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Bone scan indicated increased radiotracer uptake in several lower thoracic vertebrae and in the fifth lumbar vertebra of varying intensity suggesting fractures of different ages
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Planar bone scans with SPECT and SPECT + CT were performed in those patients who underwent peri-operative evaluation for vertebroplasty. The scans were evaluated separately to identify the "culprit" vertebra (e) by two readers and their results were analyzed.
Use of planar and SPECT bone scan for identifying the "culprit" vertebra (e) for vertebrop...
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Objective:
The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique.
Methods:
Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or...
Citations
... SPECT images can be anatomically localized on the CT, and anatomic abnormalities on CT images can draw attention to subtle areas of SPECT tracer uptake. SPECT/CT has been shown to more precisely localize abnormalities in the vertebra compared to SPECT imaging alone, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [54]. Studies have demonstrated a 63% to 80% agreement between SPECT/CT and MRI in detection of acute VCF [55,56]. ...
... Tc-99m SPECT/CT Spine Area of Interest. SPECT/ CT has been shown to precisely localize abnormalities in the vertebra, particularly in complicated cases, such as multiple collapsed vertebrae of different ages [54]. However, MRI has greater sensitivity and specificity for metastasis in certain locations of the spine [111] and for certain primaries, such as prostate cancer [112]. ...
Vertebral compression fractures (VCFs) have various causes, including osteoporosis, neoplasms, and acute trauma. As painful VCFs may contribute to general physical deconditioning, management of painful VCFs has the potential for improving quality of life and preventing superimposed medical complications. Various imaging modalities can be used to evaluate a VCF to help determine the etiology and guide intervention. The first-line treatment of painful VCFs has been nonoperative or conservative management as most VCFs show gradual improvement in pain over 2 to 12 weeks, with variable return of function. There is evidence that vertebral augmentation (VA) is associated with better pain relief and improved functional outcomes compared to conservative therapy for osteoporotic VCFs. A multidisciplinary approach is necessary for the management of painful pathologic VCFs, with management strategies including medications to affect bone turnover, radiation therapy, and interventions such as VA and percutaneous thermal ablation to alleviate symptoms. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Use of SPECT/CT (Single Photon Emission Computed Tomography/Computed Tomography) is increasing providing additional information in patients with inconclusive clinical examination and unremarkable imaging findings presenting with chronic pain after total ankle arthroplasty. To differentiate the cause of pain after total ankle arthroplasty can be challenging. SPECT/CT combines structural and metabolic imaging as a hybrid tool leading to higher specificity and overall diagnostic accuracy presumably in cases of gutter impingement, prosthetic loosening, and osteoarthritis of adjacent joints. Moreover, SPECT/CT can complement diagnostic work up in periprosthetic joint infections. Basal tracer enhancement has to be considered for the interpretation of imaging findings.
Vertebral compression fractures (VCFs) can have a variety of etiologies, including trauma, osteoporosis, or neoplastic infiltration. Osteoporosis related fractures are the most common cause of VCFs and have a high prevalence among all postmenopausal women with increasing incidence in similarly aged men. Trauma is the most common etiology in those >50 years of age. However, many cancers, such as breast, prostate, thyroid, and lung, have a propensity to metastasize to bone, which can lead to malignant VCFs. Indeed, the spine is third most common site of metastases after lung and liver. In addition, primary tumors of bone and lymphoproliferative diseases such as lymphoma and multiple myeloma can be the cause of malignant VCFs. Although patient clinical history could help raising suspicion for a particular disorder, the characterization of VCFs is usually referred to diagnostic imaging. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Resumen
