Glossary. Springer International Publishing AG 2017 A.H. Elgazzar, Orthopedic Nuclear Medicine, DOI /

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1 Glossary Ankylosing spondylitis The most common type of spondyloarthropathies with chronic inflammatory changes leading to stiffening and fusion (ankylosis) of the spine and sacroiliac with a strong genetic predisposition associated with HLA B27. Other joints, such as hips, knees, and shoulders, are involved in approximately 30% of patients. Apophysis An accessory secondary ossification center that develops late and forms a protrusion from the growing bone where tendons and ligaments insert or originate. Avulsion Complete separation of tendons or ligaments, with or without a portion of bone and/or cartilage. Behçet s syndrome An uncommon disorder characterized by recurrent oral and genital ulceration, uveitis, or retinal vasculitis, cutaneous pustules, or erythema nodosum and synovitis. The disease is more common in Mediterranean countries and Japan than in the United States. Bone contusion (bone bruise) A term describing microfractures of trabecular bone together with edema or hemorrhage within the marrow. Brodie s abscess An intraosseous abscess in the cortex that becomes walled off by reactive bone. Calciphylaxis Soft tissue calcification in response to administration of an agent after induction of a hypersensitive state. Calcinosis cutis A term used to describe a group of disorders in which calcium deposits form in the skin, subcutaneous tissue, and connective tissue sheaths around the muscles but not within the muscles. Chronic nonbacterial osteomyelitis This term has emerged as a global term to describe a group of autoinflammatory bone diseases, including chronic recurrent multifocal osteomyelitis (CRMO), synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome, and diffuse sclerosing osteitis (DSO). These disease entities are sterile bone lesions that may include associated systemic and dermatologic manifestations. Costochondritis (Tietze s syndrome) A common painful condition that affects the costochondral junction, usually in young patients, and is self-limiting. The etiology remains unknown, although trauma and infection have been proposed. It can affect any rib, but the first and second ribs are most commonly involved. Complex regional pain syndrome type I (reflex sympathetic dystrophy) A pain syndrome that usually develops after an initiating noxious event with no identifiable major nerve injury, is not limited to the distribution of a single peripheral nerve, and is disproportional to the inciting event or expected healing response. CPPD Calcium pyrophosphate dihydrate deposition disease, also called pseudogout and chondrocalcinosis: a type of crystal deposition arthropathy with such crystals deposited in cartilage, synovium, tendons, and ligaments. Diffuse idiopathic skeletal hyperostosis (DISH) Also known as Forestier s disease or senile ankylosing hyperostosis; is a common progressive noninflammatory bone and enthesis disorder of unknown etiology affecting the Springer International Publishing AG 2017 A.H. Elgazzar, Orthopedic Nuclear Medicine, DOI /

2 418 Glossary elderly population (up to 30% of men older than the age of 50 years). It is characterized by calcification and ossification of the spinal and various extraspinal soft tissues, mainly entheses, ligaments, and joint capsules. Dystrophic calcification A type of soft tissue calcification that occurs in the setting of normal serum calcium and phosphate levels and occurs in damaged, inflamed, neoplastic, or necrotic tissue. Endochondral ossification Most of the skeleton forms by this type of ossification, where a preexisting cartilage forms first and then undergoes ossification. Enteropathic arthropathies Arthropathies associated with inflammatory bowel diseases, including ulcerative colitis, Crohn s disease, Whipple s disease, intestinal bypass surgery, and celiac disease. Entheses The sites of insertion of tendons, ligaments, and articular capsule to bone. Enthesopathy A pathologic process affecting entheses particularly trauma and/or inflammation resulting in regional periosteal reaction with osteoblastic bone activity. Fibrous dysplasia A benign bone disorder characterized by the presence in the fibrous tissue in lesions of trabeculae of non- lamellar bone (woven bone) which remains essentially unchanged. Flare pattern on bone scan An initial apparent deterioration of primary or some or all metastatic lesions on the bone scan, followed by improvement usually accompanying successful treatment. Fracture delayed union Delay of fracture union beyond the expected time (usually 9 months). Fracture nonunion Complete cessation of repair process of a fracture. Fracture A break in the continuity of a bone. Gout A metabolic disorder that results in hyperuricemia and leads to deposition of monosodium urate monohydrate crystals in various sites in the body, especially joint cartilage. Heterotopic ossification A specific type of soft tissue calcification that may or may not follow trauma and is due to a complex pathogenetic mechanism believed to be due to transformation of certain primitive cells of mesenchymal origin in the connective tissue septa within muscles into bone-forming cells. Hypertrophic osteoarthropathy A form of periostitis that may be painful and may be associated with clubbing of fingers and toes, sweating, and thickening of skin. It may be primary or may follow a variety of pathologic conditions, predominantly intrathoracic, and is characterized by periosteal new bone formation. Impingement syndromes A group of painful conditions caused by friction of joint tissue, which include bone impingement, soft tissue impingement, and entrapment neuropathy, depending on the type of tissue involved. Inflammation A complex nonspecific tissue reaction to injury caused by many agents such as living agents such as bacteria and viruses, leading to infection, or nonliving agents, including chemical, physical, and immunologic factors or radiation. Intramembranous ossification Occurs through the transformation of mesenchymal cells into osteoblasts, seen in flat bones of the skull, part of the mandible, and part of the clavicle. Involucrum A layer of new bone formation around the site of skeletal infection formed secondary to the body s response to that infection. Lisfranc injury Fracture or fracture- dislocation of tarsometatarsal joints. Malunion Healing of a bone in a nonanatomic orientation. Mandibular condylar hyperplasia A unilateral developmental abnormality of the mandible leading to asymmetry in condyles that may result in facial asymmetry. Metastatic calcification The type of soft tissue calcification that involves viable undamaged normal tissue as a result of hypercalcemia and/or hyperphosphatemia associated with increased calcium phosphate product locally or systematically. Myositis ossificans progressiva The congenital and rare form of heterotopic ossification. Osteochondritis dissecans Transchondral fracture with fragmentation and separation of portions of cartilage or cartilage and bone; most prevalent in adolescents.

