Quantitative Assessment of Para-Osteo-Arthropathy and Its Maturation on Serial Radionuclide Bone Images

Tanaka, Toshiyuki; Rossier, Alain B.; Hussey, Robert W.; Ahnberg, Donald S.; Treves, S. Ted

doi:10.1148/123.1.217

Cited by 52 publications

(23 citation statements)

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“…67 ± 69,133 The three-phase bone scanning is the most sensitive technique for diagnosing NHO and, although generally aspeci®c, may reach a fair degree of speci®city once clinical signs and likelihood have given rise to reasonable clinical suspicion. 28,49,70,126,129,132 For monitoring NHO activity, plain radiographs and elevated SAP levels may be valuable as long as they show modi®cation from one examination to the next, but currently the three-phase bone scan seems to be thè golden standard'. CT and MRI scanning are mainly used to aid in the development of a surgical plan.…”

Section: Resultsmentioning

confidence: 99%

“…28 In monitoring NHO maturation, the three-phase bone scan seems the most sensitive tool and currently the`golden standard'. 49,126,129,132 Nonetheless, the criteria for maturity rating on the bone scans remains a topic of discussion. Whether a qualitative assessment eg a continuous decrease in the uptake or a steady state in the radionuclide accumulation, or a quantitative assessment such as speci®c uptake ratios should be considered as the best maturity index remains unclear.…”

Section: Radiological Examinationmentioning

confidence: 99%

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Neurogenic heterotopic ossification in spinal cord injury

2002

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Neurogenic heterotopic ossi®cation (NHO) is a frequent complication in spinal cord injury (SCI) that is often di cult to treat. This review emphasizes the incidence, risk factors and clinical signs of NHO in SCI patients. Although the exact pathophysiology underlying NHO in neurologic patients is not yet understood, di erent pathogenic mechanisms have been proposed in the literature. A selection of the most important theories will be given and discussed. Moreover the di erent diagnostic, therapeutic, and preventive methods currently used in NHO management after SCI will be reviewed.

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Section: Resultsmentioning

confidence: 99%

Section: Radiological Examinationmentioning

confidence: 99%

Neurogenic heterotopic ossification in spinal cord injury

2002

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Section: Literature Reviewmentioning

confidence: 99%

“…The original description of heterotopic bone formation associated with spinal cord injury was given in 1918 by Dejerine and Gillier, who noted it in 48% of the paraplegic and quadriplegic patients they investigated (2). Now, heterotopic ossification around the hip is a well-recognized complication of spinal cord injury, the incidence of which is routinely reported to be 15% to 20% (2). Proposed theories for the development of these various forms of MO include implantation of periosteum into the muscle, escape of osteogenic cells from the periosteum, ossification of a hematoma and metaplasia of connective tissue cells (3).…”

Section: Literature Reviewmentioning

confidence: 99%

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Severe myositis ossificans in a paraplegic trauma patient: Influence in pressure sore management

Park¹

2004

J Plast Surg

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Myositis ossificans (MO) is a benign, progressive, ossifying lesion that displays a characteristic zonal histological appearance. MO traumatica is a localized form of heterotopic bone formation, associated with repetitive micro-and/or macrotrauma in the majority of cases. The importance of imaging to differentiate MO from sarcomatous change and to determine maturity of the lesion is identified because suboptimal operative intervention on immature MO inevitably results in recurrence. A severe case of MO in a 24-year-old paraplegic man with chronic bilateral greater trochanteric pressure sores is presented, and the importance of the MO in the etiology and treatment of this case is discussed. An extensive review of the literature is included and integrated.Key Words: Heterotopic ossification; Myositis ossificans; Paraplegic; Pressure sore Myosite ossifiante sévère chez un polytraumatisé paraplégique : Influence du traitement des escarres de décubitus La myosite ossifiante (MO) est une lésion progressive bénigne caractérisée par son aspect histologique circonscrit. La MO traumatique est une forme localisée de formation osseuse hétérotopique associée à un microet/ou macrotraumatisme dans la majorité des cas. L'importance de l'imagerie pour différencier la MO d'une lésion sarcomateuse et pour déter-miner la maturité de la lésion est à souligner puisqu'une intervention chirurgicale stratégique suboptimale sur une MO immature entraîne inévitablement la récurrence. Un cas sévère de MO chez un paraplégique de 24 ans présentant des escarres de décubitus trochantériennes bilatérales chroniques est présenté ici. On aborde en outre l'importance de la MO dans l'étiologie et le traitement de ce cas. L'article propose aussi une revue complète de la littérature.A 24-year-old trauma patient, paraplegic secondary to a gunshot wound at the T5 level, was referred to the Plastic Surgery Division of the McGill University Hospital Center with grade IV bilateral trochanteric pressure sores. During the investigation, the presence of severe, left-sided pelvic myositis ossificans (MO) resulting in a fixed flexion contracture of the hip was noted. The patient had severe pain and spasm on leg extension and was unable to sleep or rest in a supine position. The radiological findings were consistent with MO. It was clear that this underlying problem had to be addressed simultaneously to provide definitive treatment of the trochanteric pressure sores. A review of the literature and details of the investigation of this specific case are provided.

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Heterotopic ossification in the setting of neuromuscular blockade

Goodman

Merkel

Perlmutter

et al. 1997

Arthritis & Rheumatism

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Objective. Heterotopic ossification (HO) is a disorder characterized by the formation of new bone in tissue that does not ossify under normal conditions. We report a series of 6 cases in which HO occurred in the setting of adult respiratory distress syndrome (ARDS). We wished to show that HO can occur after neuromuscular blockade and that these cases might provide additional evidence that HO is influenced by neural mechanisms.Methods. Cases of HO were selected from the consultation services at the Massachusetts General Hospital and the Brigham and Women's Hospital. Affected patients all had ARDS and had been treated with a neuromuscular blocking agent. Patients with a history of stroke, burn, head trauma, spinal cord injury, or joint replacement were excluded from this study.Results. Heterotopic bone appeared around large joints in a pattern identical to that seen in patients with paralysis, traumatic brain injury, severe burns, or trauma. New bone formation was self-limited over a period of 1-2 years. Alkaline phosphatase and technetium bone scan were sensitive ways of detecting early disease and monitoring disease activity. Medical therapies had limited benefit. Surgical excision of mature new bone appeared to be the only definitive therapy.Conclusion. Neuromuscular blockade in the setting of ARDS appears to be an important risk factor for the development of HO. The similarity of these cases of HO occurring in patients with brain or spinal cord injury raises the possibility that neural mechanisms

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Quantitative Assessment of Para-Osteo-Arthropathy and Its Maturation on Serial Radionuclide Bone Images

Cited by 52 publications

References 0 publications

Neurogenic heterotopic ossification in spinal cord injury

Neurogenic heterotopic ossification in spinal cord injury

Severe myositis ossificans in a paraplegic trauma patient: Influence in pressure sore management

Heterotopic ossification in the setting of neuromuscular blockade

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