technetium-tc-99m-medronate and Skin-Ulcer

Calciphylaxis is a highly morbid syndrome of vascular calcification and skin necrosis, the pathophysiology of which remains largely elusive. We report a patient with end-stage renal disease and multiple painful skin lesions who underwent a bone scan for extremity pain. Increased tracer accumulation was seen in the subcutaneous tissues of the trunk and lower extremities. In this case, the bone scan aided in the diagnosis and treatment of calciphylaxis for a patient who experienced a relatively short hospital stay.

Topics: Aged; Bone and Bones; Calcinosis; Calciphylaxis; Female; Humans; Kidney Failure, Chronic; Necrosis; Radionuclide Imaging; Radiopharmaceuticals; Skin Ulcer; Syndrome; Technetium Tc 99m Medronate; Vascular Diseases

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

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

The authors reviewed the three-phase bone scans and radiographs of 24 patients with suspected pedal osteomyelitis who also had histologic confirmation of the diagnosis. Twenty patients had a pedal ulcer, cellulitis, or necrosis. Sensitivity and specificity of bone scanning were 70% and 43% respectively. Sensitivity and specificity of radiography were 70% and 50% respectively. The non-invasive diagnosis of pedal osteomyelitis remains problematic due to the poor specificity of bone scans and radiographs.

Topics: Adult; Aged; Cellulitis; Diagnosis, Differential; Female; Foot Diseases; Humans; Male; Middle Aged; Osteomyelitis; Osteonecrosis; Radiography; Radionuclide Imaging; Retrospective Studies; Skin Ulcer; Technetium Tc 99m Medronate

Topics: Abscess; Foot Diseases; Humans; Kidney Diseases; Middle Aged; Radionuclide Imaging; Skin Ulcer; Technetium Tc 99m Medronate

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

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

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