3 Glossary Osteomalacia Abnormal mineralization of bone with a decrease in bone density secondary to lack of both calcium and phosphorus with no decrease in the amount of osteoid (bone formation). Osteomyelitis A term applied to skeletal infection when it involves the bone marrow. Osteopetrosis A rare inherited metabolic bone disease characterized by a generalized increase in skeletal mass due to a congenital defect in the development or function of the osteoclasts, leading to defective bone resorption. Osteoporosis Reduction of bone tissue amount increasing the likelihood of fractures. Oxalosis Deposition of calcium oxalate crystals that leads to arthropathy. Pathologic fracture A fracture at a site of preexisting abnormalities that weaken bone. Patellofemoral stress syndrome (patellofemoral pain syndrome) A common musculoskeletal disorder believed to be due to abnormal motion or pressure between the patella and femur secondary to chondromalacia and malalignment, but overuse is currently believed to be the most important etiology. It causes pain, sometimes sharp and acute. Plantar fasciitis (calcaneal periosteitis) An inflammatory condition that can occur as an isolated entity, e.g., secondary to occupation or degenerative, or may accompany spondyloarthropathies. Podagra A term describing affection of the metatarsophalangeal joint of the great toe in gout, the most typical finding of gouty arthritis. Progressive diaphyseal dysplasia (Camurati- Engelmann disease) Rare autosomal dominant hereditary disorder characterized by progressive bone formation along the periosteal and endosteal surfaces of long bones and sometimes the skull with widening of bones. It is usually manifested in childhood but can present later. It may cause pain, muscle weakness, and occasionally deafness. Pseudarthrosis A gap between the fracture bone ends containing a space filled with fluid. Also termed false joint. Reactive arthritis (Reiter s disease) A syndrome characterized by a combination of nongonococcal urethritis, arthritis, and conjunctivitis. 419 Renal osteodystrophy A metabolic condition of the bone associated with chronic renal failure. Rheumatoid arthritis An autoimmune disease causing inflammation of connective tissue, mainly in the joints, with synovial inflammatory response triggered by immune complexes in the blood and synovial tissue through activation of plasma protein complement. This inflammation spreads from the synovial membrane to the articular cartilage, the joint capsule, and the surrounding tendons and ligaments, leading to pain, loss of function, and joint deformity. SAPHO syndrome A syndrome characterized by synovitis, acne, palmoplantar pustulosis, hyperostosis, and osteitis. The small and large joints of the feet, ankles, knees, hips, right sacroiliac joints, and shoulders are affected by the synovitis. Scheuermann disease A destructive form of osteochondrosis with erosions of the end plates of two adjacent vertebrae and anterior wedging of thoracic vertebrae. Schmorl s node Herniation of nucleus pulposus upward or downward through the cartilaginous and bony end plate into the body of an adjacent vertebra. Usually involves the inferior end plate of the lower thoracic and lumbar vertebral bodies. Involvement of both the inferior and the superior end plates is not uncommon. Septic tenosynovitis An inflammatory condition affecting generally the flexor tendons of the hands and feet of diabetic patients and resulting from penetrating injuries or spread of infection from a contiguous focus of infection. Sequestrum Segmental bone necrosis that develops when normal blood supply to the bone is interrupted by the edema and ischemia produced by the inflammation. Shin splints Periosteal elevation with reactive bone formation secondary to extreme tension on muscles or muscle groups inserting on bones. Slipped capital femoral epiphysis Displacement of the femoral head from the femoral neck at the site of the growth plate during growth. Spondyloarthropathies A group of seronegative arthropathies formerly called rheumatoid

4 420 variants that share common clinical and radiographic features with characteristic involvement of the sacroiliac joints, the spine, and, to various degrees, the peripheral joints, are linked to HLA B27 histocompatibility antigen, and include ankylosing spondylitis, psoriatic arthritis, reactive arthritis (Reiter s disease), and enteropathic spondylitis. Spondylolysis A loss of continuity of bone of the neuroarch of the vertebra due to stress or trauma. Spondylolisthesis Forward movement of one vertebra on another, usually as a result of fracture of the neuroarch. Sprains Tears of ligaments. Strains Tears of tendons. Stress fracture A pathologic condition of bone due to repeated episodes of stress, each less forceful than that needed to cause acute fracture of the bony cortex. Synovial joints Specialized joints that are found mainly in the appendicular skeleton and allow free motion. Tarsal coalition Fusion of the talus and calcaneus or of the navicular and calcaneus due to failure of normal segmentation of their ossification centers during embryogenesis. Glossary Toddler s fracture Fracture in preschool children which is typically a non-displaced spiral fracture of the mid-tibia but also includes fractures of other bones, such as the fibula, calcaneus, talus, metatarsal, and cuboid bones. Transient synovitis A joint inflammation of unknown origin and self-limiting course affecting most frequently boys between 5 and 10 years of age. It was previously known as toxic synovitis and affects preferentially the hip or knee and subsides without antibiotics. T-score A parameter used to express bone mineral density by relating an individual s bone density to the mean BMD of healthy young adults, matched for gender and ethnic group. Tumoral calcinosis A type of soft tissue calcification characterized by large, calcified, periarticular soft tissue masses of calcium phosphate near the large joints such as the hip, the shoulder, and the elbow, in addition to the wrist, hands, and feet. Woven bone Immature non-lamellar bone that is later normally converted to lamellar bone. Z-score A parameter used to express bone mineral density by comparing the bone density value of an individual to the mean value expected for his/her age group.

5 A Achilles tendinitis, 183 Acute chest syndrome, 205, 207 Acute fracture, scintigraphic appearance, scintigraphic imaging battered child syndrome, growth plate injuries, , 162, 163 Lisfranc fracture, 157, 160, 161 Osgood-Schlatter disease, osteochondritis dissecans, rib fracture, scaphoid bone fracture, , 159 Scheuermann s disease, 165 slipped capital femoral epiphysis, sternal fracture, tarsal coalition, 164 toddler s injury, scintigraphic role, Acute inflammation, 38 40, 286, 339 Aluminum toxicity, 131, 132 Aneurysmal bone cyst (ABC), Angiogenesis, 27, 39 Ankle synoviorthesis, 405 Ankle trauma, 358 Ankylosing spondylitis, 297, 298, 406 Antibiotics, 38, 45, 69, 300, 316 Apophysis, 2 4, 182, 192, 207 Atrophic non-union, 153, 179, 180 Avulsion injury, 153, , 182, 183 B Baker s cyst, , 295, 401 Basal cell carcinomas, 132, 325 Batson s venous plexus, 228, 230 Battered child syndrome, Behçet s syndrome, 282, 299 Body habitus, 21, 30, 31, 111, 113 Bone anatomy blood supply, 6, 7 cellular level, 5 6 features, 6 9 gross level, 4 molecular level, 6 tissue level, 4 5 development, 2 3 function, 7 metabolism, 7, Bone disease classification, 13 diagnosis F-18 FDG, 18 F-18 sodium fluoride, 18 In-111 oxine leukocytes, 17 lamellar bone, 15 scintigraphic-pathological correlation, 18 Tc-99m sestamibi, 17 Tc-99m sulfur colloid, 18 thallium-201, 17 imaging modalities, 14 Bone expansion, 128, 231, 232 Bone hemangiomas, 222, 245, 247, 248 Bone marrow active hematopoietic marrow, 310 alterations, 311 blood flow, 308 composition, 308 conversion, 310, 311 distribution, 308, 309 elements, 308 function of, 308 histologic section, 307, 308 imaging of, pre-and postnatal hematopoiesis, 308, 309 radionuclide therapy, 410 reconversion, 310, 311 Springer International Publishing AG 2017 A.H. Elgazzar, Orthopedic Nuclear Medicine, DOI /

6 422 Bone marrow (cont.) red marrow, 310 scintigraphy diabetic foot osteomyelitis diagnosis, F-FLT, 314 Gaucher s disease, IM-WPRT, 318 indium-111 chloride, 313 Paget s disease, 319 prosthetic joint infection diagnosis, sickle cell disease, 317, 318 Tc-99m MAb, 312, 313 Tc-99m SC SPECT, 318 Tc-99m sulfur colloid whole-body scan, Tc-99M-WBC, tumors and extension, 320 yellow marrow, 310 Bone marrow edema syndrome, 88, 200 Bone mass density (BMD), 109, Bone matrix, 5 7, 19, 111, 193, 388, 389 Bone modeling units (BMU), 10 Bone, remodeling healing, 152 osteoporosis, 109, 110 Paget s disease, phases, Bone resorption, 1, 5, , 110, 116, 117, 132, 227, 256 Bone scan acquisition, bone imaging radiopharmaceuticals, diagnostic errors sources history and physical examination, 30 interpretation, patient, 30 radiopharmaceuticals, technique, 31, 33 examination, 21 imaging time, instrumentation, of joint disorders, 282 patient history, 21 patient preparation, positioning, 23, post-imaging, scintigraphic methods, Bone turnover, 10, 120 Breast cancer combined F-18 NaF and F-18 FDG PET/CT, F-18 FDG PET/CT study, 259, 260 incidence of, 257 PET imaging, Tc-99m MDP bone scan, 258 Tc-99m MDP SPECT/CT study, Brodie s abscess, 42, 43, 45 C Café-au-lait pigmentation, 128 Caffey s disease. See Infantile cortical hyperostosis Caffey-Silverman syndrome. See Infantile cortical hyperostosis Calcinosis cutis, Calcium pyrophosphate dihydrate (CPPD) deposition disease, , 344 Callus, 151 Camurati-Engelmann disease, 134, 136 Cancer-related bone pain treatment clinical response, contraindications, 394 current indications, 394 hemibody irradiation, 389 inflammatory and neuropathic mechanisms, 388 mechanism of action, pain relief, 389 palliative option, 389 precautions and radiation safety, radiopharmaceuticals, 390 dosimetric features, 393 hematological effects, 393 Lu-177, 392 phosphorus-32 orthophosphate, 391 radium-223 dichloride, 392 Re-188-HEDP, 392 Re-188-(V)DMSA, 392 rhenium-186 ethylene hydroxy diphosphonate, 391 Sm-153-EDTMP, 391 strontium-89 chloride, 389, 391 therapeutic response, 394 tin-117m diethylenetriaminepentaacetic acid, Carcinoid tumor, 268 Cardiac calcinosis, 323 Carpal tunnel syndrome, 184 Cartilaginous joint, 12 Cellulitis, 56 58, 61, 66 c-fos proto-oncogenes, 102, 104 Chondrogenic tumors, Chondrosarcoma, Chordoma, Chronic active osteomyelitis, 42, 62, 73, 75 80, Chronic recurrent multifocal osteomyelitis (CRMO), 86 Circulatory disorders. See Osteonecrosis Closed fracture, 148 Cold lesions, 252, Collagenic tumors, 220 Combined F-18 NaF and F-18 FDG PET/CT breast cancer, lung cancer, soft tissue and bone disease staging, 376 Combined modality, 63 65

