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Nuklearmedizin 2001; 40(06): 187-192
DOI: 10.1055/s-0038-1625759
Editorial
Schattauer GmbH

3-Phase bone imaging and SPECT in the follow up of patients with allogenic vascularized knee joint transplants

3-Phasen-Skelettszintigraphie und SPECT in der Nachsorge der ersten Patienten mit allogener gefäßgestielter Kniegelenktransplantation
N. Manthey MD
1   Department of Nuclear Medicine
,
M. H. Kirschner MD
2   Department of Surgery
,
A. Neriich MD
3   Institute of Pathology
,
G. O. Hofmann MD
4   Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Germany Trauma Center Murnau, Germany
,
K. Tatsch MD
1   Department of Nuclear Medicine
,
K. Hahn MD
1   Department of Nuclear Medicine
› Author Affiliations
Further Information

Publication History

Received: 30 March 2001

08 June 2001

Publication Date:
20 February 2018 (online)

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Summary

Vascularized allotransplantation of knee joints under immunosuppression is a novel approach in orthopedic surgery. During the postoperative course immunosuppressive management depends on perfusion and viability of the graft. Aim: Evaluation of different diagnostic tools in regard to their usefulness and reliability to provide information about microvascularity and viability of vascularized knee joint allografts. Methods: Four patients with allogenic knee joint transplants were studied up to 26 months after transplantation with 3-phase bone scans and SPECT. The results were compared with duplex sonography, angiography, and histology. Results: Two cases without complications were characterized by adequate perfusion in duplex sonography, angiography and early bone scans. Late bone scans demonstrated increased bone metabolism of the transplant. Corresponding biopsy revealed viable bone cells. In one case with partial thrombosis and one case with complete thrombosis of the transplant vessels rapidly decreasing or missing perfusion was detected by duplex sonography, angiography, and bloodpool scintigraphy. Late bone scans showed reduced or absent bone metabolism. Biopsy demonstrated necrotic bone tissue. Due to the advantage of a tomographic technique SPECT allowed a more reliable assessment of graft viability as compared to planar imaging. Conclusion: Our findings confirm bone scintigraphy as a valuable diagnostic tool in patients with allogenic vascularized knee joint transplants. In contrast to other diagnostic approaches, scintigraphy provides reliable information on both viability and perfusion of the transplant within a single noninvasive clinical investigation.

Zusammenfassung

Die gefäßgestielte allogene Kniegelenktransplantation stellt eine neue Form des Kniegelenkersatzes in der orthopädischen Chirurgie dar. Postoperativ wird das immunsuppressive Management von der Perfusion und Vitalität des Transplantates entscheidend mitbestimmt. Ziel: Prüfung verschiedener Methoden bezüglich ihrer Eignung, die vaskuläre Situation und Vitalität derartiger Transplantate zu beurteilen. Methode: Bei 4 Patienten mit einem gefäßgestielten allogenen Kniegelenktransplantat wurden bis zu 26 Monate postoperativ 3-Pha-sen-Skelettszintigramme ergänzt durch SPECT mit den Ergebnissen von Angiographie, Duplexsonographie und Histologie verglichen. Ergebnisse: Zwei Patienten mit komplikationslosem Verlauf zeigten in allen Verfahren eine regelrechte Transplantatdurchblutung. Ein erhöhter Knochenstoffwechsel des Transplantates als Hinweis für vitales Knochengewebe wurde mittels Biopsie bestätigt. Dagegen zeigte sich bei Thrombose (n = 1) oder Abstoßung (n = 1) eine verminderte bis fehlende Perfusion im Frühscan, bestätigt durch Duplexsonographie, Angiographie und Biopsie. In diesen Fällen wies ein reduzierter oder fehlender Knochenstoffwechsel auf eine fehlende Vitalität des Transplantates hin, die bioptisch bestätigt wurde. Aufgrund der überlagerungsfreien Darstellung hatte SPECT gegenüber planaren Bildern eine höhere Aussagekraft hinsichtlich der Vitalitätsbeurteilung des Transplantats. Schlussfolgerung: Die 3-Phasen-Skelettszintigraphie kombiniert mit SPECT ist ein empfehlenswertes nicht-invasives Verfahren zur Verlaufskontrolle bei der gefäßgestielten allogenen Kniegelenktransplantation. Im Vergleich zu den alternativen Methoden bietet es die Möglichkeit, Durchblutung und Vitalität des Transplantats in einer einzigen Untersuchung zu beurteilen.

