Involutional Osteoporosis

Compression Fracture Vertebrae

Involutional osteoporosis includes senile osteoporosis and postmenopausal osteoporosis. The reported incidences vary according to the diagnostic method used and the population studied. One radiographic study of spinal osteoporosis in a series of ambulatory women aged between 45 and 79 years recorded an incidence of 29 (Smith et al. 1960). Most recent studies have indicated a prevalence of 50 in women and 20 in men in their late seventies (Fujiwara 2004) and 11.4 in women of 50 years or older...

Transient Regional Osteoporosis

Radiographic Pictures Osteoporosis

Two closely related types of transient regional osteoporosis have been described transient osteoporosis of the hip and regional migratory osteoporosis. Classically, these two conditions have been dealt with as separate entities because of the difference between the involved site and the migratory nature of the latter disease. On the whole, however, the clinical, radiographic, and scintigraphic manifestations of these two diseases largely overlap, and their close kinship has been stressed...

Transient Osteoporosis with Bone Marrow Edema

Can Marrow Edema Painful

This condition has been proposed as a syndrome that is associated with osteoporosis (Wilson et al. 1988). These authors reported ten patients with hip or knee pain whose radiographs were either normal or minimally os-teopenic at the diseased site. Bone scintigraphy showed increased tracer uptake, and MRI demonstrated decreased signal intensity on T1- weighted images and increased signal intensity on T2-weighted images, denoting hyperemia and edema. Clinical symptoms slowly resolved over a...

Sterile Traumatic Synovitis

Periarticular Osteopenia

Following contusion or a sprain of a joint sterile synovitis may develop. Such a synovitis is caused by or associated with bone contusion, distension arrows . B Anterior pinhole scan reveals intense periarticular uptake with narrowed joint space arrows rupture of the anterior cruciate ligament, meniscal tear, or impingement of reparative tissue Comin and Rodriguez-Merchan 1997 Huh et al. 2004 . The traumatic synovitis produces sterile effusion of various amounts, which occasionally may result...

Charcots Joint or Neuroarthropathy

Charcot Joint

Charcot's joint involves virtually any joints under physical stress. As the term neuroarthropa-thy denotes destructive arthropathy of Char-cot's joint is caused by a number of diseases that affect the central or peripheral sensory nerve fibers, rendering patients insensitive to pain and vulnerable to trauma. Causes include tabes dorsalis, syringomyelia, spinal injury, hemiplegia, poliomyelitis, and diabetes melli-tus. Pathologically, the condition is characterized by chondrolysis, fracture and...

Abnormal Bone Scan

Scintigraphic manifestations of bone and joint diseases can be described from four different view points the morphology and number, the mode of tracer uptake, the tracer distribution pattern, and the vascularity and blood-pool pattern as revealed by nuclear angiography. More specifically, morphological changes can be expressed in terms of size, shape, contour, position, and texture the number s may be solitary, multiple, or innumerable the tracer uptake and vascularity may be increased,...

Severs Disease Calcaneal Apophysis

Calcaneal Epiphyses

The existence of Sever's disease, or calcaneal apophysitis, as a clinical entity was once ques- Fig. 13.9A-C Fine fissures within condensed apophysis and nuclear angiography in Sever's disease. A Lateral radiograph of painful left calcaneus in a 14-year-old boy shows fine fissures and marginal fragmentations in condensed apophysis arrows . B Nuclear arteriogram reveals increased blood flow and pool in the retrocalcaneal surface arrowheads . C Equilibrium bone scan demonstrates increased uptake...

Secondary Hypertrophic Osteoarthropathy

Hypertrophic Pulmonary Osteoarthropathy

Secondary hypertrophic osteoarthropathy may be caused by a variety of pulmonary, pleural, abdominal, and cardiac diseases and other conditions such as SLE. Principal pathological alteration is periostitis with new bone deposition and intense overgrowth of vascular connective tissue that surrounds the tendon, bone, and joint. Synovitis is not uncommon, but usually mild. Hypertrophy may improve or even Fig. 12.21A, B Secondary hypertrophic osteoarthropathy. A Dorsoventral radiograph of the left...

