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

We evaluated the role of bone scintigraphy in 60 osteoporotic patients with back pain. Thirty-four had scintigraphic evidence of vertebral fracture and were found to have a significantly lower bone density compared to those without fractures (p = 0.01). In only 14 patients was vertebral fracture considered to be the sole cause of pain with 38 having alternative abnormalities, the most common of which was facet joint disease (n = 30). Results of bone scintigraphy influenced a direct change in management in 18 patients and were able to exclude vertebral fracture as a cause of symptoms in 30. In symptomatic osteoporotic patients the bone scan may be helpful in elucidating the etiology of back pain and can impact on patient management.

Topics: Back Pain; Bone Density; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Percutaneous vertebroplasty is a minimally invasive radiological procedure intended for relieving painful vertebral fractures. Suitability depends largely on fracture age, with acute osteoporotic fractures being most appropriate. Selection and planning usually involves either Tc MDP scintigraphy or MRI. There is evidence indicating that either modality is predictive of response to vertebroplasty, but there is limited evidence promoting their combined use.. The aim of the study was to establish the degree of concordance between MRI and Tc MDP scintigraphy in vertebral fracture assessment.. Our institution routinely uses both MRI and Tc MDP scintigraphy in vertebroplasty planning. This retrospective analysis included 39 patients, with a total of 73 vertebral fractures, all treated with vertebroplasty. The fractures were classified according to fracture age, aetiology and intermodality concordance.. The overall concordance between MRI and Tc MDP scintigraphy was 63%. Almost twice as many fractures classified as 'acute/ subacute' on MRI were so classified on Tc MDP scintigraphy.. Using MRI without Tc MDP scintigraphy, 48.2% of the potentially suitable vertebroplasty targets (37% of the total vertebral lesions) would likely have been overlooked. Clearly, Tc MDP scintigraphy and MRI provide different but complementary information on vertebral fractures, and these results support the use of dual-modality assessment in vertebroplasty selection and planning.

Topics: Aged; Aged, 80 and over; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Radionuclide Imaging; Retrospective Studies; Spinal Fractures; Technetium Tc 99m Medronate; Vertebroplasty

To assess the value of bone scan imaging in determining painful vertebrae of osteoporotic vertebral compression fractures (OVCFs) patients with contraindications to MRI.. Twenty-three OVCFs patients with contraindications to MRI, diagnosed and treated in our hospital between December 2007 and November 2010, were enrolled in this retrospective study. There were 18 females and five males, aged from 57 to 87 years, with a mean age of 69.5 years. All patients underwent X-ray, CT scans examinations and bone scan to determine painful vertebrae. After the painful vertebra was defined, percutaneous kyphoplasty (PKP) was performed. Efficacy of PKP was assessed with visual analog (VAS) pain scale and the Oswestry Disability Index (ODI) preoperatively, postoperatively and during final follow-up assessments.. The painful vertebrae shown on radiological films did not accord with those found based on bone scan imaging, with a high rate of incongruent findings (27.3%, 9/33). Radiological films showed 33 vertebrae with fractures, but only 26 vertebrae (22 patients) were selected as painful vertebrae for PKP based on bone scan imaging. There were statistically significant differences in mean VAS and ODI between the preoperative and the postoperative assessments; no significant differences were observed between postoperative and final follow-up assessments.. For the OVCFs patients with contraindications to MRI, bone scan imaging could be used to determine painful vertebrae, which is an effective method.

