Robert Lisbona

Observations on the sequential use of 99mTc-phosphate complex and 67Ga imaging in osteomyelitis, cellulitis, and septic arthritis.

Sequential studies with 99mTc-methylene diphosphonate (99mTc-MDP) and 67Ga were performed in 40 patients to determine the role of each agent in evaluating osteomyelitis, cellulitis, and spetic arthritis. Apart from the value of 67Ga in distinguishing cellulitis from osteomyelitis, it is a good adjuvant to 99mTc-MDP imaging in chronic osteomyelitis to identify continuing or recurrent sepsis and localize the focus of infection more precisely.

99mTc-PP and 67Ga Imaging Following Insertion of Orthopedic Devices

Deposition of 67Ga in bone does not explicitly imply osteomyelitis. Osteomyelitis complicating insertion of orthopedic devices is manifested by lack of congruence in the distribution patterns of 99mTc-PP and 67Ga. Congruent patterns can reflect the increased bone reaction to implantation or loosening of the device, not necessarily osteomyelitis. Both (a) nonseptic synovitis secondary to reactive bursa formation and (b) cellulitis exhibit an affinity for 67Ga and virtually none for 99mTc-PP, whereas the reverse is true for heterotopic bone. Thus combined sequential 99mTc-PP/67Ga imaging is necessary for evaluation of complications associated with internal orthopedic devices.

Diagnostic applications of radiopertechnetate and radiohippurate imaging in post-renal transplant complications

Radiopertechnetate and radiohippurate imaging offer a noninvasive method of distinguishing between various complications of renal transplantation. They are especially useful in patients on dialysis, may anticipate biochemical changes by as much as 48 hours, and also provide a useful independent means of confirming the biochemical and clinical parameters. The potential hazards of angiography and retrograde ureteral catheterization are eliminated.

A Nucleography and Radioangiographic Study of a Patient with Torsion of the Spleen

A rare case of torsion of the spleen is described in which the radio-colloid image disclosed absent spleen function in association with a mobile left upper quadrant mass. Celiac angiography showed looping of the splenic artery with stenosis at the point of twisting and a prolonged splenogram; there was failure to visualize the splenic vein.

Radionuclide Imaging of Septic Joints and Their Differentiation from Periarticular Osteomyelitis and Cellulitis in Pediatrics

Thirty-eight children who had septic arthritis, juxtaarticular osteomyelitis, cellulitis or a combination thereof were studied on consecutive days with 99mTc-methylene diphosphonate (99mTc-MDP) and 67Ga-citrate (67Ga) imaging, respectively, in an attempt to make a definitive diagnosis. The 99mTc-MDP uptake reflects the bone response to the septic process, whereas 67Ga seems to be concentrated at the site of infection by the inflammatory components. By utilizing the information from both modalities the septic focus was disclosed in all cases, and in the majority of patients the precise location of the infection, i.e., bone, synovium, or adjacent soft tissue was possible. The relatively poor resolution of the gamma camera vis a vis radiography was the limiting factor, particularly with infants, in determining the exact site of the septic process. Early in the evolution of the disease radionuclide imaging is considerably more sensitive than radiography.

Assessment of bone viability by scintiscanning in frostbite injuries.

Radionuclide bone imaging with a radiotechnetium-labeled phosphate (99mTc-methylene diphosphonate) has been employed to study the extremities injured by frostbite. The degree of accretion of the radiopharmaceutical in bone is dependent on the integrity of the vascular supply. This property has been used successfully to distinguish viable and nonviable bone.

Serial 67ga-citrate Imaging During Treatment of Acute Osteomyelitis in Childhood

To test the hypothesis that abnormalities on 67Gacitrate scans parallel the clinical course of acute osteomyelitis and revert to normal with successful antibiotic therapy, serial scans were performed in ten children. Scans improved markedly within the first two to four weeks of treatment, but abnormalities persisted at six or more weeks in over 50% of the cases, despite complete clinical resolutions of disease.

A Longitudinal Comparison of the Kinetics of 99mTc-MDP and 99mTc-EHDP in Humans

99mTc-MDP and 99mTc-EHDP were compared in 11 volunteers and 20 patients for blood retention, urinary excretion, bone to soft tissue background and overall quality of the radionuclide images. 99mTc-MDP showed significant superiority in most of the parameters tested making it the preferred radiopharmaceutical. However, in those patients exhibiting skeletal disease both 99mTc-MDP and 99mTc-EHDP disclosed the same lesions with approximately equal relief.