Palestro C J, Torres M A
Division of Nuclear Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
Semin Nucl Med. 1997 Oct;27(4):334-45. doi: 10.1016/s0001-2998(97)80006-2.
In otherwise normal bone, Three Phase Bone Scintigraphy is sensitive and specific for osteomyelitis. In patients with underlying osseous abnormalities the specificity of the study is decreased. The four phase bone scan, bone/gallium scintigraphy, leukocyte imaging, leukocyte/bone and leukocyte/marrow studies have all been reported to increase specificity. The techniques, strategies, and limitations are discussed. No single study is equally useful in all situations. Labeled leukocyte imaging is of little value in vertebral osteomyelitis because this entity often presents as a nonspecific photopenic defect. The preferred technique for the spine is bone/gallium imaging. Intense uptake, on bone scintigraphy, in two adjacent vertebrae with loss of the disc space is highly suggestive of spinal osteomyelitis. Gallium not only enhances the specificity of the diagnosis but provides information about surrounding soft tissue infection. In the diabetic foot, labeled leukocyte imaging alone is sufficient to determine the presence of osteomyelitis in the fore--foot. In the midfoot and hindfoot it may be necessary to combine leukocyte scintigraphy with bone scintigraphy to precisely localize the infection. Labeled leukocytes accumulate in the uninfected neuropathic joint and preliminary data suggest that leukocyte/marrow imaging may be useful to determine the significance of such uptake. For the painful joint replacement, if infection is the primary concern, leukocyte/marrow scintigraphy should be performed initially. If any postoperative complication, regardless of type, is the concern, it is reasonable to begin with bone scintigraphy because a normal study rules strongly against any complication. An abnormal bone scan will require additional studies to more precisely determine the cause of that abnormality.
在其他方面正常的骨骼中，三相骨闪烁扫描对骨髓炎具有敏感性和特异性。对于存在潜在骨异常的患者，该检查的特异性会降低。据报道，四相骨扫描、骨/镓闪烁扫描、白细胞显像、白细胞/骨和白细胞/骨髓研究均能提高特异性。本文将对这些技术、策略及局限性进行讨论。没有哪一项检查在所有情况下都同样有用。标记白细胞显像在脊椎骨髓炎中价值不大，因为该病症常表现为非特异性的放射性缺损。脊柱的首选检查技术是骨/镓显像。骨闪烁扫描显示两个相邻椎体摄取增强且椎间盘间隙消失，高度提示脊柱骨髓炎。镓不仅能提高诊断的特异性，还能提供有关周围软组织感染的信息。在糖尿病足中，单独的标记白细胞显像足以确定前足是否存在骨髓炎。在中足和后足，可能需要将白细胞闪烁扫描与骨闪烁扫描相结合，以精确确定感染部位。标记白细胞会在未感染的神经病变关节中积聚，初步数据表明白细胞/骨髓显像可能有助于确定这种摄取的意义。对于疼痛的关节置换，如果主要担心感染，应首先进行白细胞/骨髓闪烁扫描。如果担心任何术后并发症，无论其类型如何，从骨闪烁扫描开始是合理的，因为正常的检查结果强烈排除任何并发症。骨扫描异常则需要进一步检查以更精确地确定异常原因。