La prueba de imagen isotópica es una técnica de imagen funcional y metabólica que permite visualizar diferentes procesos fisiopatológicos en función del radiofármaco utilizado. Para el estudio de las patologías benignas del aparato locomotor, existen principalmente tres familias de radiofármacos. La primera familia de radiofármacos sirve para visualizar la actividad osteoblástica de las lesiones óseas. En la gammagrafía ósea, el radiofármaco utilizado es un bifosfonato marcado con tecnecio 99m (99mTc). La gammagrafía ósea está indicada en la búsqueda de patologías osteoarticulares infecciosas o inflamatorias (osteomielitis, síndrome de dolor regional complejo, etc.), en complicaciones ortopédicas con presencia de material de osteosíntesis (búsqueda de aflojamiento de implantes, seudoartrosis) o en la búsqueda de fracturas de esfuerzo. Además, la gammagrafía permite obtener imágenes de todo el esqueleto, lo que resulta útil para evaluar enfermedades óseas benignas como la displasia fibrosa. En la tomografía por emisión de positrones (PET), el radiofármaco utilizado para visualizar la actividad osteoblástica es el fluoruro de sodio marcado con ¹⁸F (¹⁸F-NaF). La PET acoplada a tomografía computarizada (PET-TC) con ¹⁸F-NaF tiene mejor resolución que las gammagrafías óseas y podría sustituirlas en muchas indicaciones. Sin embargo, su uso no está muy extendido en la práctica debido a su coste y a su limitada disponibilidad. La segunda familia de radiofármacos permite marcar los leucocitos. Así, una gammagrafía con leucocitos marcados hace posible la detección de leucocitos que se acumulan en los focos de infección. La sensibilidad de este método varía según el lugar de la infección, con una mejor sensibilidad para las infecciones del esqueleto apendicular distal o periprotésico que para las del esqueleto axial. El último radiofármaco utilizado es la fluorodesoxiglucosa marcada con ¹⁸F (¹⁸F-FDG). Se trata de un análogo de la glucosa que permite localizar focos musculoesqueléticos con un elevado metabolismo de los glúcidos, como los focos infecciosos, inflamatorios o neoplásicos.
The goal of this review is to assess the importance of various imaging modalities which can be used in assessing the viability and integrity of the bone allograft. As it is widely in use in majority of major and minor reconstructive procedures.
Although the use of SPECT/CT, PET/CT, and PET/MR in different bone diseases was discussed in several chapters of this book, a separate chapter putting together the clinical uses and impacts of such important modalities in the diagnosis and follow-up of bone diseases is thought to be warranted given the importance of such modern imaging modalities.
Radionuclide bone scanning has been used routinely in the evaluation of bone pathology for decades. The greatest strength of the procedure is its extreme sensitivity for bone metabolism, allowing it to distinguish between active and inactive bony abnormalities. The downside of this reliance on abnormal bone turnover is the relative lack of anatomical detail compared with ever-improving CT and MRI technology. Fusion imaging using SPECT/CT (SCT), PET/CT, and PET/MRI offers an opportunity to combine the sensitivity of nuclear medicine examinations with the anatomical detail of CT and MRI. This fusion of technologies is especially important in situations where anatomical imaging modalities alone provide insufficient diagnostic information. In this review, we highlight the utility of SPECT/CT bone imaging in the pre- and postoperative evaluation of patients undergoing procedures of the spine, foot, and ankle.
El adenoma pleomórfico es considerado el tumor benigno más frecuente de las glándulas salivales y se caracteriza histológicamente por presentar tanto elementos epiteliales como mesenquimales. El presente estudio tiene como objetivo reportar un caso clínico de adenoma pleomórfico en paladar de grandes dimensiones de un paciente masculino de 45 años de edad, tratado en la Unidad de Cirugía Buco-Maxilofacial del Hospital General del Este «Dr. Domingo Luciani» quien inicia enfermedad actual, hace 17 años aproximadamente presentando un aumento de volumen progresivo en paladar. Se planificó quirúrgicamente para una maxilectomía de Brown tipo II B y colocación de placa obturadora. En un control postoperatorio de 10 meses se evidenció formación de tejido en la región del lecho quirúrgico de aspecto similar a la mucosa circundante sin señales de recidiva con presencia de fístula oro-nasal de aproximadamente 2 cm de diámetro. Actualmente se encuentra en programación de cierre de la misma con colgajos locales y posterior rehabilitación protésica.
