Abstracts XIX Brazilian Congress of Nuclear Medicine

8. ORTHOPHEADICS

Lima MCL; Etchebehere ECSC; Oliveira JI; Maules F; Ramos CD; Camargo EE. Division of Nuclear Medicine, Department of Radiology and Department of Internal Medicine, Campinas State University ( UNICAMP), Campinas, Brazil

Repetitive strain injuries (RSI) are characterized by lesions to the soft tissue after strainful work. RSI require rapid diagnosis and treatment since it may lead to temporary or permanent functional impairment. Diagnosis is based mainly on clinical complaints, physical examination and radiographs. The purpose of this study was to verify the utility of bone, [Tc-99m] sestamibi and gallium-67 scintigraphies in the diagnosis of RSI. Five patients (pts) (4 male, 1 female), mean age 38.8 years with an 8 hour daily work schedule, mean service time of 116.8 months and different jobs, were studied. RSI was graded I – IV, based on clinical findings and complemented by ultra-sound (US) and x-rays. Pts were then submitted to three-phase bone scan (TPBS) with [Tc-99m] MDP and to [Tc–99m] sestamibi (SS) and gallium-67 (GS) scintigraphies, with a maximum time interval of 2 months between all three studies. Findings were graded as mild, moderate and severe. TPBS was normal in 2 pts and revealed mild uptake in the shoulder of the other 3 pts. SS revealed mild uptake in the shoulder of 1 pt. GS demonstrated mild uptake in 3 pts (2 in the right shoulder and 1 on both shoulders) and moderate in 2 (1 on both shoulders and the other in the superior third of the right arm). X-rays were normal in all pts and US was abnormal in the right shoulder of 2 pts. TPBS and SS were not effective in the early diagnosis of RSI, detecting changes only in grade IV lesions. GS was abnormal in the earlier stages of the disease, but the abnormalities and grades were not always in agreement (one grade II pt showed greater uptake than a grade III pt). Scintigraphies were useful only in the advanced stages of RSI.

Etchebehere ECSC, Grigolon MV, Ramos CD, Santos AO, Lima MCL, Belangero W, Camargo EE. Division of Nuclear Medicine, Department of Radiology and Department of Orthopedics and Traumatology, Campinas State University (UNICAMP), Campinas, Brazil.

Congenital short femur is the most common longitudinal growth deficit of the femur. Treatment is based on femoral elongation by external fixation, but the prediction of patient outcome is difficult. The purpose of this study was to evaluate the usefulness of bone scintigraphy as a prognostic tool after femoral elongation in patients (pts) with congenital short femur. Five pts with congenital short femur, ages ranging from 5 to 14 years, 3 males and 2 females, were studied. Pts underwent surgery with placement of a Lazlo-Cañadel elongator. Pts were evaluated clinically and submitted to an elongation of 2 mm per day. Three phase bone scintigraphy studies were performed 1, 2 and 4 months after surgery. Pts received an intravenous injection of 7.4 MBq/kg (0.2 mCi/kg) of [Tc-99m]MDP. Three-phase bone scintigraphy was performed in the supine position in a scintillation camera with a LEAP collimator. For the blood flow and equilibrium phases pts were positioned with the elongation region in the center of view. For interpretation, the amount of radioactivity present in all three phases was used and graded as absent, mild, moderate and marked activity. Scintigraphic data were correlated with the clinical outcome. Pts with moderate or marked uptake in the delayed images had a favorable outcome. In contrast, pts with mild or no uptake in the delayed images had an unfavorable outcome. Blood flow and equilibrium images were less important than the delayed images in the prognostic evaluation of these pts.

Three-phase bone scintigraphy can be used to as a predictor of the outcome of treatment with elongation in pts with congenital short femur.

Carvalho,L.; Polary Fo.,L.H.B.; Sergio,N.R.; Farias,M.S.; Lima,C.F.; Andrade,L.R.; Braga,H.M.; Moraes,R.F.; Rezende,M.O.; Barroso,A.A.. Nuclear Medcenter - Belo Horizonte - MG - BR.

sandrorb@inetminas.estaminas.com.br

Nuclear Medicine is looking for new ways of medical action. Our study aim to awake the attention to athletic medicine. Stress fracture is a common injury in healthy athletic patients and leads to local pain, often with no radiologic finds. We report two cases of young athletic patients (volley-ball players) presented with right and left leg pain, normal radiologic evaluations and stress fracture signs detected with Tc99m-MDP scintigraphy.

8.4 - CALCANEUS ULTRASONOMETRY AND BONE DENSITOMETRY IN A SAMPLE OF PER AND POST-MENOPAUSE WOMEN : COMPARATIVE RESULTS.

Araújo WM, Morita DM, João Francisco M. Neto - DIMEN & Medicina Nuclear & Campinas/SP/Brazil & PUC Campinas/Brazil.