Reflex Sympathetic Dystrophy

Reflex Sympathetic Nerve Dystrophy

It is a rheumatic disorder of clinical importance and academic interest. Involvement is usually regional and diffuse, but can be segmental and small in rare cases Helms et al. 1980 . The condition is also referred to as causalgia, Sudeck's atrophy, posttraumatic osteoporosis and angiospasm, reflex neurovascular dystrophy, and the shoulder-hand syndrome. Common symptoms include pain, swelling, stiffness, tenderness, vasomotor and sensory disturbances, hyperesthesia, disability,...

Osteodystrophy Associated with Hyperparathyroidism and Brown Tumor

Loss Lamina Dura

Osteodystrophy associated with hyperparathy-roidism is a well-established clinicopathologi-cal entity of radiographic and scintigraphic interest. Hyperparathyroidism may be classified into the primary, secondary, or tertiary form. The primary type results from increased parathormone production with resultant excessive bone calcium mobilization. The etiology includes adenoma 75 , hyperplasia, and carcinoma. This is a disease of middle-age and older, and women are affected twice as frequently as...

Metabolic Bone Diseases and Drug Induced Osteoporosis

Metabolic Bone Disease Cats

Bone scintigraphy has traditionally been considered to be not as useful as radiography in the study of metabolic bone diseases including senile or postmenopausal osteoporosis, osteo-dystrophy, drug-induced osteoporosis, and rickets and osteomalacia. However, aided by the pinhole technique, 99mTc-MDP bone scin-tigraphy has been shown to be able to portray characteristic features in systemic and local osteoporosis or osteopenia, which is defined as a state of reduced bone mass with increased...

Avascular Necrosis in Chronic Alcoholism

Osteonecrosis The Right Femoral Head

The existence of a close cause-and-effect relationship between alcoholism and avascular os-teonecrosis has long been noted, most typically Fig. 14.3A-C Bone infarctions. A Anteroposterior radiograph of the right hip in a 55-year-old woman with multiple, idiopathic bone infarctions reveals irregularly mottled and ring-like densities in the head and proximal metadiaphysis of the right femur arrows, arrowheads . The lesion in the greater trochanteric region has the classic serpiginous contour...

Muscular and Musculotendinous Rheumatism Syndromes

Medial Epicondylitis Elbow Radiograph

Muscular and musculotendinous rheumatism syndromes of both scintigraphic and radiographic interest include myositis ossificans, rhabdomyolysis, musculotendinous unit injuries, and distal femoral cortical desmoid. Myositis ossificans denotes a condition in which the skeletal muscle is heterotopically ossified. The ossifying myositis caused by trauma is referred to as myositis ossificans traumatica and that unrelated to trauma is called myositis ossificans nontraumatica or pseudomalignant osseous...

Legg CalvePerthes Disease Capital Femoral Epiphysis

Five Year Boy Joints Hip

This is the most common osteochondrosis, affecting predominantly boys with a peak age of incidence from 6 to 10 years. The involvement is for the most part unilateral, with a bilateral incidence of about 10 . The presenting clinical symptoms are limp, limited joint motion, and pain. The etiology is not established, but traumatic insult to the vulnerable retinacular arteries, which mainly nourish the femoral head during the active growth stage, seems plausible. The vascular injury with...

Osteomyelitis of the Spine

What Vertebral Endplate

Osteomyelitis of the spine pyogenic spondyli-tis typically affects adults. The main causative agents include S. aureus and streptococcus, and rarely gram-negative bacilli and salmonella. Pyogenic spondylitis may result from the direct implantation of organisms at the time of operation. However, in the vast majority the infection is blood-borne. The organisms are introduced through the arterial rather than venous pathway, and the early foci are located in the subchondral zone or the endplate of...

