technetium-tc-99m-medronate and Spinal-Diseases

This article provides a brief overview of the current state of hybrid single-photon emission computed tomography/computer tomography (SPECT/CT) imaging in musculoskeletal infections. SPECT/CT imaging, compared with conventional planar study and SPECT alone, provides improved anatomic localization of infection and more accurate delineation of the extent of infection. This article emphasizes three clinical aspects where SPECT/CT is found to be most useful: differentiating between soft tissue and bone infections, assessing suspected infected sites with underlying structural bone alterations, and defining infective focus when complex anatomy is involved. The accurate assessment of site of infection is vital for selecting the most appropriate therapeutic strategy. Other advantages of SPECT/CT imaging such as reducing the inconvenience of combination planar studies, providing additional CT information, and increasing interobserver agreement are also discussed.

Topics: Bone Diseases; Child; Foot Diseases; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Musculoskeletal Diseases; Postoperative Complications; Soft Tissue Infections; Spinal Diseases; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Wounds and Injuries

Single photon emission computed tomography (SPECT) is a valuable addition to bone scintigraphy. SPECT removes from the diagnostic image unwanted activity which originates from in front and behind the tomographic plane of medical interest. This tomographic procedure allows one to examine with greater contrast and anatomic clarity such structures as the spine, hips, knees, and temporomandibular joints (TMJ). Abnormalities also seen on planar bone scintigrams often are more convincingly identified and better localized by SPECT. SPECT may even detect skeletal abnormalities not evident on planar views. These advantages of SPECT must be weighed against the superior resolution of planar bone scintigraphy. For this reason, SPECT complements, but does not replace planar bone scintigraphy. Including SPECT as an additional component of the skeletal examination does not place excessive demands on either gamma camera use or technologist time. Those nuclear medicine facilities offering bone SPECT for the evaluation of back, hip, knee, and TMJ pain should anticipate a larger volume of patient referrals.

Topics: Bone and Bones; Bone Diseases; Humans; Joint Diseases; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, Emission-Computed

We report the MDP SPECT/CT findings of Baastrup disease in the interspinal region of L4 to L5 in a 76-year-old woman with a history of lung cancer. Baastrup disease, also known as "kissing" spine, is characterized by close contact of adjacent spinous processes with resultant enlargement, flattening, and reactive sclerosis of apposing interspinous surfaces. Knowledge regarding the appearance of Baastrup disease on 99mTc-MDP SPECT/CT is important to distinguish it from spinal bone metastasis.

Topics: Aged; Female; Humans; Lumbar Vertebrae; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Scintigraphic examination of the thoracic spine is well documented. However, there is limited information about the effects of time on image quality in the period following injection of radionuclide. This study aimed to determine the optimal time point after injection of (99m)Tc-HDP (hydroxymethylene-diphosphonate) to achieve scintigraphic images with the best possible contrast and adequate count rates. Scintigraphic images of the thoracic spine of 21 horses were acquired two, four and six hours after administering (99m)Tc-HDP. Eight regions of interest were drawn in the images, four in the spinous processes and four in the adjacent soft tissue. The bone uptake, soft tissue uptake and the bone-to-soft tissue ratio were determined and compared between the different time points. Total count rates decreased with time after injection, but were at least as high as 150,000 counts per image at every time point after injection. The bone-to-soft tissue ratio was significantly higher for the images acquired after six hours compared to those acquired after two and four hours (P<0.01). Delayed scintigraphic examinations of the spinous processes of the equine thoracic spine achieved images with high contrast and sufficient count rates. Therefore, the scintigraphic examination of the equine thoracic spine is recommended to be done four to six hours after injecting (99m)Tc-HDP. However, additional studies should be performed to determine the effect of delayed image acquisition compared to images taken after three hours on the detectability of lesions in other parts of the thoracic spine and the soft tissue.

Topics: Animals; Female; Horse Diseases; Horses; Male; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Spine; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors

