Method for differential diagnostics of inspecific inflammatory processes of motor system

FIELD: medicine.

SUBSTANCE: the present innovation deals with radionuclide diagnostics of any inspecific inflammatory processes of motor system. Moreover, it deals with intravenous injecting 199Tl-chloride followed by planar scintigraphy and visual detection for the area of its increased accumulation. Moreover, 199Tl-chloride should be injected in the dosage of 5.0 mCi, planar scintigraphy should be performed polypositionally and according to maximal value ER obtained 20 min after intravenous injection of 199Tl-chloride and corresponding to counterlateral area one should diagnose the presence and local activity of inflammatory process. In the wrist, in the foot, in the forearm at ER being below 1.21 - no inflammation should be detected, at ER ranged 1.21-2.69 - inactive inflammatory process should be detected or its subacute or chronic phase, at ER being above 2.69 - active inflammatory process, acute phase should be determined. In hip joint, femur, shin and scapula at ER ranged 1.07-2.31 - inactive inflammatory process, subacute or chronic phase, at ER being above 2.31 - active inflammatory process and acute phase should be detected. The present innovation enables to apply new scintigraphic differential-diagnostic criteria of inspecific inflammatory processes of motor system.

EFFECT: higher diagnostic efficiency of scintigraphy.

6 ex

 

The invention relates to the field of medicine, specifically for radionuclide diagnosis of any nonspecific inflammatory processes of the musculoskeletal system.

The known method scintigraphic diagnosis of inflammatory processes in the area of the esophago-gastric junction in the mect-version. For use as a radiopharmaceutical (RN)201T1-chloride, administered intravenously in a diagnostic dose of 3.0 mCi (111 MBq). With the aim of improving the delivery of the radiopharmaceutical to the field of inflammation intravenous dipyridamole dose of 0.56 mg/kg weight of the patient [1]. However, when using this method, the localization of the inflammatory process limited to the esophageal-gastric junction, and use as radiopharmaceuticals201T1-chloride, similar pharmacokinetic199T1-chloride, significantly increases the radiation dose to critical organs, which limits the use of this method for dynamic monitoring of the inflammatory process and monitoring of anti-inflammatory therapy [2, 3].

The closest in technical essence of the present invention is a method of diagnosis of purulent inflammatory processes, including musculoskeletal, using scintigraphy with199T1-chloride, held 20 minutes after nutrive the aqueous injection of radiopharmaceuticals in diagnostic dose of 4.0 mCi (148 MBq). Local accumulation of the radiopharmaceutical in excess of the accumulation of symmetric or healthy section 245%, determine the area of inflammatory infiltration [2]. However, this method scintigraphic diagnosis only allows you to diagnose purulent inflammation, which is a significant limitation. Thus, using this method, it is impossible to diagnose an inflammatory process depending on the local activity of inflammation (phase and magnitude of the research object.

A new technical result is the empowerment of scintigraphy with199T1-chloride in the diagnosis of inflammatory processes, enhancing its diagnostic efficiency through the use of new scintigraphic differential diagnostic criteria of nonspecific inflammatory processes musculoskeletal depending on the degree of increased radiotracer accumulation in the inflammation and value of the research object.

What's new is that199T1-chloride is injected at a dose of 5.0 mCi and obtained 20 minutes after intravenous injection of the magnitude of the ER [4, 5], corresponding to the ratio of accumulation199T1-chloride in the field of inflammation and the corresponding contralateral region, diagnose the presence of a local inflammatory activity: in the brush, foot, forearm when ER less 1,21 - no is their inflammation, when ER from 1.21 to 2.69 - inactive inflammation, subacute or chronic phase, when ER over 2,69 - active inflammation, acute phase; in the hip joint, thigh, leg and shoulder blade when ER less 1,07 - the absence of inflammation, ER of 1.07 to 2,31 - inactive inflammation, subacute or chronic phase, when ER over 2,31 - active inflammation, the acute phase.

Data essential features not known from the prior art, and they explicitly do not follow for professionals. The proposed method is passed clinical trials. Thus, the proposed solution meets the criteria of the invention of "novelty", "inventive step", "industrially applicable".

