Atrophic Arthropathy and Diabetic Neuritis

Schwarz, Gerhart S.; Berenyi, Magdalena R.; Siegel, Martin W.

doi:10.2214/ajr.106.3.523

Cited by 47 publications

(7 citation statements)

References 3 publications

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“…), all of whom turned out to be true-positive for osteomyelitis, with 99m Tc-HMPAO WBC A/N ratios of at least 2. A high bone uptake is expected in these patients because of underlying neuropathic bone changes (19)(20)(21). Previous studies with combined 99m Tc-HMPAO/MDP imaging in diabetic foot ulcers prove to be useful in diagnosing osteomyelitis (18,22).…”

Section: Discussionmentioning

confidence: 99%

The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

Ballani

Al-Huda²,

Khan³

et al. 2007

Journal of Nuclear Medicine Technology

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Our objective in this study was to evaluate whether measurement of quantitative uptake of 99m Tc-methylene diphosphate (MDP) and 99m Tc-hexamethylpropyleneamine oxime (HMPAO) white blood cells (WBCs) is useful in detecting osteomyelitis in peripheral bony lesions. Methods: Twenty-four patients (12 men and 12 women; age range, 25-72 y) were referred for imaging because of clinically suspected osteomyelitis. They had a traumatic fracture (n 5 10), knee prosthesis (n 5 5), hip prosthesis (n 5 2), diabetic foot (n 5 4), or chronic osteomyelitis (n 5 3). Threephase bone scanning and 99m Tc-HMPAO WBC studies were performed on all patients within the same week. Regions of interest were drawn over the abnormal bony sites and the contralateral normal sites, and the abnormal-to-normal uptake ratios (A/N ratios) were obtained for both studies. Results: All patients had abnormal findings on 3-phase bone scanning, whereas 17 (71%) had abnormal findings on 99m Tc-HMPAO WBC studies, of which 15 were confirmed to be true-positive. In those 15 patients, the mean A/N ratios for 99m Tc-MDP and 99m Tc-HMPAO WBC were 3.0 6 1.6 (range, 1.3-6.2) and 1.8 6 0.3 (range, 1.4-2.2), respectively. In the other 9 patients, whose scan results were clinically confirmed to be true-negative, the mean A/N ratios for 99m Tc-MDP and 99m Tc-HMPAO WBC were 2.1 6 1.2 and 1.2 6 0.2, respectively. In the group with a 99m Tc-MDP A/N ratio greater than 2 (n 5 15), 87% (13/15) had a high 99m Tc-HMPAO WBC A/N ratio (.1.5), including 2 that were falsepositive. In the remaining 2 patients, one with chronic osteomyelitis and the other with a recent hip prosthesis, 99m Tc-HMPAO WBC ratios were normal. In the group with a bone A/N ratio of less than 2 (n 5 9), only 4 patients (44%) were true-positive for acute osteomyelitis. Conclusion: 99m Tc-MDP bone scanning alone, with an A/N ratio of more than 2, is useful in detecting osteomyelitis in violated bone except in the case of a recent hip prosthesis or chronic osteomyelitis.

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Section: Discussionmentioning

confidence: 99%

The Value of Quantitative Uptake of 99mTc-MDP and 99mTc-HMPAO White Blood Cells in Detecting Osteomyelitis in Violated Peripheral Bones

Ballani

Al-Huda²,

Khan³

et al. 2007

Journal of Nuclear Medicine Technology

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“…Resorption of bone in diabetic neuropathy possibly may be facilitated by a constant state of vasodilatation secondary to autosympathectomy (6). An adequate blood supply is required for bone resorption, and most patients with diabetic osteopathy have a healthy arterial circulation (1, 7).…”

Section: Discussionmentioning

confidence: 99%

Diabetic Osteopathy: Report of a Relentlessly Progressive Case, with Clinico‐Pathologic Correlations

Shagan

Friedman

Allesandri

1973

J American Geriatrics Society

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“…It almost always involves the lower extremities, usually the forefeet or the hindfeet. A rare atrophic form is characterized by bone atrophy and destruction, with the frequent development of "mortar and pestle" or "pencil-in-cup" joint deformities 3 . There is a predilection for upper extremity joints.…”

Section: Rheumatologymentioning

confidence: 99%

“…The sensory neuropathy predisposes to physical or thermal trauma, while the autonomic neuropathy leads to vasomotor instability with color changes of the skin, edema and swelling of the fingers with subsequent fibrosis, and sclerodactyly. The combined injury of the sensory and autonomic nerve fibers thus results in loss of pain sensation and loss of vasoconstriction, leading to hyperemia 3 . The latter has been postulated to be an important mechanism in bone resorption 3 .…”

Section: Rheumatologymentioning

confidence: 99%

“…The combined injury of the sensory and autonomic nerve fibers thus results in loss of pain sensation and loss of vasoconstriction, leading to hyperemia 3 . The latter has been postulated to be an important mechanism in bone resorption 3 . Our patient's acroosteolysis might also have resulted from repeated needlesticks of her fingertips and her reliance on sign language to communicate.…”

Section: Rheumatologymentioning

confidence: 99%

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