in which three-phase bone imaging exhibited a dramatic increase in early flow after a simple derived exercise stress. The three-phase bone scan should play a key role in the assessment of exercise pain, and may be enhanced by the addition of simple exercise intervention.

Topics: Adult; Anterior Compartment Syndrome; Bone and Bones; Cumulative Trauma Disorders; Exercise; Exercise Test; Humans; Male; Pain; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate; Tibia

Sarcoidosis is rarely recognized as an osseous manifestations alone. Patients with osseous involvement usually have a chronic multivisceral form of the disease. The authors report a case of osseous sarcoidosis without other visceral involvement. A bone scan was requested to evaluate the extent of the bone involvement and explore buttocks pain.

Topics: Arthralgia; Bone Diseases; Buttocks; Chronic Disease; Foot Diseases; Hand; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Sacroiliac Joint; Sarcoidosis; Technetium Tc 99m Medronate

The aim of this study was to clarify the clinical role of bone single photon emission tomography (SPET) of the lumbar spine in young persons with persistent lumbar pain which might be due to spondylolysis. Thirty-one bone SPET studies were performed on 25 patients (19 males, 6 females) aged 7-26 years (average 15.6 years) who had suffered lumbar pain associated with physical activity, and who were suspected of having spondylolysis. Planar and SPET images of the lumbar spine were obtained 2-3 h following the injection of 99Tc(m)-methylene diphosphonate using a single-head rotating gamma camera. The findings on the bone scintigram were compared with those on the radiograph. Bone scintigraphy at presentation was positive in only 7 of 15 sites of the pars interarticularis defects demonstrated on plain radiographs. On the other hand, seven sites of the pars interarticularis which were normal on the radiograph were positive on bone SPET. As clinical symptoms improved after immobilization using a lumbar corset, bone SPET tended to revert towards normal. The planar image was abnormal in only 8 (42%) of the 19 abnormal sites on the SPET image. A bone SPET study is indicated in patients who are negative on radiological tests and who are still suspected of having spondylolysis. If SPET is positive in these patients, the increased bone uptake is most likely suggestive of a state of 'stress reaction', and may be a good indicator for patient management. If negative, further radiological examinations will be required for proper assessment of the origin of lumbar pain.

Topics: Adolescent; Adult; Child; Female; Gamma Cameras; Humans; Lumbar Vertebrae; Male; Pain; Radiography; Spondylolysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Our purpose was to assess the role of MRI in evaluating the musculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the pubic ring was performed in 11 young athletes (soccer players) with long-standing groin pain. MR findings were compared with plain films and isotope examination (bone scan Tc 99M). Abnormal MRI findings included a broadened and irregular symphysis with a characteristic pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior pubic ramus at a distance from the symphysis. Positive findings were also observed on plain films and on nuclear medicine studies. However, the imaging findings in the superior public ramus of the symphysis was located considerably more laterally on MRI. MRI is a valuable method for evaluating discrete and ambiguous pelvic pain in athletes, particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing pain localized laterally in the groin.

Topics: Adolescent; Adult; Bone Diseases; Chronic Disease; Humans; Inguinal Canal; Joint Diseases; Ligaments; Magnetic Resonance Imaging; Male; Pain; Pelvic Bones; Pubic Bone; Pubic Symphysis; Radiography; Radionuclide Imaging; Soccer; Technetium Tc 99m Medronate

A series of plain radiographs, bone scans, bone marrow scans, and MRIs is reported in a patient with Gaucher disease type I, in whom two episodes of acute bone crisis developed during a 6-year period of follow-up. Acute bone crisis and global indolent bone marrow displacement could both be assessed by bone marrow scintigraphy, whereas MRI could better clarify the corti-comedullary alteration after bone infarction. Thus, MRI and bone marrow scintigraphy could be used as complementary imaging methods in the management of patients with Gaucher disease.

Topics: Acute Disease; Adult; Biopsy; Bone and Bones; Bone Diseases; Bone Marrow; Diagnostic Imaging; Follow-Up Studies; Gaucher Disease; Humans; Infarction; Magnetic Resonance Imaging; Male; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

This study compares the bone scan appearances in 32 patients with medial tibial syndrome (MTS) with the appearance in 28 patients with confirmed chronic compartment syndrome (CCS). A distinctive pattern of uptake was seen in 30 patients, 24 of whom had MTS and 6 of whom had CCS. Of the patients with normal scans, only 4 had MTS, the remaining 15 had CCS. Both of these findings are statistically significant and confirm that bone scans are a useful diagnostic tool in the differential diagnosis of exercise-induced lower leg pain.

Topics: Adult; Anterior Compartment Syndrome; Athletic Injuries; Diagnosis, Differential; Exercise; Female; Fractures, Stress; Humans; Male; Pain; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate; Tibia

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

In patients affected by unbearable pain secondary to peripheral vascular disorders beyond surgical repair such as thromboangitis obliterans, diabetic microangiopathy, arteriosclerosis obliterans, there is a need to establish the degree of micro-circulation functionality before proceeding with invasive pain therapy, such as Spinal Cord Stimulation (SCS). From our series some cases of refractory ischaemic pain subjected to nuclear medicine techniques assessment before and after SCS implant will be presented; these data suggest that the use of radionuclides for quantifying regional perfusion, in view of the information it offers us both in the dynamic angiographic phase and in the later static phase, constitutes a very valid aid in the diagnosis and treatment of chronic pain conditions of ischaemic origin. Cutaneous, musculoskeletal and bone flow scintiscan is a non-invasive procedure which allowed us to make an objective selection of patients who are candidates for prolonged conservative treatment thus limiting the incidence of ineffective permanent SCS implants.