The use of technetium-99m methylene diphosphonate single-photon emission tomography/computed tomography (99mTc-MDP SPECT/CT) of the spine and sacrum has increased over the past years; however, there is little information about the optimal clinical role and true clinical impact of this modality.. All 99mTc-MDP SPECT/CT examinations of the spine and sacrum performed at our large multispecialty institution between 1 January 2008 and 12 April 2012 were identified. The indications, findings, clinical context, and impact on patient management were identified through a retrospective chart review.. Of the 212 99mTc-MDP SPECT/CT examinations of the spine and sacrum identified, 191 (90%) were for pain evaluation, 14 (7%) were to assess infection, and seven (3%) were to evaluate a potential malignancy. The most common specific indication was evaluation of facet joint pain in 70/191 (37%) patients, and the most common finding was facet joint activity in 106/212 (50%) patients. Several findings were reported, although facet joint activity was the most frequent. The other findings included costovertebral joint activity, pars interarticularis defects, an osteoid osteoma, a lumbosacral pseudoarticulation, and a postoperative pseudoarthrosis. A resultant change in clinical management was documented in 168/212 (79%) patients. Ninety-two of the 212 (44%) patients had undergone an MRI of the same region for any indication within ±6 months.. 99mTc-MDP SPECT/CT of the spine and sacrum is most frequently used for the diagnosis and management of pain. It helps identify several potential pain generators, is often used in patients who have a near-contemporaneous MRI, and has an impact on the procedural and/or conservative management in most patients. In addition, several areas in need of future research to establish the optimal clinical role of this modality were identified.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Back Pain; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Sacrum; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Young Adult

Topics: Antibodies, Monoclonal; Antirheumatic Agents; Arthritis; Bone and Bones; Bone Neoplasms; Humans; Infliximab; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Aged; Ciprofloxacin; Citrates; False Negative Reactions; Female; Gallium; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Streptococcal Infections; Streptococcus agalactiae; Technetium; Technetium Tc 99m Medronate

Topics: Child, Preschool; Eosinophilic Granuloma; Humans; Humerus; Male; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

A retrospective study was made to evaluate the usefulness of bone SPECT of the dorsolumbar spine in identifying benign and malignant lesions. A study was made of oncological patients who presented active images in the spinal column visible on planar radionuclide scans who also underwent SPECT. The average follow-up period was 25+/-13 months.. In 43 neoplastic patients 55 visible lesions on SPECT were evaluated, of which 29 were benign and 26 metastatic. The criteria for benign lesions were the absence of change or involution without treatment in the follow-up period. The criteria for classifying metastases were: 1. Positive biopsy. 2. Neurological complications derived from the lesion. 3. Increased extension and tracer uptake by the lesion, and the appearance of other bone metastases.. Twelve of 15 lesions located in the vertebral body or pedicle and 11/16 located in the body with extension toward the pedicles were metastases. Twenty-one of 24 lesions located on the anterior face of the vertebral body, articular processes, lamina, or intervertebral disk were benign.. Bone SPECT was useful for locating the vertebral lesion, which in many cases allows differentiation of benign and metastatic lesions.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Evaluation Studies as Topic; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Neoplasms; Osteoarthritis; Retrospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra.

Topics: Cervical Vertebrae; Child; Histiocytosis, Langerhans-Cell; Humans; Male; Radiopharmaceuticals; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Abscess; Data Display; Humans; Image Enhancement; Lumbar Vertebrae; Male; Middle Aged; Preoperative Care; Psoas Abscess; Radiology, Interventional; Radiopharmaceuticals; Spinal Diseases; Staphylococcal Infections; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The most common form of Gaucher's disease, type 1 (chronic non-neuronopathic), results in accumulation of glucocerebroside in reticuloendothelial cells of the spleen, liver and bone marrow, with frequent occurrence of bone pain due to vaso-occlusive crisis. We report the finding of a "cold" vertebral body on bone scan in two patients with Gaucher's disease and bone crisis. Photopenia was so striking as to give the appearance of a "missing" vertebra. Concurrent plain films appeared normal. In one patient Gaucher's disease had not previously been diagnosed.

Topics: Adolescent; Child, Preschool; Female; Gaucher Disease; Humans; Infarction; Lumbar Vertebrae; Male; Radionuclide Imaging; Spinal Diseases; Technetium Tc 99m Medronate

Determining the etiology of a focal lesion seen on bone scan in patients with primary tumors usually requires the use of other imaging procedures or biopsy. Single positron emission computed tomography (SPECT) with high resolution multidetector systems can localize the specific site of a vertebral lesion and in this way potentially differentiate between benign and metastatic disease. SPECT images of the lower thoracic and lumbar spine were reviewed for lesion location and intensity by two experienced interpreters. Follow-up data were adequate to ascertain the cause of 71 lesions seen on SPECT in 29 patients. Twenty-six of these lesions were not seen on planar images. Of the 71 lesions, 44 were benign and 27 metastatic. Of the 15 lesions where the pedicle was involved, 11 were found to metastatic. There were a total of 14 facet lesions, 9 of which were present in vertebra with no lesions at sites other than the facets. All 9 of these isolated facet lesions turned out to be benign. Lesion intensity did not distinguish benign from malignant disease. We conclude that SPECT imaging is useful in determining the etiology of focal lesions seen on bone scan in patients with a known primary tumor referred for evaluation of metastatic disease.