Neonatal and Infantile Osteomyelitis

Bone Scan Cold Spot

Osteomyelitis and pyarthrosis are not common in infants and children. Nevertheless, these constitute important causes of chronic illness and serious deformity that last a long time. The symptoms of infantile, especially neonatal, skeletal infections are peculiarly subtle, usually manifesting as pseudoparalysis of a limb at most and fever only in half of cases Fig. 6.17A-C Acute infective periostitis. A Anteroposterior radiograph of the right lower leg in an 18-year-old girl with multiple bone...

Osteomyelitis in Diabetic Foot

Osteomyelitis Toe Diabetic

Diabetic foot denotes a complex bone and joint disorder that involves the foot in patients with longstanding diabetes. Infection directly extends from either contiguous cellulitis or infected skin ulcers or is mediated by the combination of circulatory, neuropathic, and degenerative alterations. Arteriosclerosis and occlusion, and resultant osteonecrosis are common complications of diabetes mellitus. In diabetics it is often difficult to distinguish between primary and secondary osteomyelitis...

LV ft

Pyogenic Spondylitis

Fig. 6.32A, B Classic osteolytic manifestation of long bone tuberculosis with abscess and unimpressive reactive bone change. A Dorsoventral radiograph of a 41-year-old female with cystic tuberculosis in the right distal radius shows a poorly defined ovoid radiolucency open arrow with reactive sclerosis in the ulnar side solid arrow . B Dorsal pinhole scan shows intense tracer uptake with a photon defect due to the abscess open arrow . Intense uptake is mainly in the ulnar side of the lesion...

Ossificationofthe Posterior Longitudinal Ligament

Ossified Posterior Longitudinal Ligament

Ossification of the posterior longitudinal ligament OPLL is an idiopathic disorder of the spine, in which calcification or ossification of various lengths occurs in the posterior longitudinal ligament. The middle cervical spine, T3 through T6, is most commonly affected. Pathologically, the condition is characterized by bony overgrowth of the ligament that is attached to the posterior surface of the vertebral body and intervertebral disk, compressing and flattening the spinal cord behind. The...

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse Idiopathic

DISH, previously known as ankylosing hyperostosis of the spine and Forestier's disease, is characterized by bony proliferation at the site of tendon and ligament attachment to bone entheses , calcification and ossification of the anterior longitudinal ligaments, and diskover-tebral osteophytosis. This is a common but not insignificant disease of the spine and extraspinal skeleton. The etiology has not been established, but some investigators consider that it may be associated with degenerative...

Odontogenous Osteitis of the Mandible Periapical Abscess

Dental Pulp

Inflammation or infection about the dental root apex is one of the most common conditions in the mandible that manifests as intense tracer uptake. The condition is also important clinically since it occasionally progresses to alveolar abscess, apical granuloma, and cyst formation. The process may be either sterile or septic with a septic source usually in the infected dental pulp. Fig. 7.14A, B Early radiation-induced osteitis in the mandible 2 months after 65 Gy irradiation with 6 MeV...

Sympathetic Synovitis

Bones And Features Right Knee

Sterile sympathetic synovitis may be created in a joint in reaction to osteomyelitis in the juxtaar-ticular bone, for example, in the hip. This type of synovitis has also been known to be triggered by an infective organism growing in a distant site as a hypersensitivity response Goldenberg 1983 . Radiography reveals joint capsular distension, occasionally with regional osteopenia. Pinhole scintigraphic features include diffusely Fig. 8.5A, B Wrapped bone sign in acute, serous, sympathetic...

Acute and Chronic Infective Osteitis and Cortical Abscess

Acute Osteomyelitis

Infective osteitis is suppurative infection of the cortical bone. It may be acute or chronic, and occurs either as an isolated disease Fig. 6.12 or a concomitant process to osteomyelitis Fig. 6.13 . Pathologically, the process is characterized by cortical bone suppuration and abscess formation. The intracortical localization is characteristic, and such a peculiar localization has been accounted for by the presence of an anastomotic vascular network of the dual blood supply from both the...

