No abstract available.
Bone Marrow* ; Radionuclide Imaging*

Osteoporosis is one of the major causes of insufficiency fractures, and since plain radiographic findings are either unhelpful or misleading, insufficiency fracture in the sacrum is particularly difficult to diagnosis and to differentiate from other disease processes such as metastasis. We report the MR findings of two cases of insufficiency fracture of the sacrum. These were not demonstrable on conventional radiographs, but bone scintigraphy revealed unilateral sacral alar uptake, suggesting an active sacral lesion. Both T1 and T2-weighted MR images demonstrated fractures of the sacrum as bands of low signal intensity, with areas of surrounding increased signal intensity seen on the latter suggesting marrow edema.
Bone Marrow ; Diagnosis ; Edema ; Fractures, Stress* ; Humans ; Neoplasm Metastasis ; Osteoporosis ; Radionuclide Imaging ; Sacrum

PURPOSE: Simple X-ray study and bone scan have limiitations for early diagnosis of bone or bone marrow lesions in multiple myeloma. The purpose of this study was to evaluate the diagnostic usefulness of bone marrow imrnunoscintigraphy using anti-granulocyte monoclonal antibody for the evaluation of bone involvement I:n multiple myeloma. MATERIALS AND METHODS: In 22 patients (Male: 15, Female: 7) with multiple myeloma, we perforrned whole-body immunoscintigraphy using ' Tc-labelled antigranulocyte antibody (BW 250/183, Scintimum Granulozyt CIS, France) and compared the findings with those of simple bone radiography and "" Tc-MDP bone scan. Abnonnal findings in bone marrow scintigraphy were, considered to be present in case of expansion of peripheral bone marrow or focal photan defect in axial bones. RESULTS: Marrow expansion was noted in 15 of 22 patients (68%). Focal photon defects were found in 18 patients (82%). While one (33%) of 3 patients with Stage II disease showed focal defects in bone marrow scan, abnormal focal defects were observed in 17 of 19 (90%) patients with Stage III. Among 124 focal abnormal sites which were observed in bone marrow scan, bone scan or simple bone radiography, bone rnarrow scan detected 92 sites (74%), whereas 82 sites (66%) were observed in simple bone radiography(58 sites, 47%) or bone scan(40 sites, 32%). Fifty-one (41%) out of 124 bone lesions were detected by bone marrow scan only, and located mostly in thoracolumbar spine. CONCLUSION: Bone marrow scan using "" Tc-labelled antigranulocyte antibody seems to be a more sensitive procedure for the detection of pathologic bone lesions than simple bone X-ray ar bone sean in patients with multiple myeloma.
Bone Marrow* ; Early Diagnosis ; Female ; Humans ; Multiple Myeloma* ; Radiography* ; Radionuclide Imaging* ; Spine

PURPOSE: Subchondral stress fracture of the femoral head is a rare condition that usually occurs as an insufficiency fracture in people with poor bone quality. This study evaluated the clinical and radiographic aspects of the subchondral stress fracture of the femoral head that occurred in the form of an insufficiency or a fatigue fracture. MATERIALS AND METHODS: Between January 1998 and April 2003, 10 cases of the subchondral stress fracture of the femoral head in 8 patients were treated. The characteristics of this condition were determined by assessing the clinical course and findings of the radiographs, bone scintigram and MR images. RESULTS: A fatigue fracture developed in 6 young healthy conscripts within 5 months after recruitment. An insufficiency fracture developed in one senile patient and in one known osteogenesis imperfecta patient. All patients except for one did not have any predisposing factors for osteonecrosis and antecedent trauma. On the initial radiographs, femoral head collapse was observed in 4 hips. Bone scintigraphs showed increased radionuclide uptake in the femoral head. The MR images demonstrated an subchondral abnormal signal intensity line (MR crescent sign) and a bone marrow edema pattern. CONCLUSION: A subchondral stress fracture of the femoral head can occur as a fatigue fracture as well as an insufficiency fracture. Bone scintigraphy is a valuable tool for screening patients suspected of having a subchondral stress fracture.
Bone Marrow ; Causality ; Edema ; Fractures, Stress* ; Head* ; Hip ; Humans ; Mass Screening ; Osteogenesis Imperfecta ; Osteonecrosis ; Radionuclide Imaging

