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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

Post-injury X-ray of the left wrist, interpreted by the radiologist as unremarkable
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Figure 3: Post-injury X-ray of the left wrist, interpreted by the radiologist as unremarkable

Mentions: A 66-year-old male, fell on outstretched left hand and complained of pain in left wrist. Plane X-ray of the left wrist was unremarkable [Figure 3] but pain persisted. TPBS was performed on 3rd day indicated localized, limited and focal increased retention of radiotracer in flow, pool and delayed images in the region of the left wrist, consistent with fracture. The TACs drawn in the flow phase of the TPBS in different regions also confirmed it [Figures 4-6]. Second plane X-ray of the left wrist after 3 weeks of the injury confirmed intra articular fracture of the radial styloid process (Chauffeur's fracture). Patient was treated by ORIF. This is an example of vascular endothelium-independent response [Figure 7].


Three phase bone scan interpretation based upon vascular endothelial response.

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

Post-injury X-ray of the left wrist, interpreted by the radiologist as unremarkable
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Post-injury X-ray of the left wrist, interpreted by the radiologist as unremarkable
Mentions: A 66-year-old male, fell on outstretched left hand and complained of pain in left wrist. Plane X-ray of the left wrist was unremarkable [Figure 3] but pain persisted. TPBS was performed on 3rd day indicated localized, limited and focal increased retention of radiotracer in flow, pool and delayed images in the region of the left wrist, consistent with fracture. The TACs drawn in the flow phase of the TPBS in different regions also confirmed it [Figures 4-6]. Second plane X-ray of the left wrist after 3 weeks of the injury confirmed intra articular fracture of the radial styloid process (Chauffeur's fracture). Patient was treated by ORIF. This is an example of vascular endothelium-independent response [Figure 7].

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