Keywords

Bone scintigraphy - vascularized bone graft - allogenic knee joint transplantation - viability - microcirculation

Schlüsselwörter

Szintigraphie - gefäßgestieltes Knochentransplantat - allogenes Kniegelenkstranplantat - Vitalität - Mikrozirkulation
 

  • References

  • 1 Hofmann GO, Kirschner MH, Wagner FW, Land W, Bühren V. First vascularized knee joint transplantation in man. Transplantationsmedizin 1996; 8: 46-7.
    Google Scholar
  • 2 Kirschner MH, Hofmann GO, Wagner F, Hower R, Walser R, Bühren V. Immunology of allogeneic bone transplantation and clinical experience in transplantation of allogeneic vascularized femur diaphyses under immunosuppression. Langenbecks Arch Chir Suppl II 1996; 1249-50.
    Google Scholar
  • 3 Dee P, Lambruschi PG, Hiebert JM. The use of Tc-99m MDP bone scanning in the study of vascularized bone implants: concise communication. J Nucl Med 1981; 22: 522-5.
    PubMedGoogle Scholar
  • 4 Hofmann GO, Kirschner MH, Wagner FW, Land W, Bühren V. Allogeneic vascularized grafting of a human knee joint with postoperative immunosuppression. Arch Orthop Trauma Surg 1997; 116: 125-8.
    CrossrefPubMedGoogle Scholar
  • 5 Hofmann GO, Kirschner MH, Brauns L, Wagner FD, Land W, Bühren V. Vascularized knee joint transplantation in man: a report on the first cases. Transpl Int 11 Suppl 1998; 1: 487-90.
    Google Scholar
  • 6 Hofmann GO, Kirschner MH, Wagner FD, Brauns L, Gonschorek O, Bühren V. Allogeneic vascularized grafting of human knee joints under postoperative immunosuppression of the recipient. World J Surg 1998; 22: 818-23.
    CrossrefPubMedGoogle Scholar
  • 7 Kirschner MH, Brauns L, Gonschorek O, Bühren V, Hofmann GO. Vascularized knee joint transplantation in man: the first two years experience. Eur J Surg 2000; 166: 320-7.
    CrossrefPubMedGoogle Scholar
  • 8 Kirschner MH, Wagner FD, Neriich A, Land W, Bühren V, Hofmann GO. Allogenic vascularized grafting of bone segments under immunosuppression. Clinical results in the transplantation of femoral diaphyses. Transpl Int 1998; 11: 195-203.
    CrossrefPubMedGoogle Scholar
  • 9 Moskowitz GW, Lukash F. Evaluation of bone graft viability. Semin Nucl Med 1988; 18: 246-54.
    CrossrefPubMedGoogle Scholar
  • 10 Weiland AJ, Daniel RK. Microvascular anastomoses for bone grafts in the treatment of massive defects in bone. J Bone Joint Surg Am 1979; 61: 98-104.
    CrossrefPubMedGoogle Scholar
  • 11 Lau RSF, Leung PG. Bone graft viability in vascularized bone graft transfer. Br J Radiol 1982; 55: 325-9.
    CrossrefPubMedGoogle Scholar
  • 12 O’Brien B, MacLeod AM, Hayhurst JW, Morrison WA. Successful transfer of a large island flap from the groin to the foot by microvascular anastomoses. Plast Reconstr Surg 1973; 52: 271-8.
    CrossrefPubMedGoogle Scholar
  • 13 Berggren A, Weiland AJ, Ostrup LT. Bone scintigraphy in evaluating the viability of composite bone grafts revascularised by microvascular anastomoses, conventional autogenous bone grafts, and free non-revascularized periosteal grafts. J Bone Joint Surg Am 1982; 64: 799-809.
    CrossrefPubMedGoogle Scholar
  • 14 Lipson RA, Dieff H, Greyson ND, Kawano H, Gross AE, Langer F, Halloran PF. Bone scanning in assessing viability of vascularized skeletal tissue transplants. Clin Orth 1981; 160: 279-89.