To evaluate the usefulness of MR in the osteomyelitis, we reviewed MR examinations of 14 patients with pyogenic osteomyelitis of the long bone. All 14 patients were confirmed to have osteomyelitis either surgically (13/14) or by aspiration (1/14). MRI was performed with 0.5R (n=8) or 2.0T (n=6) SE technique, and Gd-DTPA enhanced T1WI was obtained in 10 examinations. Anatomic location of lesions were femur (8/14), tibia (5/14),m and fibula (1/14). The marrow cavity and soft tissue were involved in 13/14, 12/14 respectively. The signals of both intraosseous and extraosseous infected area were iso to low signal intensity to muscles on T1WI and high signal intensity on PDWI & T2WI. Rim or diffuse enhancement of the marrow cavity and soft tissue were seen in all (10/10) cases. Sequestra, periosteal reaction. And cortical defect were found in 12/14, 10/14, 9/14. MR provided more accurate and detailed anatomic information including extent of disease and possible activity than bone scintigraphy, CT, or conventional radiography. We conclude that MR might be the choice of modality in the diagnosis of osteomyelitis of the long bone.
Bone Marrow ; Diagnosis ; Femur ; Fibula ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging ; Muscles ; Osteomyelitis* ; Radiography ; Radionuclide Imaging ; Tibia

PURPOSE: To evaluate the frequency of peritumoral bone marrow(BM) edema accompanying benign giant celltumor(GCT) of the appendicular bone by magnetic resonance(MR) imaging and to correlate MRI findings with those ofplain radiography and bone scintigraphy. MATERIALS AND METHODS: Eighteen cases of pathologically proven benignGCT of the appendicular bone were retrospectively analyzed using MR images, plain radiographs and bonescintigrams. A plain radiograph was available in 15 cases, and a scintigram in six. Marrow edema was defined asperitumoral signal changes which were of homogeneous intermediate or low signal intensity(SI) on T1WI and high SIon T2WI, relative to the SI of normal BM, and homogeneous enhancement on Gd-DTPA-enhanced T1WI. The transitionzone, sclerotic margin and aggressiveness of the lesion were assessed on the basis of plain radiographs. BM edemaseen on MR images was correlated with plain radiographic and scintigraphic findings. RESULTS: 1. Peritumoral BMedema was seen on MR images in 10 of 18 cases (55.5%). 2. In 8 of 15 cases for which plain radiographs wereavailable, MR imaging revealed BM edema. In six of these eight, transition zone was wide, while in two it wasnarrow. Six of seven patients without marrow edema showed a wide transition zone, and in one this was narrow.There was significant correlation between BM edema shown by MR imaging and the transition zone seen on plainradiographs (x2, p<0.05). But The aggressiveness shown by plain radiographs correlated only marginally, while thepresence of sclerotic rim did not correlate. 3. All six cases for which a bone scintigram was available showed anextended uptake pattern. In five of the six, MR imaging revealed edema. CONCLUSION: Peritumoral BM edema wasfrequently seen (55.5%) in the GCTs of appendicular bone ; it was more often shown in association with a widetransition zone by plain radiographs.
Bone Marrow* ; Edema* ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Magnetic Resonance Imaging ; Radiography ; Radionuclide Imaging ; Retrospective Studies

Magnetic resonance imaging(MRI) appears to be the most sensitive modality for early diagnosis of avascular necrosis of the femoral head and has recently been recommanded as a means of strengthening individual treatment decisions, However, MR signal patterns in AVN has been described to vary widely. And the understanding of the anatomic and pathologic structures represented on the MRI thus appears desirable for improved tissue characterization, staging of disease, and therapeutic planning. The object of this study was to analyze the correlation of MRI, radiographic staging, radionuclide imaging, and histological findings in AVN of the femoral head. The authors analyzed retrospectively 30 patients(36 hips) of AVN of the femoral head who underwent bipolar hemiarthroplasty or total hip replacement arthroplasty at Korea University Hospital from Nov. 1990 to Oct. 1993. The radiographic stage was evaluated according to Ficat and Arlet classification, and MRI was evaluated according to Mitchell et al. classification. The histologic changes corresponding to MRI abnormalities were assessed in 10 fresh surgical specimens. The obtained results were as follows; 1. Nine cases (25%) were class A, 3 class B (8%), 6 class C (17%) and 18 class D(50%) by Michell et al. classification on MRI and typical double line sign was found in 20 cases(56%). 2. Most of the cases of Ficat and Arlet stage II in simple radiograph showed MR class A or B, and stage III and IV showed class C or D. 3. There cases(10%) showed false negative studies in radionuclide imaging. 4. The necrotic bone & marrow and amorphous cellular debris represented the low signal intensity on both T1WI and T2WI, and repairing tissue, thickened trabeculae with mesenchymal cell infiltration was low signal intensity in T1WI and intermediate signal intensity in T2WI, and fibrous tissue was low signal intensity on both T1WI and T2WI. 5. MR classification by Mitchell et al. was not correlated with histological finding in respect of progression. Above results suggest that MRI provide the information about accurate anatomical location and involved site of necrosis, while MR classification by Mitchell et al. was not useful for staging of pathogenic process of AVN of the femoral head. The therapeutic plan and modalities have to be estabilished by comprehensive analysis of MRI, simple radiograph and other diagnostic modalities.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Bone Marrow ; Classification ; Early Diagnosis ; Head ; Hemiarthroplasty ; Korea ; Magnetic Resonance Imaging ; Necrosis ; Radionuclide Imaging ; Retrospective Studies

Infectious and inflammatory bone diseases include a wide range of disease process, depending on the patient's age, location of infection, various causative organisms, duration from symtom onset, accompanied fracture or prior surgery, prosthesis insertion, and underlying systemic disease such as diabetes, etc. Bone infection may induce massive destruction of bones and joints, results in functional reduction and disability. The key to successful management is early diagnosis and proper treatment. Various radionuclide imaging methods including three phase bone scan, Ga-67 scan, WBC scan, and combined imaging techniques such as bone/Ga-67 scan, WBC/bone marrow scan add complementary role to the radiologic imaging modalities including plain radiography, CT and MRI. F-18 FDG PET imaging also has recently been introduced in diagnosis of infected prosthesis and chronic active osteomyelitis. Selection of proper nuclear medicine imaging method will improve the diagnostic accuracy of infectious and inflammatory bone diseases, based on understading of pathogenesis and radiologic imaging findings.
Bone Diseases ; Bone Diseases, Infectious* ; Bone Marrow ; Diagnosis* ; Early Diagnosis ; Joints ; Magnetic Resonance Imaging ; Nuclear Medicine* ; Osteomyelitis ; Prostheses and Implants ; Radiography ; Radionuclide Imaging

BACKGROUND: Bone marrow scintigraphy using Tc-99m labeled antigranulocyte antibody has been reported to be able to evaluate bone marrow status. We have performed antigranulocyte antibody scan and hematopoietic activity in order to identify bone marrow status in patients with hematologic diseases. METHODS: Sixty-nine patients were enrolled in this study from October 1995 to May 1997. Images were acquired at four and twenty-four hour after injecion of 20mCi 99mTc labeled antigranulocyte antibody (BW 250/183). Patients were divided into four groups according to scintigraphic findings, those with increased marrow uptake (marrow expansion), decreased uptake, focal defect and normal findings. RESULTS: Leukemias and myelodysplastic syndromes frequently showed bone marrow expansion. Seventeen of 21 patients (81%) with AML, and all of ALL and biphenotypic leukemias showed bone marrow expansion. Five of 6 with CML, all Hodgkin's diseases and 3 of 4 MDS also showed marrow expansion. In contrast, all aplastic anemia patients showed decreased marrow uptake, and extra-axial noted in 2 patients with aplastic anemia. All of ten patients with multiple myeloma and 2 of 4 (50%) with Hodgkin disease showed focal marrow defects. Three of 11 with non-Hodgkin lymphoma and 4 of 21 with AML also showed focal marrow defects. CONCLUSION: Bone marrow scintigraphy using antigranulocyte antibody has clearly demonstrated the distribution of bone marrow in various hematologic diseases. Thus, it seems to be a useful method in the assessment of bone marrow status in patients with hematologic disease.
Anemia, Aplastic ; Bone Marrow ; Hematologic Diseases* ; Hodgkin Disease ; Humans ; Leukemia ; Lymphoma, Non-Hodgkin ; Multiple Myeloma ; Myelodysplastic Syndromes ; Radionuclide Imaging

No abstract available.
Bone Marrow Cells/pathology ; Bone and Bones/radionuclide imaging ; Female ; Humans ; Lung Neoplasms/diagnosis/radiography ; Middle Aged ; Multimodal Imaging ; Multiple Myeloma/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed