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Title: Technetium Tc 99m diphosphonate bone scan. False-normal findings in elderly patients with hematogenous vertebral osteomyelitis

Abstract

Hematogenous osteomyelitis is usually diagnosed by an abnormal technetium Tc 99m diphosphonate bone scan in symptomatic patients who have positive blood cultures. False-normal 99mTc bone scans have been described recently in neonates with biopsy-proved osteomyelitis. This phenomenon seems to be extremely rare in adults. Two elderly patients with hematogenous vertebral osteomyelitis had normal technetium Tc 99m diphosphonate bone scans when first evaluated. In both cases the bone scans became abnormal four to six weeks after onset of symptoms and two to four weeks after the initial normal results of the study. When suggested by the clinical picture, hematogenous osteomyelitis cannot be ruled out by a normal 99mTc bone scan at any age. Gallium scan, computed tomographic scan, or bone biopsy can be helpful in such cases.

Authors:
; ;
Publication Date:
Research Org.:
Roger Williams General Hospital, Providence, RI
OSTI Identifier:
5725690
Resource Type:
Journal Article
Resource Relation:
Journal Name: Arch. Intern. Med.; (United States); Journal Volume: 147:11
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; OSTEOMYELITIS; DIAGNOSIS; SKELETON; RADIOISOTOPE SCANNING; AGED ADULTS; ISOMERIC NUCLEI; PATIENTS; SPONDYLITIS; TECHNETIUM 99; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BODY; COUNTING TECHNIQUES; DISEASES; HOURS LIVING RADIOISOTOPES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPES; NUCLEI; ODD-EVEN NUCLEI; ORGANS; RADIOISOTOPES; RHEUMATIC DISEASES; SKELETAL DISEASES; TECHNETIUM ISOTOPES; YEARS LIVING RADIOISOTOPES; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Schlaeffer, F., Mikolich, D.J., and Mates, S.M.. Technetium Tc 99m diphosphonate bone scan. False-normal findings in elderly patients with hematogenous vertebral osteomyelitis. United States: N. p., 1987. Web. doi:10.1001/archinte.147.11.2024.
Schlaeffer, F., Mikolich, D.J., & Mates, S.M.. Technetium Tc 99m diphosphonate bone scan. False-normal findings in elderly patients with hematogenous vertebral osteomyelitis. United States. doi:10.1001/archinte.147.11.2024.
Schlaeffer, F., Mikolich, D.J., and Mates, S.M.. Sun . "Technetium Tc 99m diphosphonate bone scan. False-normal findings in elderly patients with hematogenous vertebral osteomyelitis". United States. doi:10.1001/archinte.147.11.2024.
@article{osti_5725690,
title = {Technetium Tc 99m diphosphonate bone scan. False-normal findings in elderly patients with hematogenous vertebral osteomyelitis},
author = {Schlaeffer, F. and Mikolich, D.J. and Mates, S.M.},
abstractNote = {Hematogenous osteomyelitis is usually diagnosed by an abnormal technetium Tc 99m diphosphonate bone scan in symptomatic patients who have positive blood cultures. False-normal 99mTc bone scans have been described recently in neonates with biopsy-proved osteomyelitis. This phenomenon seems to be extremely rare in adults. Two elderly patients with hematogenous vertebral osteomyelitis had normal technetium Tc 99m diphosphonate bone scans when first evaluated. In both cases the bone scans became abnormal four to six weeks after onset of symptoms and two to four weeks after the initial normal results of the study. When suggested by the clinical picture, hematogenous osteomyelitis cannot be ruled out by a normal 99mTc bone scan at any age. Gallium scan, computed tomographic scan, or bone biopsy can be helpful in such cases.},
doi = {10.1001/archinte.147.11.2024},
journal = {Arch. Intern. Med.; (United States)},
number = ,
volume = 147:11,
place = {United States},
year = {Sun Nov 01 00:00:00 EST 1987},
month = {Sun Nov 01 00:00:00 EST 1987}
}
  • In osteomyelitis, bone-scan findings precede the appearance of bone changes on radiographs. In cases where focal ischemia occurs, the earliest scan finding may be a cold area that later becomes hot as active periostitis develops.
  • Technetium-99m bone scanning reveals a spectrum of findings in the diagnosis of acute hematogenous osteomyelitis. Both cold and hot abnormalities are found. Gallium-67 citrate imaging is recommended when /sup 99m/Tc phosphate scans are inconclusive.
  • Twenty-one neonates suspected of having acute osteomyelitis were studied by technetium-99m phosphate radiopharmaceuticals. Of the ten infants subsequently proven to have osteomyelitis involving 20 sites in all, only six sites (31.5%) were abnormal by bone imaging. Fifty-eight percent were normal and 10.5% equivocal. These poor results are contrary to the high accuracy rate achieved in slightly older infants; they negate the ability of the bone scan to diagnose neonatal osteomyelitis.
  • Hematogenous pyogenic vertebral osteomyelitis (HPVO) continues to be a diagnostic problem for clinicians due to nonspecific presentation of the disease (1,2). We reviewed our experience of the last 10 years to determine the diagnostic usefulness of radionuclide bone studies in this disease. We found 15 patients whose primary diagnosis was HPVO. Of the 15 patients, 12 had (99mTc)MDP bone scans which were all positive. Five of the 12 patients had positive (/sup 67/Ga)citrate scans and one patient with chronic active HPVO had negative /sup 67/Ga and (/sup 111/In)WBC bone images. At the same time, three patients' spine x-rays and onemore » patient's CT scan of the vertebra were normal. Additionally, in three patients spine x-rays were interpreted as consistent with degenerative joint disease that contributed to the delay of the diagnosis. We conclude that when HPVO is suspected an abnormal (99mTc)MDP bone image increases the probability of the disease, even if the x-rays and CT scans of the spine are normal. An abnormal /sup 67/Ga image following an abnormal 99mTc bone image increases the specificity of the diagnosis. Normal (99mTc)MDP and (/sup 67/Ga)citrate bone images of the vertebra virtually exclude the diagnosis of HPVO.« less
  • A case of occult pelvic osteomyelitis is presented. The involved portions of the left pubis and left ischium presented as cold areas on the original bone scan with /sup 99m/Tc-diphosphonate. The presumed mechanism for this unusual finding in osteomyelitis is compression of the microcirculation to bone by subperiosteal and intraosseous pus.