Lumbosacral transitional vertebral articulation: evaluation by planar and SPECT bone scintigraphy.

It has been suggested that low back pain (LBP) may arise from lumbosacral transitional vertebral articulation (LSTVA) itself. It is known that bone scintigraphy is a valuable tool for the recognition of pain arising from bone and articular diseases. Therefore we aimed to show planar and SPECT bone scintigraphic findings of LSTVA and compare them with the LBP and X-ray findings. Twenty-eight patients (aged 20-63 years) in whom LSTVA had been identified radiographically were evaluated with planar bone scintigraphy, utilizing 99mTc methylene diphosphonate; and single photon emission computed tomography (SPECT) bone scintigraphy. Eighteen patients had LBP whereas 10 had not. There were 25 type IIA, one type IIB and two type IIIA LSTV articulation. On planar images, normal or non-focal minimally increased uptake superimposed on the upper sacroiliac joint was seen in patients without degenerative changes regardless of LBP whereas SPECT showed non-focal mild increased uptake on the area medial to the upper sacroiliac joint. Planar scans showed normal to non-focal mild, and mild-to-moderately increased uptake whereas SPECT demonstrated focal mild-to-moderately and markedly increased uptake in patients with degenerative changes without LBP and with LBP, respectively. The X-ray results showed an association of LBP degenerative changes, and the SPECT results showed a focal, markedly increased, uptake. We conclude that this focal, markedly increased, uptake may show the metabolically active degenerative changes of LSTV articulation and may help to reveal the pain arising from LSTVA. Therefore we propose that bone scintigraphy may be considered for the evaluation of patients with LBP thought to arise from LSTV articulation.

99mTc-sestamibi muscle scintigraphy to assess the response to neuromuscular electrical stimulation of normal quadriceps femoris muscle.

OBJECTIVES: Neuromuscular electrical stimulation (NMES) is widely used for improving muscle strength by simultaneous contraction in the prevention of muscle atrophy. Although there exist many clinical methods for evaluating the therapeutic response of muscles, 99mTc-sestamibi which is a skeletal muscle perfusion and metabolism agent has not previously been used for this purpose. The aim of our work was to ascertain whether 99Tc-sestamibi muscle scintigraphy is useful in the monitoring of therapeutic response to NMES in healthy women. METHODS: The study included 16 women aged between 21 and 45, with a mean age of 32.7 +/- 6.4. Both quadriceps femoris muscles (QFM) of each patient were studied. After randomization to remove the effect of the dominant side, one QFM of each patient was subjected to the NMES procedure for a period of 20 days. NMES was performed with an alternating biphasic rectangular current, from a computed electrical stimulator daily for 23 minutes. After measurement of skinfold thickness over the thigh, pre- and post-NMES girth measurements were assessed in centimeters. Sixty minutes after injections of 555 MBq 99mTc-sestamibi, static images of the thigh were obtained for 5 minutes. The thigh-to-knee uptake ratio was calculated by semiquantitative analysis and normalized to body surface area (NUR = normalized uptake ratio). RESULTS: The difference between the pre and post NMES NUR values was significant (1.76 +/- 0.31 versus 2.25 +/- 0.38, p = 0.0000). The percentage (%) increase in NUR values also well correlated with the % increase in thigh girth measurements (r = 0.89, p = 0.0000). CONCLUSION: These results indicated that 99mTc-sestamibi muscle scintigraphy as a new tool may be useful in evaluating therapeutic response to NMES.

Technetium-99m sestamibi limb scintigraphy in post-traumatic reflex sympathetic dystrophy: preliminary results.

Reflex sympathetic dystrophy (RSD) has widely variable clinical manifestations. Its pathogenesis remains partially unexplained. RSD is commonly divided into three stages; these stages are not always clearly separable, but staging remains important for correct treatment. Since the disease involves soft tissue alterations as well as bone changes, we decided to investigate whether technetium-99m sestamibi limb imaging can be used to evaluate the soft tissue appearance. Fifteen patients (seven females and eight males; age range 12-68 years) with clinically significant post-fracture RSD were evaluated with both three-phase bone scan (TPBS) and 99mTc-sestamibi limb scintigraphy. Although, in general, patients with similar duration of disease, clinical stage and TPBS activity tended to have similar patterns of sestamibi uptake, discordant uptake patterns were observed in some patients with clinical stage 1. Thus, of 12 patients with stage I disease, eight had increased 99mTc-sestamibi activity in the distal part of the affected limb, while three had normal activity and one had decreased activity. All three patients with stage II disease showed normal 99mTc-sestamibi uptake. Although most of the patients with increased 99mTc-sestamibi uptake had increased activity on all three phases of the bone scan, there were discordant results between the scan patterns in other patients. On the basis of these findings, we suggest that 99mTc-sestamibi imaging may contribute to the differentiation between clinical stages and may permit evaluation of the disease course and selection of appropriate therapy. 99mTc-sestamibi imaging is not, however, a primary diagnostic procedure for RSD.

Magnetic resonance imaging in follow-up of treated clubfoot during childhood.

In this study, we evaluated the short-term results of surgically treated clubfoot with magnetic resonance imaging (MRI). T1- and T2-weighted MRI images with 4-mm slices in the standard anatomic sagittal, transverse, and coronal planes were obtained in seven cases of clubfoot aged 4--11 years (mean 5.6 years old). The mean follow-up period was 3.6 years (ranged between 2 and 6 years). Sagittal talocalcaneal angle, talar head and neck axis internal rotation, calcaneal axis internal rotation, transverse talar neck and head/calcaneus angle and posterior calcaneus external rotation were measured. Three cases with dorsal talonavicular subluxation and a case of calcaneocuboid luxation were demonstrated by MRI. It was concluded that MRI may help to understand results of surgically-treated clubfoot by revealing hindfoot articular relationships and many complications.

Acetabular dysplasia in normal Turkish adults.

The aim of this investigation was to examine normal hip joint morphometry and the acetabular dysplasia rate in Turkish adults. Center-edge angle, acetabular angle, acetabular depth, acetabular roof obliquity, and roof angle were measured in standardized pelvic radiographs of 495 adults without any hip symptoms. The center-edge angle was significantly different in the patients over the age of 70 than all other age groups except those in the 60 to 69 group. Additionally, there were differences between those in the 60 to 69 age group compared to those in the 20 to 29 age group. The acetabular angle showed a significant difference between gender and between the age groups over 60. The acetabular angle was negatively correlated with center-edge angle. Even though no significant differences were observed in the acetabular depth, differences in acetabular roof obliquity and roof angle were related to gender and age, all showed high standard deviations. The rate of acetabular dysplasia was 2.4% in the Turkish adult population aged 20 to 79. It is concluded that the center-edge angle may be a useful parameter in the evaluation of acetabular dysplasia if one is aware of its difference in patients over the age of 60.