    Google Scholar
  • 15 Berggren A, Weiland AJ, Ostrup LT, Dorfman H. Microvascular free bone transfer with revascularization of the medullary and periostal circulation or the periosteal circulation alone. J Bone Joint Surg Am 1982; 64: 73-87.
    CrossrefPubMedGoogle Scholar
  • 16 Gratz KF. Funktionsszintigraphie in der Transplantatnachsorge. Nuklearmedizin 1993; 32: 215-21.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Collier BD, Hellman RS, Krasnow AZ. Bone SPECT. Semin Nucl Med 1987; 3: 247-66.
    Google Scholar
  • 18 Itoh K, Minami A, Sakuma T, Furudate M. The use of three-phase bone imaging in vascularized fibular and iliac bone grafts. Clin Nucl Med 1989; 14: 494-500.
    CrossrefPubMedGoogle Scholar
  • 19 Berding G, Bothe K, Gratz KF, Schmelzeisen R, Neukam FW, Hundeshagen H. Bone scintigraphy in the evaluation of bone grafts used for mandibular reconstruction. Eur J Nucl Med 1994; 21: 113-7.
    CrossrefPubMedGoogle Scholar
  • 20 Lorraine M, Shulkin L, Sullivan MJ, Rubinstein MI, Baker SR. Utility of emission tomography in evaluation of mandibular bone grafts. Arch Otolaryngol Head Neck Surg 1990; 116: 191-6.
    CrossrefPubMedGoogle Scholar
  • 21 Lavender JP, Khan RA, Hughes SP. Blood flow and tracer uptake in normal and abnormal canine bone: comparisons with Sr-85 microspheres, Kr-81m, and Tc-99m MDP. J Nucl Med 1979; 20: 413-8.
    PubMedGoogle Scholar
  • 22 Riggs Jr SA, Wood MB, Cooney WP, Kelly PJ. Blood flow and bone uptake of 99mTc-labeled methylene diphosphonate. J Orthop Res 1984; 1: 236-43.
    PubMedGoogle Scholar
  • 23 Sagar VV, Piccone JM, Charkes ND. Studies of skeletal tracer kinetics. III. Tc 99m(Sn)methy-lenediphosphonate uptake in the canine tibia as a function of blood flow. J Nucl Med 1979; 20: 1257-61.
    PubMedGoogle Scholar
  • 24 Bos KE. Bone scintigraphy of experimental composite bone grafts revascularized by microvascular anastomoses. Plast Reconstr Surg 1979; 64: 353-60.
    CrossrefPubMedGoogle Scholar
  • 25 Zinberg EM, Wood MB, Brown ML. Vascularized bone transfer: evaluation of viability by postoperative bone scan. J Reconstr Microsurg 1985; 2: 13-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Schuind FA, Schoutens A, Noorberger M, Burny F. Is early bone scintigraphy a reliable method to assess the viability of vascularized bone transplants?. J Reconstr Microsurg 1993; 9: 399-403.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Takato T, Harii K, Nakatsuka T. The sequential evaluation of bone scintigraphy: an analysis of revascularised bone grafts. Br J Plast Surg 1988; 41: 262-9.
    CrossrefPubMedGoogle Scholar
  • 28 Kirschner MH, Manthey N, Tatsch K, Nerlich A, Hahn K, Hofmann GO. Use of three-phase bone scans and SPET in the follow-up of patients with allogenic vascularized femur transplants. Nucl Med Commun 1999; 20: 517-24.
    CrossrefPubMedGoogle Scholar
  • 29 Krasnow AZ, Collier BD, Peck DC, Hellman RS, Dellis CJ, Kir KM, Isitman AT. The value of oblique angle reorientation in SPECT bone scintigraphy of the hips. Clin Nucl Med 1990; 15: 287-92.
    CrossrefPubMedGoogle Scholar
  • 30 Fujikawa Y, Torisu T, Takasita M, Masumi S. Grafted bone used in acetabular reconstruction: assessment by SPECT scintigraphy. Skeletal Radiol 1995; 24: 441-5.
    CrossrefPubMedGoogle Scholar