Spondylolysis

Pars Defect

Spondylolysis refers to the bone defect in the pars interarticularis. It is caused by repeated trauma or physical stress to the biomechani-cally vulnerable lamina between the superior and inferior articular facets. Spondylolysis divides a vertebra into the superior and inferior segment. The former segment includes the vertebral body, pedicles, transverse processes, and superior articular facet and the latter the inferior articular facet, laminae, and spinous process. Spondylolysis is an...

Sclerosing Osteomyelitis of Garre

Osteomyelitis Garr

This is a rare nonpurulent variant of subacute or chronic osteomyelitis. Pathologically, the condition is characterized by prominent proliferation and thickening of the periosteum and spongy trabeculae, but with little pus formation, necrosis, or granulation tissue. The mandible is the typical site of involvement. When a long bone is affected the diaphysis is the site of predilection, and this finding contrasts with the metaphyseal predilection of acute osteomyelitis. Radiography shows diffuse...

Limbus Vertebra

Schmorl Nodes Vertebra

Limbus vertebra is the marginal dislocation of nucleus pulposus, another mode of disk her-niation. It occurs typically in the anterior or posterior edge of the vertebral body, radio-graphically manifesting as the division of a small fragment with a cleavage Fig. 9.60A . A fragment is not present in every case Fig. 9.61A . Pinhole scintigraphically, the lim-bus with sclerosis is characterized by intense uptake localized to the anterior or posterior edge of an endplate, beaking outward when Fig....

C

Giant Schmorl Node Development

Lamellated with well-developed Haversian canals but poorly formed marrow Ono et al. 1977 . The most typical lesion occurs in the cervical spine, although other levels are not ex empted. It is a fairly common disorder with prevalence rates of 2-4 in the middle-aged and older populations in Asian countries Ogata and Kawaguchi 2004 . The disorder may pass symptomlessly or cause numbness and tingling pain in the fingers, head and neck pain, and severe anesthesia of the trunk and lower extremities....

Osteitis Pubis

Scintigraphy Symphysis

Osteitis pubis is a nonspecific inflammatory disease of the symphysis pubis. The involvement is symmetrical, but the unilateral type is not rare. It develops after delivery and a pelvic operation such as prostatectomy or bladder surgery, although idiopathic occurrence in men or nulliparous women has been reported Numaguchi 1971 Segal and Kellogg 1954 . The histological feature is simple bony condensation Rendich and Shapiro 1936 . Clinically, the postoperative type is painful, whereas the...

Osteomyelitis in Flat and Irregular Bones

Osteomyelitis Skull

The irregular bone most often affected with osteomyelitis in adults is the spine this is discussed in detail below. The next most commonly affected bones are the pelvis, skull, and tarsal bones. Fig. 6.22A, B Brodie's abscess. A AP radiograph of the right distal femoral metaphysis in a 31-year-old male patient with Brodie's abscess shows irregular lucent defects surrounded by diffuse sclerosis. The defects are created by saucerization. B Anterior pinhole scan of the same infective lesion shows...

Condensing Osteitis of the Clavicle

Pubis Osteitis

Originally described by Brower et al. 1974 as a clavicular version of osteitis condensans ilii and osteitis pubis, this entity is clinically characterized by painful swelling of the medial end of the clavicle again in young women of child- bearing age. Undue stress to the clavicle appears to be the cause. Pathology is not related to infection, neoplasm, or avascular necrosis. The main histological changes include apposi-tional trabecular thickening in the cancellous bone and periosteal...

Radiographic Manifestations

Involucrum Cloaca Sequestrum

The earliest but nonspecific radiographic change of acute osteomyelitis is soft-tissue swelling with the obliteration of the fat plane. It can be detected as early as 3 days after the sudden onset of disease. However, the direct sign of bone infection manifests more than a week later. The initial bone alterations are local os-teopenia and osteolysis typically in the long bone metaphysis. With the rapid progress of the disease, infection spreads rampantly from cancellous bone to cortex and...

