technetium-tc-99m-medronate and Spondylitis

This study investigated the value of fluorine-18 2'-deoxy-2-fluoro- D-glucose (FDG) imaging with a double-headed gamma camera operated in coincidence (hybrid PET) detection mode in patients with suspected spondylitis. Comparison was made with conventional nuclear medicine imaging modalities and magnetic resonance imaging (MRI). Sixteen patients with suspected spondylitis (nine male, seven female, mean age 59 years) prospectively underwent FDG hybrid PET (296 MBq) and MRI. For intra-individual comparison, the patients were also imaged with technetium-99m methylene diphosphonate (MDP) (555 MBq) ( n=13) and/or gallium-67 citrate (185 MBq) ( n=11). For FDG hybrid PET, two or three transverse scans were performed. Ratios of infected (target) to non-infected (background) (T/B) vertebral bodies were calculated. MR images were obtained of the region of interest. Patients found positive for spondylitis with MRI and/or FDG hybrid PET underwent surgical intervention and histological grading of the individual infected foci. Twelve out of 16 patients were found to be positive for spondylitis. Independent of the grade of infection and the location in the spine, all known infected vertebrae ( n=23, 9 thoracic, 12 lumbar, 2 sacral) were detected by FDG hybrid PET. T/B ratios higher than 1.45+/-0.05 (at 1 h p.i.) were indicative of infectious disease, whereas ratios below this value were found in cases of degenerative change. FDG hybrid PET was superior to MRI in patients who had a history of surgery and suffered from a high-grade infection in combination with paravertebral abscess formation ( n=2; further computed tomography was needed) and in those with low-grade spondylitis ( n=2, no oedema) or discitis ( n=2, mild oedema). False-positive 67Ga citrate images ( n=5: 2 spondylodiscitis, 1 aortitis, 1 pleuritis, 1 pulmonary tuberculosis) and 99mTc-MDP SPET ( n=4: 1 osteoporosis, 2 spondylodiscitis, 1 fracture) were equally well detected by FDG hybrid PET and MRI. No diagnostic problems were seen in the other patients ( n=5). In this study, FDG hybrid PET was superior to MRI, 67Ga citrate and (99m)Tc-MDP, especially in patients with low-grade spondylitis (as compared with MRI), adjacent soft tissue infections (as compared with 67Ga citrate) and advanced bone degeneration (as compared with 99mTc-MDP).

Topics: Adult; Aged; Biopsy, Needle; Citrates; False Negative Reactions; False Positive Reactions; Female; Fluorodeoxyglucose F18; Gallium; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radiography; Radiopharmaceuticals; Sensitivity and Specificity; Spondylitis; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging of the gouty spine is rare. We describe a 66-year-old man who presented with pain and numbness in the right lower leg; he reported a 2-month history of intermittent low back pain. Imaging revealed neoplastic lesions of the spine, which were initially regarded as tumors. Thus, the patient underwent surgical removal of the lumbar lesion. However, the postoperative pathological diagnosis was gout spondylitis. In this report, we show multimodal images of advanced gout spondylitis. The metabolic information provided by SPECT/CT, combined with the microscopic changes in bone structure revealed by dual-source thin-layer CT and the anatomical localization information provided by magnetic resonance imaging, can help clinicians to more fully understand the pathophysiological mechanisms and imaging manifestations of gout from multiple perspectives, thereby reducing the rate of misdiagnosis.

Topics: Aged; Gout; Humans; Male; Spondylarthritis; Spondylitis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Chronic contained rupture of an abdominal aortic aneurysm (AAA) is a rare event, making its diagnosis difficult. A delayed diagnosis and delayed surgical repair compromise the outcome. In this paper the authors report the case of a chronic contained rupture of an AAA causing spinal destruction, in which diagnosis was difficult because the lesion produced symptoms mimicking those of pyogenic spondylitis.

