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Utility of Three-Phase Skeletal Scintigraphy in Suspected Osteomyelitis: Concise Communication

Alan H. Maurer^*,, David C. P. Chen, Edwaldo E. Camargo, Dean F. Wong, Henry N. Wagner, Jr. and Philip O. Alderson

The Johns Hopkins Medical Institutions, Baltimore, Maryland

Correspondence: For reprints contact: Alan Maurer, MD, Nuclear Medicine, Johns Hopkins Medical Institutions, 615 N. Wolfe St., Baltimore, MD 21205.

ABSTRACT

Three-phase skeletal scintigraphy, consisting of a radionuclide angiogram, an immediate post injection "blood-pool" image, and 2–3 hr delayed images, was performed on 98 patients with suspected osteomyelitis. This procedure was evaluated by first interpreting only the delayed images, next the combination of "blood-pool" and delayed images, and finally the three-phase study. There was no change in the sensitivity (12/13 = 0.92) for detecting osteomyelitis, but the false-positive rate for osteomyelitis decreased from 0.25 (21/85) to 0.06 (5/85). In 21 of 64 patients (33%) with abnormal studies, the "blood-pool" image and/or the radionuclide angiogram led to a more accurate scintigraphic diagnosis. In 12 patients (19%) the "blood pool" alone was enough to achieve the correct final diagnosis and was used most often to identify noninfectious skeletal disease. In 9 patients (14%) the radionuclide angiogram was required for an accurate interpretation and was considered essential most often in cases of soft-tissue infection. Both radionuclide angiography and "blood-pool" imaging appear to augment the specificity of skeletal scintigraphy in patients with suspected osteomyelitis.

FOOTNOTES

^* Current address: Div. of Nucl. Med., Temple Univ. Hospital, 3401 N. Broad St., Philadelphia, PA 19140.

Current address: Director, Div. of Nucl. Med., Columbia-Presbyterian Hospital, 630 W. 168th St., New York, NY 10032.

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