Tibial periosteal reactions in soldiers. A scintigraphic study of 29 cases of lower leg pain.

Twenty-two soldiers with tibial pain along the posteromedial tibial border (29 painful tibias) entered the study. The tibias were evaluated using radiographs and scintigraphs. Follow-up scintigraphs of 12 tibias were performed. The scintigraphic lesions were classified as Stages 0-V depending on the percentage of bone thickness involved. No attempts were made to differentiate between shin splints and stress fractures. Twenty-four symptomatic lesions and five asymptomatic lesions were found by scintigraphy. Radiographic changes were found in all the lesions classified as Stage III or higher, in some Stage II lesions, but never in Stages 0 and I lesions. Because intense scintigraphic uptake is seen in bone tumors, radiographs are needed to exclude this diagnosis. Radiographs were, however, not as sensitive as scintigraphs for differentiating the periosteal injuries seen in this study. The initial scintigraphs can be used to classify the lesions. Follow-up scintigraphs are not useful because they take months to return to normal. Consequently, the clinical symptoms and the level of pain should be the guidelines for treatment.

Interobserver variation of angioscintigraphy for deep vein thrombosis.

Angioscintigrams of the deep veins in the legs were obtained in a consecutive series of 119 patients, suspected of deep vein thrombosis. Two nuclear medicine specialists independently read the angioscintigrams for presence of focal-filling defects, increased tissue activity, or collaterals and gave a final diagnosis of deep vein thrombosis. The overall agreement for the four findings were 0.83, 0.74, 0.75, and 0.84, respectively. After adjusting the overall agreement for expected chance agreement, kappa values of 0.56, 0.47, 0.21, and 0.64 were obtained. The interobserver variation of the angioscintigraphic diagnosis for deep vein thrombosis is comparable to that of the radiographic phlebography. As the angioscintigraphic technique is almost without any risk and inconvenience to the patient, it constitutes a relevant diagnostic alternative in the diagnosis of deep vein thrombosis.

The predictive value of bone scintigraphy after internal fixation of femoral neck fractures.

Persisting pain of the hip following internal fixation of fracture of the neck of the femur is often caused by capital necrosis or non-union. In a randomized trial 35 patients had 99mTc-MDP bone scintigraphy performed 6 weeks, 3, 6, and 12 months after internal fixation of their subcapital fractures with a sliding screw-plate or a sliding nail-plate. The purpose was to find out whether bone scintigraphy could predict capital necrosis or non-union before it shows up on plain radiographs, which happens later. The patients were followed up for an average of 44 months (range 12-64). Radiologically, capital necrosis occurred in five patients and non-union in six. Bone scintigraphy showed decreasing activity in the 1st year after operation in uncomplicated cases (P less than 0.03). However, it was impossible to distinguish patients with capital necrosis or non union from those with uneventful healing. There were no significant differences in the scintigraphic appearance between groups at most risk, e.g. Garden stage 3 and 4 fractures versus Garden stage 1 and 2, and fixation by sliding nail versus fixation by sliding screw-plate. In conclusion, bone scintigrams during the first 6 months after operation do not reliably predict failure of internal fixation of fractures of the neck of the femur.

Micturition cystourethrography using X-ray or scintigraphy in children with reflux.

Thirty children with first time urinary tract infection were investigated for vesicoureteral reflux after bladder catheterization. Micturition cystourethrography with X-ray was compared to scintigraphy because scintigraphy gives less than 10% radiation dose by fluoroscopy. Reflux to the renal pelvis was observed more frequently with scintigraphy, otherwise the nosographic sensitivity and the predictive value of a negative test were about the same (0.90). Scintigraphy is therefore recommended for routine control of reflux in children.

Bone scintigraphy in Moore hemiarthroplasty with and without cement following femoral neck fractures. A controlled study.

