Kim E E, Haynie T P, Podoloff D A, Lowry P A, Harle T S
Division of Diagnostic Imaging, University of Texas M.D. Anderson Hospital, Houston.
Crit Rev Diagn Imaging. 1989;29(3):257-305.
Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In-111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis.
尽管关于放射性核素成像的确切作用存在争议，但它在疑似骨髓炎患者的评估中发挥着重要作用。通过使用锝-99m亚甲基二膦酸盐（MDP）的三相技术，能最好地实现骨髓炎与蜂窝织炎的鉴别。通常，有必要获取多个投照位和放大视图，以充分评估可疑区域。对于临床强烈怀疑骨髓炎而常规骨扫描结果不明确或正常的病例，建议进行镓-67或铟-111白细胞扫描。在早期骨髓炎且最初有光子缺乏性病变的情况下，48至72小时后重复骨扫描可能显示放射性增加。铟-111白细胞成像有助于评估疑似骨髓炎并发近期骨折或手术的情况，但必须结合临床和影像学表现综合判断。识别某些成像模式似乎有助于将骨髓炎与化脓性关节炎或蜂窝织炎区分开来。
