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Figures
- FIGURE 1.
Example images of osteomyelitis (arrows). Significant uptake of 99mTc-MDP is seen in right first toe in all 3 phases of skeletal scintigraphy, accompanied by intense radiotracer uptake indicating osteomyelitis on 99mTc-IgG scan. (A) Flow phase of 99mTc-MDP skeletal scintigraphy. (B) Blood-pool phase of 99mTc-MDP bone scintigraphy. (C) Delayed phase of 99mTc-MDP skeletal scintigraphy. (D) Five-hour 99mTc-IgG scintigraphy. (E) Twenty-four-hour 99mTc-IgG scintigraphy.
- FIGURE 2.
Example images of cellulitis (arrows). Significant uptake of 99mTc-MDP is seen in left fifth metatarsi in flow and blood-pool phases of skeletal scintigraphy, but activity is normal in delayed phase and there is no significant uptake in same region on 99mTc-IgG scan. (A) Flow phase of 99mTc-MDP skeletal scintigraphy. (B) Blood-pool phase of 99mTc-MDP bone scintigraphy. (C) Delayed phase of 99mTc-MDP skeletal scintigraphy. (D) Five-hour 99mTc-IgG scintigraphy. (E) Twenty-four-hour 99mTc-IgG scintigraphy.
- FIGURE 3.
Example images of aseptic inflammation (arrows). Significant uptake of 99mTc-MDP is seen in dorsal aspect of left foot (talus bone) in all 3 phases of skeletal scintigraphy, but there is no significant uptake on 99mTc-IgG scan. (A) Flow phase of 99mTc-MDP skeletal scintigraphy. (B) Blood-pool phase of 99mTc-MDP bone scintigraphy. (C) Delayed phase of 99mTc-MDP skeletal scintigraphy. (D) Five-hour 99mTc-IgG scintigraphy. (E) Twenty-four-hour 99mTc-IgG scintigraphy.
Tables
99mTc-IgG scan Patient no. Ulcer location Radiograph 5-h 24-h 99mTc-MDP scan (delayed phase) Definitive diagnosis 1 L calcaneus − ++ ++ ++ OM 2 R first toe − ± ± + Cellulitis 2 L talus − ++ + ++ Aseptic inflammation 3 R fifth metatarsal + ++ + ++ OM 4 R first toe − ± − + Cellulitis 4 L MTP joint − − − ++ Aseptic inflammation 5 External malleolus + ++ + ++ OM 6 L first toe − + ± ± Cellulitis 7 R first toe + ++ + ++ OM 7 R second toe − ++ ++ ++ OM 8 R first toe + ++ ++ ++ OM 9 L second metatarsal − ++ ++ ++ OM 10 R second metatarsal + ± ± + Cellulitis 11 R talus − ++ ++ ++ Aseptic inflammation 12 L calcaneus − + + ++ Cellulitis 13 R external malleolus + ++ ++ ++ OM 14 Fifth metatarsals − ± ± + Cellulitis 15 Surgical stump − ++ ++ ++ Cellulitis 15 R fifth toe − ++ ++ ++ Cellulitis 16 R third metatarsal − ± ± + Cellulitis 17 R first toe − ++ ++ ++ OM 18 Third metatarsals + ++ + ++ OM 18 R first toe − ± ± ± Cellulitis − = Absence of uptake; ± = faint uptake; + = moderate uptake; ++ = marked uptake; OM = osteomyelitis; MTP = metatarsophalyngeal.
Procedure True-positive (n) False-positive (n) True-negative (n) False-negative (n) Sensitivity (%) Specificity (%) PPV (%) NPV (%) 3-phase 99mTc-MDP 10 6 7 0 100 53.8 62.5 100 5-h 99mTc-IgG 10 4 9 0 100 69.2 71 100 24-h 99mTc-IgG 6 3 10 4 60 76.9 66.6 71.4 PPV = positive predictive value; NPV = negative predictive value.
Procedure Osteomyelitis Cellulitis Aseptic inflammation 3-phase 99mTc-MDP 7.2 ± 4.2 1.8 ± 1.4 6.0 ± 4.8 5-h 99mTc-IgG 5.1 ± 1.8 2.3 ± 1.0 4.4 ± 1.5 24-h 99mTc-IgG 4.9 ± 2.0 2.1 ± 0.7 4.3 ± 1.0 Data are mean ± SD.
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