Topics: Colonic Neoplasms; Diagnosis, Differential; Diagnostic Imaging; Follow-Up Studies; Humans; Image Enhancement; Lumbar Vertebrae; Lung Neoplasms; Male; Osteoarthritis; Prostatic Neoplasms; Sensitivity and Specificity; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to evaluate the usefulness of SPECT bone imaging in targeting the precise location of vertebral abnormalities to ascertain whether such knowledge would help in differentiating between metastatic and benign lesions. SPECT images of the thoracolumbar spine in 50 patients were correlated with plain x-rays, CT, MRI, PET, and bone scans and 6-month clinical follow-ups. SPECT images revealed 110 lesions, 35 of which were metastases. Twenty-four of 25 lesions involving the vertebral body with extension into posterior elements were metastases, as well as 10 of 39 lesions found in the vertebral body and 1 of 4 found in the spinous process. All lesions limited to the anterior aspect of the vertebral body (13/13), facet joints (23/23), and intervertebral disk space (6/6) were benign. In conclusion, SPECT imaging of the thoracolumbar spine is helpful in determining the precise anatomic location of vertebral abnormalities, and knowledge of the location can be used to determine whether these abnormalities in cancer patients are benign entities or metastases.

Topics: Diagnostic Imaging; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Male; Middle Aged; Prospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors; Tomography, Emission-Computed, Single-Photon

Acquisitions of 360 degrees are usually performed for bone single photon emission computed tomography (SPECT). However, the spine is a peripheral and median structure, it therefore seemed interesting to compare the 360 degrees and the posterior 180 degrees SPECT images. In a phantom study and in 25 adult patients, the 360 degrees SPECT images were compared with the posterior 180 degrees images obtained during the same acquisition: the posterior 180 degrees images are at least equivalent to the 360 degrees images. With a reduction in the examination time, SPECT could become easier to perform, especially in patients suffering from back pain.

Topics: Adult; Aged; Aged, 80 and over; Back Pain; Female; Follow-Up Studies; Gamma Cameras; Humans; Male; Middle Aged; Models, Structural; Osteitis Deformans; Spinal Diseases; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Seventy-six 111In-labeled leukocyte images performed on 71 patients with possible vertebral osteomyelitis were reviewed. Twenty-eight cases of vertebral osteomyelitis were diagnosed. Vertebral labeled leukocyte activity was normal in 2, increased in 11, and decreased in 15 cases of osteomyelitis. The median duration of symptoms was significantly longer in patients with osteomyelitis and decreased vertebral activity than in patients with osteomyelitis and increased activity (3 mo versus 2 wk; p = 0.019). No significant relationship between the duration of antibiotic therapy and the appearance of vertebral osteomyelitis on leukocyte images was identified (p = 0.62). Increased vertebral activity was highly specific (98%) for osteomyelitis but relatively insensitive (39%). Decreased activity was neither sensitive (54%) nor specific (52%). Seven patients with clinically resolved infection underwent follow-up imaging. Of four patients who initially presented with increased activity, one had normal and three had decreased vertebral activity on follow up studies. All three patients with decreased activity initially had decreased activity on follow-up. Using increased or decreased activity as criteria for infection, the accuracy of leukocyte imaging for diagnosing vertebral osteomyelitis was 66%, similar to that of 99mTc bone imaging (63%) in our population. Leukocyte imaging did however provide important information about extraosseous infection in 12 of the patients studied.

Topics: Bacterial Infections; Female; Humans; Indium Radioisotopes; Leukocytes; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Spinal Diseases; Technetium Tc 99m Medronate

Bone scanning and X-ray imaging are complementary diagnostic procedures providing different information on morphology and function. This is true for diseases of the spine. For further evaluation of lesions that have already been localized, bone scanning should be performed after X-ray examinations if any questions are still open (e.g., extent of disturbed bone metabolism, viability, age of a spine fracture, response to therapy). Typical scintigraphic patterns specific for few bone diseases are exceptional, being confined to Paget's diseases and degenerative changes in the cervical spine. As a first imaging modality, however, bone scanning should be employed in the follow-up of patients with malignancies and the probability of bone metastases. In a second step, bone lesions identified by scintigraphy should be checked by X-ray imaging. In this order and context, the high sensitivity of bone scanning and the high specificity of X-ray imaging optimize the accuracy of the diagnoses achieved with the different radiological modalities.