Topics: Aged; Aneurysm, Ruptured; Aortic Aneurysm, Abdominal; Chronic Disease; Diagnosis, Differential; Humans; Ilium; Intervertebral Disc; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Spondylitis; Suppuration; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A case of atypical osseous tuberculosis (TB) mimicking multiple secondary metastases on radiologic and nuclear imaging is presented.. To emphasize the contribution of nuclear bone scanning for the assessment of osseous tuberculosis in typical and atypical presentations.. Skeletal locations of TB mostly involve the dorsolumbar spine and diagnosis is often delayed. The presence of multiple TB sites can mimic secondary metastases and biopsy remains the mainstay for final diagnosis.. Clinical symptoms, lab tests, and imaging data are presented. Possible diagnoses are discussed. A review of imaging characteristics in cases of typical and atypical presentations of osseous TB is proposed.. A dorsal spine spondylitis was first diagnosed on a 56-year-old patient presenting neurologic deficit of the left arm. Fine needle aspiration identified bacterial infection but was negative for Mycobacterium tuberculosis. Whole-body bone scan allowed the identification of an asymptomatic sacroiliac lesion, which was accessible to biopsy and gave a final diagnosis.. Nuclear bone scanning should be kept in mind when assessing spinal pain in patients at high risk of TB infection or reactivation.

Topics: Africa, Northern; Arm; Back Pain; Biopsy, Fine-Needle; Diabetes Complications; Diagnosis, Differential; Epidural Abscess; False Negative Reactions; Humans; Lumbar Vertebrae; Male; Middle Aged; Mycobacterium tuberculosis; Osteolysis; Paralysis; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Sacroiliac Joint; Sacrum; Spinal Neoplasms; Spondylitis; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tuberculoma; Tuberculosis, Osteoarticular

To evaluate late correlative imaging findings in relation to clinical outcome in persons with previous acute infective spondylitis, the authors performed bone and leukocyte scintigraphy (planar and SPECT imaging) and magnetic resonance imaging of the spine in nine patients (two men, seven women; mean age, 66 years; age range, 57 to 84 years) 3.1 years (range, 0.9 to 6.2 years) after the acute disease.. All images were evaluated visually. The relevant uptake on SPECT images was also quantitated using an adjacent normal vertebral body as the reference area.. Except for one patient, all other patients had increased uptake in the affected vertebra on bone scintigraphy [corrected]. In leukocyte scintigraphy, clearly decreased uptake was noted quantitatively in six of the seven patients who underwent SPECT. On the magnetic resonance and computed tomographic scans, the typical findings were destruction of intervertebral disks and compression deformities of vertebral bodies, but there was high interindividual variance of other findings, such as osteophytes, spondylolisthesis, increased vertebral fat content, and postoperative changes. These data show that nearly all patients with previously acute infective spondylitis have gross abnormal anatomic and functional imaging findings years after the acute disease, despite good clinical outcome [corrected].. The utility of bone and leukocyte scans in the diagnosis of reactivated spondylitis is limited, and incidentally observed abnormal imaging findings in asymptomatic patients with known previous spondylitis should be interpreted with caution.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radiopharmaceuticals; Spondylitis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adult; Colitis, Ulcerative; Female; Humans; Ligaments; Radionuclide Imaging; Sacroiliac Joint; Spondylitis; Technetium Tc 99m Medronate; Tendinopathy

MRI of proven spondylitis was performed in 39 patients. Acute spondylitis appeared hypointense on T1-weighted and hyperintense on T2-weighted images. Following intravenous application of Gd-DTPA, enhancement of the marrow and disk was seen. With progressive healing increasing signal was seen on T1-weighted images. This was caused by the presence of focal fat marrow representing the first sign of therapy response. Corresponding to the clinical healing process T1-signal increased due to fatty marrow, while the T2-signal decreased as well as the enhancement following Gd-DTPA application. Therefore, MR imaging can be recommended as the method of choice for early diagnosis of spondylitis and assessment of therapy response.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Discitis; Female; Follow-Up Studies; Gadolinium; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Retrospective Studies; Spine; Spondylitis; Technetium Tc 99m Medronate; Tomography, X-Ray; Wound Healing

