False positive bone scan in bone tumors of the lower limb.

When examined using bone scanning agents, eight out of nine patients with lower limb malignancy, and neither of two affected in the upper limb showed a pathologic focus of isotope uptake in an area distal to the tumor. On pathologic examination the positive findings proved false. Such misleading results were found to be avoidable if a tumor-seeking agent instead of a bone scanning one is used.     

Significance of absent or faint kidney sign on bone scan.

Seven men, six suffering from widespread bone metastases of prostatic origin and one with urinary bladder carcinoma, demonstrated minimal or no discernible radioactivity in the kidneys and urinary bladder at the time of bone scanning using 99mTc-stannous polyphosphate. The mechanism behind this scan finding is thought to be rapid and enhanced uptake of the radiopharmaceutical by pathologic bone. The significance of the faint or absent kidney sign in bone scanning, particularly in cases where abnormally homogeneous and symmetric radioactivity exists, is discussed.     

Unicentric osteosarcoma of bone with subsequent skeletal metastases

Five cases of unicentric osteosarcoma with subsequent skeletal metastases are reviewed. Skeletal metastases may occur prior to pulmonary metastases in such patients. Initial and periodic bone scanning is therefore justified since early detection of distant bone lesions may have important therapeutic implications. A classification of multiple site osteosarcoma based upon clinical, pathologic, and radiologic characteristics is proposed.     

Nonosseous abnormalities on bone scans

Although bone scanning is a test primarily concerned with skeletal abnormalities, important nonosseous findings are occasionally present on the images. To gauge the significance of such nonosseous uptake and, in particular, to determine whether these findings contain useful diagnostic information, the technical and medical staff in nuclear medicine must recognize the various patterns of nonbony uptake and understand their causes. The objectives of this article are to demonstrate the appearances of nonosseous uptake on bone scans, to categorize the forms of soft-tissue uptake, to emphasize technical artifacts leading to soft-tissue uptake, and to highlight the clinical significance of pathologic soft-tissue uptake.     

Use of recombinant human bone morphogenetic protein-2 to enhance tendon healing in a bone tunnel.

This study examines the hypothesis that recombinant human bone morphogenetic protein-2 can enhance bone ingrowth into a tendon graft placed into a bone tunnel. We transplanted the long digital extensor tendon into a drill hole in the proximal tibia in 65 adult mongrel dogs. We applied two different doses of the bone morphogenetic protein to the tendon-bone interface in one limb using an absorbable type I collagen sponge carrier and only the collagen sponge to the contralateral (control) limb. The healed tendon-bone attachment was evaluated at serial times between 3 days and 8 weeks using radiography, histologic examination, and biomechanical testing. At all time points, histologic and radiographic examination demonstrated more extensive bone formation around the tendon with closer apposition of new bone to the tendon in the protein-treated limb than in the paired control limb. Biomechanical testing demonstrated higher tendon pull-out strength in the protein-treated side at all time points, with a statistically significant difference between the low-dose-treated side and the control side at 2 weeks. The histologic and biomechanical data suggested superior healing at the lower protein dose. This study demonstrated that bone morphogenetic protein can accelerate the healing process when a tendon graft is transplanted into a bone tunnel.     

Role of bone scanning in detection of subclinical bone metastasis in nasopharyngeal carcinoma

One hundred thirty-two new patients with nasopharyngeal carcinoma and no evidence of distant metastases were evaluated for bone metastases with bone scanning. Forty-four patients had abnormal hypercaptation. These abnormal findings were considered related to benign diseases in 39 patients after correlating clinical examinations and skeletal radiographs. The remaining five patients had positive bone scanning which was suggestive of bone metastasis. There were 13 patients who developed symptomatic bone metastases over a follow-up period of 0.2-41 months. In three of these, the bone metastases corresponded to the sites of abnormal hypercaptation in the initial positive bone scanning. In view of the low sensitivity and specificity of bone scanning in this setting, routine bone scanning for staging nasopharyngeal carcinoma is not recommended. But in the research setting, baseline scanning is useful to make subsequent scanning more valuable, and it reduces false-positive results.     