7 423 Compact bone, 5, 10, 110, 114 Complex regional pain syndrome-1 acute phase, 123 atrophic phase, 123 bone scan, 124, 126 diagnosis, 124 dystrophic phase, 123 histopathological changes, 123 pathophysiology, 123 scintigraphic patterns, Composite Severity (CSI), 67 Compression fractures, 349, Computed tomography (CT), 51 Congenital disorders, 13, 132, 133 Correlative imaging, 14. See also Individual disease conditions Costochondritis, 299 Coupling, Paget s disease, 104 Coupling signal, in bone remodeling, 10, 11, 104 CRMO. See Chronic recurrent multifocal osteomyelitis (CRMO) Crush syndrome, 345 Crystal deposition arthropathies CPPD deposition disease, Gouty arthritis, Cushing s syndrome, 111, 128 D Delayed union, 152 Diabetic foot osteomyelitis, 47, 48, 63 69, , 362, 373 Diaphysis, 2, 3, 5, 7, 131, 136, 170, 199, 217, 220 Diffuse idiopathic skeletal hyperostosis (DISH), Diffuse metastases, Diffuse sclerosing osteitis (DSO), 86 Dual-energy X-ray absorptiometry (DXA), 112 Dysbaric osteonecrosis, 206 Dysprosium-165, 400 Dystrophic calcification arterial calcium deposits, 325, 328 in breast cancer, causes of, 324 in lung cancer, 325, 326 mucinous cystadenocarcinoma, 325, 327 Tc-99m MDP image, 325, 328 E Ectopic calcification, 131, 153, 344 Elbow synoviorthesis, 404 Endochondral ossification, 2, 153, 157, 206, 333 Enteropathic spondylitis, 298, 299 Enthesopathies, 183 Epiphyseal osteomyelitis, 84 Epiphysis, 2, 3, 5, 84 Erbium-169 citrate, 399 Escherichia coli, 43, 44 Estimated radiation absorbed dose, 17, 18 Ewing s sarcoma imaging, 245, 246 origin, 220 sites of involvement, 220, 222 Expansion, bone, 18 Extraction efficiency, 19 F Falx cerebri calcification, 134 Feet fracture, 172 Femoral head bone lesion, 254 multifocal osteonecrosis, osteonecrosis, 194 in adults, in children, Femoral neck fracture, F-18 FDG PET/CT breast cancer, 259, 260 chronic active osteomyelitis, 75, clinical uses, 372 combined F-18 NaF and, diabetic foot osteomyelitis, 373 metastatic bone disease, 372 osteogenic sarcoma, 270 post-arthroplastic infections, primary and metastatic tumors, 372 prostate cancer, 262 radiation absorbed dose, 18 spondylodiscitis, 72, 373 uptake, 235, 242 Fibrodysplasia ossificans progressiva. See Myositis ossificans progressiva Fibrosarcoma, 220 Fibrous dysplasia bone scan, CT scan, 131 etiology, 128 FDG PET, 131 MRI, 131 radiographic findings, 128 Fibrous joint, 12 Flare phenomenon, 256 Fluoride toxicity, 131 Foot trauma, 358 Fracture acute, classification, 148 fatigue, , 170, 173, 174 healing,

8 424 Fracture (cont.) mal-union, 153 non-union atrophic, 153 hypertrophic, 153 scintigraphic evaluation bone graft viability, fracture healing, 179, 180 metallic implants removal, spondylolisthesis, 150, 152 spondylolysis, 150, 151 stress, Freiberg s disease, F-18 sodium fluoride PET/CT, bone imaging, 20 clinical use, 374 combined F-18 FDG PET/CT, low back pain, 294 lung cancer, 263 multiple fractures, 170 radiation absorbed dose, 18 thyroid cancer, 265 Full width at half maximum (FWHM), 27 G Gallium-67 citrate imaging, 60 chronic osteomyelitis, 73, 75 radiation absorbed dose, 17 in vertebral osteomyelitis, Gallium-68-PET/CT, 63, 378 Gallium-68 PSMA PET/CT, 378, 381 Gamma cameras, 22, 53, 84, 250, 391 Garre s sclerosing osteomyelitis, 88 Gastrointestinal tumors, 266, 268 Gaucher s disease, Giant cell tumors, Gleason s score, 261 Gorlin s syndrome, 132, 134, 135 Gouty arthritis, Granulation tissue, 151, 193, 289, 404 Growth hormone, 10 Growth plate injuries, 155, , 162, 163 Gynecological tumors, 266 H Haemophilus influenzae, 288 Hardcastle syndrome. See Medullary diaphyseal sclerosis Healing bone graft, fracture, inflammation, 40 Hemangioma. See bone hemangioma Heterotopic bone formation acquired form, 331 complications, 333 correlative imaging, 339 definition, 331 fibrodysplasia ossificans progressiva, 333 hereditary form, 331 heterotopic ossification, 331 hypervascularity, 333 incidence, 331 myositis ossificans, 331, 332 myositis ossificans progressiva, 339, 342 pathogenesis, 332 prevalence, 332 progressive osseous heteroplasia, 333, scintigraphic evaluation gallium-67 uptake, 339, 341 immature heterotopic bone formation, indium-labeled WBC studies, pathological conditions, 337, 339 serial bone scans, 334, 335 SPECT/CT, 335, Tc-99m MDP bone scan, 337, 338, 341 three-phase bone scans, 335, 336 SPECT/CT imaging, 364, tumoral calcinosis, 331, tumoral calcium pyrophosphate dihydrate crystal deposition disease, 344 High turnover disorder, 10, 120 Hip arthroplasty, 48, 80, 199, 301, 331, 337 Hip synoviorthesis, 404 Hodgkin s lymphoma, 41, 266, 320 Holmium-166 ferric hydroxide, 400 Hungry bone syndrome, 117 Hyperparathyroidism bone scan, hypocalcemia, 117 primary, 116 secondary, tertiary, 117 Hyperthyroidism, 131 Hypertrophic neuroarthropathy, 47, 296 Hypertrophic non-union, 153 Hypertrophic osteoarthropathy lung cancer, 127, 128 pathological condition, 127 primary, 127 scintigraphic patterns, secondary, 127 Hypervitaminosis A, 131 Hypocalcemia, 115, 116, 119, 120, 232 Hypothyroidism, 131 I IGF. See Insulin growth factor (IGF) Iliac crest, 3, 182 Immunoscintigraphy, Impingement syndrome, In-111 antimyosin, 182 Incomplete fracture, 148 Indium-111 labeled leukocytes in diabetic foot infection, in periprosthetic infection, radiation absorbed dose, 17

