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Predicting the Outcome of Distraction Osteogenesis by 3-Phase Bone Scintigraphy

¹ Department of Biotracer Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
² Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan

View larger version (49K): [in a new window]   FIGURE 1. A 10-y-old boy, with osteosarcoma of left femoral metaphysis, received chemotherapy before and after surgery. He had marginal excision of tumor and bone transport with Ilizarov external fixator. (A) Radiograph shows callus formation in diaphysial distraction segment. (B) Blood-pool image and delayed image show increased activities in distraction segments. Increased activities are also shown in growth plates in both images. ROI was set on distraction segment and symmetric ROI was set on contralateral normal area as control. Uptake ratio of blood-pool image was 1.3, and uptake ratio of delayed image was 4.4.

View larger version (13K): [in a new window]   FIGURE 2. Box plot graphics of DR in groups A–C. Box indicates lower and upper quartiles, and central line and open circle in box are median and mean, respectively. Upper and lower ends of vertical line indicate 90 percentile and 10 percentile, respectively. NS = not statistically significant. DR of group A was significantly lower than that of other 2 groups.

View larger version (17K): [in a new window]   FIGURE 3. Distraction indices of poor and good consolidation groups. Distraction index of poor consolidation group was significantly larger than that of good consolidation group. However, poor consolidation group was not differentiated from good consolidation group because of significant overlap.

View larger version (26K): [in a new window]   FIGURE 4. Comparison of poor and good consolidation group in PI, BPR, and DR. Each horizontal dashed line indicates optimal cutoff levels obtained by ROC analysis, which were 1.1 in PI, 1.2 in BPR, and 2.2 in DR.

View larger version (12K): [in a new window]   FIGURE 5. ROC curves of detectability of poor consolidation group in PI, BPR, and DR. Area under ROC curve of DR was significantly larger than that of other 2 indices. FPF = false-positive fraction; TPF = true-positive fraction; Az = area under ROC curve.