Topics: Adult; Aged; Bone and Bones; Electric Stimulation Therapy; Female; Humans; Infusions, Intravenous; Ischemia; Male; Middle Aged; Muscles; Pain; Pain Management; Peripheral Vascular Diseases; Radionuclide Imaging; Regional Blood Flow; Skin; Spinal Cord; Technetium Tc 99m Medronate

Seventy-one athletes with 74 stress injuries to the femur were studied using a case-controlled design. Forty-three were females (26.6 yrs) and 28 were males (31.2 yrs). Each patient had exercise-induced pain in the hip, groin or thigh and a Tec-99m-MDP bone scan showing focal uptake of radionuclide in the femur. Running was the most common activity at the time of injury (89.2%) followed by triathlon (4.6%) and aerobic dance (4.6%). Thirty per cent of the runners had increased their training duration immediately prior to their first symptom. Anterior thigh pain was the most frequent site of exercise-induced pain (45.9%) followed by hip pain (27%) and groin pain (8.1%). During the clinical examination, when asked to hop on the affected limb, 70.3% of the patients had pain reproduced in the hip, groin or anterior thigh. There were 39 cases (53%) involving focal uptake of radionuclide in the femoral shaft, 15 (20%) in the lesser trochanter, 11 (15%) in the intertrochanteric region between the femoral neck and the greater trochanter, 8 (11%) in the femoral neck and 1 (1%) in the greater trochanter. Two patients suffered displaced fractures, one at the femoral neck and the other in the shaft of the femur. Neither patient had previously sought medical attention for their leg pain. Of 46 plain radiographs taken, only 11 (24%) were abnormal. The mean time to diagnosis and recovery were 6.6 and 10.4 weeks respectively. Substitution of cycling and water exercise for running were the most common therapeutic interventions.

Topics: Adult; Case-Control Studies; Female; Femoral Fractures; Femoral Neck Fractures; Femur; Femur Neck; Follow-Up Studies; Fracture Healing; Fractures, Stress; Gait; Humans; Male; Pain; Radiography; Radionuclide Imaging; Running; Technetium Tc 99m Medronate

We reviewed the plain radiographs, bone scans and hip aspiration results of 54 patients with painful hip arthroplasties which had been explored surgically, to compare the results of the investigations with the operative findings. For acetabular loosening, the sensitivity and specificity of bone scanning were 87% and 95%, with an accuracy of 90%: for serial plain radiography sensitivity was 95%, specificity 100% and accuracy 97%. For femoral component loosening, bone scan sensitivity was 85%, specificity 100% and accuracy 89%: the sensitivity of plain radiography was 100%, with specificity 92% and accuracy 98%. Technetium bone scanning did not provide additional information with regard to loosening and is not necessary in the routine investigation of a painful hip arthroplasty. Serial pain radiography is the most effective method of detecting loosening, and bone scanning is useful only when radiography is inconclusive with regard to loosening or infection.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Diagnosis, Differential; Evaluation Studies as Topic; Female; Hip Prosthesis; Humans; Male; Middle Aged; Pain; Prosthesis Failure; Prosthesis-Related Infections; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Severity of Illness Index; Suction; Technetium Tc 99m Medronate

Patients (n = 181) with the irritable hip syndrome were reviewed. Four of these were found to have Perthes disease and 3 cases had septic arthritis. Ultrasonography provides accurate information as to the presence or absence of an effusion in children with an irritable hip syndrome. The likelihood of a positive result is higher in the early course of the disease process (i.e. within 3 days). Bone scanning, if done routinely will help in the early diagnosis of Perthes disease. Recurrence of the symptoms occurred in 18% of patients and most of them were within 12 months of the first onset of symptoms.

Topics: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Hip Joint; Humans; Infant; Joint Diseases; Legg-Calve-Perthes Disease; Male; Pain; Radionuclide Imaging; Recurrence; Retrospective Studies; Syndrome; Technetium Tc 99m Medronate; Ultrasonography

The possible contribution of an inflammatory component in osteoarthritis was investigated. There was no correlation between the percentage uptakes of 99Tcm-hexamethylpropyleneamine oxime (HMPAO)-labelled white blood cells and 99Tcm-methylene diphosphonate (MDP) and between the former and pain scores. A significant correlation was found between the percentage uptake of 99Tcm-MDP and pain scores (0.002 > P > 0.01). In osteoarthritis, 99Tcm-HMPAO-labelled white cell imaging may or may not show a positive localization in the synovial membrane. Positive white cell localization appears to be limited to the area that corresponds to the radiological evidence of the condition and the positive uptake of the skeletal imaging agent.

Topics: Adult; Aged; Cell Movement; Female; Humans; Inflammation; Knee Joint; Leukocytes; Male; Middle Aged; Neutrophils; Organotechnetium Compounds; Osteoarthritis; Oximes; Pain; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Nineteen patients with anterior knee pain without the classical features of reflex sympathetic dystrophy (RSD) were investigated by local anesthetic sympathetic blockade. Scintigraphy was performed before the sympathetic blockade in all the cases, and the scintigraphic appearances were correlated with the clinical response. Eleven patients responded to the blockade (9 good and 2 fair). Only 1 out of 10 patients with increased scintigraphic uptake failed to respond, whereas 7 out of 9 patients with normal uptake failed to respond. Our study suggests that a sympathetically mediated component may exist in patients with anterior knee pain without RSD, and that scintigraphy is useful in identifying those patients for whom sympathetic blockade may be helpful.

