technetium-tc-99m-medronate and Pseudarthrosis

This study investigated the radiographic and scintigraphic courses of union in cervical interbody fusion using hydroxyapatite (HA) grafts or iliac bone autografts.. Twelve patients underwent both serial plain radiography and bone scintigraphy during the 12 mo after surgery. Serial plain radiographs were obtained every month until the end of the study period. Bone scintigrams with 99mTc-hydroxymethylene diphosphonate (HMDP) were obtained at 2 wk and at 1, 2, 3, and 6 mo. Uptake of 99mTc-HMDP in the graft was expressed as a ratio of the counts in the graft to those in the axis.. In the HA graft group, the plain radiographs of all patients showed a radiolucent stripe that disappeared 7.3 +/- 1.5 (mean +/- SD) months after surgery. In the autograft group, a radiolucent stripe around the graft was not seen for any patient, and union was confirmed by follow-up radiographs within 6 mo after surgery. The serial changes in the 99mTc-HMDP uptake ratio showed no difference between the 2 groups. The 99mTc-HMDP uptake ratio peaked 1 mo after surgery and decreased rapidly to a plateau within 2 mo.. In the HA graft group, despite the presence of a radiolucent stripe around the graft for more than 6 mo, the scintigraphic course of union was not different from that in the autograft group. The likelihood is that the presence of a radiolucent stripe around the HA graft in the early months after surgery is not always a sign of pseudoarthrosis.

Topics: Biocompatible Materials; Cervical Vertebrae; Durapatite; Female; Humans; Ilium; Male; Middle Aged; Pseudarthrosis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fusion; Technetium Tc 99m Medronate; Time Factors

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

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

On the technetium-99m bone scan the vast majority of nonunion cases show an intense tracer uptake at the fracture site, as do fractures undergoing normal healing. Therefore static bone scintigraphy usually does not contribute to the diagnosis of nonunion. One of the main causes of delayed fracture healing is infection. Increased blood flow and blood pool as demonstrated during the first and second phases of a 3-phase bone scan are consistent with an inflammatory reaction but are not pathognomonic for infection. A gallium-67 scan is indicative of infection if Ga-67 uptake exceeds Tc-99m uptake on the bone scan. The most specific tracers for infection however are leukocytes labeled with indium-111 or technetium-99m.

Topics: Citrates; Citric Acid; Gallium Radioisotopes; Humans; Indium Radioisotopes; Leukocytes; Pseudarthrosis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Fibroma; Humans; Male; Melanoma; Pseudarthrosis; Radionuclide Imaging; Skin Neoplasms; Technetium Tc 99m Medronate

Twelve patients who had undergone osteosynthesis with a metal plate combined with a frozen homoplastic bone graft for the treatment of fractures or pseudarthrosis were subjected to bone scintigraphy with 99 Tc MDP. This investigation showed the graft to be a site of early and specific accumulation of the tracer. This finding supports early colonization of the graft by vascular structures and osteoblastic cells. In view of the small number of cases studied and our incomplete knowledge of the metabolic processes involved these considerations must remain hypotheses but given the excellent clinical results obtained, the relationships between homoplastic bone and host bone merit further investigation.

Topics: Adult; Aged; Bone Plates; Bone Transplantation; Female; Fractures, Bone; Humans; Male; Middle Aged; Pseudarthrosis; Radionuclide Imaging; Technetium Tc 99m Medronate; Transplantation, Homologous

Topics: Adolescent; Child; Follow-Up Studies; Humans; Postoperative Complications; Pseudarthrosis; Radionuclide Imaging; Scoliosis; Spinal Fusion; Technetium Tc 99m Medronate

Hypertrophic pseudarthrosis was studied with Tc-99m MDP and Ga-67 citrate in 11 patients. Two of the 11 pseudarthroses were complicated by infection. A high concentration of both radiopharmaceuticals was obtained at all 11 sites and their distribution patterns were identical. It was therefore impossible to distinguish the infected from the noninfected pseudarthroses by using Ga-67.

Topics: Bacterial Infections; Diphosphonates; Gallium Radioisotopes; Humans; Hypertrophy; Pseudarthrosis; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate