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CASE REPORT
Year : 2010  |  Volume : 25  |  Issue : 1  |  Page : 25-26 Table of Contents   

Tc99m MDP bone SPECT in a case of osteomyelitis of the skull


Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication22-May-2010

Correspondence Address:
B R Mittal
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.63597

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   Abstract 

A seven-year-old male child presented with swelling at the left temporal region. His skull X-ray was normal. A three-phase bone scan showed increased blood flow, soft tissue activity, and increased tracer concentration in the left temporal region. Single photon emission computed tomography (SPECT) imaging of the skull revealed full thickness involvement of the left temporal bone. Our case report shows that, in osteomyelitis of the skull, SPECT imaging provides significantly more information for identifying the extent and thickness of bone involvement.

Keywords: Bone SPECT, 99mTc- MDP, osteomyelitis skull


How to cite this article:
Sethi RS, Mittal B R, Bhattacharya A, Singh B. Tc99m MDP bone SPECT in a case of osteomyelitis of the skull. Indian J Nucl Med 2010;25:25-6

How to cite this URL:
Sethi RS, Mittal B R, Bhattacharya A, Singh B. Tc99m MDP bone SPECT in a case of osteomyelitis of the skull. Indian J Nucl Med [serial online] 2010 [cited 2019 Nov 16];25:25-6. Available from: http://www.ijnm.in/text.asp?2010/25/1/25/63597


   Introduction Top


We report a case where SPECT has shown an incremental value over conventional three phase Bone Scintigraphy in diagnosing osteomyelitis of skull


   Case Report Top


A seven-year-old male child presented with a swelling of two months' duration in the left temporal region. It was not associated with fever and there was no history of trauma. On examination, the swelling was 4 X 4 cm in size and hard in consistency. The skull X-ray was normal. Fine needle aspiration cytology (FNAC) was suggestive of inflammation. However, no response was noticed with broad spectrum antibiotics given for two weeks. Subsequently, a three-phase bone scan done with 99mTc-MDP (Methylene Diphosphonate) showed increased blood flow and soft tissue tracer concentration in the left temporal region. Delayed static images also showed increased tracer concentration in the left temporal region [Figure 1]a. However, to determine the full extent of bone involvement, a SPECT study of the skull was performed, which revealed increased tracer concentration in the left temporal region, involving full thickness of the bone [Figure 1]b and c. Finally a diagnosis of acute inflammatory process involving the left temporal region was made. Later curettage of the swelling was done and the subperiosteal pus collection was drained. Pus culture showed growth of Staphylococcus aureus. The patient responded to oral cloxacillin.


   Discussion Top


Acute osteomyelitis may be of hematogenous origin or may be caused by a direct wound or puncture. Hematogenous osteomyelitis is a relatively common problem in children. Early diagnosis and treatment frequently leads to complete recovery. Early diagnosis may be difficult, because conventional and radiological findings are often nonspecific, subtle or simply absent. Skeletal scintigraphy may establish an early diagnosis and thus lead to therapy before much bone destruction occurs. In a three-phase bone scan, initial hyperemia represents increased blood flow due to inflammation, while delayed bone images demonstrate increased radiotracer concentration. [1],[2] Photopenic or cold patterns may also be seen in acute hematogenous osteomyelitis. [3],[4] Acute hematogenous osteomyelitis most often involves rapidly growing bone and characteristically localizes in the metaphysis of long bones. [5] In children, the most common sites of osteomyelitis are the head of the femur, humerus head, ileum, ischium, talus, and patella. [4] Osteomyelitis of the skull as demonstrated in this case is an uncommon entity. The focus of infection being near the brain, the urgency in making this diagnosis and starting therapy is self-evident. This case shows how a three-phase bone scan along with the SPECT of the skull were helpful in making the diagnosis of osteomyelitis of the skull and in describing the extent of bone involvement. Skull SPECT is a good adjunctive technique to the three-phase bone scan in such cases.

 
   References Top

1.Gilday DL, Paul DJ, Paterson J. Diagnosis of osteomyelitis in children by combined blood pool and bone imaging. Radiology 1975;117:331-5.  Back to cited text no. 1  [PUBMED]    
2.Glasier CM, Seibert JJ, Williamson SL. The gamut of increased whole bone activity in bone scintigraphy in children. Clin Nucl Med 1987;12:192-7.  Back to cited text no. 2  [PUBMED]    
3.Rosovsky M, Goldfarb CR, Finestone H, Ongseng F. "Cold spots" in pediatric bone imaging. Semin Nucl Med 1994;24:184-6.  Back to cited text no. 3  [PUBMED]    
4.Rehm PK, Aaron AD. Extensive photopenic osteomyelitis. J Nucl Med 1996;37:1676-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Treves ST. Pediatric nuclear medicine. 2nd ed. Springer-Verlag; 1995. p. 245.  Back to cited text no. 5      


    Figures

  [Figure 1]


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