Focal skeletal muscle uptake of 99mTechnetium-hydroxymethylene diphosphonate following peroneal nerve blocks in horses.
Abstract: We have observed focal skeletal muscle uptake of 99mTechnetium-hydroxymethylene diphosphonate (Tc-HDP), which could mimic a tibial lesion, in horses following peroneal nerve blocks. To characterize this observation further, 45 bone phase scintigrams were performed in 12 horses undergoing peroneal nerve blocks. Scans were performed before, and 1, 3, 7, and 14 days postblock. The superficial and deep branches of the peroneal nerve were blocked by injecting 10 ml of 2% mepivacaine in one limb and 20 ml in the other. Images were evaluated for uptake at the block site and uptake likely to mimic a tibial lesion. Regions of interest were placed over the block site and distal tibia. Count density ratios were used to estimate change in uptake intensity over time. The overall proportion affected was 0.52 (95% confidence interval [CI], 0.36-0.68; P < 0.001) 1 day postblock and 0.24 (95% CI, 0.13-0.40; P = 0.005) 3 days postblock. The overall proportion likely to mimic a tibial lesion was 0.19 (95% CI, 0.09-0.33; P < 0.001) 1 day postblock and 0.21 (95% CI, 0.09-0.40; P = 0.005) 3 days postblock. Focal skeletal muscle uptake was seen in only one horse 7 days postblock. Increased uptake intensity was associated with higher local anesthetic dose (P = 0.042). Peroneal nerve blocks cause focal skeletal muscle uptake of 99mTc-HDP on bone phase scintigraphy. This occurs in approximately 50% of blocked limbs and can mimic a tibial lesion on the lateral view in approximately 20% of blocked limbs.
Publication Date: 2010-05-18 PubMed ID: 20469559DOI: 10.1111/j.1740-8261.2009.01658.xGoogle Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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The research article focuses on the investigation of how a certain radioactive substance, 99mTechnetium-hydroxymethylene diphosphonate (Tc-HDP), accumulates in horse muscle after a peroneal nerve block and its potential to falsely suggest a tibial bone lesion.
Methodology of the research
- The study was carried out on 12 horses undergoing peroneal nerve blocks. A total of 45 bone phase scintigrams, which are specialized images using a radioactive tracer, were performed at different intervals: before the nerve blocking, and at 1, 3, 7, and 14 days after the procedure.
- The nerve blocking was done on the superficial and deep branches of the peroneal nerve by injecting an anaesthetic (mepivacaine) at two different volumes, 10 ml and 20 ml, one in each limb of the horse.
- The acquired images were inspected for possible uptake of Tc-HDP at the site of block and for any uptake mimicking a lesion in the tibia, a bone in the horse’s lower limb.
- By setting regions of interest over the block site and distal tibia, researchers used count density ratio analysis to estimate any change in Tc-HDP uptake over time.
Results obtained
- The study showed significant focal skeletal muscle uptake of Tc-HDP, which was observed in approximately 52% of blocked limbs on the first day after performing the peroneal nerve block, then it reduced to 24% by the third day post-block.
- Moreover, the mimicked tibial lesion through Tc-HDP uptake occurred in about 19% of the blocked limbs one day post-block and remained relatively consistent at 21% three days post-block.
- Only one horse showed such focal skeletal muscle uptake seven days after the nerve block.
- The findings suggest that the intensity of Tc-HDP uptake increases with higher doses of the anesthetic used for nerve blocking (
P=0.042).
Implication of the findings
- The research indicates that a peroneal nerve block in horses may lead to the focal uptake of Tc-HDP in the skeletal muscles, which could be interpreted wrongly as a tibial lesion — a bone defect — on the lateral view of about 20% of the blocked limbs.
- This unintended effect could cause misdiagnosis and requires consideration when conducting imaging studies and subsequent interpretations.
Cite This Article
APA
Griffin JF, Young BD, Fosgate GT, Walker MA, Watkins JP.
(2010).
Focal skeletal muscle uptake of 99mTechnetium-hydroxymethylene diphosphonate following peroneal nerve blocks in horses.
Vet Radiol Ultrasound, 51(3), 338-343.
https://doi.org/10.1111/j.1740-8261.2009.01658.x Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, Texas A&M University, College Station, TX 77843-4475, USA. jgriffin@cvm.tamu.edu
MeSH Terms
- Animals
- Female
- Horses
- Male
- Muscle, Skeletal / diagnostic imaging
- Muscle, Skeletal / innervation
- Nerve Block / veterinary
- Peroneal Nerve
- Radionuclide Imaging
- Radiopharmaceuticals
- Technetium Tc 99m Medronate / analogs & derivatives
Citations
This article has been cited 1 times.- Klein GL. The Role of Bone Secreted Factors in Burn-Induced Muscle Cachexia. Curr Osteoporos Rep 2018 Feb;16(1):26-31.
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