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PubMed1992

Technetium-99m-diphosphonate, gallium-67 and labeled leukocyte scanning techniques in tibial nonunion.

On the technetium-99m bone scan the vast majority of nonunion cases show an intense tracer uptake at the fracture site, as do fractures undergoing normal healing. Therefore static bone scintigraphy usually does not contribute to the diagnosis of nonunion. One of the main causes of delayed fracture healing is infection. Increased blood flow and blood pool as demonstrated during the first and second phases of a 3-phase bone scan are consistent with an inflammatory reaction but are not pathognomonic for infection. A gallium-67 scan is indicative of infection if Ga-67 uptake exceeds Tc-99m uptake on the bone scan. The most specific tracers for infection however are leukocytes labeled with indium-111 or technetium-99m.

Citrates↗
PubMed1992

Quantitative bone scintigraphy and 24-hour whole-body counting of 99mTc-methylene diphosphonate in patients with prostatic carcinoma.

Thirty-four patients with prostatic carcinoma were studied with quantitative bone scintigraphy and whole-body counting (WBC) 1 and 24 h after injection of 99mTc-MDP before as well as two weeks and two months after orchiectomy. Thirteen of the patients had normal bone scintigrams and WBR at the three different investigations; 21 had skeletal metastases. The latter showed throughout the study higher local gamma camera count rates as well as WBR values than the patients with normal scintigrams. In these patients a "flare phenomenon", with an increase in count rate two weeks after orchiectomy followed by a decrease two months post-operatively, was seen with quantitative bone scintigraphy but not with WBC. However, WBC may be a valuable method indicating the total extent of skeletal metastases in the body, while quantitative bone scintigraphy is more accurate in the interpretation of individual skeletal metastases.

Aged↗
PubMed1991

Radionuclide diagnosis of vertebral osteomyelitis: indium-111-leukocyte and technetium-99m-methylene diphosphonate bone scintigraphy.

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.

Bacterial Infections↗
PubMed1989

[Magistral preparation of methylene diphosphonate and its clinical evaluation in radionuclide diagnosis of the skeleton].

The present authors report on their own method of preparation of a frozen kit of methylenediphosphonate (MDP) which has been hitherto imported from the foreign currency area. The preparation after labelling with 99mTc serves for scintigraphy of the skeleton. The rate of MDP and the reducing reagent (SnCl2.2H2O)-5:1 proved to be the most advantageous. The preparation was compared with two more radiopharmaceuticals: hydroxyethylidenedisphosphanate (HEDP) and pyrophosphate (PYP). The results of a subjective evaluation of readability of scintigrams with grades 1-5 are unequivocally more favourable for MDP and HEDP (2.3 and 2.4) against PYP (3.1). MDP possessed the best rate of the number of impulses from the bone and the surrounding tissue--the background of the radiopharmaceuticals under study. The authors also examined the rapidity of uptake of MDP in the bone, kidney and its elimination from the plasma. The obtained results were in good agreement with commercial preparations tested at different laboratories. The use of MDP prepared in this manner is a contribution both to economy and clinical practice.

Bone and Bones↗