technetium-tc-99m-medronate and Paraplegia

Topics: Hip; Humans; Male; Middle Aged; Ossification, Heterotopic; Paraplegia; Radiopharmaceuticals; Spinal Injuries; Technetium Tc 99m Medronate

An atypical heterotopic bone formation that was difficult to diagnose presented in a young paraplegic patient as an acute deep vein thrombosis. A number of imaging methods, including contrast venography, ultrasonography, conventional radiography, bone scanning, leukocyte scanning, computed tomography, and magnetic resonance imaging, were used to arrive eventually at the final diagnosis. Early bone scanning remains a sensitive and effective method of diagnosis. Computed tomography can be useful in difficult cases, but the role of other imaging studies appears limited.

Topics: Adult; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Myositis Ossificans; Paraplegia; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The clinical findings, laboratory data, radiographs, and radionuclide studies of 50 patients referred for evaluation of possible heterotopic bone formation (HBF) were reviewed. HBF begins approximately 17 days following injury or neurologic insult, heralded by an acute rise in serum alkaline phosphatase (SAP), and increased vascularity on three-phase radionuclide bone imaging (RNBI). RNBI soft-tissue uptake is evident at 24 days and radiographic calcification is visible 1 wk later. Clinical signs and symptoms occur relatively late in the course of disease. HBF mimics thrombophlebitis and should be considered in all patients referred for venography if the clinical situation is appropriate. Serial SAP measurements and three-phase RNBI should allow early diagnosis in virtually all cases.

Topics: Adolescent; Adult; Aged; Alkaline Phosphatase; Calcium; Diphosphonates; Female; Humans; Male; Middle Aged; Ossification, Heterotopic; Paraplegia; Quadriplegia; Radionuclide Imaging; Spinal Cord Injuries; Technetium; Technetium Tc 99m Medronate