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Der Nuklearmediziner 2002; 25(4): 238-249
DOI: 10.1055/s-2002-36474
Skelettdiagnostik

© Georg Thieme Verlag Stuttgart · New York

Nuklearmedizinische Diagnostik erregerbedingter Skeletterkrankungen

Scintigraphic Evaluation of Infective Skeletal DiseasesJ. Meller1 , U. Siefker1 , W. Becker †1
  • 1Abteilung Nuklearmedizin, Zentrum Radiologie, Georg-August- Universität Göttingen
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Publication History

Publication Date:
07 January 2003 (online)

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Zusammenfassung

Grundlage der nuklearmedizinischen Diagnostik erregerbedingter Skeletterkrankungen ist die Drei-Phasen-Skelettszintigraphie. Es handelt sich hierbei um eine sehr sensitive Methode bei der Abklärung akuter und chronischer Osteomyelitiden und septischer Arthrititiden. Eine Normalbefund schließt eine inflammatorische Erkrankung des Skeletts in der Regel aus.
Während die Spezifität der Skelettszintigraphie bei akuten Osteomyelitiden in einem nicht traumatisierten Knochen ebenfalls hoch ist, müssen bei der postraumatischen und bei der chronischen Osteomyelitis entzündungsspezifische Radiopharmezeutika wie markierte Leukozyten zum Einsatz kommen um reparative von florid entzündlichen Veränderungen zu unterscheiden.
Im Achsenskelett-fernen Regionen können hierzu markierte Leukozyten verwendet werden, während im Achsenskelett die F-18-FDG-PET mit einem dedizierten System oder mit einer Koinzidenzkamera eingesetzt werden muss.
Bei der septischen Arthritis bleibt die seit langem etablierte In-111-Leukozytenszintigraphie die Methode der Wahl.

Abstract

The three phase bone scan is still the basic investigation in the evaluation of infective skeletal diseases in nuclear medicine. The bone scan is highly sensitive in the diagnostic work-up of acute and chronic osteomyelitis as well as in septic arthritis. It is well established that a negative scan virtually rules out active disease.
While the specificity of the three phase bone scan is high in acute osteomyelitis in a non violated bone, other tracers like labeled white blood cells have to be used in the postraumatic and postoperative situation in order to differentiate reparative changes from active inflammation.
The diagnostic accuracy of labeled bood cells may be sufficient in the investigation of chronic osteomyelitis in the appendicular skeleton but in the investigation of the central skeleton, F-18-FDG PET either performed with a dedicated system or with a coincidence camera is warranted.
In septic arthritis, In-111- labeled white blood cells scans still remain the procedure of choice.

Schlüsselwörter

Osteomyelitis - Arthritis - Szintigraphie - PET - markierte Leukozyten

Key words

Osteomyelitis - arthritis - scintigraphy - PET - labeled leucocytes

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Dr. med. J. Meller

Abteilung Nuklearmedizin

Robert-Koch-Str. 130

37075 Göttingen

Phone: 05 51/39-85 12

Fax: 05 51/39-85 26

Email: jmeller@med.uni-goettingen.de