The method is as follows.199T1-chloride is injected in the amount of 5.0 mCi (185 MBq). After 20 minutes, then spend prepositional (at least in frontal and lateral projections) planar scintigraphy on gamma-camera "LFOV" with a high-energy collimator (300 Kev) and a set of pulses from 100 to 300 thousand for the position. Perform a qualitative assessment of accumulation199T1-chloride by visually identify the areas of greatest increased its accumulation. Conduct a quantitative assessment of increased radiotracer accumulation by calculating the ER relative accumulation of radiotracer in the field of inflammation and suitable for the soup of the contralateral region [4, 5]. Diagnostics is carried out differentially, depending on the size of the object of study, which is divided into "small" (hand, foot, forearm) and large (hip, femur, tibia, scapula). The absence of an inflammatory process of hand, foot and forearm diagnosed with ER less 1,21, and hip joint, femur, tibia, scapula - ER when less of 1.07. Inactive, subacute or chronic inflammation of hand, foot and forearm diagnosed with ER from 1.21 to 2.69, and the hip joint, femur, tibia, scapula - when ER of 1.07 to 2,31. Active inflammation, acute inflammation of the hand, foot and forearm diagnosed with ER over 2,69, and hip joint, femur, tibia, scapula - when ER over 2,31.

Purulent inflammatory process according to the previously proposed method was diagnosed with ER over 3,45 (equivalent to the excess accumulation of radiotracer in balanced or healthy section 245%). Thus, a new differential-diagnostic criteria not inconsistent with previously used, essentially adding to them.

The method has its advantages and limitations, from which flow indications and relative contraindications. Readings include: 1) clinically reasonable suspicion for the presence of inflammation at any site, limited support-the motor is tion apparatus, including uncertain phase of the process, 2) clinical uncertainty regarding the inflammatory process in patients with high risk (diabetic foot syndrome, neurotrophic disorders and other), 3) clinical situations that require exceptions latent flowing inflammatory process. Relative contraindications due to the conditions under which the diagnostic effectiveness of the proposed method the least. These include: 1) obesity of III-IV degree (low sensitivity), 2) suspected the presence of a neoplastic process (low specificity of the method), 3) exacerbation of chronic osteomyelitis (low sensitivity), 4) status after hip arthroplasty (low sensitivity).

Diagnostic effectiveness of the proposed method of diagnosis: sensitivity 91.4%, while the specificity to 92.3%, accuracy - to 91.7% in the detection of nonspecific inflammatory process; taking into account the diagnostic phase of inflammation, these numbers are to 75.8%, up to 80,0% to 77.1 percent respectively. In observance of the indications and relative contraindications to the method of its sensitivity, specificity and accuracy are 96,6%, 91,7% and 95.1%, respectively, in the diagnosis of inflammatory process; taking into account the diagnostician the key phase of inflammation, these numbers are of 85.2%, 71,4% and 80.5%, respectively.

Specific examples of the implementation of the method

Example 1. Patient S., 54 years old, medical history, No. 31, the date of receipt of 20.01.2003, was hospitalized about a decompensation of diabetes mellitus type I heavy flow, complicated nonproliferative diabetic retinopathy, nephropathy 2 tbsp., fatty hepatosis, distal polyneuropathy. Among opportunistic diseases - sarcoidosis lungs with lesions of intrathoracic lymph nodes (about which the patient takes the corticosteroid kenalog). Hyperglycemia - to 19.3 mmol/l In the General analysis of blood (21.01.03) - a slight increase of the sedimentation rate of 16 mm/h, but otherwise unremarkable. Clinically - the diabetic foot syndrome, neuropathic ulcer 1 finger on the right foot. Given the presence of decompensated diabetes mellitus, steroid therapy, the clinical situation characterized by a high likelihood of the presence of latent flowing inflammatory process in the area of 1 finger on the right foot. For exceptions (22.01.03) is the radionuclide study. Planar scintigraphy of both feet in frontal and lateral projections in the static mode with a set of pulses to 200,000 perform 20 minutes after intravenous injection199T1-chloride in an amount of 5 mCi (185 MBq), conduct a qualitative assessment of the accumulation of radiotracer put the m visual identification of the areas of greatest increased its accumulation and quantitative by calculating the ER.

On the scintigrams of both feet determined blindly, increased uptake of the radiopharmaceutical, close to diffuse in region 1 finger on the right foot. In quantifying ER=1,17. In this case explores the foot. In case there is no non-specific inflammatory process, as ER less 1,21. The results of scintigraphy confirmed positive clinical dynamics of state neuropathic ulcers 1 finger on the right foot.