Topics: Adolescent; Adult; Autonomic Nerve Block; Female; Humans; Knee Joint; Male; Middle Aged; Pain; Pain Management; Pain, Postoperative; Patella; Radionuclide Imaging; Technetium Tc 99m Medronate

Small children often cannot describe the location of bone pain for parents or physicians. Bone scans were performed in 56 children under five years of age with lower extremity pain and/or gait abnormalities of unknown etiology. Patients with fever, and those known to have infection, child abuse, malignancy, and/or radiographic abnormalities were excluded. Thirty patients had abnormal bone scans. Abnormalities included evidence of hip synovitis (4), femoral head avascularity (2), various proximal femoral abnormalities (3), knee synovitis (3), toddler's fracture (1), various tibial or fibular abnormalities (4), and various abnormalities of the tarsal bones (16). Tarsal bone abnormalities included four with abnormal calcaneal uptake and nine with abnormal uptake in or adjacent to the cuboid bone. Correlative imaging studies were available for 26 sites, and focal bone findings were noted at only five locations. Tarsal bone abnormalities accounted for over half of the scintigraphic abnormalities in these preschool children with gait abnormalities. Abnormal uptake in/or adjacent to the cuboid bone was common and probably represented stress injury.

Topics: Bone Diseases; Child, Preschool; Female; Hip Joint; Humans; Infant; Knee; Leg; Male; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate the patterns of renal images and the diagnostic value as a screening test of the whole-body bone and renal scintigraphy with technetium-99m-methylene diphosphonate (99mTc-MDP) or -pyrophosphate (99mTc-PYP), we performed bone scintigraphy in 6 patients with acute renal failure (ARF) with severe loin pain and patchy renal vasoconstriction on postcontrast renal computed tomography (CT). All 6 patients were young and previously healthy but experienced severe loin pain after track events. Five took analgesics. Postcontrast renal CT showed patchy low-density areas or diffuse enhancement immediately after radiocontrast injection and then patchy wedge-shaped enhancement 24 or 48 h later, which subsequently disappeared 72 h later. On the whole-body bone scintigrams with 99mTc-MDP or 99mTc-PYP before obtaining renal CT, there was no increased uptake of isotope in the soft tissue, and multiple patchy increased accumulations of the isotope in the kidney were observed in 5 patients. In 2 patients, renal scintigraphies with technetium-99m-dimercaptosuccinate showed photon-deficient areas in the same areas of patchy isotope accumulation in the whole-body bone scintigraphies. Whole-body image and renal scintigraphy with bone-seeking agents may be useful as a screening test and in the search for the theoretical evidence of ARF with severe loin pain and patchy renal vasoconstriction.

Topics: Acute Kidney Injury; Adolescent; Adult; Bone and Bones; Female; Humans; Kidney; Male; Pain; Renal Circulation; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Vasoconstriction

Seventy-two joint arthroplasties undergoing total hip or total knee surgery were studied prospectively with plain radiographs, three-phase bone imaging (3PBI), erythrocyte sedimentation rate (ESR), aspiration of the joint for culture, and multiple intraoperative cultures at the time of revision. Intraoperative cultures and the operative appearance were used to form a diagnosis of definite infection (unequivocal microbiology and gross sepsis), possible infection (positive microbiology or gross sepsis), or no infection (neither positive microbiology nor gross sepsis). For the preoperative diagnosis of infection, as opposed to aseptic loosening, 3PBI alone had a sensitivity of 33% and a specificity of 86%. In conjunction with plain radiographs, minimal improvement in accuracy was seen. A preoperative ESR greater than 30 had low sensitivity (60%) and a specificity of (65%). However, the ESR was statistically significantly higher in the joints with definite infection as compared to those joints without infection. The preoperative joint aspiration had a sensitivity of 67% and a specificity of 96% and, therefore, appears to be the most useful single test in the workup of a painful total joint arthroplasty.

Topics: Aged; Arthrography; Blood Sedimentation; Bone and Bones; Diagnosis, Differential; Hip Prosthesis; Humans; Knee Prosthesis; Pain; Prospective Studies; Prosthesis Failure; Prosthesis-Related Infections; Radionuclide Imaging; Reoperation; Sensitivity and Specificity; Suction; Technetium Tc 99m Medronate

Of thirty-four occurrences of bone pain in seventeen children and young adults who had type-I Gaucher disease, twenty-five were finally diagnosed as bone crises. On the basis of a bone scan with technetium-99m methylene diphosphonate, a correct diagnosis of bone crisis was made for twenty-three occurrences, with a sensitivity of 0.92. At the onset of a crisis, the bone scan typically showed decreased uptake of radionuclide at the involved site. After six weeks, a repeat bone scan of the long bones showed a ring of increased uptake surrounding an area of decreased uptake. At six months, the appearance of the bones on the radionuclide scan was normal.

Topics: Adolescent; Adult; Bone Diseases; Child; Female; Femur; Gaucher Disease; Humans; Humerus; Male; Pain; Predictive Value of Tests; Prospective Studies; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tibia

Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. The three-phase bone scan is therefore very useful in diagnosing PF and in distinguishing it from other etiologies of the painful heel syndrome.

Topics: Adult; Chronic Disease; Fasciitis; Female; Heel; Humans; Male; Middle Aged; Pain; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

Interleukin-2 is receiving widespread interest as an immunotherapeutic agent in the treatment of certain cancers. Severe arthralgias recently have been reported as a significant side effect, and the cause of pain is unknown. Because interleukin-2 is an immune modulator, we reviewed the 99mTc-methylene diphosphonate scintigrams in nine patients who had developed shoulder arthralgias while receiving interleukin-2 for metastatic melanoma. In eight of the patients, the scintigrams showed diffuse increased uptake of radionuclide in the shoulders. Four patients had radiographs of their shoulders, all of which were normal. Bone scintigraphy in patients receiving interleukin-2 as immunotherapy for metastatic melanoma shows increased radionuclide activity in the shoulders. This process may relate to the role of interleukin-2 as a mediator in the inflammatory response.