Topics: Aged; Aged, 80 and over; Female; Follow-Up Studies; Fractures, Compression; Humans; Kyphoplasty; Male; Middle Aged; Osteoporotic Fractures; Pain Measurement; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Spinal Fractures; Technetium Tc 99m Medronate; Treatment Outcome

Longer life span has resulted in increased risk of vertebral osteoporotic fractures. Among minimally invasive procedures, percutaneous vertebroplasty (PV) has shown excellent results in the treatment of chronic vertebral pain. The role of preintervention bone single photon emission computed tomography-computed tomography (SPECT-CT) has not been clearly established for the management of these patients.. To determine the value of bone SPECT-CT in patient selection, treatment planning, and prediction of response to PV. A comparison with magnetic resonance imaging (MRI) was also aimed.. Prospective consecutive series.. We studied the performance of bone SPECT-CT on 33 consecutive patients with chronic pain because of vertebral fracture intended for PV.. Improvement of clinical status was based on comparison of preprocedure and postprocedure outcome measurements of pain, mobility, and analgesic use.. Bone SPECT was done using a dual-detector variable-angle gamma camera coupled with a two-slice CT scanner (Symbia T2 System; Siemens, Munich, Germany). Magnetic resonance imaging was done using a magnet of 1.5 T (Giroscan System ACS NT Intera; Philips, Amsterdam, The Netherlands).. Of the 33 patients, 24 finally underwent PV. Positive SPECT-CT images predicted clinical improvement in 91% (21 of 23) of them. Agreement between SPECT-CT and MRI was 80% (20 of 25). Single photon emission computed tomography-computed tomography images showed an alternative cause of pain in some cases, such as new fractures or multiple coexisting fractures, persisting bone remodeling in a previous cemented vertebra, and facet or discal degenerative disease. Single photon emission computed tomography-computed tomography was mandatory in eight patients that could no receive MRI, all of whom improved after PV.. Positive bone SPECT-CT seems a good predictor of postprocedural response. It also adds valuable information as to the cause of back pain and facilitates complete patient evaluation in patients that can not receive MRI.

Topics: Aged; Chronic Pain; Clinical Protocols; Humans; Magnetic Resonance Imaging; Male; Minimally Invasive Surgical Procedures; Pain, Postoperative; Patient Selection; Predictive Value of Tests; Prognosis; Prospective Studies; Radiopharmaceuticals; Reproducibility of Results; Spinal Fractures; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Vertebroplasty

Favorable vertebroplasty outcomes reflect accurate preoperative identification of vertebral fracture targets, operator proficiency, and assiduous fracture aftercare. Conventional teaching is that nuclear bone scintigraphy is not helpful in the management of osteolytic myeloma bone disease. Nuclear bone scintigraphy in two patients with multiple myeloma and vertebral fracture pain convincingly identified the fracturing vertebral level and provided confidence that synchronous vertebral fractures were not missed, whereas neither had been appreciated by either radiography or magnetic resonance imaging.

Topics: Aged; Bone Neoplasms; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Positron-Emission Tomography; Predictive Value of Tests; Preoperative Care; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae; Vertebroplasty

Dedicated multislice single-photon emission computed tomography-computed tomography (SPECT-CT) is useful for accurate anatomic localization and lesion characterization of abnormal findings on planar scintigraphy. We present a case of a 33-year-old woman with a history of low back pain. Lumbar spine radiographs demonstrated irregularity of the superior end plate of L2 with an associated compression fracture. A Tc-99m MDP bone scan was performed given her young age and the absence of a history of trauma. The whole body planar imaging revealed nonspecific findings of diffuse linear increased tracer uptake involving L2. The SPECT-CT findings were in keeping with spinal tuberculosis. This was confirmed with culture of CT-guided aspiration of a left psoas collection, which revealed heavy growth of Mycobacterium tuberculosis. This case highlights the benefits of multislice SPECT-CT imaging in the anatomic localization of increased metabolic activity and provision of additional diagnostic information. This enabled rapid diagnosis and management.