We evaluated the monoclonal antibody MAb, BW 250/183, which is easy to label with Tc-99m, with respect to its clinical application for the detection of inflammatory processes in bone and joint diseases. This monoclonal antibody is a murine immunoglobulin (IgG1 isotype), directed against NCA 95 (nonspecific cross-reacting antigen), which is also present on the surface of neutrophil granulocytes. We investigated patients with acute (n = 9) and chronic (n = 3) osteomyelitis, with coxitis (n = 3) and coxarthrosis (n = 2), with septic hip prosthesis (n = 8) and loosening hip prosthesis (n = 14), with low back pain (n = 4), with spondylitis (n = 5) and with postoperative spondylodiscitis (n = 9). With reference to the total number of patients examined in this study we found 29 true positive results, 22 true negative results, 4 false negative results and 2 false positive results. This gives a sensitivity of 88% and a specificity of 92%. The lesions were already visualized within 4 to 6 hours, but 24 hour pictures are desirable. SPECT pictures are mandatory in patients with diseases of the hip or of the spine because sensitivity is considerably improved thereby.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Arthritis, Infectious; Bone Diseases; Discitis; Female; Humans; Inflammation; Joint Diseases; Male; Middle Aged; Osteoarthritis, Hip; Osteomyelitis; Prosthesis Failure; Radionuclide Imaging; Spondylitis; 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

Topics: Aged; Arthritis, Infectious; Humans; Lumbar Vertebrae; Male; Radionuclide Imaging; Spondylitis; Staphylococcal Infections; Staphylococcus aureus; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Female; Humans; Lumbar Vertebrae; Middle Aged; Radionuclide Imaging; Spondylitis; Staphylococcal Infections; Staphylococcus epidermidis; Technetium Tc 99m Medronate

Topics: Aged; Candidiasis; Diphosphonates; Humans; Intervertebral Disc; Lumbar Vertebrae; Male; Osteomyelitis; Radiography; Radionuclide Imaging; Spondylitis; Technetium; Technetium Tc 99m Medronate

Nonpyogenic discitis (NPD) is diagnosed on radiograms by the demonstration of the narrow disc-space with involvement of the adjacent vertebral bodies, and with radioisotope--by showing the increased uptake at the same level. Four phases are recognised in the development of the imaging changes. The isotope scan is important, especially in the latent phase of the disease when the radiograms are still negative. Radiologists are urged to consider the possibility of NPD in any child with vague abdominal, leg or back complaints whose origin cannot be ascertained. The experience of imaging diagnosis in five children is described and the differential diagnosis is discussed.

Topics: Child; Child, Preschool; Diagnosis, Differential; Diphosphonates; Female; Humans; Infant; Intervertebral Disc; Male; Spondylitis; Technetium; Technetium Tc 99m Medronate

Thirty-six patients with bacterial spondylitis and eight patients with hemispherical spondylosclerosis (Dihlmann 1981) were examined by conventional x-ray techniques, computed tomography, 99mTc-MDP scintigraphy and 67Gallium scintigraphy. Conventional radiology is adequate for making the diagnosis. Where there is doubt, however, and for observing the progress of the disease, CT and scintigraphy may be used. Hemispherical spondylosclerosis can be identified by means of these additional methods.

Topics: Adult; Aged; Diagnosis, Differential; Diphosphonates; Gallium Radioisotopes; Humans; Middle Aged; Radionuclide Imaging; Sclerosis; Spine; Spondylitis; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tuberculosis, Spinal

99m technetium methylene diphosphate was used for whole body scanning and linear multiplane tomoscanning in 10 patients with typical clinical symptoms of prolapsed disc, in order to investigate whether there would be an increased focal accumulation corresponding to the bone structures adjacent to the affected disc. The diagnosis of a prolapsed disc was confined by amipaque myelography, carried out in 9 patients, and finally verified at operation. In none of the 10 cases could accumulation of radioactivity in the bony structures of the affected lumar segment be demonstrated. Consequently this method has not been adopted for the diagnosis of prolapsed lumbar discs. However it was demonstrated that 99m technetium methylene diphosphate scintillography is useful in the differential diagnosis of anchylosing spondylitis and discitis.

Topics: Adult; Diagnosis, Differential; Diphosphonates; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Myelography; Radionuclide Imaging; Spondylitis; Spondylitis, Ankylosing; Technetium; Technetium Tc 99m Medronate