Radionuclide bone scintigraphy in sports injuries.

Bone scintigraphy is one of the mainstays of molecular imaging. It has retained its relevance in the imaging of acute and chronic trauma and sporting injuries in particular. The basic reasons for its longevity are the high lesional conspicuity and technological changes in gamma camera design. The implementation of hybrid imaging devices with computed tomography scanners colocated with the gamma camera has revolutionized the technique by allowing a host of improvements in spatial resolution and anatomical registration. Both bone and soft-tissue lesions can be visualized and identified with greater and more convincing accuracy. The additional benefit of detecting injury before anatomical changes in high-level athletes has cost and performance advantages over other imaging modalities. The applications of the new imaging techniques will be illustrated in the setting of bone and soft-tissue trauma arising from sporting injuries.

SPECT/CT of femeroacetabular impingement.

Femoroacetabular impingement is a recently described condition thought to be associated with early onset osteoarthritis. We describe 2 cases of femoroacetabular impingement that were initially unrecognized despite multimodality imaging, including radiographs, MRI, and scintigraphy. The scintigraphic appearance may mimic avascular necrosis. There are limited reports of femoroacetabular impingement in the nuclear medicine literature. We propose that the finding of increased uptake in the superior femoral neck associated with osteoarthritic uptake involving the superior hip joint suggests the diagnosis of either cam or mixed cam-pincer impingement.

Lateral hip pain: does imaging predict response to localized injection?

Lateral hip pain is a common complaint in patients with a history of lower back pain from spinal disease. These patients often are diagnosed and treated for trochanteric bursitis because of localized pain and tenderness in the lateral hip. We presumed numerous scintigraphic features could provide diagnostic criteria for diagnosing gluteus medius tendinitis and trochanteric bursitis. A study was designed to assess the scintigraphic criteria for diagnosis of trochanteric bursitis and to evaluate the relationship of trochanteric bursitis to gluteus medius tendinitis and lumbar degenerative disease in predicting relapse after injection. We evaluated 97 patients with greater trochanteric pain syndrome to find a correlation between trochanteric bursitis, gluteus medius tendinitis, and spinal degenerative disease using scintigraphy and magnetic resonance imaging. We also evaluated predictors for responding to trochanteric injection of local anesthetic/glucocorticoid injection. We found a correlation between lumbar degenerative disease, gluteus medius tendinopathy, and trochanteric bursitis. Of these, 30 of 48 patients (63%) responded to injection of local anesthetic and glucocorticoids. The major predictor of relapse of pain after injection in 18 patients was the presence of moderate to severe lumbar degenerative disease seen on scintigraphic imaging. We propose a mechanistic model of the greater trochanteric pain syndrome to explain the interrelationship and response to therapy. Scintigraphy can provide sensitive and specific diagnoses of gluteus medius tendinitis and trochanteric bursitis.

Bone scintigraphy in acetabular labral tears.

BACKGROUND: Acetabular labral tears are an increasingly recognized cause of hip pain in young adults with hip dysplasia and older patients with degenerative disease of the hips. METHODS: The authors analyzed retrospectively bone scintigraphy in 27 patients with acetabular labral tears diagnosed by MRI/arthroscopy. Analysis was also made of scintigraphy in 30 patients without labral tears being investigated for other causes of hip pain for comparison. RESULTS: Patients with labral tears had hyperemia of the superior or superomedial aspect of the acetabulum and increased delayed uptake in either a focal superior pattern or in an "eyebrow" pattern of a superomedial tear. This pattern was not seen in any other sources of hip pathology. CONCLUSION: Uptake in the superior or superomedial aspect of the acetabular rim is characteristic of a labral tear. Absence of this pattern carries a high negative predictive value for the diagnosis.

Scintigraphy of injuries to the distal tibiofibular syndesmosis.

Ankle sprains are a common injury and may occur in as many as 75% of sporting participants. More complex injuries involving a rotational component may lead to injury of the interosseous membrane, its supporting ligaments, or the tibial plafond, compromising the integrity of the ankle mortice. Four such cases that show the scintigraphic manifestation of the injury are presented. In addition to the standard planar views of the ankles, special magnified anterior views were obtained with the feet in internal rotation of 25 degrees to 35 degrees. These special views facilitated the diagnoses.

Scintigraphy of cubital bursitis.

A 50-year-old man with psoriatic arthropathy was examined for a painful mass in the left cubital fossa. The clinical findings indicated a tumor or infection. Computed tomographic scanning and bone scintigraphy also raised the possibility of a malignant lesion. Surgical exploration revealed that the mass was a chronically inflamed bicipitoradial bursa adherent to the biceps tendon. This is a rare condition, with only a handful of cases described in the literature. This is the first scintigraphic case reported. The imaging features of the bursa are discussed in terms of the anatomy.