Example 2. Patient M., aged 65, the case history No. 555, date 9.10.2002, the hospital treatment for decompensated insulin dependent diabetes mellitus type II severe, complicated diabetic retinopathy 2 tbsp., nephropathy 2 tbsp., macro - and microangiopathy of the lower extremities, distal polyneuropathy, diabetic foot syndrome mixed with the presence of trophic ulcers of the lower third of the left tibia. Among concomitant diseases, bronchial asthma, bronchial, about which the patient takes prednisone at a dose of 10 mg/day. Complaints of pain in the left leg, in the area of the ulcer on the posterior surface of the tibia. Examination: on the posterior surface of the tibia ulcerative defect in cross-section approximately 5-6 cm with a slight serous discharge. Hyperglycemia - to 17.7 mmol/l In the General analysis of blood (10.10.02) pathological is izmenenii not identified. The clinical situation characterized by a high risk of nonspecific inflammatory process in the area of the ulcer. For exceptions (10.10.02) is the radionuclide study. Planar scintigraphy both legs straight and lateral projections in the static mode with a set of pulses to 300,000 perform 20 minutes after intravenous injection199T1-chloride in an amount of 5 mCi (185 MBq), conduct qualitative and quantitative assessment of radiotracer accumulation, compute ER.

On the scintigrams both legs visually increased radiotracer accumulation was not detected. For quantitative analysis as an area of interest defined region corresponding to the projection of the ulcer at the level of the lower third of the left tibia. In quantifying ER=1,05. Object of research is the Shin. In case there is no non-specific inflammatory process, as ER less of 1.07. The results of scintigraphy confirmed the presence of a positive clinical dynamics on the background of vascular and correcting for diabetes therapy. At discharge, ulcer filled with granulations, separated from it not.

Example 3. Patient T., 50 years history No. 596, date 29.05.2002, was hospitalized over the felon third finger on the right hand, limping is the lymphadenitis, erysipelas of the right forearm. Complaints received at a pain in the third finger of the right hand, raise the temperature to 39.0°C. Clinically at the time of admission (29.05.02): the right foot swollen and hyperemic from wrist to elbow, in the upper and middle thirds of the forearm throughout its circumference crimson, covered in bubbles; third finger hyperemia, swelling but it is not expressed. In General, the analysis of blood (30.05.02), increased erythrocyte sedimentation rate of 30 mm/h, the shift of leukocyte formula to the left. The patient receives within 7 days of antibiotics gentamicin, penicillin, Cefazolin. Clinically observed positive trend in the reduction of pain, redness and swelling of the right forearm and hand, normalization of body temperature. In order to clarify the phase of the inflammatory process and prevent foci of suppurative inflammation in the soft tissues of the right upper limb 4.06.02) is the radionuclide study. Planar scintigraphy both hands and forearms in frontal and lateral projections in the static mode with a set of pulses to 200,000 perform 20 minutes after intravenous injection199T1-chloride in an amount of 5 mCi (185 MBq), conduct a qualitative assessment of radiotracer accumulation by visual identification of the areas of greatest increased its accumulation and quantitative way is ycycline ER.

On the scintigrams hands and forearms to the right in the projection of the soft tissues of the forearm and hand is determined by the increased uptake of the radiopharmaceutical diffuse nature. Plots of the local accumulation of the radiopharmaceutical is not revealed. In quantifying ER=1,25 in the brush and ER=1,32 in the forearm. The objects of study are the hand and forearm. In this case, diagnosed inactive inflammation, subacute or chronic, because both values ER is in the interval from 1.21 to 2.69. The results of scintigraphy confirmed positive clinical dynamics of the inflammatory process against the backdrop of ongoing antibiotic therapy. The patient was discharged with recovery.

Example 4. Patient S., 19 years old, medical history, No. 616, date 5.06.2002, was hospitalized with the diagnosis: foreign body in soft tissues of the lateral surface of the medial third of the left femur. A history of chronic osteomyelitis of the left femur. Recent exacerbation of 5 years ago, on occasion of which was carried out surgical treatment (incision, drainage of the middle third of the lateral surface of the femur). Since the condition is satisfactory. About 1 month ago appeared swelling, soreness after exercise. Clinically - swelling and redness of the soft tissues of the lateral surface of the medial third of the left femur. Palpation - inflammatory is considerable infiltration 15× 9 cm, moderately painful. In General, the analysis of blood (29.05.02) - the EMAS to 22 mm/h, but otherwise unremarkable. Ultrasound (3.06.02): liquid formation in the soft tissues of the middle third of the thigh on the lateral surface. Radiography of the left femur (14.05.02): fresh bone-destructive changes it is not revealed. 30.05.2002 planar scintigraphy hips in a straight line, lateral and oblique projections in static mode with a set of pulses to 300,000 perform 20 minutes after intravenous injection199T1-chloride in an amount of 5 mCi (185 MBq) with subsequent quantitative and qualitative assessment of the accumulation of the radiopharmaceutical.