Topics: Adult; Female; Fractures, Compression; Humans; Lumbar Vertebrae; Mycobacterium tuberculosis; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Tuberculosis, Spinal; 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

Topics: Adult; Cervical Vertebrae; Female; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Radiopharmaceuticals; Sarcoidosis; Spinal Fractures; Spinal Fusion; Technetium Tc 99m Medronate; Thoracic Vertebrae

The purpose of this study was to reassess whether the Honda sign (HS) and its variants on bone scans can be used to differentiate an insufficiency fracture (IF) of the sacrum from a metastasis and to evaluate extrapelvic tracer accumulation in patients suspected of having a sacral IF.. We retrospectively reviewed 34 bone scans of 26 patients suspected of having a sacral IF between January 1998 and June 2003.. Twenty-four of the patients had a sacral IF and 1 had a sacral metastasis from prostate cancer and another from lung cancer. The bone scans of only 15 (63%) of the 24 patients with a sacral IF exhibited the HS, 8 (33%) scans exhibited variants, and 4 (4%) scans showed whole-sacrum uptake. One of the 2 patients with metastasis exhibited the HS and the other exhibited a variant. The sensitivity and positive predictive value of HS plus its variants as diagnostic criteria for sacral IF were 96% and 92%, respectively. Seventeen patients (71%) had extrasacral accumulation. The most common site was the pubic bone (50%, 12 of 24), and the second most common site was the spine (46%, 11 of 24), where the accumulation was the result of a compression fracture or degenerative joint disease of the spine.. A "Honda sign or variation" with evidence of fractures elsewhere or no evidence of other metastatic disease should be strong evidence for a sacral insufficiency fracture. The likelihood of having a solitary metastasis to the sacrum is small.

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sacrum; Sensitivity and Specificity; Spinal Fractures; Spinal Neoplasms; Technetium Tc 99m Medronate

Skeletal scintigraphy is an important method for showing evidence of stress injuries affecting the partes interarticulares of young athletes with low back pain. Other etiologies of low back pain may also cause uptake abnormalities in these patients. How often do the results of skeletal scintigraphy support diagnoses other than stress injuries to the partes interarticulares and what are these diagnoses?. We retrospectively reviewed the records of 209 young patients (149 females, 60 males; age range: 8-21 years, mean: 15.7 years) with low back pain and no previously treated vertebral condition who were consecutively referred from a sports medicine clinic to skeletal scintigraphy.. Sites of high uptake supportive of diagnoses other than pars interarticularis stress were shown in 36 (17%) of the 209 patients. Other diagnoses supported by skeletal scintigraphy included stress at the articulation between a transitional vertebra and the sacrum, injuries to the vertebral body ring apophysis, sacral fracture, spinous process injury, and sacroiliac joint stress.. Skeletal scintigraphy shows uptake abnormalities supportive of diagnoses other than pars interarticularis stress in a significant number of young patients with low back pain. The uptake abnormalities shown are usually stress-related in this select population.

Topics: Adolescent; Adult; Athletic Injuries; Female; Fractures, Stress; Humans; Low Back Pain; Lumbar Vertebrae; Male; Radiopharmaceuticals; Retrospective Studies; Sacrum; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Osteoporosis is the most common of the metabolic bone diseases, and is an important cause of morbidity in the elderly. Bone scintigraphy is used to detect skeletal lesions at the earliest possible time, to monitor the course of the skeletal discase and to evaluate the metabolic activity of skeletal lesions. The aim of this study was to determine, by using the bone scan age of vertebral fractures in patients with severe osteoporosis, and make correlation between bone scintigraphy and mineral bone density. Material and methods 30 female patients were studied with bone scintigraphy after BMD.BMD was measurred with DEXA Hologic QDR 4500 Elite System. Correlation between T-score and uptake of radiofarmaceutical (Tc-99mMDP) was 0.849, and it was high. Intensity of uptake of Tc-99m MDP scintigraphy is an accurate method for the detection and ageing of fractures in osteoporotic patients.

Topics: Absorptiometry, Photon; Bone and Bones; Bone Density; Female; Fractures, Spontaneous; Humans; Middle Aged; Osteoporosis, Postmenopausal; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate

We present an unusual case of the incidental finding of a penile implant on a whole-body bone scan obtained for back pain in a patient with osteoporosis and vertebral body fractures. On 2 separate occasions, this patient underwent 3-h delayed whole-body bone scanning with (99m)Tc-methylene diphosphonate. The images showed acute and then subacute vertebral body fractures. On both imaging occasions, the bone scan that included the region of the implant clearly showed the penis, but visualization was better on the second scan. Penile implants have not been described in the nuclear medicine literature, and it is important to recognize the diagnostic possibilities when penile photopenia is identified.

