Detection of acute osteomyelitis with indium-111 labeled white blood cells in a patient with sickle cell disease.

A young patient with sickle cell disease (SCD) and multiple hospitalizations for crisis was admitted because of suspected osteomyelitis. Initial laboratory work, radiographs, and bone images were not contributory. An In-111 white blood cell (WBC) study demonstrated two areas of increased radionuclide uptake consistent with osteomyelitis. One of these had associated soft tissue infection. No other areas of active osteomyelitis were visualized, in spite of the presence of several additional infection sites. Imaging with In-111 WBC is probably not justified for routine diagnosis of acute osteomyelitis in areas free of previous disease, where conventional bone images are highly efficient. In-111 WBC imaging, however, may be helpful in detecting osteomyelitis in selected patients with SCD in whom Tc-99m bone images and radiographs are usually abnormal and difficult to interpret due to previous bone infarcts. Localization of the infection focus is very important in choosing the aspiration site for bacteriologic studies. A negative study, however, should be interpreted cautiously.

Diagnosis of vertebral osteomyelitis: clinical, radiological and scintigraphic features.

Incidence of non-tuberculous vertebral osteomyelitis has been increasing significantly over the past 15 years. Its prompt diagnosis remains difficult. Presented here are five cases of vertebral osteomyelitis studied clinically, with laboratory studies, radiographically, and with Tc-99m bone and In-111 labeled white blood cells (In-111 WBC) scintigrams. Three of the cases are described in detail. The In-111 WBC studies were not found useful in detecting the infection in four out of the five patients. Reasons for these false negative results are discussed. Clinical, etiopathogenic and radiographic characteristics of vertebral osteomyelitis are also presented.

Importance of markers in Tc-99m pyrophosphate myocardial images.

A false-positive Tc-99m PYP myocardial scan may result due to gastric activity from breakdown of radiopharmaceutical and accumulation of Tc-99m pertechnetate in gastric cells. Importance of anatomic landmarks during early blood pool images is emphasized to prevent this error.

Plantar fascitis--early blood pool images in diagnosis of inflammatory process.

Bone scintigraphy is of diagnostic value in stress fractures where radiography may not be helpful. Obtaining early blood pool images during scintigraphy for suspected stress fractures may help to identify soft tissue inflammation (plantar fascitis) when delayed images are normal.