The series of scintigrams hips in the projection of the soft tissues of the medial third of the left femur on the lateral surface is defined by an area of increased radiotracer accumulation with ER=1,64. In the projection of the femur increased radiotracer accumulation is absent. In this case explores the thigh. In the specific case diagnosed inactive inflammation, subacute or chronic, because the value of ER is in the interval of 1.07 to 2,31.

However, on the basis of clinical status and a comprehensive radiation survey suspicion of abscess in the soft tissues of the medial third of the left femur. 5.06.2002 is surgery (incision, reorganization, revision, drainage), pus is not received. Post-mortem examination (FA is the hip) (14.06.2002): chronic inflammation with outcome in fibrous tissue.

Thus, the results of scintigraphic studies were fully confirmed histologically; was correctly diagnosed and the presence of inflammation, and its phase.

Example 5. Patient M., 52-year history No. 576, date 21.05.2002, was in the hospital with decompensated diabetes mellitus type II, complicated diabetic foot syndrome on the left. About a month ago there were pains in 4-5 fingers of the left foot and the corresponding interdigital period. Clinically (21.05.02): stop swollen in the field of logistics and the interdigital period of 4-5 fingers left. There is a wound with purulent discharge in the interdigital interval of 1.5×1.5 cm During inspection of the wound is allocated about 10.0 ml of yellow-gray pus, the wound is deep - 4-5 see Hyperglycemia - to 20.8 mmol/L. 29.05.2002 g stop less swollen, palpation painless, there is a fistula at the base 3 of the toe, the wound between 4 and 5 fingers without purulent discharge. Produced surgical debridement of the wound, removed the bone sequestration, the drainage at the base of the 4 main phalanx.

Inspect feet (30.05.02). Planar scintigraphy of both feet in frontal and lateral projections in the static mode with a set of pulses to 200,000 perform 20 minutes after intravenous injection199T1-chloride in an amount of 5 mCi (185 MBq) with subsequent qualitative and quantitative calculated on the Yu ER rating of radiotracer accumulation.

On the scintigrams both stop in the projection of the base of the 4-5 main phalanges of the left foot is determined by the local area of increased radiotracer accumulation with ER=3,97. In this case explores the foot. Therefore, in a particular case is diagnosed by the presence of active, acute inflammatory process, because ER exceeds 2,69.

Clinically (10.06.02): after postoperative "light period" foot swollen, hyperemic, fluctuates. The abscess is opened, received 5.0 ml of pus. Radiography (10.06.02): diabetic osteoarthropathy, osteomyelitis 4 metatarsal bone and the proximal phalanx of 4th finger; compared with the previous x-ray negative dynamics (in the form of significant increase of destructive changes).

Thus, it was correctly diagnosed the presence of latent flowing inflammatory process and its phase (active purulent inflammation).

Example 6. Patient K., 37 years old, medical history, No. 1067, date 12.11.2002, the hospital treatment for cellulitis of the lower third of the left thigh, complicated by abscess formation. Complaints at admission for pain in the lower third of the left femur and knee joint, which is enhanced by motion, therefore limiting the amount of movement in the knee joint. Body temperature at admission 39,4°C. Clinically: in the lower Tr is t left hip and knee replacement - the increase in the volume of soft tissue, tenderness, limitation of motion in the knee joint. In General, the analysis of blood (13.11.02) leukocytosis 12.5 G/l, increased erythrocyte sedimentation rate to 57 mm/h, the shift of leukocyte formula to the left. Ultrasound (11.11.02): in the lower third of the left femur and knee joint on the posterior-lateral surface is determined by a multi-chamber fluid to the formation of large dimensions, with multiple pockets, the content in them is heterogeneous, with small easily movable suspension, it is placed under the muscle layer and directly adjacent to the bone. It is assumed the presence of an abscess in the soft tissues of the lower third of the left femur. To clarify the diagnosis (13.11.02) is the radionuclide study. Examine the hip. Planar scintigraphy in frontal and lateral projections in the static mode with a set of pulses to 200,000 perform 20 minutes after intravenous injection199T1-chloride in an amount of 5 mCi (185 MBq) with subsequent qualitative and quantitative calculation ER rating of radiotracer accumulation.

On the scintigrams hips in the frontal and lateral projections in the soft tissues of the lower third of the left femur and the knee joint is determined by the local accumulation of the radiopharmaceutical. Quantitative assessment is made by calculating the ER in frontal and lateral projections. The highest value in the lateral projection, is ER=4,54. The object of research is the s in this case the thigh. Because ER in a particular case exceeds 2,31, diagnose active, acute inflammation.

