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Novel use of gamma correction for precise 99mTc-HDP pinhole bone scan diagnosis and classification of knee occult fractures

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Abstract

Objective

The aim of this study was to introduce gamma correction pinhole bone scan (GCPBS) to depict specific signs of knee occult fractures (OF) on 99mTc-hydroxydiphosphonate (HDP) scan.

Materials and Methods

Thirty-six cases of six different types of knee OF in 27 consecutive patients (male = 20, female = 7, and age = 18–86 years) were enrolled. The diagnosis was made on the basis of a history of acute or subacute knee trauma, local pain, tenderness, cutaneous injury, negative conventional radiography, and positive magnetic resonance imaging (MRI). Because of the impracticability of histological verification of individual OF, MRI was utilized as a gold standard of diagnosis and classification. All patients had 99mTc-HDP bone scanning and supplementary GCPBS. GCPBS signs were correlated and compared with those of MRI. The efficacy of gamma correction of ordinary parallel collimator and pinhole collimator scans were collated.

Results

Gamma correction pinhole bone scan depicted the signs characteristic of six different types of OF. They were well defined stuffed globular tracer uptake in geographic I fractures (n = 9), block-like uptake in geographic II fractures (n = 7), simple or branching linear uptake in linear cancellous fractures (n = 4), compression in impacted fractures (n = 2), stippled-serpentine uptake in reticular fractures (n = 11), and irregular subcortical uptake in osteochondral fractures (n = 3). All fractures were equally well or more distinctly depicted on GCPBS than on MRI except geographic II fracture, the details of which were not appreciated on GCPBS. Parallel collimator scan also yielded to gamma correction, but the results were inferior to those of the pinhole scan.

Conclusions

Gamma correction pinhole bone scan can depict the specific diagnostic signs in six different types of knee occult fractures. The specific diagnostic capability along with the lower cost and wider global availability of bone scanning would make GCPBS an effective alternative.

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Acknowledgements

The authors are grateful for Dr. Yoon Kwang Kim, Chairman of the Sung-Ae Medical Foundation, for his generous support. Thanks are also due to Mr. Jae Woong Yoon, BSc, for reviewing gamma correction physics, Mrs. Bong Kyun Bae and Byong Heon Jeon for computer engineering, Kee Sup Chung, RT, and Jae Wan Kim, RT, for skillfully performing pinhole scans, and Ms. Mi Hye Chae for faithful secretarial assistance.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Sung Ae General Hospital, Seoul, Korea

    Yong-Whee Bahk

  2. Department of Orthopedic Surgery, Sung Ae General Hospital, Seoul, Korea

    Ho-Seung Jeon

  3. Department of Radiology, Sung Ae General Hospital, Seoul, Korea

    Jang Min Kim

  4. Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Jung Mee Park, Yong-An Chung, Sung-Hoon Kim & Soo-Kyo Chung

  5. Institute of Catholic Integrative Medicine (ICIM), Incheon St. Mary’s Hospital, Incheon, South Korea

    Yong-An Chung

  6. Department of Radiology and Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    E. Edmund Kim

  7. Department of Radiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, #665 Bupyeong-dong, Bupyeong-gu, Incheon, South Korea

    Yong-An Chung

Authors
  1. Yong-Whee Bahk
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  2. Ho-Seung Jeon
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  3. Jang Min Kim
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  4. Jung Mee Park
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  5. Yong-An Chung
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  6. E. Edmund Kim
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  7. Sung-Hoon Kim
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  8. Soo-Kyo Chung
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Corresponding author

Correspondence to Yong-An Chung.

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Bahk, YW., Jeon, HS., Kim, J.M. et al. Novel use of gamma correction for precise 99mTc-HDP pinhole bone scan diagnosis and classification of knee occult fractures. Skeletal Radiol 39, 807–813 (2010). https://doi.org/10.1007/s00256-010-0925-1

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  • DOI: https://doi.org/10.1007/s00256-010-0925-1

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