Reactive endosteal bone formation

The microstructure of reactive endosteal new bone was examined using undecalcified ground sections in five pathologic conditions (bone metastasis from prostate cancer in seven cases, intervertebral osteochondrosis in five, Paget disease in four, chronic suppurative osteomyelitis in two, and fracture healing in one). To determine a basic form of rapid intramembranous bone formation, fetal rat calvaria and primitive bones made in clonal osteogenic cell culture were also observed. In slow bone-forming conditions, lamellar new bone was deposited on pre-existing trabecular surface and caused trabecular thickening on radiographs. In contrast, in rapid bone-forming conditions, woven bone was deposited as spicules extending from trabecular surface so as to form new networks in intertrabecular space. This causes obscurity of trabecular margins radiographically. Reactive endosteal bone formation may be nonspecific and have a significance for assessing the virulence of underlying pathologic conditions like periosteal reactions.     

Postprandial blush in multiphase bone scanning

The presence of transient soft-tissue activity in the left side and the lower midportion of the abdomen on the early phases of the multiphase bone scan represents postprandial physiologic hyperemia of the small intestine. The bowel uptake was present in all 33 patients ingesting food between 15 min and 3.5 hr before scanning. In those patients who had not eaten within 4 hr of the study, only 25% demonstrated bowel activity. The observation of bowel uptake is important in differentiating a physiologic phenomenon from pathologic accumulations of activity. Pathology should be ruled out when bowel activity is not located in the usual left flank and lower mid-abdomen, or is present in a fasting individual.     

纳米羟基磷灰石／聚酰胺66复合生物活性人工骨在肢体骨缺损应用87例

目的观察纳米羟基磷灰石／聚酰胺66（n—HA／PA66）复合生物活性人工骨在四肢骨缺损术中填充植骨的安全性和临床疗效。方法对87例四肢骨手术后骨缺损,包括四肢松质骨暴力压缩骨折导致骨缺损和干骺端良性骨肿瘤术后骨缺损的患者,采用n—HA／PA66复合生物活性人工骨填充植骨。术前、术后1周及3、6、12个月分别摄x线片及CT,观察骨缺损的修复生长和植骨融合情况。结果随访6～28个月（平均8个月）,伤VI均甲级愈合,无切口感染、非特异炎症反应和排斥反应;X线片和CT检查示：术后骨缺损区域填充良好,密度较松质骨稍低,材料与周围骨边界清楚;术后1个月,骨缺损区密度逐渐升高,可见植骨周围模糊,有少量新生骨痂形成;术后3个月,骨缺损区密度明显升高,植骨周围间隙开始向中心融合成片,更多新生骨痂影融合;术后6个月,骨缺损区密度明显升高,大量新生骨痂形成。临床骨愈合时间为术后3～7个月,平均3．8个月,愈合率为91．5％。结论纳米羟基磷灰石／聚酰胺66复合生物活性人工骨用于治疗四肢骨缺损,能与植骨区骨生长融合,无不良反应,疗效满意,是一种安全有效的骨缺损植骨填充材料。     

Radionuclide bone image in growing and stable bone island

A normal radionuclide bone image can facilitate distinction between a bone island and significant pathologic processes, especially an osteoblastic metastasis. This distinction becomes more crucial when growth is detected in an isolated sclerotic bone lesion or if a relatively large sclerotic lesion is detected de novo in patients with a known neoplasm. This report presents three patients with isolated bone islands: two with interval growth, the other with a relatively large stable lesion; all showing a normal radionuclide bone image.     

Massive bone allograft: a salvage procedure for complex bone loss due to high-velocity missiles--a long-term follow-up

The treatment of high-velocity missile injury to the limbs is often associated with segmental bone loss, as well as damage to neurovascular and soft tissue. In such "limb threatening" cases, massive bone allograft can fill the bone defect and offer stability to the soft tissue reconstruction. The return of function in the affected limb is relatively rapid when using this method as a primary procedure. The indications for use of this technique and illustrative case reports are presented and discussed.     