Topics: Bone and Bones; Diphosphonates; Etidronic Acid; Humans; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Spinal Diseases; Spinal Injuries; Spinal Neoplasms; Spondylitis; Technetium; Technetium Tc 99m Medronate; Whole-Body Counting

The authors retrospectively compared magnetic resonance images and bone scintigraphy obtained from 144 patients. Fifty-six patients having a known primary malignancy were evaluated for metastases (Group 1), and 88 patients were evaluated for back pain (Group 2). Interpretation was normal in 36/144 patients (11 in Group 1 and 25 in Group 2), and similar abnormal foci were visualized in the osseous spine in 54/144 patients (32 in Group 1 and 22 in Group 2). Magnetic resonance imaging showed abnormalities in the osseous spine that were not visualized on bone scintigraphy in 43/144 patients (10 in Group 1 and 33 in Group 2); these included bone metastasis, benign neoplasm (hemangioma), Schmorl's node, intervertebral disk disease, and bone disease (osteophyte, spondylolisthesis, facet hypertrophy). In addition, magnetic resonance imaging showed epidural or paravertebral extension of the tumor or infection in 37/144 patients (30 in Group 1 and 7 in Group 2). Bone scintigraphy demonstrated abnormalities not visualized on magnetic resonance imaging in 11/144 patients (3 in Group 1 and 8 in Group 2). Bone scintigraphy showed abnormalities in locations not evaluated by magnetic resonance imaging but relevant to the symptomatology or disease in 42/144 patients (37 in Group 1 and 5 in Group 2). These data indicate that magnetic resonance imaging and bone scintigraphy are complementary. Bone scintigraphy remains the best screening procedure to show the location of abnormal areas in the spine and elsewhere in the skeleton. Magnetic resonance imaging is useful in differentiating neoplasm, infection, intervertebral disk disease, and, in some instances, degenerative bone disease.

Topics: Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Retrospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate

Solitary abnormalities located within the spine from 75 bone images with Tc-99m MDP were reviewed. For the sake of convenience, patients were grouped in three classes of age: 15-50, 51-65, and 66-90 years. In 67 cases, the diagnosis was apparent from clinical studies, x-ray examinations, or biopsies. In eight cases, no diagnosis could be made. The maximum percentage of lesion sites were within the lumbar spine (45 cases). Metastatic lesions were the most common solitary abnormalities within the spine (29.3%). Osteoporosis was second (24%) with the maximum percentage in age group 66-99 years (83%) with a greater female predominance (67%).

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate

We reviewed the medical records and technetium bone/joint scans of 160 children presenting to the inpatient Pediatric Rheumatology service over a 3-year period. When the scan result (normal versus abnormal) was considered for each patient as a whole, scan sensitivity and specificity were both approximately 75%. However, when each joint was considered individually, sensitivity decreased to 37%, while specificity rose to more than 95% when compared to clinical examination. Reasons for these variations and their clinical correlation are discussed. Overall, radionuclide bone/joint scanning was found to be very useful in the evaluation of monoarticular and nonrheumatic disorders, but it did not alter therapy in children with known connective tissue disorders or other polyarticular diseases.

Topics: Adolescent; Arthritis; Arthritis, Juvenile; Bone and Bones; Child; Child, Preschool; Female; Humans; Infant; Joint Diseases; Joints; Male; Radionuclide Imaging; Rheumatic Diseases; Spinal Diseases; Technetium Tc 99m Medronate

A 29-year-old male presented with a two month history of intermittent low back pain following a febrile illness. Two planar bone scans performed with Tc-99m MDP were normal despite roentgenographic and SPECT scintigraphic evidence of discitis. This case demonstrates the increased sensitivity of SPECT in the diagnosis of discitis.

Topics: Adult; Humans; Intervertebral Disc; Lumbar Vertebrae; Male; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, Emission-Computed

This study looks retrospectively at 113 patients with low back pain referred by orthopaedic surgeons for bone scanning. 79 scans (70%) were reported normal and 34 scans (30%) abnormal. 61 out of the 79 patients with normal scans were diagnosed and managed as "chronic back strain". Negative bone scans were also encountered in 3 patients with degenerative disease, 3 with prolapsed intervertebral disc and one with spondylolysis. In those patients with positive scans, a varied range of diagnoses was encountered, the main ones being bone metastases, previous trauma, osteomyelitis and degenerative disease. The scan was shown to be helpful in deciding on the presence or absence of pathology, and in identifying the sites of involvement, but not the nature of the disease. A higher likelihood of positivity is seen in the more elderly patients as well as those below 20 years of age. In interpreting the scan, the clinical context is important e.g. a history of trauma, previous surgery or of malignant disease. The bone scan may be normal in disc prolapse and in degenerative disease of the spine.