Quantitative bone computed tomography and bone densitometry have shown to be useful parameters of evaluation of mineral bone loss. Recent studies have demonstrated that ultrasonometric measures are also suitable on evaluation of bone microstructure and fracture risk, linked to bone "resistence". The aim of this study was compare ultrasonometric with densitometric bone values in a sample of female patients, per and post menopause. Authors evaluated 500 white women patients, per and post menopause, in a sample of Campinas population. All of them underwent calcaneus ultrasonometric evaluation (Achilles Lunar Equipment) and bone densitometry (DEXA – Dual Energy X-ray Absorptiometry – IQ Lunar Equipment) of lombar vertebras and femur, in a single day. Afterward, it was proceeded data statistical analyses. It was noted statistically significant correlation between ultrasonometry and column bone densitometry (r=0,49) and femur (r=0,61). Negative correlation was found relative to ultrasonometry and age (r=-0,49). Ultrasonometry can, even without substitute bone densitometry measure, evaluate the "stiffness" of bone microstructure, because of the positive correlation between densitometric (femur mainly) and ultrasonometric values noted in this casuistic.

Fontes, L B A ; Rossi G S ; Sapienza, M T ; Watanabe, T ; Costa , P L A; Oliveira, C R G C M; Picolo, D S; Vazquez A C; Buchpiguel, C A - Centro de Medicina Nuclear- Departamento de Radiologia - HCFMUSP

Paget disease affects 5% of the population older than 40 years. The incidence of malignant transformation ranges from 0,7% to 14 % and the most common histological type is osteosarcoma. This case describes a 75 year old male with polyostotic Paget’s disease and rare malignant degeneration in the right ulna whose histological type was malignant fibrous histiocytoma. The radionuclide scan with MDP Tc 99m showed a cold area which was associated with marked increase in MDP - Tc 99 M uptake throughout all of the other affected bones and the same was seen on the Tl 201 imaging. In oposite to a few reports in the literature , the authors showed marked Talio-201 uptake in Paget’s disease , wheter malignant degeneration is present or not.

Gomes RCB, Telles GS,Gonçalves CCR, Orlando MMC,Antonucci JB.Sá V.F.; Boasquevisque E.M. - Universidade Estadual do Rio de Janeiro -Hospital Universitário Pedro Ernesto - Rio de Janeiro - Brasil

Three patients with solitary litic bone lesions was studied with 99mTc-MDP bone scan and radiologic (including CT ) examinations. The results were compared with the histopathologioc ndings. All lesions showed hiperperfusion and low bone uptake of 9mTc-MDP 3 hours later. Galium-67 and Tc-99m Sestamibi scan were done in two of them and

demonstrated high lesion uptake which was correlated with the primary neoplasma.

Santos, MJ; Kato, M. ; Rego, SFM - Nuclear Medicine Institute of Ribeirao Preto - DIMEN- Ribeirão Preto - SP.

The Hypertrophic Osteoarthropathy is a syndrome caracterized by three main features: clubbing of fingers and ankee bones, poliarthritis and periosteal reaction. Several precursory diseases, throracic or nonthoracic may develop this syndrom and pul monary carcinoma plays an outstanding role in this group. Its ethiology is unknown and a great deal of theorys try to explain the mechanism of its formations. The production of a toxic substance by the primary disease might be responsible for the ativation of the periostic reaction. The periostic reaction mainly attacks long bone diaphysis (femoris, humeri, etc) in a simetric pattern which can be confirmed by X-ray and bone scintigraphy. According to the literature secondary Hypertrophic Ostteoarthropathy plays the role of an effect preeceding the cause and may present a manifestation even two years before the disease which caused it we report the casew of a 62-year-old male, seen by an orthopedist because of important pains and aches in the lower members, mainly the thighs and a bone scintigraphy was requestd showing as result an increased uptake of the radiopharmaceuticals in the cortical edge of femoris, being interpreted as HO. Several siple X-rays of lower members were carried out after the scintigraphy confirming the periostitis. Its ethiology was investigated, but with no success. After a two-year-accompaniment, the patient has reported specific pulmonary complaints, which led to a pulmonary biopsy diagnosed as Pulmonary Adenocarcinoma. The coinclusion were that the scintigraphy is indeed an important method to diagnose the disease (HO) and the findings related to it may preced the radiographic alterations.

Siqueira CF,Torres F,Cicarini DM,Vieira AAB,Rezende MO,Vieira AAB.

Hypertrophic Osteoarthropathy (HO) is a still elusive paraneoplastic syndrome which is commonly related to lung cancer, showing peculiar features on bone scintigraphy. Differential diagnosis is a clinical challenge involving metastatic osteogenic disorders and oasteoarticular processes. Two female patients diagnosed with lung cancer underwent Tc-99m-MDP bone scintigraphy as part of the staging procedure. 4 hours after administration of 25 mCi of the radiopharmaceutical, images were obtained through a 2-head tomographic digital gamma camera (Helix, Elscint). HO was present in both cases, one of them also showing hyperactivity in the hemithorax where the tumor was located MDP bone scintigraphy was of paramount importance both for differential diagnosis and adequate management.

1.Cardiology |  2.Endocrinology | 3.Equipment: Quality Control | 4.Gastroenterology |  5.Infectious Diseases |  6.Nephro-Urology |  7.Oncology |  8.Orthopheadics | 9.PET/SPECT | 10.Pneumology |  11.Radiobiology |  12.Radiopharmacy |  13.Special Clinical Applications |  14.Neuropsychiatry |