Figure 10a.

Fourth-degree frostbite of the right hand in a 65-year-old woman. (a) Palmar photograph obtained at bone scintigraphy shows tip gangrene of all digits. (b–d) Multiphase ^99mTc-MDP bone scintigraphic images show absent tracer uptake within the distal second, third, and fourth digits and absent tracer uptake distal to the fifth digit metacarpophalangeal joint in the palmar blood flow phase at 120 seconds (b), soft-tissue phase (c), and 3.5-hour delayed phase (d). Note the preservation of tracer uptake throughout the thumb. (e–g) Fused SPECT/CT images of the right hand (obtained in different projections) show the exact level of bone necrosis within the right second, third, fourth, and fifth digits, with preserved uptake throughout the thumb. (h, i) Palmar (h) and dorsal (i) photographs obtained 1 week after bone scintigraphy demonstrate the level of tissue loss previously defined at SPECT/CT.