Topics: Adult; Female; Humans; Interleukin-2; Male; Melanoma; Middle Aged; Pain; Radionuclide Imaging; Shoulder Joint; Synovitis; Technetium Tc 99m Medronate

Pelvic pain in cancer patients can result from several causes. The most appropriate choice of imaging techniques for evaluating such patients has not been established. We evaluated 27 cancer patients with pelvic pain by using radionuclide bone scintigraphy (24 patients), abdominal CT (27 patients), and pelvic MR imaging (27 patients) and used the correlation between symptoms and imaging findings to compare these imaging methods. The study population included 11 patients with Ewing sarcoma, six with other sarcomas, five with colorectal cancers, and five with other tumors. All patients had pelvic pain, and eight had pain radiating to a leg. Twenty-three patients had soft-tissue masses, and 19 had bone metastases; 16 had both. Findings on bone scans explained the symptoms in 17 (71%) of 24 patients, findings on CT in 23 (85%) of 27 patients, and findings on MR imaging in 25 (93%) of 27 patients. The difference between bone scanning and CT or MR was statistically significant (p less than .05); however, the difference between CT and MR imaging was not significant (p greater than .05). MR imaging detected 41 (98%) of 42 relevant lesions, whereas CT detected 31 (74%) of 42, and bone scanning 17 (44%) of 39. We conclude that MR is superior to either bone scanning or CT in the initial evaluation of pelvic pain in cancer patients. Such information can be important in directing the treatment of these patients.

Topics: Adolescent; Adult; Bone Neoplasms; Diagnostic Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pain; Pelvic Neoplasms; Retrospective Studies; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In 61 painful cemented total hip arthroplasties the diagnostic specificity was 0.7 for plain radiography and 0.46 for scintigraphy. The diagnostic sensitivity was 0.97 for radiography and 0.77 for scintigraphy. False negative radiology occurred in 0.05 and false positive in 0.23. False negative scintigraphy was encountered in 0.27 and false positive in 0.49. Seven of thirty-nine hips were operatively explored because of false positive scintigraphy. In conclusion, Tc-99m-MDP scintigraphy could not used as a complementary diagnostic measure in our hands.

Topics: Adult; Aged; Aged, 80 and over; Hip Joint; Hip Prosthesis; Humans; Middle Aged; Pain; Postoperative Complications; Predictive Value of Tests; Radiography; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Naviculo-cuneiform coalition is a very rare condition and has only been reported by Lusby and Miki. We hereby describe three cases of this condition. The chief complaint was mild pain in the midfoot region especially after physical activity. There were no detectable deformities such as calcaneo-valgus, flatfoot or peroneal spastic foot, moreover the range of motion of the subtalar joint appeared to be normal. Conventional tomography confirmed coalition in two out of our three cases. 99mTc-MDP bone scintigraphy may be useful as a screening procedure. In past the pain associated with tarsal coalition was considered to result from the decreased range of motion in the fused joint due to ossification. However, our study have indicated that pain appeared to originate from the weakness of the cartilagenous bridges relative to the weight-bearing force over the naviculo-cuneiform joint.

Topics: Adolescent; Adult; Female; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Synostosis; Tarsal Bones; Technetium Tc 99m Medronate; Tomography, X-Ray

45 children presenting with acute hip pain were prospectively evaluated with conventional radiography, radioisotope bone scan, and magnetic resonance imaging (MRI). The final diagnoses were transient synovitis (n = 17), septic arthritis (n = 2), Legg-Calve-Perthes disease (LCPD, n = 13), epiphyseal dysplasia (n = 2), other conditions (n = 4), and normal findings (n = 7). In the work-up MRI provided more morphologic information than other techniques and enlarged the diagnostic possibilities. It was the only imaging technique able to give an early indication of bone marrow involvement in systemic diseases. For the early diagnosis of LCPD, MRI was as sensitive as isotope bone scan and more precise than conventional radiography. In the follow-up of LCPD patients MRI was not able to indicate the start of revascularisation of the necrotic area, which bone scans showed reliably in six patients: but MRI provided excellent evaluation of the position, form and size of the femoral head and the surrounding soft tissues.

Topics: Acute Disease; Arthritis, Infectious; Child; Child, Preschool; Chondrodysplasia Punctata; Female; Femur Head Necrosis; Hip Joint; Humans; Legg-Calve-Perthes Disease; Magnetic Resonance Imaging; Male; Pain; Prospective Studies; Radionuclide Imaging; Synovitis; Technetium Tc 99m Medronate

Reflex sympathetic dystrophy syndrome (RSDS) is a painful and disabling problem, the diagnosis of which can be difficult to confirm by objective measures. The three-phase technetium bone scan (TPBS), with a combined sensitivity and specificity of greater than 90%, has been recommended for use in the diagnosis of RSDS. The purpose of this study was to determine the predictive value and usefulness of the TPBS in the diagnosis of RSDS and to discover how the predictive value might be influenced by demographic and medical factors (eg, duration of symptoms). A retrospective chart review was conducted of 119 patients who underwent a TPBS as part of a workup for unexplained limb pain. Twenty-five patients met the Kozin criteria for definite or probable RSDS. All patients were injected with technetium-99m methylene diphosphonate and scanned using established criteria. The three-hour delayed image demonstrated a sensitivity of 44%, a specificity of 92%, a positive predictive value of 61%, and a negative predictive value of 86%. The blood-flow and pool-imaging phases added no further sensitivity or specificity to that achieved by the uptake scan in patients with upper-extremity involvement. Blood-flow and pool-imaging did improve the predictive value of the TPBS in patients with involvement of the lower extremities. We conclude that a more cost-effective approach to diagnosis of upper-extremity RSDS is to use the uptake scan alone.

