Measurement of blood flow in tibial fracture patients using positron emission tomography

Abstract

The quantification of local bone blood flow in man has not previously been possible, despite its importance in the study of normal and pathological bone. We report the use of positron emission tomography, using 15O-labelled water, to measure bone blood flow in patients with closed unilateral fractures of the tibia. We compared fractured and unfractured limbs; alterations in blood flow paralleled those found in animal models. There was increased tibial blood flow at the fracture site as early as 24 hours after fracture, reaching up to 14 times that in the normal limb at two weeks. Blood flow increase was less in displaced than in undisplaced fractures. The muscle to bone ratios of blood flow were similar to those in previous animal work using other techniques. Positron emission tomography will allow study of human bone blood flow in vivo in a wide variety of pathological conditions.

Rapid bone and blood flow formation in impacted morselized allograftsPositron emission tomography (PET) studies on allografts in 5 femoral component revisions of total hip arthroplasty

“…The integration time was fixed at 180 seconds. Similar methods have been used to study bone blood flow quantitatively and been found to give reliable results (Ashcroft et al 1992, Piert et al 1998.…”

“…We used [ 15 O] water PET to measure absolute values of regional bone blood flow in units mL/ min/100 mL, a standard PET method in the study of blood flow in soft tissues, which has been used in bone as well (Raichle et al 1983, Ashcroft et al 1992, Ruotsalainen et al 1997. Although theoretically feasible as a tracer of perfusion in all tissues, some assumptions about constants used in the [ 15 O] water model program were made in this study without experimental validation.…”

Skeletal Blood Flow in Bone Repair and Maintenance

“…In a study of two patients using PET imaging, blood flow rate was 3 to 6 times greater in the fractured tibia than the contralateral tibia 24 hours after injury, suggesting significant vasodilation associated with the fracture (58). Using LDF to quantify blood flow rate, researchers demonstrated that the nitric oxide (NO) synthase inhibitor L-NAME only attenuated blood flow rate in the first day after tibial fracture (74).…”

O2‐consumption, blood flow and PO2 in bone

“…(Blood flow may be increased up to 6-fold, e. g., during fracture healing [13,14,15,4,5]). If the O 2 consumption rate is 0.1 ml/100 g*min, then bone tissue extracts 10 % of the transported O 2 .…”