Atlas of sodium fluoride PET bone scans: atlas of NaF PET bone scans

Sodium fluoride (NaF) is a bone-seeking positron-emitting tracer with high sensitivity and specificity for detection of osseous lesions, particularly osteolytic lesions. We believe that NaF positron emission tomography (PET)/computed tomography (CT) scans can provide a more thorough and conclusive evaluation of bone diseases than conventional Technetium-99m-methylene diphosphonate bone scans. Understanding both normal and pathologic patterns is important for the evaluation and interpretation of these studies. Thus, an atlas of NaF positron emission tomography/computed tomography bone scans demonstrating benign, pathologic, and malignant osseous lesions as well as extraosseous lesions will be invaluable in the correct interpretation and diagnosis of osseous lesions.     

不同部位骨原发性非霍奇金淋巴瘤的影像表现对比分析

目的:对比分析发生于不同部位的骨原发性非霍奇金淋巴瘤(PNLB)的影像表现.方法:搜集经手术病理及免疫组化证实的25例PNLB患者,按照病变发生部位分为四肢骨组(13例)和躯干骨组(12例).对两组的患者发病年龄、骨质破坏类型、软组织肿块大小及包绕骨病变形式、MRI信号特点进行分析.结果:四肢骨组的患者发病年龄(中位年...     

Magnetic resonance of the bone marrow

Magnetic resonance imaging has opened new possibilities to current diagnostic radiology in the evaluation of bone marrow. In the past, bone marrow imaging was based on conventional radiology, nuclear medicine and computed tomography; they all exhibited some capabilities but also some limitations. Bone image on MR scans is due to bone marrow, with its different components of red and yellow marrow. Since red marrow is mostly liquid and yellow marrow contains large amounts of fat, the signal will vary, on T1-weighted images, according to their different proportions. There is a gradual change from red marrow to yellow marrow from birth to adulthood: this change determines the MR appearance of bone marrow, the different features of which should be known for a correct evaluation of pathologic findings. MRI is extremely effective in the evaluation of infiltrative disorders of bone marrow, such as leukemia, lymphoma, myeloma, primary and metastatic skeletal tumors, and infections. MRI allows depletive disorders of bone marrow and ischemic processes to be studied. Finally, MRI allows the non-invasive follow up of bone marrow pathologic conditions, thus representing a valid alternative to biopsy.     

Prostate cancer bone metastases confined to the distal left lower limb

Bone metastases from prostate cancer most commonly affect the axial and proximal appendicular skeleton with rare involvement of the distal limbs. We describe a case of multiple bone metastases confined to the left lower limb in a patient with biochemical recurrence of prostate cancer. Following an initial post-operative PSA rise, the patient received a course of salvage radiotherapy to the pelvis, however, the PSA level continued to rise and two consequent staging CT scans were negative for local recurrence and metastatic disease. Subsequent development of left ankle pain and swelling led the patient to present to his General Practitioner, which triggered a series of imaging investigations that revealed isolated left lower limb bone metastases. This case report highlights the need to consider peripheral limb bone metastases in patients with biochemical recurrence of prostate cancer, particularly in the setting of a negative staging CT scan and/or bone pain.     

Augmentation of tendon healing in an intraarticular bone tunnel with use of a bone growth factor.

We hypothesized that an exogenous bone growth factor could augment healing of a tendon graft in a bone tunnel in a rabbit anterior cruciate ligament-reconstruction model. Seventy rabbits underwent bilateral anterior cruciate ligament reconstructions with a semitendinosus tendon graft. One limb received a collagen sponge carrier vehicle containing a mixture of bone-derived proteins while the contralateral limb was treated with either no sponge or a sponge without bone-derived proteins. The reconstruction was evaluated at 2, 4, or 8 weeks with histologic, biomechanical, and magnetic resonance imaging analysis. Histologic analysis demonstrated that specimens treated with bone-derived proteins had a more consistent, dense interface tissue and closer apposition of new bone to the graft, with occasional formation of a fibrocartilaginous interface, when compared with control specimens. The treated specimens had significantly higher load-to-failure rates than did control specimens. Treatment with bone-derived proteins resulted in an average increase in tensile strength of 65%. The treated specimens were stronger than control specimens at each time point, but the difference was greatest at 8 weeks. On the basis of signal characteristics and new bone formation, magnetic resonance imaging was useful for predicting which limb was treated, the site of failure, and the limbs with higher load-to-failure values. This study demonstrates the potential for augmenting tendon healing in an intraarticular bone tunnel using an osteoinductive growth factor.     