Topics: Adult; Extremities; Humans; Methods; Pain; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Male; Pain; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Ballet dancers are athletes susceptible to ligamentous and bony injury. We reviewed retrospectively the bone scans (technetium-99m methylene diphosphonate) of 23 ballet dancers with pain in the back and/or lower extremities to determine the usefulness of scintigraphy in the detection of stress lesions of bone. The scintigraphic studies in 19 dancers identified multiple areas of stress injury in both symptomatic and asymptomatic locations. Thirteen dancers had 22 stress fractures (microfractures of trabeculae with associated bone repair) manifested by an intense focus of increased uptake of radiopharmaceutical, and 19 dancers had stress reactions (areas of accelerated remodeling and resorption of bone) demonstrated by diffusely increased uptake of radiotracer. Ten of the 13 dancers with stress fractures were symptomatic and six of the 19 dancers with stress reactions were symptomatic. The radiographs of 10 dancers with positive bone scans were normal or showed no distinction between acute and chronic injuries. Stress fractures were most prevalent in the feet, and stress reactions were most prevalent in the tibiae. The study confirmed that ballet dancers sustain significant bone stress in their legs and feet. Our results show that scintigraphy can be used to detect stress fractures and stress reactions at both symptomatic and asymptomatic sites in this population.

Topics: Adolescent; Adult; Ankle Injuries; Bone and Bones; Child; Cumulative Trauma Disorders; Dancing; Female; Fibula; Fractures, Bone; Humans; Leg Injuries; Male; Metatarsal Bones; Middle Aged; Pain; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tibia

A useful protocol for the evaluation of hip pain in the pediatric patient, using a combination of plain radiographs, hip ultrasound (US), and triple phase radionuclide bone scans is presented. Patients with hip pain were initially evaluated by plain radiographs of the pelvis and hips. If no diagnosis was reached, the hips were studied for effusions by real-time hip ultrasonography. If an effusion was present, the joint was aspirated for diagnosis. If no effusion was present by US or if no diagnosis was reached by aspiration, triple phase radionuclide bone scans were performed. Fifty patients were evaluated by this prospective protocol, and the diagnosis was reached in 48 of the 50 cases (10 by plain radiographs, 16 by US, and aspiration of the joint, and 22 by triple phase bone scans). Hip effusions were found in 20 patients by US, with no false positives or false negatives. Previous studies for detecting effusions by US have emphasized absolute measurements of the capsular width, but we report a typical appearance of the hip capsule when fluid is present (a bulging convex capsule). When no effusion is present, the capsule is concave and parallels the long axis of the femoral neck.

Topics: Child; Clinical Protocols; Diagnostic Imaging; Exudates and Transudates; Hip Joint; Humans; Joint Diseases; Pain; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Ultrasonography

Early detection of inflammatory arthropathy is notoriously difficult with standard radiographic techniques. We therefore assessed bone turnover with technetium Tc 99m medronate in 16 patients with persistent polyarthralgias who had no clinical synovitis, normal radiographs, and nondiagnostic results from laboratory evaluations. Abnormal scans were found in 11 of 16; five were unremarkable. Scan abnormality corresponded with symptomatic joints (11 of 11 patients). These 11 patients had normal test results for rheumatoid factor, antinuclear antibody, and HLA-B27. Patients with abnormal scans were treated with nonsteroidal antiinflammatory drugs or analgesics (11 of 11), hydroxychloroquine sulfate (four), or gold salts (one), with improvement (nine of 11); patients with normal scans (five of five) were treated successfully with nonsteroidal antiinflammatory drugs or analgesics and reassurance. One patient with a normal scan developed sarcoidosis; one, hypermobility syndrome; and one, a viral syndrome. Two patients had no diagnosis. Abnormal technetium Tc 99m medronate scans in patients with previously undiagnosed polyarthralgias suggested inflammatory arthropathy and influenced management decisions with favorable therapeutic outcomes.

Topics: Adult; Arthritis; Arthrography; Female; Humans; Joints; Male; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

A series of 40 patients were studied, who were operated upon for a painful total hip prosthesis, half of which were infected. In each case, preoperative scintigraphy was performed using Tc99, Ga67 and In111. The images obtained with Tc and Ga were compared with those of In111 and analysed with respect to sensitivity, specificity, accuracy and the predictive value of a positive or negative test. In111 had a predictive value of more than 90% and showed greater reliability in the diagnosis of an infection as the cause of a painful total hip prosthesis.

Topics: Bacterial Infections; Gallium Radioisotopes; Hip Joint; Hip Prosthesis; Humans; Indium Radioisotopes; Pain; Prosthesis Failure; Radionuclide Imaging; Reoperation; Technetium Tc 99m Medronate

Two new radiopharmaceuticals, 186Re-1-hydroxyethylidenediphosphonate (186Re-HEDP) and 153Sm-ethylenediaminetetramethylenephosphonate (153Sm-EDTMP), have been proposed as palliative treatments for metastatic bone cancer. Biolocalization properties of these chelates in animals as well as the physical decay and production properties of the respective radionuclides are consistent with those of a therapeutic agent. Subtherapeutic doses of both agents have been administered to human cancer patients to determine their biokinetics and skeletal localization. The 186Re-HEDP studies were conducted at the University of Cincinnati while the 153Sm-EDTMP studies were conducted at the University of Missouri-Columbia. The pharmacokinetics of these agents in humans were consistent with those found in animals. Imaging studies show that the retained activity localizes primarily in the skeleton with high selective uptake in skeletal lesions; there is no visualization of other organs or soft tissue. This paper will review the development and preparation procedures for these radiopharmaceuticals and briefly summarize the animal and patient data.

Topics: Animals; Bone Neoplasms; Dogs; Etidronic Acid; Humans; Kinetics; Organophosphorus Compounds; Pain; Rabbits; Radioisotopes; Radionuclide Imaging; Rhenium; Samarium; Technetium Tc 99m Medronate; Tissue Distribution

The authors examined the relationships among Tc-99m radionuclide bone scan findings, pain, and radiolucent lines in 35 postsurgical knees. Our prospective study included bone scans, as well as radiographic and clinical examination three, seven, and 12 months after knee replacement surgery in 35 patients. Twenty-seven patients had no pain 12 months after surgery and eight patients had moderate or severe pain. Prosthetic loosening was seen in one patient. Thirty-three patients exhibited a radiolucent line under the tibial part of the prosthesis. Isotope uptake was the same in the painful and nonpainful knees, and the degree of isotope uptake did not correlate with the development of radiolucent lines around the prosthetic components.