In a controlled clinical trial patients with acute femoral neck fractures were allocated into two groups of treatment. One group (14 patients) had a Moore hemiarthroplasty cemented with methyl methacrylate, and the other (15 patients) a noncemented prosthesis. Bone scanning with 99m-Tc-MDP was performed 6 weeks, 3 months, 6 months and 12 months after the operation. Increased activity without time-trend was found at the operated side during the entire observation period in both groups. The activity was equally increased in the two groups. No correlation was found between the scintigraphic activity and the functional hip assessment according to Merle d'Aubigné. Bone scintigraphy is of no diagnostic value in the evaluation of a hemiarthroplasty, cemented or without cementation, during the first year postoperatively, as an increased activity might be expected through the entire period.

Colorectal bleeding localized with gamma camera.

Localization of colorectal bleeding using a gamma camera was attempted in a prospective study of 24 patients after in-vivo labelling of their erythrocytes with 99mTc-pertechnetate. In 7 of 8 patients with bright-red rectal bleeding a correct localization was given by scintiphotos, thus helping the surgeon to plan the operative procedure. Of 11 patients with recently acute colorectal bleeding but no signs of actual haemorrhage, 8 had no scintigraphic bleeding. Five investigations had to be excluded due to technical errors. The scintigraphic classification was correct in a significant number of patients (p less than 0.02). It is concluded that bleeding can be identified in colorectum at brisk-haemorrhagic stools and be correctly localized to the right or left side of the colon. This non-invasive scintigraphic procedure should therefore be undertaken before an abdominal 2-3 vessel arteriography is performed.

Joint involvement in psoriasis: scintigraphic, radiologic and clinical findings.

The results of a double-blind prospective study on patients with uncomplicated psoriasis (Ps), psoriasis with arthritis (PA) and a control group (C) are reported. The three groups were matched for age and sex. In the Ps and C groups no significant difference of the radiographic and scintigraphic results was found. The PA group showed significantly more scintigraphic accumulations compared to the two other groups, but no connection between scintigraphy and joint symptoms was found. The patients in the Ps and PA groups were treated with zinc sulfate per os for 8 weeks with no change in the radiographic findings. The PA group showed less and the Ps group more scintigraphic lesions after treatment. During treatment a small but significant decrease in hemoglobin, serum iron and gamma globulin was shown.

Clinical evaluation of hepatic scintigraphy.

The diagnostic accuracy of liver scintigraphy concerning focal liver diseases was evaluated. Two groups of patients were examined. The first group was examined with a rectilinear scanner and a definite diagnosis was obtained in 176 cases. The predictive diagnostic values of the scintigraphic diagnosis: focal liver lesion present (PV pos.) was 71% (57--83), focal liver lesion not present (PV neg.) was 84% (76--90) (95% confidence limits in brackets). The second group was examined with a gamma camera and a definite diagnosis was obtained in 41 cases. Here the PV pos. was 56% (21--86) and the PV neg. 97% (84--100). A motion correction devise did not improve the interpretation. A survey of the literature indicates that the accuracy despite progressive technological development has not improved during the last 6 or 7 years. Despite its limitations the author finds liver scintigraphy indicated in patients with suspected or proven cancer.

Uptake of 67Ga in malignant lesions of the lung and lymphatic tissue.

Thirty-nine patients were given 67Ga intravenously before thoracotomy because of suspected lung cancer. Specimens of relevant tissue were removed and counted in a well-counter. The uptake of 67Ga in bronchogenic epidermoid and anaplastic tumours was greater than the uptake in normal lung tissue, while the uptake in adenocarcinomas seemed to be equal to that in normal tissue. Two out of seven benign lesions showed greater uptake than normal tissue. Thus 67Ga seems to be of limited value in the differentiation of malignant from benign lesions of the lung. The uptake in lymphatic tissue showed a great variation which did not indicate whether metastases were present or not. For this reason 67Ga seems to be of no use for demonstration of metastases in regional lymph nodes from cancer of the lung.