9 in vertebral osteomyelitis, 70 Infantile cortical hyperostosis, 88, 89, 136 Infantile osteomyelitis, Infectious arthritis, 48 49, 85, 288 Inflammation acute cancer patients, 41 cellular changes, healing, 40 vascular changes, chronic, 40 classification, 38 definition, 38 Inflammatory joint disease infectious (see Infectious arthritis) noninfectious crystal deposition arthropathies, neuroarthropathy, 296 rheumatoid arthritis, sacroiliitis, , 296 spondyloarthropathies, Insulin growth factor (IGF), 10 Intensity-modulated whole-pelvic radiation therapy (IM-WPRT), 318 International Committee for Standards in Bone Measurement (ICSBM), 113 Intramembranous ossification, 2, 3, 153 Involucrum, 42, 43, 51 Irregular bones, 6 Ischial tuberosity, 2 J Joints anatomy, 11, 13 classification, 12 disease classification, 13 inflammatory disease, 13 noninflammatory disease, 13 physiology, 11, 13 types, 12 Joint disorder Behçet s syndrome, 299 classification, costochondritis, 299 CPPD, gouty arthritis, infectious arthritis, 288 neuroarthropathy, 296 osteoarthritis, periarticular soft tissue syndrome, 301 DISH, plantar fasciitis, septic bursitis, 302 septic tenosynovitis, 302 rheumatoid arthritis, sacroiliitis, , 296 SAPHO syndrome, spondyloarthropathies, ankylosing spondylitis, 297, 298 enteropathic spondylitis, 299 psoriatic arthritis, 297 reactive arthritis, synovitis renal transplant, 300 transient, 300 K Kaposi s sarcoma, 268 Klebsiella pneumoniae, 43, 70 Knee arthroplasty, 48, 81, 317 Knee impingement syndromes, 184 Knee prosthesis, 48, 77, 82, 83, 361, 373 Knee, spontaneous osteonecrosis, 201 primary, 203 secondary, 203 stage I, stage II, 203 stage III, 203 stage IV, Knee synoviorthesis, 405 Kohler s disease, 208, 209 L Lamellar bone, 2, 15 16, 55, 227, 333, 389 Laminin, 7 Legg-Calve-Perthes disease, Legg-Perthes disease, 119, 196 Lesser trochanter, 4, 182 Ligament injuries, 153 Ligament tears, 183 Lisfranc fracture, 157 Lung cancer, Lu-177 somatostatin analogues, 387 Lutetium-177 ethylenediaminetetramethylene phosphonic acid (Lu-177 EDTMP), M Maffucci syndrome, 218 Magnetic resonance imaging (MRI), diabetic foot osteomyelitis, in vertebral osteomyelitis, 70, 72 Malignant fibrous histiocytoma, 132 Malignant hypercalcemia, Matrix size, 27, 28 McCune-Albright syndrome, 128 Medullary diaphyseal sclerosis, 132, 134 Meniscal tears, 183 Metabolic disorders, 13 Metaiodobenzylguanidine (MIBG), 16, 213, , 388, 409 Metallic implants, removal, Metaphysis, 2, 3, 5 7, 44, 45, 49, 57, 59, 115, 157, 159, 167, 204, 217, 220, 236