Topics: Aged; Female; Femur; Humans; Knee Prosthesis; Male; Middle Aged; Pain; Patella; Prospective Studies; Prosthesis Failure; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

Topics: Gallium Radioisotopes; Humans; Joints; Pain; Prostheses and Implants; Radionuclide Imaging; Technetium Tc 99m Medronate

Eighty patients who complained of retropatellar pain underwent evaluation by bone scintigraphy, intraosseous pressure determination, radiography, arthroscopy and physical diagnostic tests. The bone scans showed that 48% of the painful knees had an increased uptake compared with 9% for the normal joints. A highly significant correlation was evident between an increased uptake and established chondromalacia. For the diagnosis of a high pressure patella, radiography was only 7% sensitive (6/88), compared with 44% (39/88) for bone scintigraphy and 78% for the clinical "sustained flexion" test. The positive predictive value of a bone scan for detecting a high pressure patella was 0.72 (39/54). The best predictor was a positive sustained flexion test with a predictive value of 0.85 (69/81).

Topics: Adolescent; Adult; Bone Marrow; Cartilage, Articular; Female; Femur; Humans; Knee Joint; Male; Middle Aged; Pain; Pain Measurement; Patella; Predictive Value of Tests; Pressure; Radionuclide Imaging; Technetium Tc 99m Medronate

We examined 26 athletes with continued pain after strenuous exercise. We found stress fractures in 15 patients, all of whom had positive roentgenographic studies. Seven of these 15 also had bone scans, all of which were positive. Five patients had stress reactions, all of which showed positive results on bone scan and negative roentgenographic results. Five had occult stress reactions manifested by pain, with normal roentgenographic and scintigraphic results, and one had minor pain not requiring radiologic studies. Stress reaction is contrasted with stress fracture by demonstrating the role of bone imaging in the diagnostic continuum of stress reaction to stress fracture.

Topics: Adult; Athletic Injuries; Extremities; Female; Follow-Up Studies; Fractures, Bone; Humans; Male; Pain; Pain Management; Radiography; Radionuclide Imaging; Stress, Mechanical; Technetium Tc 99m Medronate; Wound Healing

Radionuclide imaging in a patient who had acute renal failure with severe loin pain and patchy renal vasoconstriction is described. The patient was studied 3h after the intravenous bolus injection of 25 mCi99mTc-methylene diphosphonate (99mTc-MDP). An intense patchy renal concentration of 99mTc-MDP was observed.

Topics: Acute Kidney Injury; Adult; Humans; Male; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urography; Vasoconstriction

The principal causes in children of a non-acute painful hip are Perthes disease and synovitis (irritable hip). The 99mTc methylene diphosphonate (MDP) bone scan appearances in Perthes disease are well-known; in synovitis, the hip may show a diffuse increase in activity or may be normal. The significance of bone scintigraphy in the clinical setting of non-acute hip symptoms with normal skeletal radiography has been evaluated in 36 symptomatic children. The mean duration of symptoms prior to scan was 3 months (range 1 week-17 months). On the basis of final diagnosis, established by clinical findings, bone scan, X-ray and follow-up, the children were divided into two groups: synovitis or Perthes disease. Of the 33 scans in the 32 children with synovitis, 18 were normal and 15 showed diffusely increased activity on the painful side. All four patients with Perthes disease had focal femoral head abnormalities in the painful hip. Of the 18 children with normal scans, none went on to develop a skeletal disorder. In children with hip pain of over 1 week's duration, the main value of the bone scan is the early detection of Perthes disease. Diffuse increased activity on the painful side suggests synovitis. A normal scan virtually excludes significant skeletal abnormality.

Topics: Child; Child, Preschool; Female; Hip Joint; Humans; Legg-Calve-Perthes Disease; Male; Pain; Radiography; Radionuclide Imaging; Synovitis; Technetium Tc 99m Medronate

Persistent discomfort in the femoropatellar joint is still one of the most disappointing aspects following total knee arthroplasty (TKA). Especially, TKA without patellofemoral replacement has a significant incidence of patellofemoral problems with a frequency between 5% and 45%. Pathomechanical factors in the development of retropatellar problems are loss of patellar thickness and retropatellar erosions. In 157 TKAs using Gschwend, Scheier, Bähler (GSB) joints without patellar resurfacing, pathomechanically postoperative vertical patellar malposition appeared to be the main cause of dysfunction. In many cases, the implantation technique leads to an artificial form of patella alta. This altered knee anatomy results in pathologic biomechanics, thus leading to reduced function. The combination of altered anatomy and reduced function leads to extensive patellar destruction and ultimately to intractable retropatellar pain.

Topics: Biomechanical Phenomena; Femur; Humans; Knee Joint; Knee Prosthesis; Pain; Patella; Postoperative Complications; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

A 46-year-old woman was admitted to our hospital because of fever of unknown origin. Her fever continued with a daily rise to around 38 degrees C to 40 degrees C for more than six months, occasionally accompanied by polyarthralgia, erythematous rash and cervical lymphadenopathy. The erythrocyte sedimentation rate was 75 mm per hour and CRP was over 6+. The white-cell count was 15,100 with 21 percent band forms and the alpha 2-globulin was 18.8 percent of total protein. The tests for autoantibodies were negative. Clinical course and laboratory findings in this case were most compatible with adult Still's disease. A radionucleotide bone scan with 99mTc showed a greatly increased uptake of the radionucleotide at the large joints of the whole body, and a gallium scan also revealed accumulation of the radionucleotide at the bone marrow of the sternum. These findings were recognized during high fever and disappeared when the body temperature returned to normal. These examinations might be useful for investigating the active site of inflammation and for studying the pathogenesis of adult Still's disease.