Periosteal reaction with normal-appearing underlying bone: a child abuse mimicker

Any irritation or disruption to the underlying bone will cause a periosteal reaction and result in new periosteal bone deposition. Periosteal bone formation may be due to either physiologic or pathologic causes. Pathologic bone formation generally results from an adjacent inflammatory process or a hypoxic or toxic stimulus. Common causes of pathologic periosteal reaction in children include trauma to the underlying bone. However, other causes such as hypervitaminosis A, prostaglandin therapy, cortical hyperostosis (Caffey's disease), hypertrophic osteoarthropathy (primary and secondary), osteomyelitis, leukemia, trauma, and syphilis must also be considered. The last four are usually associated with some degree of bone destruction, while in the first four diseases the underlying bone is left radiologically intact. This paper will concentrate on those diseases that appear to leave the underlying bone intact. The clinical and radiological features that help to differentiate some of these entities are presented. Electronic Publication     

The role of ultrasound in the early diagnosis and management of heterotopic bone formation

Heterotopic bone formation (HBF) is one of the many causes of painful limb swelling and is well recognized as posing clinical, radiological, and pathological diagnostic difficulties. We have evaluated the use of sonography to determine its role in reaching a diagnosis at a time when symptoms are maximal and the radiological diagnostic features absent. Serial ultrasound examination identified unique 'zone phenomea' in a heterogeneous group of eight patients before the classic radiological features appeared. The zone transformation matches the evolution and maturation process described pathologically and forms the basis of an early definitive diagnosis in all cases. The sonographic features are specific for the condition, unlike the scintigraphic appearances. Although CT confirms the peripheral location of the calcification, the low cost, safety, and general availability of ultrasound scanning make it the optimum imaging method for diagnosing and monitoring heterotopic bone formation.     

Technical errors in planar bone scanning

Optimal technique for planar bone scanning improves image quality, which in turn improves diagnostic efficacy. Because planar bone scanning is one of the most frequently performed nuclear medicine examinations, maintaining high standards for this examination is a daily concern for most nuclear medicine departments. Although some problems such as patient motion are frequently encountered, the degraded images produced by many other deviations from optimal technique are rarely seen in clinical practice and therefore may be difficult to recognize. The objectives of this article are to list optimal techniques for 3-phase and whole-body bone scanning, to describe and illustrate a selection of deviations from these optimal techniques for planar bone scanning, and to explain how to minimize or avoid such technical errors.     

18F-FDG hPET/CT显像与99Tcm-MDP骨显像探测骨转移瘤的价值

目的　探讨1 8F 脱氧葡萄糖 (FDG)hPET CT与99Tcm 亚甲基二膦酸盐 (MDP)骨显像探测骨转移瘤的临床价值。方法　临床拟诊恶性肿瘤或肿瘤术后复发合并骨病变患者 34例 ,均于 2周内分别行FDG和MDP骨显像 ,其中 31例经手术或活组织病理检查证实为原发肿瘤患者 ,余 3例为原发灶不明但广泛骨转移者。结果　 34例患者中 2 6例有骨转移 ,共探测到 75个骨病灶 ,其中骨转移灶 6 3个 ,良性病灶 12个 (其中骨退行性变 8个 ,肋骨骨折 2个 ,结核和慢性炎症各 1个 )。1 8F FDGhPET CT显像探测骨转移瘤灵敏度为 90 5 % ,特异性为 83 3% ,准确性为 89 3% ;99Tcm MDP骨显像分别为 79 4 % ,75 0 %和 78 7% (P均 >0 0 5 )。结论　99Tcm MDP骨显像仍为诊断骨转移瘤的首选方法 ,1 8F FDGhPET CT显像对鉴别诊断骨转移瘤具有一定临床价值。