title: Novel use of gamma correction for precise (99m)Tc-HDP pinhole bone scan diagnosis and classification of knee occult fractures.
abstract: OBJECTIVE
  The aim of this study was to introduce gamma correction pinhole bone scan (GCPBS) to depict specific signs of knee occult fractures (OF) on (99m)Tc-hydroxydiphosphonate (HDP) scan.
  
  
  METHODS
  Thirty-six cases of six different types of knee OF in 27 consecutive patients (male = 20, female = 7, and age = 18-86 years) were enrolled. The diagnosis was made on the basis of a history of acute or subacute knee trauma, local pain, tenderness, cutaneous injury, negative conventional radiography, and positive magnetic resonance imaging (MRI). Because of the impracticability of histological verification of individual OF, MRI was utilized as a gold standard of diagnosis and classification. All patients had (99m)Tc-HDP bone scanning and supplementary GCPBS. GCPBS signs were correlated and compared with those of MRI. The efficacy of gamma correction of ordinary parallel collimator and pinhole collimator scans were collated.
  
  
  RESULTS
  Gamma correction pinhole bone scan depicted the signs characteristic of six different types of OF. They were well defined stuffed globular tracer uptake in geographic I fractures (n = 9), block-like uptake in geographic II fractures (n = 7), simple or branching linear uptake in linear cancellous fractures (n = 4), compression in impacted fractures (n = 2), stippled-serpentine uptake in reticular fractures (n = 11), and irregular subcortical uptake in osteochondral fractures (n = 3). All fractures were equally well or more distinctly depicted on GCPBS than on MRI except geographic II fracture, the details of which were not appreciated on GCPBS. Parallel collimator scan also yielded to gamma correction, but the results were inferior to those of the pinhole scan.
  
  
  CONCLUSIONS
  Gamma correction pinhole bone scan can depict the specific diagnostic signs in six different types of knee occult fractures. The specific diagnostic capability along with the lower cost and wider global availability of bone scanning would make GCPBS an effective alternative.
authors.affiliation: Department of Nuclear Medicine, Sung Ae General Hospital, Seoul, Korea.
authors.forename: Yong-Whee
authors.initials: YW
authors.lastname: Bahk
authors.forename: Ho-Seung
authors.initials: HS
authors.lastname: Jeon
authors.forename: Jang Min
authors.initials: JM
authors.lastname: Kim
authors.forename: Jung Mee
authors.initials: JM
authors.lastname: Park
authors.forename: Yong-An
authors.initials: YA
authors.lastname: Chung
authors.forename: E Edmund
authors.initials: EE
authors.lastname: Kim
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Kim
authors.forename: Soo-Kyo
authors.initials: SK
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004164:Diphosphonates; D005260:Female; D005596:Fractures, Closed / Q000145:classification / Q000175:diagnosis; D006801:Humans; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D012189:Retrospective Studies
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; C060491:technetium Tc 99m hydroxydiphosphonate
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