Topics: Arthritis, Juvenile; Bone and Bones; Female; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Joints; Middle Aged; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

In order to evaluate the clinical utility of sequential technetium-99m HMDP-gallium-67 scanning in patients with painful orthopedic prosthesis, a retrospective review was made of 154 sequential scans performed in 130 patients. Criteria for a positive study included spatially incongruent gallium-technetium uptake or gallium uptake that was congruent but more intense than technetium. Images were interpreted as negative if gallium was congruent and less intense than technetium. Sixty-six patients underwent surgery (31 infected, 35 aseptic), and 64 were evaluated clinically (3 infected, 61 aseptic). The combined results of the surgical and nonsurgical patients yielded a sensitivity of 66%, a specificity of 81%, and an accuracy of 77%. In this series, the technetium-gallium scan combination has proven to be helpful but more recent techniques such as indium-111-labeled leukocytes may prove to be superior to sequential technetium-gallium imaging.

Topics: Adult; Aged; Female; Gallium Radioisotopes; Humans; Infections; Joint Prosthesis; Male; Middle Aged; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Child; Child, Preschool; Female; Hip Joint; Humans; Male; Pain; Proteoglycans; Radionuclide Imaging; Synovial Fluid; Synovitis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Young patients with symptoms of anterior knee discomfort represent a most difficult and often enigmatic clinical group, in large part because of the highly subjective nature of the condition. A primary clinical research goal over the past several years has been a search for reliable objective indicators of a presumed underlying pathologic process to account for the symptoms. We believe that the use of the bone scan along with other clinical and experimental data has provided a new and previously unappreciated perspective of a dynamic osseous process occurring in many such patients. With further investigation, this process may clarify certain confusing aspects of the symptoms experienced by patients with patellofemoral pain. The technique and its clinical applications are still in its infancy, yet it appears to hold promise for the future. It is hoped that exposure to this method of evaluation will serve as a basis for an understanding of the benefits, limitations, and implications of this technique as further developments occur.

Topics: Adolescent; Adult; Arthroscopy; Cartilage Diseases; Computers; Female; Femur; Homeostasis; Humans; Knee Injuries; Knee Joint; Male; Middle Aged; Models, Biological; Osteoclasts; Pain; Patella; Prostaglandins E; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Technetium Tc 99m Medronate

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

In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

Topics: Fractures, Bone; Humans; Male; Military Personnel; Pain; Physical Education and Training; Physical Exertion; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

A 30-yr-old diver experienced pain in the area of the sacroiliac joint during the descent phase of air diving to less than 10 ATA. Computed tomography of the pelvis demonstrated two gas-filled cysts within the ilium. The mechanism by which this lesion causes pain is discussed and reports of gas within bone are reviewed.

Topics: Adult; Bone Diseases; Cysts; Decompression Sickness; Diving; Gases; Humans; Male; Pain; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

99mTc-MDP-scintimetry was performed in 25 consecutive cases of radiographically silent transient synovitis of the hip in children. Fourteen cases had normal scintimetry; seven cases had an increased uptake in the epiphysis; four cases had markedly defective uptake in the epiphysis, indicating interrupted vascular supply. At repeat scintimetry 6 weeks later, the uptake was normal or increased in three of these four cases; the one case with a persistent defect was the only case in this series who later developed radiographic evidence of Legg-Calvé-Perthes' disease. In some cases presenting with clinical symptoms of synovitis of the hip, there is a transient, spontaneously recovering ischaemia of the proximal femoral epiphysis, not followed by radiographic evidence of necrosis. This should be considered in attempts to make a pre-radiographic diagnosis of Legg-Calvé-Perthes' disease by radionuclide methods.

Topics: Child; Child, Preschool; Diphosphonates; Female; Femur Head; Hip; Humans; Infant; Ischemia; Legg-Calve-Perthes Disease; Male; Pain; Radionuclide Imaging; Synovitis; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Ankle Injuries; Diphosphonates; Female; Fractures, Bone; Humans; Pain; Radionuclide Imaging; Talus; Technetium; Technetium Tc 99m Medronate

Thirteen patients with isolated pain and swelling of a sterno-clavicular clavicular joint have been reviewed. Three groups were identified. Group 1 comprised four patients, all of whom had a short history of less than six weeks and suffered a pyarthrosis or malignant disease; group 2, four patients who were shown to have features of condensing osteitis of the clavicle (Cone et al, 1983); and group 3, five patients, had degenerative arthritis of a sterno-clavicular joint. The only difference between groups 2 and 3 were that patients in group 3 had a rather longer history, both articular surfaces were involved and showed a possible increase in the incidence of degenerative joint disease elsewhere. It is suggested that condensing osteitis is but a part of a spectrum of degenerative disease of the sterno-clavicular joints, akin to discogenic vertebral body sclerosis (McCarthy & Dorfman, 1982).

Topics: Adult; Aged; Arthritis; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteitis; Pain; Radiography; Radionuclide Imaging; Sclerosis; Sternoclavicular Joint; Technetium Tc 99m Medronate

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

There were 23 patients who had revisions of their failed hip arthroplasties and a prior radiophosphate assessment of the joint components. In this selected group of patients the true positive incidence of abnormal scintigraphic findings for femoral component loosening was 19 out of 20 (95%) and the true negative incidence was two out of two by the criteria adopted. The true positive incidence of such findings, indicating acetabular component loosening, was seven out of seven, and the true negative was nine out of 10. Some of these patients also had contrast arthrography and the incidences of true positive and true negative findings for femoral component loosening were seven out of 15 (47%) and one out of one, respectively. Prediction of the status of the acetabulum was poorer using this technique with true positive and true negative incidences of four out of nine and two out of five, respectively.