14.11.02 is surgical treatment: in the lower third of the soft tissues of the left femur was thick needle puncture, the resulting pus; made 2 deep incision of 4 cm, removed about 100 ml of thick pus.

Thus, it was correctly diagnosed the presence of actively flowing inflammatory process and its phase (acute inflammation).

The positive effect of the proposed method is confirmed by the results of its application in 41 patients (49 locations) at the age from 18 to 88 years, investigated over suspected presence of nonspecific inflammatory process in different locations musculoskeletal system.

Thus, the proposed method for the diagnosis of inflammation can differentially diagnose the presence of a nonspecific inflammatory process depending on the differential diagnostic criteria: ER and the value of the object of research. This substantially increases the amount of diagnostic information obtained using planar scintigraphy with199T1-chloride.

References

1. De Gregorio B.T., Fennerty M.B., Wilson R.A. Noninvasive diagnosis of gastroesophageal inflammation using dipyridamole thallium-201 tomography // American Journal of Gastroenterology, 1998/ V.98, no 8, pp. 1255-1259.

2. Patent No. 2171691 C1. Date PU is likely: 2001.08.10. Country of publication: EN. Title: method for the diagnosis of suppurative inflammation. The name of the inventor: Zavadovsky E, Skuridin B.C., kileen O.Y, V.I. Chernov, Lishmanov SHE

3. Lishmanov SHE, V.I. Chernov Scintigraphy of the myocardium in nuclear cardiology // Publishing house of Tomsk University, Tomsk, 1997, pp. 27-40.

4. Sato, S., Ogasawara, K., Kinouchi H., Kohsyu K., Yoshimoto T. Probable brain abscess presenting as a high uptake lesion on thallium-201 single photon emission computed tomography-a case report // Neurology Medicine Chir. (Tokyo), 1997/ V.37, No. 10, pp. 775-778.

5. Utsunomiya K., Narabayashi I, Nishigaki H. et al. Clinical significance of thallium-201 and gallium-67 scintigraphy in pulmonary tuberculosis // European Journal of Nuclear Medicine, 1997/ V.24, No. 3, pp. 252-257.

The method of differential diagnosis of nonspecific inflammatory processes of the musculoskeletal system, which includes intravenous199T1-chloride, subsequent planar scintigraphy and visual scoping increased its accumulation, characterized in that the199T1-chloride is injected at a dose of 5.0 mCi, planar scintigraphy performed poleposition and obtained 20 min after intravenous injection199T1-chloride according to the maximum value of ER, the corresponding relation of accumulation199T1-chloride in the field of inflammation and the corresponding contralateral region, diagnose the presence of a local inflammatory activity: in the brush, foot, forearm when ER less 1,21 - the absence of inflammation, when ER from 1.21 up to 2,69 - inactive inflammation, subacute or chronic phase, when ER over 2.69 - active inflammation, acute phase; in the hip joint, thigh, leg and shoulder blade at an ER less than 1.07 absence of inflammation, ER of 1.07 to 2,31 - inactive inflammation, subacute or chronic phase, when ER over 2,31 - active inflammation, the acute phase.



 

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4 dwg

FIELD: medicine, radio diagnostics.

SUBSTANCE: one should intravenously inject osteotropic technetium99-labelled radiopharmpreparation followed by planar static scintigraphy, emission computer tomography and computerized informational processing due to building a three-dimensional model. Then comes comparative quantitative evaluation for accumulation of radiopharmpreparation in transplant's projection and in the part of intact bony tissue being transplant-symmetrical one to detect a corresponding coefficient of accumulation the value of which being ≥4.0 indicates restored efficient perfusion and intensive metabolic process in fragment's bony tissue.

EFFECT: higher accuracy and efficiency of diagnostics.

2 ex

FIELD: medicine.

SUBSTANCE: the present innovation deals with radionuclide diagnostics of inflammatory processes in female inner reproductive organs and their complications due to injecting 199Tl-chloride intravenously followed by scintigraphy and detecting the area of inflammatory infiltration. Moreover, 199Tl-chloride should be introduced at the quantity of 5.0 mCi and at increased scintillation count in projection of inner reproductive organs being above the background value in soft tissues of the upper femoral third by 63.2 ± 16.2% it is possible to diagnose the presence of inflammatory process that corresponds to sub-acute or chronic stage, by 111.1 ± 20.2% and higher - to acute phase of inflammation, below 4.1 ± 1.8% - its absence and at availability of diffuse heterogeneous spread accumulation of radiopharmpreparation without any distinct borders one should diagnose pelvioperitonitis.

EFFECT: higher accuracy of diagnostics.

4 dwg, 4 ex

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