10 426 Metastatic bone disease bone resorption, 227 definition, 225 detection modalities, 249 distribution of, FDG PET, F-18 PET, 250 generalized/metabolic consequences, hematogenous spread, 227 intraspinal spread, 227 local consequences, lymphatic spread, 227 mixed osteolytic/osteoblastic bone metastases, 228, 230 osteoblastic bone metastases, 226, 230 osteolytic bone metastases, 226, 230 PET, 213, 249 radiopharmaceuticals, 214 reactive bone formation, 227 scintigraphic patterns cold lesions, diffuse pattern, flare pattern, 256 solitary lesion, symmetrical pattern, 257 typical pattern, 251, 252 sequential events, tumors spreading, sources, 230 SPECT/CT, 249 stromal bone formation, 227 therapeutic response, 213 Metastatic calcification causes of, 325, 328 chronic renal failure, 328, 329 Metastatic prostate carcinoma, 408 Mineral homeostasis, 7 Multifocal osteomyelitis, Multifocal osteonecrosis, Multi-phase bone scanning, 51, 55 56, 64 Muscle stress, 33 Myelogenic tumors Ewing s sarcoma, myeloma, 220, 221 Myeloma imaging, origin, 220 photomicrograph, 220, 221 radionuclide therapy, sites of involvement, 220, 221 Myoglobulinuria, 345 Myositis ossificans progressiva, 339, 342 N NaF PET/MR, 378 Nasopharyngeal carcinoma, Necrotic bone, 47, 193, 205 Neonatal osteomyelitis, 40, 57, 58, 84 Neoplastic diseases metastasis (see Metastatic bone disease) primary bone tumors (see Primary bone tumors) SPECT/CT benign tumors, 353 heterotopic bone formation, 364, 366 infections, osteoarthritis, osteonecrosis, sacroiliitis, 364 skeletal metastases, trauma, Neuroarthropathy, 296 Neuroblastoma, , Neutrophils, 38, 39, 42, 53, 286 Nonbacterial osteomyelitis, 86 Non-Hodgkin s lymphoma, 41, 254, 324 Noninfectious inflammatory conditions infantile cortical hyperostosis, 88 osteitis condensans ilii, 88 osteitis condensans of the clavicle, osteitis pubis, 88 sternoclavicular hyperostosis, 88 Noninflammatory joint disease, 13, 282, 288 Nonneoplastic diseases, SPECT/CT imaging ankle and foot trauma, 358 compression fractures, 357, 358 diabetic foot osteomyelitis, 362 heterotopic bone formation, osteoarthritis, osteochondritis dissecans, 360 osteonecrosis, rib fractures, 357 sacroiliitis, 364, 365 soft tissue infection, 362 spinal fusion, spondylolysis, 357 tarsal coalition, 360 wrist and hand trauma, 360 Nutrient arteries, 6 O Oblique fracture, 148 Ollier disease, 218 Oncogenic osteomalacia, 232 Open fracture, 148 Osgood-Schlatter disease, , 208 Ossification centers, 2, 3, 164, 206, 208 Osteitis condensans ilii, 88 Osteitis condensans of the clavicle, 88, 90 Osteitis deformans. See Paget s disease Osteitis fibrosa, Osteitis pubis, 91 Osteoarthritis, Baker s cyst, commonly involved joints, 288, 290 degree of uptake, 292, 293 extrinsic repair, 289 F-18 NaF PET/CT study, 293, 296 intrinsic repair, 291

11 pathological characteristics, primary, secondary, 291 Tc99m MDP bone scan, , 297 Osteoblast, 2 Osteoblastoma, 215, 235, 238 Osteocalcin, 7 Osteochondritis dissicans. See Transchondral fractures Osteochondroma blood pool activity, 236, 240 bone scintigraphy, 238, 244 MRI, 238 radiographic appearance, 238 Osteochondroses, Osteoclast, 1, 5, 7, 10 Osteocyte, 7 Osteogenic sarcoma bone marrow involvement, 216 F-18 FDG PET study, 270, 273 imaging, , origin, 216 sites of involvement, 216, 217 whole-body bone scan, 268 Osteogenic tumors origin, 215 osteoblastoma, 216 osteogenic sarcoma, 216, 217 osteoid osteoma, 215, 216 Osteoid osteoma imaging, nonsteroidal anti-inflammatory drugs, 215 origin, 215 prostaglandins levels, 215 sites of involvement, 215, 216 Osteomalacia, Osteomyelitis, 338, 362. See also Skeletal infections acute hematogenous, 43 algorithm, 85 Brodie s abscess, 42, 43 chronic, 42, classification, CRMO, 86 definition, 41 diabetic foot, 47, epiphyseal, 84 Garre s sclerosing, 88 imaging, and infectious arthritis, vs. infectious arthritis, 85 metaphysis, 44 neonatal, 84 nonbacterial, 86 organisms, 43, 44 periprosthetic infections, 48 posttraumatic, sequestrum, 42, 43 sickle cell disease, 47, 84 vascular communication, 44, 45 vertebral, Osteonecrosis adults, femoral head blood pool imaging, 199 F-18 PET/CT, 200 MRI, pinhole scintigraphy, 200 SPECT, 199, 200 spontaneous, causes, 191, 192 children, femoral head, dysbaric, 206 knee, multifocal, osteochondroses, pathophysiology, post-traumatic, 195 scintigraphic features, scintigraphic staging, sickle cell disease, SPECT/CT slices and MIP images, 369, 370 Tc-99m MDP and labeled WBC SPECT/CT study, Osteonectin, 7 Osteopenia, 11, 109, 112, 114, 154 Osteopetrosis, 132, 133 Osteoporosis BMD, 112, 113 causes, 110 classification, 110 densitometry, 111, 113, 115 diagnosis, 114 DXA, 112 etiology, 110 femur, 113 multiple fragile fractures, 111, 112 peak bone mass, 109, 110 prevalence, 109 remodeling, 109, 110 risk factors, 111 senile, 110 T-score, 112, 113 Z-score, 112, 113 Osteoporosis circumscripta, 106, 108 Oteochondritis dissecans, 360 P Pachydermoperiostosis, 126 Paget s disease, 319 bone remodeling, bone resorption, diagnosis bone densitometry, 106 bone scanning, In-111 white blood cell, 107, 108 MRI, 106 radiograph, 106, 107 etiology, 102 genetic factors,