Topics: Acetabulum; Adult; Aged; Diagnostic Errors; Female; Femur Head; Hip Joint; Hip Prosthesis; Humans; Male; Middle Aged; Pain; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

In a retrospective study of 254 women with carcinoma of the breast (mean age 55.4 years) the occurrence of bone pain was compared with results of skeletal scanning, skeletal X-ray examinations and routine biochemical findings. Typical signs of skeletal metastases were found in bone scans of 119 patients, 88 (74%) of whom had bone pain. Alkaline phosphatase was elevated in 54 (45%), LDH in 32 (27%), and gamma-GT in 69 patients (58%). There was a statistical correlation between the number of affected skeletal parts and the absolute level of alkaline phosphatase (P less than 0.001) and of LDH (P less than 0.05). Skeletal scans gave no evidence of bone metastases in 36 patients who had bone pains. In this group of patients alkaline phosphatase was elevated in 4, LDH in 1 and gamma-GT in 12 patients. Routine scanning of 254 patients revealed skeletal metastases in 12% without any clinical symptoms. Bone pain and (or) increased activity of alkaline phosphatase occurred in 91% of patients with skeletal metastases. In our view, bone scan in the postoperative control of breast cancer is justified only after onset of clinical symptoms and (or) if there is an abnormally raised alkaline phosphatase activity.

Topics: Adult; Aged; Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; Clinical Enzyme Tests; Diphosphonates; Female; gamma-Glutamyltransferase; Humans; L-Lactate Dehydrogenase; Middle Aged; Pain; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Bone Diseases; Carpal Bones; Diphosphonates; Female; Humans; Pain; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography

The os trigonum is an accessory bone of the foot found in 7% of the normal adult population. It is located at the posterolateral projection of the talus, and can occasionally give rise to symptoms of acute and chronic unexplained ankle pain. We report three patients, one with acute fracture and two with chronic ankle symptoms. Technetium 99 methylene diphosphonate showed intense focal uptake at the posterior talus pointing to the os trigonum as the site of symptoms. It was excised in two patients with complete relief. The third went on to develop an asymptomatic nonunion. We recommend bone scanning as a procedure that is helpful in delineating obscure pain in the ankle that may be due to chronic irritative nonunion of the os trigonum.

Topics: Adolescent; Adult; Ankle; Diphosphonates; Fractures, Bone; Humans; Male; Pain; Radiography; Radionuclide Imaging; Syndrome; Talus; Technetium; Technetium Tc 99m Medronate

Topics: Abdomen; Aged; Cysts; Diphosphonates; Female; Humans; Inflammation; Kidney Neoplasms; Male; Middle Aged; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Ureteral Calculi; Urine; Urologic Diseases

Human calcitonin (Cibacalcin), at a dose of 0.5 mg daily for 15 days followed by 0.5 mg every other day for 4-6 months, was administered to 11 patients (eight men and three women, aged 36-74 years) with posttraumatic reflex sympathetic dystrophy of the lower limbs (stage I-II). Within one month there was significant lessening of pain, improved mobility and less oedema. Biochemical tests were within normal limits before and after treatment, while the pre-treatment raised bone retention of 99mTc-methylene-diphosphonate and increased blood flow in the affected area became normal during treatment. In nine patients healing occurred in the course of four to six months on treatment, in two patients after more than six months. There were no serious side-effects requiring interruption of treatment. These results indicate that human calcitonin should be tried in the treatment of this condition.

Topics: Adult; Aged; Bone and Bones; Calcitonin; Diphosphonates; Drug Evaluation; Female; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Reflex Sympathetic Dystrophy; Technetium; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes.

Topics: Adolescent; Adult; Arthritis; Athletic Injuries; Bone and Bones; Diphosphonates; Female; Fractures, Bone; Humans; Leg; Male; Muscles; Pain; Radionuclide Imaging; Sports Medicine; Technetium; Technetium Tc 99m Medronate

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.

Topics: Adult; Aged; Diphosphonates; Female; Humans; Knee Joint; Male; Middle Aged; Osteoporosis; Pain; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibial Fractures

The records of 100 patients with localized prostatic cancer were examined retrospectively in an effort to determine the usefulness of routine 99mtechnetium bone scans following definitive therapy with 125iodine implantation or external beam irradiation. With a mean followup of 47 months per patient 19 per cent of these patients had positive scans and an additional 15 per cent had scans that were considered equivocal. Of the 100 patients none had a positive scan in the absence of either an elevated serum acid phosphatase or bone pain. In our series the low incidence of positive scans as the sole evidence of disease progression does not support its routine use after definitive therapy for localized carcinoma of the prostate.

Topics: Acid Phosphatase; Adenocarcinoma; Bone and Bones; Brachytherapy; Diphosphonates; Humans; Iodine Radioisotopes; Male; Pain; Prostatic Neoplasms; Radioisotope Teletherapy; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Fourteen patients with 20 total hip joint replacements were studied for 14 painful prosthetic hips. Clinical examination, plain film radiographs and 99Tcm-MDP bone scans failed to differentiate between infection and mechanical loosening of a prosthesis. Sequential use of 99Tcm-MDP and 67Ga-citrate bone scans were performed in an attempt to discover underlying infectious process. Increased focal uptake of both radiopharmaceuticals over the same hip indicated an infectious process responsible for prosthetic loosening. There were no false positive gallium examinations. Sequential use of 99Tcm-phosphate compounds and 67Ga-citrate is recommended for differentiation between mechanical loosening of a prosthesis and loosening of a prosthesis secondary to an infectious process.

Topics: Adult; Aged; Bacterial Infections; Diagnosis, Differential; Diphosphonates; Female; Gallium Radioisotopes; Hip; Hip Prosthesis; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate