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Utility of skeletal scintigraphy for osteomyelitis evaluation of amputees and patients with orthopedic devices

¹ Nuclear Medicine Service, Dept. of Radiology, Walter Reed Army Medical Center, Washington, District of Columbia

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Objectives: We investigated the utility of a bone scan in amputees and patients with orthopedic devices in the diagnosis of osteomyelitis. Our institution has seen a tremendous increase in the number and severity of extremity trauma since the advent of the Persian Gulf conflict. Amputees and patients requiring surgical instrumentation may require different approaches than traditionally employed and modifying current diagnostic strategies may improve overall medical care.

Methods: We retrospectively reviewed all three-phase bone scan reports (1,475 patients) between the months of 09/01/2006 to 09/01/2007 at our institution. The inclusion criteria for our study were patients who had either an extremity amputation or current orthopedic device in an extremity, being referred for potential osteomyelitis.

Results: A total of 29 patients met the inclusion criteria for our study. Out of the 29 patients, 28 (97%) had increased activity in the region of interest (ROI). Of these 28 scans, 23 (82%) revealed increased activity on all three phases of the examination. One (4%) had increased uptake on two phases. Four (14%) had increased uptake only on delayed-phase images. Of the 28 scans which had activity in the ROI, 27 (96%) cases were referred for an In-111 tagged white blood cell (WBC)/Tc-99m sulfur colloid study to diagnose or exclude osteomyelitis.

Conclusions: Based on this data, we propose that patients who have undergone an amputation or have a current orthopedic device in an extremity should proceed directly to a more definitive examination (tagged WBC/sulfur colloid) when a diagnosis of osteomyelitis is considered. Skeletal scintigraphy provides little diagnostic benefit and results in unnecessary radiation exposure for this patient population.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Kao, Y.-E. Articles by Stack, A. PubMed Articles by Kao, Y.-E. Articles by Stack, A.