Topics: Aged; Aged, 80 and over; Humans; Male; Penile Prosthesis; Penis; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Adolescent; Athletic Injuries; Back Pain; Fractures, Stress; Humans; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Fracture Healing; Hemangioma; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fractures; Spinal Neoplasms; Technetium Tc 99m Medronate

A 71-year-old woman presenting with severe low back pain was found to have a large oval area of increased sacral uptake on Tc-99m MDP scan, with corresponding T1-hypointense and T2-hyperintense areas on magnetic resonance (MR) images, highly suggestive of malignancy. Open biopsies showed only callus formation. The patient responded clinically to conservative measures, with twice-repeated follow-up Tc-99m MDP and MR scans documenting resolution of transient bone marrow oedema. We suggest that this form of marrow oedema represents a variant pattern of sacral insufficiency fractures.

Topics: Aged; Bone Marrow; Edema; Female; Fractures, Spontaneous; Humans; Magnetic Resonance Imaging; Radiopharmaceuticals; Sacrum; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

This article describes dual-head pinhole bone scintigraphy (DHPBS), which makes use of two opposing pinhole-collimated detectors to obtain one pair of magnified images of bone and joint at one time. The aims are to reduce scan time and solve the problem of the blind zone that is created in the background in single-head pinhole bone scintigraphy.. DHPBS was used for normal hip and knee joints and one case each of lumbar spondylosis, vertebral compression fracture and pyoankle. The gamma camera used was a digital dual-head SPECT camera (Sopha Camera DST; Sopha Medical Vision International, Buc Cedex, France) connected to an XT data processor and a printer. Each of two opposing detectors was collimated with either a 3- or 5-mm pinhole collimator. The scan was performed 2-3 hr postinjection of 12-25 mCi 99mTc-oxidronate. Some 1500-2000 Kilocounts were accumulated at 15-40 min per pair. Anterior and posterior views were taken for the spine and hip and medial and lateral views for the knee and ankle. DHPBS images were correlated to radiographs.. DHPBS produced a pair of high-resolution bone and joint images at one time, reducing scan time by nearly half for each image. The paired DHPBS images clearly visualized both foreground and background objects, which effectively eliminated the blind zone.. DHPBS can significantly improve efficiency and diagnostic acumen.

Topics: Aged; Ankle Joint; Bone and Bones; Child; Female; Fractures, Spontaneous; Gamma Cameras; Hip Joint; Humans; Knee Joint; Lumbar Vertebrae; Male; Middle Aged; Radiopharmaceuticals; Spinal Fractures; Spinal Osteophytosis; Synovitis; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Female; Fractures, Stress; Humans; Magnetic Resonance Imaging; Sacrum; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

To determine the radiographic appearance of osteoporotic vertebral fracture.. Lateral thoracic and lumbar spine radiographs were examined in 58 patients (812 vertebra) with osteoporosis and evidence of vertebral collapse at bone scintigraphy. Scintigraphic activity was graded as faint, moderate, or intense. Anterior, middle, and posterior heights of the T-4 to L-5 vertebrae were measured. The degree of vertebral deformity was derived by comparing a ratio of heights with the normal mean.. At radiography, 378 of the 812 vertebrae (47%) were normal, 434 (53%) had deformities that were more than two standard deviations (SDs) below the normal mean, 304 (37%) had deformities that were more than three SDs below the normal mean, and 222 (27%) had deformities that were more than four SDs below the normal mean. Of 86 vertebrae that showed moderate or intense radionuclide uptake at scintigraphy, all had deformities that were more than two SDs below the normal mean, and 80 (93%) had deformities that were more than three SDs below the normal mean.. Only in vertebrae with deformities more than three SDs below the normal mean can fractures be confidently diagnosed.

Topics: Female; Fractures, Spontaneous; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis, Postmenopausal; Radiography; Radionuclide Imaging; Reference Values; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Adult; Athletic Injuries; Diagnosis, Differential; Fractures, Stress; Humans; Lumbar Vertebrae; Male; Spinal Fractures; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A case of delayed posttraumatic vertebral collapse (Kummell's disease) is described and documented with serial radiographs, computed tomographic scans, and bone scans. The bone scan was normal before the back injury occurred and showed increased radionuclide uptake 3 weeks after injury and before vertebral collapse. Plain radiographs and computed tomographic scans taken during the interval between injury and collapse revealed no evidence of fracture or bone destruction. The authors believe this represents the first example of Kummell's phenomenon documented with serial computed tomographic and bone scans, and provides further support to the ischemic necrosis theory as the underlying process.

Topics: Aged; Back Injuries; Humans; Male; Radionuclide Imaging; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors; Tomography, X-Ray Computed

Skeletal injuries may be overlooked in multiply-injured patients. Skeletal scintigraphy, a very sensitive indicator of skeletal injuries, may give complementary information. We therefore performed scintigraphic screening in 20 patients with multiple injuries. In all, 38 fractures were diagnosed by plain skeletal radiography, and were also visualized scintigraphically. Furthermore, scintigraphy revealed a fracture of the pelvis in one patient and a tibial plateau fracture in another. Scintigraphy was, however, negative in three patients; two with fractures of the transverse processes in the lumbar spine and one with a cervical spine fracture of the articular processes with dislocation. The use of scintigraphy as a screening method in patients with multiple injuries may be helpful in the diagnosis of skeletal injuries. However, fractures of the vertebral column were not always visualized, possibly because of technically inadequate examinations in injured patients unable to co-operate.

Topics: Accidental Falls; Accidents, Traffic; Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Evaluation Studies as Topic; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Multiple Trauma; Radiography; Radionuclide Imaging; Spinal Fractures; Technetium Tc 99m Medronate

The provision of care to polytraumatised patients is a particular diagnostic and therapeutic challenge. The examination data of 162 polytraumatised patients were retrospectively investigated to determine the diagnostic gain provided by skeletal scintigraphy with 99mTc-HMDP. It was found that every fresh fracture (with the exception of fractures to the skull) led to a scintigraphically clearly demonstrable remodelling reaction within ten to 14 days. The timing of the examination was of decisive importance for the information yield. Not until about the tenth to 12th day did also those fractures that showed a delayed uptake show adequately signal-intensive areas of uptake in the scintigram. Typical examples were additional fractures of the spine and pelvis in patients immobilised by fractures of the limbs. At this time, with the aim of skeletal scintigraphy, an additional fracture was found in half of all patients, and was subsequently verified radiologically. Additional diagnostic information is independent of the ability of the patient to cooperate. This was of particular importance in the case of the very severely injured and old patients. Skeletal scintigraphy can be employed with equal efficacy to reliably exclude bone injuries. Thus, skeletal scintigraphy if of particular significance in the determination of the extent of bone injury in polytraumatised patients. This applies in particular to the preparation of an expertise. Thus, as in the case of staging of malignomas, the additional performance of bone scanning twelve to 14 days after traumatisation should form part of routine care offered to polytraumatised patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Child; Female; Fracture Fixation, Internal; Fractures, Bone; Fractures, Open; Humans; Injury Severity Score; Length of Stay; Male; Middle Aged; Multiple Trauma; Radionuclide Imaging; Spinal Fractures; Technetium Tc 99m Medronate

A young patient with severe generalized osteopenia and multiple compressed vertebral fractures caused by systemic mastocytosis is presented. Extensive clinical, laboratory, and pathologic examination showed the involvement of the skeleton alone. Follow-up bone scintigraphy with Tc-99m MDP during a period of 6 years demonstrated migratory multiple axial lesions. These results suggest that Tc-99m MDP imaging is an accurate detection of the activity of the disease.

Topics: Adult; Fractures, Spontaneous; Humans; Male; Mastocytosis; Osteoporosis; Radionuclide Imaging; Spinal Fractures; Technetium Tc 99m Medronate