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Three phase bone scan interpretation based upon vascular endothelial response.

Kumar K - Indian J Nucl Med (2015 Apr-Jun)

Bottom Line: The data clearly indicated that 100% of the cases of bone infection (osteomyelitis/arthritis/cellulitis) and cases of CRPS/RSD showed generalized massive flow and pool pattern.All 100% published cases of osteomyelitis in the literature showed positive vascular endothelial response.Larger studies are recommended.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, Carl Vinson VA Medical Center, Dublin, GA, USA.

ABSTRACT

Objectives: A new method of interpretation of Three Phase Bone Scan (TPBS) scan based upon the normal physiological vascular endothelial related response.

Materials and methods: Fifty cases of TPBS were evaluated. Thirteen were normal. In remaining 37 positive studies, 20 showed localized hyperemic response. All localized hyperemic responses except one with vascular endothelial dysfunction were without infection (95.0%). Infection could be ruled out in absence of generalized massive flow and pool response. All 17 cases with generalized massive hyperemic response had infection, consistent with infection or CRPS/RSD. Micro-bacterial or histological confirmation of infection was obtained in 11 cases. All 11 cases with confirmed infection showed generalized massive hyperemic response (100.0%). Two were CRPS/RSD and 2 cases were of cellulitis (100.0%). Among remaining 2, one refused surgery and other was lost to follow-up. Additionally, 20 published cases in the literature of osteomyelitis were also analyzed. Nineteen cases of bone and joint infection, (osteomyelitis/arthritis/cellulitis) except one with endothelial dysfunction showed generalized massive increased flow and pool response (95.0%). All published cases of osteomyelitis in the literature showed generalized massive hyperemic response (100.0%).

Results: The data clearly indicated that 100% of the cases of bone infection (osteomyelitis/arthritis/cellulitis) and cases of CRPS/RSD showed generalized massive flow and pool pattern. Infection could be ruled out in absence of generalized massive flow and pool response. All 100% published cases of osteomyelitis in the literature showed positive vascular endothelial response.

Conclusion: By incorporating the concept of vascular endothelial related response causing massive vasodilatation in infection, the interpretation of the TPBS can be more précised as it is based upon the normal physiology. Larger studies are recommended.

No MeSH data available.


Related in: MedlinePlus

Flow phase of the three phase bone scan, following left arm injection of the radiotracer Technetium-99m methylene diphosphonate indicating extensive increased activity in the left lower extremity, extending from A, thigh to B, leg up to the malleoli consistent with large response
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Figure 1: Flow phase of the three phase bone scan, following left arm injection of the radiotracer Technetium-99m methylene diphosphonate indicating extensive increased activity in the left lower extremity, extending from A, thigh to B, leg up to the malleoli consistent with large response

Mentions: A 62-year-old man with recent-onset DM, had left total knee replacement 3 years ago with persistent pain and swelling in the left lower extremity for the last 3 months. No definitive clinical evidence to suggest infection. Erythrocyte sedimentation rate, WBC and C-reactive protein mildly increased. The flow and the blood-pool phase images of the TPBS indicated asymmetrical pattern with generalized massive response extending up to the left malleoli, consistent with large vascular endothelium-dependent response. Delayed phase images of the TPBS indicated retention of radiotracer in the left knee bones, consistent with infection [Figures 1 and 2]. Infection was confirmed by aspirating the injected saline. Patient was placed for 6 weeks on intravenous antibiotics with no significant improvement. Revision prosthetic replacement after total eradication of infection was planned. Till the last information, the infected total knee prosthesis was removed and replaced with antibiotic-loaded spacer with the hope to re-implant new total knee prosthesis after complete eradication of the infection. This is an example of vascular endothelium-dependent response.


Three phase bone scan interpretation based upon vascular endothelial response.

Kumar K - Indian J Nucl Med (2015 Apr-Jun)

Flow phase of the three phase bone scan, following left arm injection of the radiotracer Technetium-99m methylene diphosphonate indicating extensive increased activity in the left lower extremity, extending from A, thigh to B, leg up to the malleoli consistent with large response
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4379667&req=5

Figure 1: Flow phase of the three phase bone scan, following left arm injection of the radiotracer Technetium-99m methylene diphosphonate indicating extensive increased activity in the left lower extremity, extending from A, thigh to B, leg up to the malleoli consistent with large response
Mentions: A 62-year-old man with recent-onset DM, had left total knee replacement 3 years ago with persistent pain and swelling in the left lower extremity for the last 3 months. No definitive clinical evidence to suggest infection. Erythrocyte sedimentation rate, WBC and C-reactive protein mildly increased. The flow and the blood-pool phase images of the TPBS indicated asymmetrical pattern with generalized massive response extending up to the left malleoli, consistent with large vascular endothelium-dependent response. Delayed phase images of the TPBS indicated retention of radiotracer in the left knee bones, consistent with infection [Figures 1 and 2]. Infection was confirmed by aspirating the injected saline. Patient was placed for 6 weeks on intravenous antibiotics with no significant improvement. Revision prosthetic replacement after total eradication of infection was planned. Till the last information, the infected total knee prosthesis was removed and replaced with antibiotic-loaded spacer with the hope to re-implant new total knee prosthesis after complete eradication of the infection. This is an example of vascular endothelium-dependent response.

Bottom Line: The data clearly indicated that 100% of the cases of bone infection (osteomyelitis/arthritis/cellulitis) and cases of CRPS/RSD showed generalized massive flow and pool pattern.All 100% published cases of osteomyelitis in the literature showed positive vascular endothelial response.Larger studies are recommended.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Nuclear Medicine, Carl Vinson VA Medical Center, Dublin, GA, USA.

ABSTRACT

Objectives: A new method of interpretation of Three Phase Bone Scan (TPBS) scan based upon the normal physiological vascular endothelial related response.

Materials and methods: Fifty cases of TPBS were evaluated. Thirteen were normal. In remaining 37 positive studies, 20 showed localized hyperemic response. All localized hyperemic responses except one with vascular endothelial dysfunction were without infection (95.0%). Infection could be ruled out in absence of generalized massive flow and pool response. All 17 cases with generalized massive hyperemic response had infection, consistent with infection or CRPS/RSD. Micro-bacterial or histological confirmation of infection was obtained in 11 cases. All 11 cases with confirmed infection showed generalized massive hyperemic response (100.0%). Two were CRPS/RSD and 2 cases were of cellulitis (100.0%). Among remaining 2, one refused surgery and other was lost to follow-up. Additionally, 20 published cases in the literature of osteomyelitis were also analyzed. Nineteen cases of bone and joint infection, (osteomyelitis/arthritis/cellulitis) except one with endothelial dysfunction showed generalized massive increased flow and pool response (95.0%). All published cases of osteomyelitis in the literature showed generalized massive hyperemic response (100.0%).

Results: The data clearly indicated that 100% of the cases of bone infection (osteomyelitis/arthritis/cellulitis) and cases of CRPS/RSD showed generalized massive flow and pool pattern. Infection could be ruled out in absence of generalized massive flow and pool response. All 100% published cases of osteomyelitis in the literature showed positive vascular endothelial response.

Conclusion: By incorporating the concept of vascular endothelial related response causing massive vasodilatation in infection, the interpretation of the TPBS can be more précised as it is based upon the normal physiology. Larger studies are recommended.

No MeSH data available.


Related in: MedlinePlus