Synovitis in Renal Transplantation and Prolonged Hemodialysis

Articular Capsule The Hip

Following renal transplantation and during long repeated hemodialysis, acute or chronic synovitis may supervene as a complication Bravo et al. 1967 . Generally, the articular inflammation is simple, but occasional infection has been reported Spencer 1986 . The physical irritation of denatured and fragmented articu Fig. 8.9A, B Acute pyarthrosis with aborted chondroly-sis following early treatment. A Anteroposterior radiograph of the left hip in another 13-year-old girl taken after aspiration of...

Radiation Osteitis Osteonecrosis

Osteonecrosis The Sacrum

The term radiation osteitis was originally coined by Ewing 1926 to describe a series of pathological changes that occur in bone after irradiation. Irradiation of bone may result in immediate or delayed arrest of cell division, cell death with reduced matrix production, metaplasia, or neoplasia. The irradiated bones manifest ischemic necrosis, sclerosis, and occasional infection of radionecrosis. These changes occur as secondary reactions to the destruction of osteoblasts and microvascular...

Pinhole Collimation Of Wrist

Mouse Bone Iliac

The anterior view of the pelvis and the hip in the pediatric and juvenile age groups shows moderate tracer uptake in the acetabular fossa, triradiate growth cartilage, femoral head and neck, and trochanters, and intense uptake in the physeal plates Fig. 4.24 . The ilium, pubis, and ischium are portrayed as independent bones at this age. The ilium is indicated by horizontal hot plates and the ischium and pubis by vertical hot plates. In younger subjects the hip joint proper is totally free of...

Accessory Navicular Bone

Femoral Artery Calcification

The navicular accessory bone is located at the medial aspect of the navicular bone proper. Its Fig. 5.18A, B Vertical linear uptake in calcified femoral arteries. A Anterior scintigraph of both thighs shows long linear uptake in the medial aspects of both thighs ar Fig. 5.18A, B Vertical linear uptake in calcified femoral arteries. A Anterior scintigraph of both thighs shows long linear uptake in the medial aspects of both thighs ar rows . B AP radiograph reveals diffusely calcified femoral...

Normal Variants

Superscan Bone

The appearance and intensity of tracer uptake within the skull vary because the count rate is comparatively low and radioactivity distribution is usually uneven. A higher count rate is commonly observed in the peripheries of the skull due to curvature and perpendicular or tangential aligning of the scan detector. Accordingly, calvarial uptake may be diffusely or locally not uniform even in the absence of hyperostosis. Diffuse increased calvarial uptake related to postmenopausal osteoporosis is...

O

A, B Right and left lateral scintigraphs of the skull show localized round photon defects in the parietal bones. C Semi-Towne's view scan shows symmetrical parietal photon defects. D, E Right and left lateral radiographs reveal lucent zones in both parietal bones. F Towne's view radiograph demonstrates typical scalloped appearance due to the absence of the outer table and diploe Fig. 5.4A-F Parietal bone thinning. A, B Right and left lateral scintigraphs of...

Rationale and Techniques of Pinhole Scintigraphy

Scan Normal Ankle

Pinhole scintigraphy is indispensable when bone changes need to be visualized in greater detail than can be achieved by an ordinary scan for analytical interpretation. The information provided by the pinhole scan is often unique and decisive in making a specific diagnosis of bone and joint disorders Bahk et al. 1987 Kim et al. 1999 . Furthermore, this examination has been shown to be of immense value in detecting the lesions that are invisible on an ordinary scan due to low photon counts Fig....

Dual Head Planar Pinhole Scintigraphy

Pecten Pubis Bone

The scope of bone diagnosis using pinhole scintigraphy has been expanded, and the efficacy has been improved with the latest introduction of dual-head planar pinhole bone scintigraphy Bahk et al. 1998a and pinhole bone SPECT Bahk et al. 1998b . Although single-head planar pinhole bone scintigraphy improves the resolution, a blind zone is inevitably created in the periphery of the field of view due to rapid radioactivity falloff. The blind zone is typically observed in the periphery of the XY...

