Comparative Analysis of (99m)Tc-MDP Three-Phase Bone Scan with SPECT/CT and (99m)Tc-HMPAO-Labeled WBC SPECT/CT in the Differential Diagnosis of Clinically Suspicious Post-traumatic Osteomyelitis / 대한핵의학회잡지

PURPOSE: To identify differences between three-phase bone scan and SPECT/CT (TBS) and WBC SPECT/CT (WS) and compare diagnostic accuracies of each modality in patients with suspicious post-traumatic osteomyelitis (OM).METHODS: Twenty-one patients with suspicious post-traumatic OM were enrolled. All patients performed TBS and WS within 1 week. Foci ofMDP andWBC accumulation were divided into three categories: bone (OM), soft tissue (soft tissue inflammation; STI), negative for inflammation (NI). Confirmative diagnosis was made upon operative pathology or long-term clinical follow-up.RESULTS: Of 21 patients, four OM, eight STI, nine NI were finally diagnosed. TBS diagnosis was correct in three of four positive cases and nine of 17 negative cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) of TBS were 75 %, 52.9 %, 57.1 %, 27.3 %, 90 %. WS diagnosis was correct in two of four positive cases and 17 of 17 negative cases. Sensitivity, specificity, accuracy, PPV, NPV were 50 %, 100 %, 81.0 %, 100 %, 89.5 %. Twelve of 21 cases showed agreement between TBS and WS. TBS misdiagnosed nine cases (six STI and two NI as eight OM; one OM as one STI), while WS misdiagnosed four cases (two OM as two STI; two STI as two NI). Combining results from TBS and WS led to better diagnostic accuracy (91.7 %) than either TBS or WS alone.CONCLUSION: TBS and WS showed moderate agreement in assessment of clinically suspected post-traumatic OM. WS better evaluated inflammation than TBS. WS tended to underestimate inflammation whereas TBS tended to overestimate inflammation. Combining TBS and WS enhanced diagnostic accuracy.

The clinical value of three phase bone scans in differentiating benign from malignant bone foci / 肿瘤研究与临床

Objective To compare the results of three phase bone scans between benign and malignant lesions, and explore its clinical value. Methods Patients with pain symptom underwent three phase bone scan. Their corresponding clinical data was collected and input into SPSS software package for further evaluation. Results Forty-nine patients had 73 positive foci in the acquiring field of vascular and blood pool phase bone scans. Excluding 10 foci that suspected of bone metastasis, 37 of 63 were malignant,26 were benign lesion. On vascular, blood pool and delayed images, benign and malignant foci did not exist any significant difference (χ2 =3.341, 1.685 and 2.923, P ＞0.05). In these lesions, 33.3 % (5/15) foci had positive vascular and blood pool results in thoracic, 72.2 % (13/18) in extremity and 75.0 % (18/24) in pelvic.There were no significant difference among subgroup of chest, abdomen, limb and pelvic diseases. In addition,4 foci outside bone system were occasionally found in three phase bone scans. Conclusion Acquiring position could significantly affect the results of three phase bone scan, for example more sensitive rate can be found for limb and pelvis lesions. This method could not significantly differentiate malignant from benign lesions, but could detect soft tissue foci or the change of blood flow, and provide more information for differential diagnosis.

Juvenile Dermatomyositis Diagnosed by (99m)Tc-HDP Three-phase Bone Scintigraphy / 핵의학분자영상

Juvenile dermatomyositis is a common inflammatory muscle disease of childhood, characterized by weakness in proximal muscles and specific skin rash. In case of juvenile dermatomyositis without characteristic clinical features, non-invasive imaging tools such as (99m)Tc-HDP three-phase bone scan are very helpful in diagnostic workup of myopathies. We report a case of 13-year old female with juvenile dermatomyositis, in which (99m)Tc-HDP three-phase bone scan was useful in diagnosis and assessing therapy response.

The Effectiveness of a Three Phase Bone Scan for Making the Diagnosis of Complex Regional Pain Syndrome

BACKGROUND: Complex regional pain syndrome (CRPS) is still difficult to diagnose in the field of chronic pain management. CRPS is diagnosed by purely clinical criteria based on the characteristic signs and symptoms, which have to be differentiated from similar pain conditions like posttraumatic neuropathic pain. Until now, there has been a lack of objective diagnostic tools to confirm the diagnosis of CRPS. The aim of this study was to evaluate the usefulness of a three phase bone scan (TBS) for making the diagnosis of CRPS. METHODS: A total of 121 patients who had been diagnosed with CRPS were evaluated. All the patients were examined by performing a TBS as a part of the diagnostic work-up. A diffuse increased tracer uptake on the delayed image (phase III) was defined as a positive finding for CRPS. RESULTS: Forty-one patients (33.9%) out of 121 showed the positive results on the TBS. The patients with a duration of pain of less than 24 months had a significantly higher positive result (43.4%) on the TBS than did the patients with duration of pain longer than 24 months (12.1%). CONCLUSIONS: A TBS could give a better objective result for diagnosing CRPS for patients with a shorter duration of pain and a TBS gives little information for the diagnosis of CRPS in patients with a duration of pain longer than 24 months.

The Value of Three Phase Bone Scan in Diagnosing Reflex Sympathetic Dystrophy in Hemiplegia

The purpose of this study is to determine the usefulness of the three-phase bone scan(TBS) in the diagnosis of reflex sympathetic dystrophy(RSD) and to evaluate the differences of TBS findings with the clinical stages of RSD. Twenty-four hemiplegic patients were assessed prospectively for radionuclide and clinical features of RSD. 5 cases of stage II RSD patients also had TBS. The results of TBS showed a high diagnostic sensitivity for the stage I RSD within three months of stroke onset. If the "positive TBS" was defined as increased radioisotope uptake in all three phase images, it showed 83.3% of sensitivity and 91.7% of specificity. If the "positive TBS" was defined as increased radioisotope only in delayed image, it showed 100% sensitivity and 66.7% specificity, There was no significant difference in TBS findings with the clinical stages of RSD. Considering difficulties in the clinical diagnosis as various features of the symptoms of RSD are often present for other reasons and increased radioisotope uptake of the delayed image can be present also in other conditions such as disuse and immobilization, TBS may be a useful diagnostic tool for RSD during early rehabilitation if "positive TBS" is defined as increased radioisotope uptake in all three images. Increased radioisotope uptake of the delayed image in patients who have no clinical RSD does not seem to be a predictor of the subsequent development of RSD.