Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography.

The diagnostic efficacy of (1) combined three-phase bone scintigraphy and In-111 labeled WBC scintigraphy (Bone/WBC), (2) MRI, and (3) conventional radiography in detecting osteomyelitis of the neuropathic foot was compared. Conventional radiography was comparable to MRI for detection of osteomyelitis. MRI best depicted the presence of osteomyelitis in the forefoot. Particularly in the setting of Charcot joints, Bone/WBC was more specific than conventional radiography or MRI.

Detection of femoral head avascular necrosis in adults by SPECT.

Twenty-one adult patients with the clinical diagnosis of avascular necrosis (AVN) of the femoral head were examined with radionuclide angiography, planar bone scintigraphy, and single photon emission computed tomography (SPECT). A final diagnosis of AVN was established for 15 symptomatic patients with a total of 20 involved hips. SPECT and planar bone scintigraphy were considered positive for AVN only if a photopenic bony defect could be identified. Using SPECT bone scintigraphy, 12 of 15 symptomatic patients and 17 of 20 involved hips (sensitivity of 0.85) were correctly identified, whereas with planar imaging only eight of 15 patients and 11 of 20 involved hips were detected. There were no false-positive diagnoses on SPECT or planar bone scintigraphy. In addition, hyperemia in the region of the proximal femoral metaphysis was demonstrated in six of 20 involved hips. It is concluded that by identifying a photopenic defect that is not evident on planar views, SPECT can contribute to the diagnosis of AVN of the femoral head. In addition, metaphyseal hyperemia appears to be a promising new scintigraphic sign of AVN worthy of further investigation.

Experimental cervical spine injury model: evaluation of airway management and splinting techniques.

We evaluated airway management maneuvers and the effects of cervical splinting on a model of an injured spinal column. X-ray films of a fresh cadaver verified a normal cervical spine. C5-C6 instability was created surgically and documented radiologically with flexion and extension maneuvers. Basic and advanced airway techniques were performed and were documented radiologically. The procedures were then repeated using different types of splinting. Chin lift, jaw thrust, esophageal obturator airway (EOA), and endotracheal intubation can cause extension, widening, and/or anterior subluxation. A two-piece, semirigid soft cervical collar may minimize flexion but not extension of the spine. With the Velcro in back, soft collars minimize flexion; with Velcro in front, they minimize extension. Standard nonsurgical airway management techniques appear to aggravate preexisting injuries. The soft collar and semirigid collar do little to prevent movement, and their presence may serve only as a warning to physicians that a neck injury may be present.