Thoracic and Lumbar Spine

Apophyseal Joints The Lumbar Spine

Because of the larger size and widely spaced vertebrae in the lower spine, the small parts of the individual vertebrae are increasingly well delineated as one descends the spinal column toward the sacrum. For a baseline study, the Fig. 4.16A, B Semilateral view of the scapula. A Near lateral pinhole scintigraph of the left scapula reveals intense tracer uptake in the spina scapularis ss , glenoid process gp , superior sa and inferior angles ia , and the acro-mion process ap . The scapular fossa...

References

Abe K, Sasaki M, Kuwabara Y, et al 2005 Comparison of 18FDG-PET with 99mTc-HMDP scintigraphy for the detection of bone metastases in patients with breast cancer. Ann Nucl Med 19 573-579 Alazraki N 1988 Radionuclide techniques. In Resnick D, Niwayama G eds Diagnosis of bone and joint disorders, 2nd edn. WB Saunders, Philadelphia Anger HO, Rosenthall DJ 1959 Scintillation camera and positron camera. Medical Radioisotope Scanning. IAEA, Vienna Bahk YW 1982 Usefulness of pinhole scintigraphy in...

Skull and Face

Stenvers Radiography

A comparatively large amount of tracer accumulates in relation to the cranial tables and sutures, orbital walls, paranasal sinuses, nasal cavity, zygoma, sphenoidal ridge, and skull base including the temporomandibular and at-lantooccipital joints Fig. 4.1 . Normally, the maxilla and mandible accumulate tracer in the premolar zones presumably due to major masticatory movement. The vertex view shows uptake in the sagittal and coronal sutures and occasional variants. The modified vertex view is...

Neck

Apophyseal Joints Cervical Spine

Pinhole scanning can be used to visualize the small parts of the individual cervical vertebrae, the hyoid bone, and the mineralized anterior neck cartilages. The spinous processes, laminae, and apophyseal joints are portrayed on the posterior view Fig. 4.8 and the vertebral bodies with the endplates, pedicles, and apophyseal joints are visualized on the lateral view Fig. 4.9 . For the topographic study of the up per cervical spine and skull base a close-up pinhole scintigraphy is taken. Thus,...

Tracer In The Tarsal Bone

Talonavicular Joint Space

On the whole, tracer is accumulated only minimally in the shafts of long bones, especially in adults, with higher uptake typically localizing to bone ends. Accordingly, pinhole scanning is more effective and informative in the periar-ticular bones of the limbs. A useful technical guideline for limb pinhole scintigraphy is to place the collimator as close as possible to the side or site of interest for example, either the medial or lateral side in the ankle and anteriorly or posteriorly in the...

Pinhole SPECT of Bone

Sub Chondral Talar Fracture Acute

SPECT is basically an image separation technique, and currently two different modes, planar and pinhole, are available. The latter mode, pinhole bone SPECT, can efficiently separate the plane of interest from overlapping ones and simultaneously magnify the scan image optically. Conventional or planar SPECT was developed first by Kuhl and Edwards 1964 who Fig. 2.3A-C Paired dual-head pinhole scans of the knee. A Lateral scan showing the lateral tibial condyle Itc , lateral femoral condyle arrows...

Introduction and Fundamentals of Pinhole Scintigraphy

Fleming Bone Scan

To those who acquired their anatomical knowledge of the skeleton with the aid of clean, dried bone specimens or a plastic mannequin it may appear as a mere inert weight-bearing scaffold of the human body. However, like all other organs, bone constantly undergoes remodeling and tubulation through the physiological and metabolic activities of osteoblasts and osteo-clasts. The principal role played by these bone cells is the maintenance of bone integrity and calcium homeostasis by balancing...

Radiopharmaceuticals

Picture Soft Tissure Colon

The advantageous properties of 99mTc were reported by Richards 1960 and Harper et al. 1965 , but it was not until the introduction of triphosphate complex by Subramanian and McAfee 1971 that 99mTc became the most promising bone scan agent. Thus, this initial work on 99mTc-labeled phosphate compounds opened a path to the development of a series of novel bone scan agents. Within a short period of time, 99mTc-labeled polyphosphate, pyrophosphate, and diphosphonate were developed in series for...