Clinical spectrum and diagnostic pitfalls of multiple abnormal uptakes on bone scintigraphy

SPECT/CT of Total Ankle Arthroplasty

Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.

SPECT/CT of Total Ankle Arthroplasty

Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.

Analysis of Missed Skeletal Injuries Detected Using Whole-Body Bone Scan Applied to Trauma Patients: A Case-Control Study

(1) Background: Skeletal injuries may be missed in patients presenting multiple traumas during initial assessment. A whole-body bone scan (WBBS) may aid the detection of missed skeletal injuries, but the current level of research in this regard is insufficient. Thus, this study aimed to investigate whether a WBBS is useful for the detection of missed skeletal injuries in patients with multiple traumas. (2) Methods: This retrospective, single-region, trauma center study was conducted at a tertiary referral center from January 2015 to May 2019. The rate of missed skeletal injuries detected via WBBSs was evaluated, and factors that could influence the outcome were analyzed and divided into missed and not-missed groups. (3) Results: A total of 1658 patients with multiple traumas who underwent WBBSs were reviewed. In the missed group, the percentage of cases with an Injury Severity Score (ISS) ≥ 16 was higher than the not-missed group (74.66% vs. 45.50%). The rate of admission route through surgery and embolization was high in the missed group. Moreover, the proportion of patients that experienced shock in the missed group was higher than that in the not-missed group (19.86% vs. 3.51%). In univariate analysis, ISS ≥ 16, admission route through surgery and embolization, orthopedic surgery involvement, and shock were related to missed skeletal injuries. ISS ≥ 16 was determined to be statistically significant in multivariate analysis. Additionally, a nomogram was constructed based on multivariable analysis. (4) Conclusions: Missed skeletal injuries were significantly associated with several statistical factors, and a WBBS can be used as a screening method to detect missed skeletal injuries in patients with multiple blunt traumas.

Whole-Body Bone Scintigraphy Helps to Detect Kidney Diseases

OBJECTIVE

We conducted this retrospective study to explore whether abnormalities on renal images obtained using whole-body bone scintigraphy (WBS) can help detect renal diseases.

MATERIALS AND METHODS

Patients who underwent WBS between June 2017 and October 2018 were screened and then underwent a minimum 6-month follow-up, during which their clinical information was tracked. The percentage of different renal abnormalities, diseases, and intervention considerations was calculated.

RESULTS

We screened 4706 WBS examinations, and 486 (10.3%) patients exhibited abnormalities on renal images. The major types of abnormal renal images obtained via WBS included images of diffuse increased uptake (10.9% [53/486]), focal increased uptake (65.6% [319/486]), diffuse decreased uptake (8.0% [39/486]), focal decreased uptake (10.7% [52/486]), heterogeneous uptake (3.3% [16/486]), and small kidney size (1.4% [7/486]). After a 6-month follow-up period, 65.4% (318/486) of our included patients exhibited confirmed kidney abnormalities that included calculus, urine accumulation, cyst, atrophy, severe hydronephrosis, and tumors. Among these patients with confirmed kidney abnormalities, 27.4% (87/318) had newly identified renal abnormalities, 11.9% (38/318) underwent further examinations by clinicians, and 7.9% (25/318) received further intervention and treatment, including surgery and chemotherapy.

CONCLUSION

Although renal images obtained with WBS could not be used to accurately evaluate kidney conditions, abnormal renal images obtained with WBS may indicate that serious renal problems exist. Therefore, both nuclear medicine physicians and clinicians should pay more attention to renal abnormalities on WBS. Patients with renal abnormalities should undergo dedicated renal examinations with WBS, which may change clinical decision-making.

Imaging features in patients with SAPHO/CRMO: a pictorial review

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome and chronic recurrent multifocal osteomyelitis (CRMO) have been described as disorders of chronic osteoarthritic inflammation frequently associated with skin manifestations, and SAPHO and CRMO (SAPHO/CRMO) are rare autoinflammatory disorders of unknown etiology. SAPHO tends to occur in adults and CRMO predominantly occurs in children and adolescents. SAPHO/CRMO can affect any skeletal region (e.g., anterior chest wall, spine, or long bones). As SAPHO/CRMO are diagnoses of exclusion, the diagnoses might be difficult if skin manifestations are not clearly evident. However, knowledge of the imaging findings of skeletal disorders is helpful for correcting the diagnosis and avoiding unnecessary invasive procedures, as well as in facilitating early diagnosis and adequate treatment. This pictorial review describes the appearance of increased skeletal uptake for SAPHO/CRMO on bone scintigraphy along with findings from radiography, computed tomography, and magnetic resonance imaging.