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Value of a 24-Hour Image (Four-Phase Bone Scan) in Assessing Osteomyelitis in Patients with Peripheral Vascular Disease

Nuclear Medicine Service and Vascular Surgery Laboratory, VA Medical Center
University of Utah, Salt Lake City, Utah

Correspondence: For reprints contact: Naomi Alazraki, MD, VA Medical Center (115), 500 Foothill Dr., Salt Lake City, UT 84148.

ABSTRACT

The delayed images of the four-phase ^99mTc phosphonate bone scan are compared with the delayed images of the three-phase study in patients with diabetes mellitus and/or peripheral vascular disease and suspected osteomyelitis. Three-phase bone imaging includes an immediate postinjection redionuclide angiogram, a blood-pool image, and delayed static images to 7 hr. The four-phase study adds a 24-hr static image. The scan is positive for osteomyelitis if images show progressively increasing lesion to background activity ratios over time. The results of analyzing 21 three- and four-phase bone scans in 17 patients were correlated with clinical course, cultures, and/or x-rays, gallium scans, and CT scans. The accuracy of four-phase bone imaging for diagnosing osteomyelitis was 85%; for three phase, 80%. Sensitivity for four phase was 80%; specificity was 87%. Sensitivity for three phase was 100%; specificity was 73%. Since over all accuracy of the four-phase study is slightly better than three phase, in these patients with diabetes mellitus and/or peripheral vascular disease, the addition of a 24-hr image, creating a four-phase bone scan, is recommended.

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