International Orthopaedics

, Volume 12, Issue 4, pp 317–322 | Cite as

Dynamic bone scintigraphy in osteochondritis dissecans

  • R. W. McCullough
  • E. J. Gandsman
  • H. E. Litchman
  • S. L. Schatz
Article

Summary

We report a retrospective study of eighteen patients with pain in the knee or ankle, eleven of whom had osteochondritis dissecans. In these patients the bone-flow time-activity curves were observed after an intravenous injection of a bolus of 99mTc MDP. The curves varied according to the severity of the clinical signs and symptoms. The diagnosis rate was 29% with static scintigraphy and this improved to 57% when dynamic flow studies were used. A positive pattern in the dynamic study together with radiographs and static scintigraphs raised the diagnosis rate to 100%; the sensitivity was 90%. These preliminary results show that dynamic bone scintigraphy holds promise as a technique for identification and management of this condition.

Key words

Bone scan Osteochondritis dissecans Dynamic blood flow 

Résumé

Etude rétrospective de dix-huit malades présentant des douleurs du genou ou de la cheville, dont onze étaient porteurs d'une ostéochondrite disséquante. Chez ces malades on a établi, après injection intra-veineuse d'un bolus de Tc99m, des courbes d'activité du flux sanguin en fonction du temps. Celles-ci varient selon l'importance de la symptomatologie. Le taux de diagnostic était de 29% avec la scintigraphie statique et il a atteint 57% lorsqu'on a eu recours à l'étude dynamique. Une réponse positive à l'épreuve dynamique associée à des arguments radiologiques et scintigraphiques statiques élève à 100% le taux de diagnostic; la sensibilité est de 90%. Ces résultats préliminaires permettent de penser que la scintigraphie dynamique est une technique valable pour le diagnostic et le traitement de l'ostéochondrite.

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References

  1. 1.
    Barrie JH (1984) Hypothesis — a diagram of the form and origin of loose bodies in osteochondritis dissecans. J Rheumatol 11: 512–513Google Scholar
  2. 2.
    Berne RM, Levy MN (1977) Cardiovascular, Physiology. CV Mosby, St. Louis. pp 193–195Google Scholar
  3. 3.
    Blumenthal NC, Posner AS (1973) Hydroxyapatite: Mechanism of formation and properties. Calc Tiss Res 2350243Google Scholar
  4. 4.
    Cahill BR, Berg BC (1983) 99m Technetium phosphate compound joint scintigraphy in the management of juvenile osteochondritis dissecans of the femoral condyles. Am J Sports Med 11: 329Google Scholar
  5. 5.
    Charkes ND, Makler PT, Philips C (1978) Studies of Skeletal tracer kinetics. I digital computer solution of a five-compartment model of (IBF) fluoride kinetics in humans. J Nucl Med 19: 1301–1309Google Scholar
  6. 6.
    Chiroff RT, Cooke III PC (1975) Osteochondritis Dissecans: A histologic and micro-radiographic analysis of surgically excised lesions. Trauma 15: 689–696Google Scholar
  7. 7.
    Cooper RR, Milgram JW, Robinson RA (1966) Morphology of the osteon. J Bone Joint Surg 48A: 1239–1271Google Scholar
  8. 8.
    Deutsch SD, Gandsman EJ (1983) The use of bone scanning for the diagnosis and management of musculoskeletal trauma. Surg Clin Na 63: 567–585Google Scholar
  9. 9.
    Deutsch SD, Gandsman EJ, Sparagen SC (1981) Quantitative regional blood-flow analysis and its clinical application during routine bone scanning. J Bone Int Surg 63A: 295–305Google Scholar
  10. 10.
    Frank R (1979) Electron microscope autoradiography of calcified tissues. Int Rev Cytol 56: 183–253Google Scholar
  11. 11.
    Gandsman EJ, Deutsch A, Tyson IB (1983) Atlas of computerized blood flow analysis in bone disease. Clin Nucl Med 8: 558–563Google Scholar
  12. 12.
    Hughes SPF, Davies DR, Bassingthwaigte JB, Knox FA, Kelly PJ (1977) Bone extraction and blood clearance of diphosphonate in the dog. Am J Phys 232: 341–347Google Scholar
  13. 13.
    Hughes S, Davies R, Khan R, Kelly P (1978) Fluid space in bone. Clin Ortho Rel Res 134: 332–341Google Scholar
  14. 14.
    Hughes SPE, Wahner HW, Kelly PJ, Davies D (1979) The extraction from the blood of phosphate compounds by canine bone. Nucl Med 18: 137–141Google Scholar
  15. 15.
    Lamki LM (1985) Bone scintigraphy: current trends and future prospects. J Nucl Med 26: 312–314Google Scholar
  16. 16.
    Linden B, Telhag H (1977) Osteochondritis dissecans, a histologic and autoradiographic study in man. Acta Orthop Scand 48: 682–686Google Scholar
  17. 17.
    Lotke PA, Ecker M, Alavi A (1977) Painful knees in older patients. Radionuclide diagnosis of possible osteonecrosis with spontaneous resolution. J Bone Joint Surg 59A: 617Google Scholar
  18. 18.
    Mausner JS, Kramer S (1985) Mausner and Bahn's epidemiology — an introductory text, 2nd ed. Saunders, PhiladelphiaGoogle Scholar
  19. 19.
    Nutton RW, Fitzgerald RH, Kelly PJ (1985) Early dynamic bone imaging as an indicator of osseous blood flow and factors affecting the uptake of 99mTC hydroxymethylene diphosphonate in healing bone. J Bone Joint Surg 67A: 763–770Google Scholar
  20. 20.
    Resnick D, Niwayama A (1981) Diagnosis of bone and joint disorders with emphasis on articular abnormalities. Saunders, PhiladelphiaGoogle Scholar
  21. 21.
    Seliger WA (1970) Tissue fluid movement in compact bone. Anat Rec 166: 247–256Google Scholar
  22. 22.
    Talmage RV (1971) Morphological and physiological considerations in a new concept of calcium transport in bone. Am J Anat 129: 467–476Google Scholar
  23. 23.
    Tyson IB, Deutsch SD, Gandsman EJ, Winkler ML (1982) Dynamic bone scanning in the differential diagnosis of skeletal lesions. Rad Isot Klin Fors 15: 331–337Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • R. W. McCullough
    • 1
  • E. J. Gandsman
    • 2
  • H. E. Litchman
    • 3
  • S. L. Schatz
    • 4
  1. 1.Department of Bio Med, Radiation Biology, ChemistryBrown UniversityProvidenceUSA
  2. 2.Department of Radiation MedicineBrown UniversityProvidenceUSA
  3. 3.Department of Orthopaedic SurgeryBrown UniversityProvidenceUSA
  4. 4.Department of RadiologyBrown University and the Miriam HospitalProvidenceUSA

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