Combined Scintigraphic and Radiographic Diagnosis of Bone by Yong Whee Bahk MD, PhD, Professor (auth.)

By Yong Whee Bahk MD, PhD, Professor (auth.)

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56). It is to be noted that the concave border of the angulated bone shaft may accumulate tracer rather intensely due to the undue stress carried by this part. Such an uptake is eccentric in location, and clearly lies out of the marrow space. 55A-C. Intramedullary localization of tracer in sclerosing osteomyelitis of Garre, A Anteroposterior radiogram of the right femoral shaft in a 36-year-old man with a chronic bone infection shows marked bony sclerosis with minimal expansion (arrow). B Ordinary anterior spot scintigram reveals intense tracer uptake without specific textural features (arrow).

For bone-free, unobstructed observation of the knee, including the femoral condyles and intercondylar fossa, tibial condyles and plateaus, and tibial tubercles, the tunnel view is ideally suited (Fig. 36C). In the side (medial or lateral) views of the knee, the femoral condyle that lies nearer to the collimator is more magnified, appearing more distinct and vice sersa (Fig, 37). The tibial tuberosity, intercondylar tubercles, and patella in profile are visualized in this view. In the side views, the peripheries of the periarticular bones that overlap each other are indicated by an intense, curvilinear tracer uptake; the adding of the tracer uptake in two different structures (Fig.

49) or isolated (Fig. 50). It remains eccentric unless the infection involves the whole circumference (Fig. 50). Nuclear angiography may prove increased vascularity locally in the affected cortex. On occasion cancer may metastasize to the cortex, scintigraphically resembling cortical infection . For the most part, however, the metastatic cortical lesion tends to be discrete and weIl demarcated (Fig. 238). • A B Fig. 48 A, B. Usefulness of pinhole scint igraphy in distinguishing an incipient juxtaphyseal infeetive foeus from the physis.

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