Ischemic Muscle Necrosis of Lower Extremities in Peripheral Arterial Disease: The Impact of 99mTc-MDP Scintigraphy on Patient Management

Abstract

Background and objectives: The objective of this study was to assess the value of a whole-body bone scintigraphy using 99m technetium labelled-methyl diphosphonate (99mTc-MDP) for the diagnosis and the assessment of grades of muscle damage after prolonged acute or chronic obstruction of the main arteries in lower extremities. Material and Methods: Fifty consecutive patients were selected for the study. The patients’ condition had not improved after primary peripheral arterial reconstruction operation or limb amputation and after conservative treatment. The clinical suspicion was of arterial obstruction and muscle necrosis. All the patients underwent whole-body scintigraphy with 99mTc-MDP. Muscle necrosis was identified as an increased soft tissue uptake of 99mTc-MDP. Results: Forty-five patients had gross muscle necrosis detected on whole-body scintigraphy with 99mTc-MDP and were histologically confirmed after repeated surgery (necrectomy or amputation) or by muscle biopsy, if only fasciotomy was performed. The location and extent of muscle injury were assessed preoperatively and the findings were confirmed in all 45 patients. Twelve patients with clinically suspected minor muscle damage, which was confirmed as relatively minor muscle necrosis on 99mTc-MDP scintigraphy, were treated conservatively. The clinical outcome of all 50 patients was favorable. The 99mTc-MDP scintigraphy, in detection of muscular necrosis, demonstrated sensitivity, specificity, and accuracy of 97.3% (95% confidence interval (CI) 85.4 to 99.3%), 30.77% (95% confidence interval (CI) 9.09 to 61.43%), and 80% (95% confidence interval (CI) 66.28 to 89.97%), respectively. Conclusion: The 99mTc-MDP scintigraphy is a valuable tool in the detection of muscular necrosis. It is able to define location, extent, and grade of involvement. Therefore, it has a clinical impact in patient management, allowing clinicians to select adequate treatment policy and specify the scope of necrectomy.

Metastatic pulmonary calcification on bone scintigraphy of a patient with lupus nephritis and end-stage renal disease

“…The underlying mechanism for soft tissue Tc99m-MDP uptake includes metastatic calcification, dystrophic calcification, and metabolic uptake, among others [1] . Increased soft tissue uptake (including the lungs) can be caused by localized inflammation or infection [2] , sequela of ischemia/infarction or necrosis [3] , and primary or metastatic malignancy [ 4 , 5 ]. Although Tc99m-MDP is an analogue of calcium and a bone-localizing radiopharmaceutical, increased soft tissue uptake may be noted in pathological conditions without tissue calcification or ectopic bone formation.…”

Strategies to Overcome the Barrier of Ischemic Microenvironment in Cell Therapy of Cardiovascular Disease

“…Despite this, in clinical practice, there are barely diagnostic tools available to enable ROI and/or i/nBZ orientated molecular treatments and most of the so far described approaches are limited to experimental studies. The rapid development of cardiovascular imaging combined with the existing and evolving tools of interventional cardiology, cardiovascular surgery, and radiology could be the next important step in reaching a more individualized cell therapy of cardiovascular disease [ 70 , 71 ].…”