12 428 Paget s disease (cont.) incidence, 102 initial phase, 104 lytic phase, mixed phase, 105 pain, 105 sarcomatous degeneration, 105 sclerotic/burned-out phase, 105 skeletal distribution, 104 treatment, 109 vascular calcification, 105 Pancreatitis, 192, 199 Papillary thyroid carcinoma, 356 Paramyxovirus, 102 Parathormone, 10 Pars interarticularis, , 357 Pathological fracture, 105, 148, 218, 220, 231, 249, 394 Pelvic fracture, Periarticular soft tissue syndromes causes, 301 DISH, plantar fasciitis, septic bursitis, 302 septic tenosynovitis, 302 SPECT/CT, 302 standard radiography, 301 ultrasonography, 301 Periosteal new bone formation, 231 Periosteum, 2, 3, 5, 7, 41, 42, 84, 105, 136, 150, 151, 164, 169, 183, 216, 222, 297 Periprosthetic infection, 48, Phosphorus-32 chromic sulfate, Phosphorus-32 orthophosphate, 391 Pigmented villonodular synovitis (PVNS), Pinhole collimator, 22 23, 57, 150, 200, 296 Pixel size, 27, 28 Plantar fasciitis, Poliomyelitis, 90 Positron emission tomography (PET), in chronic osteomyelitis, 77 combined F-18 NaF and F-18 FDG PET/CT, 376, , F-18 FDG PET/CT, F-18 sodium fluoride PET/CT, Ga-68-citrate PET/CT, 372, 378 Ga-68 PSMA PET/CT, 378 in vertebral osteomyelitis, 72 Post-poliomyelitis syndrome, 90 Primary bone tumors, 13, 14 ABC, bone hemangiomas, 222 chondrogenic tumors, chordoma, collagenic tumors, 220 CT, 213 F-18 fluorodeoxyglucose study, 232, 234, 235 giant cell tumors, MRI, 213, myelogenic tumors, origin and classification, 215 osteogenic tumors, PET, radiopharmaceuticals, 214 Tc-99m MDP bone scan, 233, 234 Tc-99m MIBI, 232, 235 T1-201 scintigraphy, 232, 234 Primary osteogenic sarcoma, Procallus, 151 Progressive diaphyseal dysplasia. See Camurati- Engelmann disease Progressive osseous heteroplasia, 333, Prostate cancer, 259, , 269 Prosthetic joint infection, 316, 317 Proteoglycans, 7 Pseudofractures, Pseudomonas aeruginosa, 43, 44, 70 Psoriatic arthritis, PVNS. See Pigmented villonodular synovitis (PVNS) R Radiation exposure, 15, 18, 19, 200, 400 Radioactive gold, 400 Radionuclide synovectomy advantages, 397 ankle synoviorthesis, 405 arthritis, contraindications, 401 elbow synoviorthesis, 404 hemophilia, 402, 404, 405 hip synoviorthesis, 403 indications, 401 knee synoviorthesis, 405 mechanism of action, 400 patient preparation, 401 radiopharmaceuticals, choice of, 398, dysprosium-165, 400 Er-169 colloid, 399 holmium-166 ferric hydroxide, 400 intra-articular administration, 397 phosphorus-32 chromic sulfate, radioactive gold, 400 Re-186 colloid, 399 rhenium-188 colloid, 400 samarium-153 hydroxyapatite, 400 yttrium-90 colloid, shoulder synoviorthesis, 403 side effects post-therapeutic regional inflammatory reaction, 406 radiation sickness, 407 radiopharmaceutical leakage, 406 somatic and genetic effects, treatment protocol, 402 Radionuclide therapy

13 advantage, 388 bone marrow ablation, 40 cancer-related bone pain, long-term consequences, 388 metastatic prostate carcinoma, 408 multiple myeloma, neuroblastoma treatment, primary osteogenic sarcoma treatment, radionuclide synovectomy, therapeutic applications, 388 Radiopharmaceuticals bone imaging diagnostic errors, F-18 sodium fluoride, 20 Tc-99m diphosphonates, 19, 20 for cancer treatment, for infection imaging, for intra-articular therapy, 397 radionuclide synovectomy, for tumor imaging, 214 Radium-223 dichloride, 392 Region of interest (ROI), 113 Reiter s disease, Renal cell carcinoma, Renal osteodystrophy, 10 bone scans, clinical presentation, 120 high turnover form, 120 Legg-Perthes disease, 119 low turnover form, 120 scintigraphic findings, skeletal changes, Tc99m MIBI, 121 Tc99m pentavalent DMSA, 121 vitamind, 119 Rhabdomyolysis, 345 Rhenium-186 ethylene hydroxy diphosphonate, 391 sulfide, 399 Rhenium-188 colloid, 400 Rhenium-188-hydroxyethylidine diphosphonate (Re-188-HEDP), 392 Rhenium-188-labeled dimercaptosuccinic acid complex (DMSA), 392 Rheumatoid arthritis bone scan, 284, 285 labeled leukocytes, 285 pathological changes, 283 radiograph, 283, 284 radionuclide synovectomy, Tc-99m-anti-E-selectin-Fab scintigraphy, 285 Tc-99m HDP, 284, 285 Tc99m-labeled anti-tnf mab, 285 Tc-99m MDP, 284 Tc-99m polyclonal HIG, 284 Rib fractures, , 172, Rickets, Rotator cuff impingement syndrome, S Sacral fractures, Sacroiliitis, , 296, 364, 365 Salmonella, 44, 47 Samarium-153 ethylenediaminetetramethylene phosphonate (Sm-153-EDTMP), 91 Samarium-153 hydroxyapatite, 400 SAPHO syndrome. See Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome Sarcomatous degeneration, 105 Scaphoid fracture, Scheuermann s disease, 165 Schmorl s node, , 179 Sclerosing osteomyelitis. See Garre s sclerosing osteomyelitis Senile osteoporosis, 110 Septic arthritis. See Infectious arthritis Sequestrum, 42, 43, 51 Short bones, 6 Shoulder synoviorthesis, 403 Sickle cell disease, 315, 317 osteomyelitis, 50, 87 osteonecrosis, , 317 Single photon emission computed tomography (SPECT) clinical uses, 350 diabetic foot osteomyelitis, 65, 66 gallium-67, 64 in neoplastic diseases benign tumors, 353 skeletal metastases, in nonneoplastic diseases ankle and foot trauma, compression fractures, 357 diabetic foot osteomyelitis, 362 heterotopic bone formation, osteoarthritis, osteochondritis dissecans, 360 osteonecrosis, rib fractures, 357 sacroiliitis, 364, 365 soft tissue infection, 362 spinal fusion, spondylolysis, 357, 359 tarsal coalition, 360 wrist and hand trauma, 360 in osteonecrosis, spine infections, 350 in spondylolisthesis, 152 in spondylolysis, 150, 152 Skeletal infections. See also Osteomyelitis combined modality, 63 diagnostic imaging, 49 follow-up, 85 morphologic imaging modalities CT, 51 MRI, 51 standard radiographs, ultrasonography, 50

