technetium-tc-99m-medronate and Venous-Insufficiency

The scintigraphic findings on bone imaging in two patients with extensive lower extremity periostitis secondary to venous insufficiency are presented. One of these patients had bilateral disease. The use of [67Ga]citrate scanning in an attempt to exclude concurrent osteomyelitis is also addressed.

Topics: Aged; Aged, 80 and over; Female; Gallium Radioisotopes; Humans; Leg; Middle Aged; Periostitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Venous Insufficiency

Topics: Bone and Bones; Female; Humans; Middle Aged; Osteomyelitis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Venous Insufficiency

The delayed images of the four-phase 99mTc phosphonate bone scan are compared with the delayed images of the three-phase study in patients with diabetes mellitus and/or peripheral vascular disease and suspected osteomyelitis. Three-phase bone imaging includes an immediate postinjection radionuclide angiogram, a blood-pool image, and delayed static images to 7 hr. The four-phase study adds a 24-hr static image. The scan is positive for osteomyelitis if images show progressively increasing lesion to background activity ratios over time. The results of analyzing 21 three- and four-phase bone scans in 17 patients were correlated with clinical course, cultures, and/or x-rays, gallium scans, and CT scans. The accuracy of four-phase bone imaging for diagnosing osteomyelitis was 85%; for three phase, 80%. Sensitivity for four phase was 80%; specificity was 87%. Sensitivity for three phase was 100%; specificity was 73%. Since overall accuracy of the four-phase study is slightly better than three phase, in these patients with diabetes mellitus and/or peripheral vascular disease, the addition of a 24-hr image, creating a four-phase bone scan, is recommended.

Topics: Diabetic Angiopathies; Diphosphonates; Humans; Leg; Leg Ulcer; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Venous Insufficiency