Topics: Adolescent; Adult; Aged; Back Pain; Child; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Radionuclide Imaging; Spinal Diseases; Spondylolysis; Technetium Tc 99m Medronate

Hematogenous pyogenic vertebral osteomyelitis (HPVO) continues to be a diagnostic problem for clinicians due to nonspecific presentation of the disease (1,2). We reviewed our experience of the last 10 years to determine the diagnostic usefulness of radionuclide bone studies in this disease. We found 15 patients whose primary diagnosis was HPVO. Of the 15 patients, 12 had [99mTc]MDP bone scans which were all positive. Five of the 12 patients had positive [67Ga]citrate scans and one patient with chronic active HPVO had negative 67Ga and [111In]WBC bone images. At the same time, three patients' spine x-rays and one patient's CT scan of the vertebra were normal. Additionally, in three patients spine x-rays were interpreted as consistent with degenerative joint disease that contributed to the delay of the diagnosis. We conclude that when HPVO is suspected an abnormal [99mTc]MDP bone image increases the probability of the disease, even if the x-rays and CT scans of the spine are normal. An abnormal 67Ga image following an abnormal 99mTc bone image increases the specificity of the diagnosis. Normal [99mTc]MDP and [67Ga]citrate bone images of the vertebra virtually exclude the diagnosis of HPVO.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Spinal Diseases; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

The uptake of [99mTc]MDP in metastatic lesions of the vertebrae was compared with the uptake in normal vertebrae. The ratio of these lesion-to-nonlesion uptakes at 4 and 24 hr was called the 24-hr/4-hr ratio (TF ratio). A similar ratio was measured for lesions in the spine due to degenerative bone disease. Lesions in vertebrae with degenerative bone disease and treated metastases had a significantly lower TF ratio than lesions in vertebrae with untreated bone metastases. These findings suggest that the TF ratio might be a reliable method for separating metastatic lesions from degenerative changes in the vertebral column, and could be especially useful in cancer patients whose bone scans demonstrate a single lesion in the spine.

Topics: Adult; Aged; Diphosphonates; Female; Humans; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Spinal Osteophytosis; Technetium; Technetium Tc 99m Medronate; Time Factors

This report describes the bone-scan appearance of significantly increased activity in a lumbar transverse process of a 15-year-old boy; we believe it represents a normal variant related to the secondary ossification center.

Topics: Adolescent; Diagnosis, Differential; Diphosphonates; Humans; Lumbar Vertebrae; Male; Ossification, Heterotopic; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Diphosphonates; Humans; Lumbar Vertebrae; Magnetic Resonance Spectroscopy; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Thirty-seven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance (MR), radiography, and radionuclide studies. These findings were correlated with the final clinical, microbiologic, or histologic diagnoses. Based on the results of these latter studies, 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. The MR appearance of vertebral osteomyelitis in this study was characteristic, and MR was as accurate and sensitive as radionuclide scanning in the detection of osteomyelitis.

Topics: Adult; Aged; Diphosphonates; Female; Follow-Up Studies; Gallium Radioisotopes; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Osteomyelitis; Prospective Studies; Radiography; Spinal Diseases; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Incidence of non-tuberculous vertebral osteomyelitis has been increasing significantly over the past 15 years. Its prompt diagnosis remains difficult. Presented here are five cases of vertebral osteomyelitis studied clinically, with laboratory studies, radiographically, and with Tc-99m bone and In-111 labeled white blood cells (In-111 WBC) scintigrams. Three of the cases are described in detail. The In-111 WBC studies were not found useful in detecting the infection in four out of the five patients. Reasons for these false negative results are discussed. Clinical, etiopathogenic and radiographic characteristics of vertebral osteomyelitis are also presented.

Topics: Adult; Aged; Female; Humans; Indium; Klebsiella pneumoniae; Leukocytes; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Pseudomonas aeruginosa; Radionuclide Imaging; Spinal Diseases; Staphylococcus aureus; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Age Factors; Aged; Cervical Vertebrae; Child; Child, Preschool; Diphosphonates; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Radionuclide Imaging; Spinal Diseases; Technetium; Technetium Tc 99m Medronate