14 430 Skeletal infections (cont.) scintigraphic methods bone scanning, gallium-67 citrate imaging, 60 immunoscintigraphy, 61 labeled leukocyte imaging, PET imaging, 62 radiopharmaceuticals, Skeletal muscle injury, 150, 182 Slipped capital femoral epiphysis, 119, 159, , 196, 197, 201, 207 Soft tissue calcification, 183 calcinosis cutis, dystrophic calcification, heterotopic bone formation, metastatic calcification, 325, 328, 329 Solitary bone lesion FDG PET, 252 incidence of malignancy, 252, 253 Tc-99m bone scan, 250, 252 T1-201 uptake, 253, 254 Spinal fusion, Spiral fracture, 148, 163 Spondyloarthropathies ankylosing spondylitis, 297, 298 causes, 296 enteropathic spondylitis, 299 MRI, 296 psoriatic arthritis, 297 Reiter s disease, sacroiliitis, 296, 297 SPECT/CT, 296 Spondylodiscitis, 373. See Vertebral osteomyelitis Spondylolisthesis, 152 Spondylolysis, 150, 357, 359 Spongy bone, 1, 4 6 Sprains, 153 Sprengel s deformity, 134 Staphylococcus aureus, 43, 44, 47, 288 Stasis, 39 Steatopygia, 31, 113, 116 Sternoclavicular hyperostosis, 88 Sternum fracture, variants, Strains, 153 Stress fracture, scintigraphic appearance, scintigraphic diagnosis feet, 172 femur, pelvic fracture, rib fracture, 172 Schmorl s node, , 179 tibia, 172 vertebral fracture, scintigraphic role, 168 Strontium-89 chloride, 389, 391 Symmetrical metastases, 257 Symphysis pubis, 4, 12, 36, 208 Synarthroses, 12 Synovial joint, 11 13, 290, 406 Synovitis PVNS, 301 in renal transplantation, transient synovitis, 300 Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome, 86, T Tarsal coalition, 164, 360 Tc-99m diphosphonates administered activity, 20 bone uptake, 20 colon activity, 33 compounds, 19 skeletal accumulation, 19 utilization, 20 Tc99m-hexamethyl propyleneamine oxime labeled leukocytes, 53 56, 62 63, 68 diabetic foot osteomyelitis, 67, 69 Tc-99m-labeled human non-specific polyclonal immunoglobulin G, 53 Tc99m sestamibi, 17 Tc-99m sulfur colloid, 17, 66, 81, 82, 84, 313, 315, 319 Tendon injuries, 153 Tenosynovitis, 302 Tentorium cerebelli calcification, 134 TGF-B. See Transforming growth factor-b (TGF-B) Thallium-201, 1, 17, 86, 214, 232, 233, 243, 254, 265 Thyroid cancer, Tibia fracture, 172 Tibial tuberosity avulsion injury. See Osgood-Schlatter disease Tietze s syndrome, 299 Tin-117m diethylenetriaminepentaacetic acid, Toddler s fracture, Total hip arthroplasty (THA), 301, 331, 332, 337, 366 Transchondral fracture, 148, 155, Transforming growth factor-b (TGF-B), 10 Transient synovitis degree of uptake, 300 etiology, 300 three-phase bone scanning, 300 Transverse fracture, 148 Traumatic disorders, 13 Trochanteric bursitis, Tumoral calcinosis, 331, Tumoral calcium pyrophosphate dihydrate crystal deposition disease, 344 Tumors and infection, differentiation, Tuning fork test (TFT), 172 U Ultrasonography, 51, 301, 401 United States Nuclear Regulatory Commission, 397

15 431 V Vascularity, 18 Vascular permeability, 38 Vasodilation, 38 Vertebral fracture, Vertebral osteomyelitis, 44, 46, 70 77, 373 Vitamin-D, 7, 10, 19. See also Hypervitaminosis D W Woven bone, 2, 15, 19, 28, 55 Wrist and hand trauma, 360 Y Yttrium-90 colloid,