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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

A proposed new classification to interpret three phase bone scan
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Figure 8: A proposed new classification to interpret three phase bone scan

Mentions: Variations are not uncommon in medicine. Our rainbow has black and brown colors also. Sometimes it may be difficult to exclude infection in acute fracture due to associated extensive traumatic inflammation producing positive large response on the flow-phase and the tissue-phase of the TPBS study. However, with the passage of time and stabilization of the fracture, the traumatic, inflammatory response subsides and the limited focal hyperemia picture emerges. Conversely, in states of poor vascularity with compromised delivery of the radiotracer, low-grade chronic infection, very early phase of infection, in bilateral limb infections as often noted in bilateral diabetic/neuropathic feet or in persons with endothelial dysfunction, which often presents clinically by associated erectile dysfunction, the classical extensive flow and tissue phase response involving large and massive areas may not be present and clear distinction between infection or no infection may be difficult. The matter compounds and becomes yet more difficult when two or more pathologies exist together. A new classification to interpret TPBS is described in Figure 8.[15] This is the first study connecting TPBS interpretation based on the vascular endothelial response. Larger studies with different common pathologies and different combinations of pathologies will help answering some of these questions.


Three phase bone scan interpretation based upon vascular endothelial response.

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

A proposed new classification to interpret three phase bone scan
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: A proposed new classification to interpret three phase bone scan
Mentions: Variations are not uncommon in medicine. Our rainbow has black and brown colors also. Sometimes it may be difficult to exclude infection in acute fracture due to associated extensive traumatic inflammation producing positive large response on the flow-phase and the tissue-phase of the TPBS study. However, with the passage of time and stabilization of the fracture, the traumatic, inflammatory response subsides and the limited focal hyperemia picture emerges. Conversely, in states of poor vascularity with compromised delivery of the radiotracer, low-grade chronic infection, very early phase of infection, in bilateral limb infections as often noted in bilateral diabetic/neuropathic feet or in persons with endothelial dysfunction, which often presents clinically by associated erectile dysfunction, the classical extensive flow and tissue phase response involving large and massive areas may not be present and clear distinction between infection or no infection may be difficult. The matter compounds and becomes yet more difficult when two or more pathologies exist together. A new classification to interpret TPBS is described in Figure 8.[15] This is the first study connecting TPBS interpretation based on the vascular endothelial response. Larger studies with different common pathologies and different combinations of pathologies will help answering some of these questions.

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