By Yong Whee Bahk MD, PhD, Professor (auth.)
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Extra info for Combined Scintigraphic and Radiographic Diagnosis of Bone and Joint Diseases
For bone-free, unobstructed observation of the knee, including the femoral condyles and intercondylar fossa, tibial condyles and plateaus, and tibial tubercles, the tunnel view is ideally suited (Fig. 36C). In the side (medial or lateral) views of the knee, the femoral condyle that lies nearer to the collimator is more magnified, appearing more distinct and vice sersa (Fig, 37). The tibial tuberosity, intercondylar tubercles, and patella in profile are visualized in this view. In the side views, the peripheries of the periarticular bones that overlap each other are indicated by an intense, curvilinear tracer uptake; the adding of the tracer uptake in two different structures (Fig.
Sooner or later the adjacent joint, if any, becomes involved. The perifocal bone reacts with proliferation and later with eburnation or sclerosis. In protracted cases, eburnation is a prominent feature. Pinhole scintigraphy portrays the devitalized and destroyed bone as a photopenic area, surrounded by a zone of intense tracer uptake (Fig. 57). The tracer uptake in chronic osteomyelitis of flat bone tends to be diffuse. The internal texture is usually inhomogeneous, giving a patchy and mottled appearance.
The iliac fossa is depicted as a large photopenic area. With a higher magnification, the anterior iliac spines, arcuate line, pecten pubis, and ischial body can be clearly visible (Fig. 30). Unlike in younger subjects the hip Fig. 31 A, B. Anterior view of the pubis. A Anterior pinhole scintigram of the symphysis pubis reveals intense tracer uptake in the pubic bones about the symphysis and the articular space, which is photopenic. B. Anterior pinhole scintigram of the dorsally inclined pubis shows drastic change in appearance.