Guest Editorial

Article Outline

• Copyright

We hope that you enjoyed reading Part I of the bone update series. In Part II, we turn our attention away from malignant conditions and focus on the rapidly expanding indications relating to benign disorders.

The topic of bone infection remains extremely important but we still often struggle when asked by our orthopedic colleagues whether a prosthesis is infected. Infection seems to be one of the most important unresolved areas, and here surely there is a clear need and an opportunity to develop and introduce a simple yet sensitive test into clinical practice, but of course that is easier said (or written) than done. Dr Bruggen and coauthors have elegantly reviewed the published data assessing the role of nuclear medicine (including positron emission tomography [PET] and single-photon emission computed tomography [SPECT]) in the diagnosis of osteomyelitis and prosthetic bone and joint infections. The authors conclude that SPECT/computed tomography (CT) using ¹¹¹In-WBC combined with ^99mTc-methylene diphosphonate (^99mTc-MDP) or ^99mTc-sulfur colloid appears to be the best imaging technique for diagnosis of bone and joint infections, and PET shows promise in several clinical scenarios.

Obtaining a specific diagnosis is often critical in the management of sport injuries, and radionuclide bone scintigraphy plays an important role. The recent advent of hybrid imaging devices has allowed the coregistration of bone scintigraphy with CT, permitting a new imaging paradigm of immense potential. Dr Van der Wall and coauthors have elegantly reviewed the role of bone scintigraphy in a variety of sports injuries. They conclude by emphasizing the importance of good history-taking, understanding of the mechanisms of the injury, and having a knowledge of anatomy to reach an accurate diagnosis.

Coregistration of anatomical and functional imaging (hybrid imaging) combines the advantages of individual studies in a synergistic manner, aiding the clinician in the efficient management of complex problems.

Coregistration of routine nuclear medicine studies with radiological imaging is well described for pathologies involving the wrist and feet. However, multislice SPECT/CT is relatively new and imaging of chronic foot pain remains complex and challenging. Dr Mohan and coworkers describe the current techniques available for imaging pathology in the foot and ankle, and share their clinical experience using multislice SPECT/CT with a comprehensive range of examples.

To date, we have focused on adults but we should not forget the importance of imaging in the pediatric population. Dr Nadel provides an excellent general overview on the radionuclide bone scintigraphy in pediatrics, while Dr Cook and coauthors take on the challenging task of discussing the role of radionuclide bone imaging for a variety of miscellaneous indications.

A dual-energy x-ray absorptiometry (DXA) scan measures bone mineral density and has an important role in the evaluation of individuals at risk of osteoporosis. Drs Blake and Fogelman provide a comprehensive review on the use of DXA in osteoporosis.

Finally, we wish to thank all the authors who have contributed and we recognize that we have been extremely fortunate to have gathered such a distinguished group of clinicians and scientists to provide updates on areas of their particular expertise. We are truly delighted with the outcome of their hard work and hope that you too will be.