Abstract
BackgroundThis study aimed to investigate the ability of whole-body bone scintigraphy (WB-BS) in the detection of multifocal osteonecrosis (ON) compared to whole-body magnetic resonance imaging (WB-MRI) and to clarify the characteristics of patients with multifocal ON among those with ON of the femoral head (ONFH) using WB-MRI.MethodsForty-six patients who had symptomatic ONFH and underwent surgery in our hospital from April 2019 to October 2020 were included in the study. Data on patient demographics, including age, sex, body mass index (BMI), history of corticosteroid intake, alcohol abuse, smoking, and symptomatic joints, were collected from their medical records. All patients underwent WB-MRI and WB-BS before surgery.ResultsThe agreement in the detection of ON by WB-MRI vs the uptake lesions by WB-BS in the hip joints was moderate (κ = 0.584), while that in other joints was low (κ < 0.40). Among the 152 joints with ON detected by WB-MRI, 92 joints (60.5%) were symptomatic, and 60 joints (39.5%) were asymptomatic. Twelve out of the 46 (26.0%) patients had multifocal (three or more distinct anatomical sites) ON. Nonetheless, while WB-BS detected symptomatic ON detected by WB-MRI as uptake lesions in 82.6% (76/92) of the joints, asymptomatic ON detected by WB-MRI was detected as uptake lesions in 21.7% (13/60) of the joints. All patients with multifocal ON had a history of steroid therapy, which was significantly higher than that in patients with oligofocal ON (P = 0.035). The patients with a hematologic disease had multifocal ON at a higher rate (P = 0.015).ConclusionsIt might be difficult for WB-BS to detect the asymptomatic ON detected by WB-MRI compared to symptomatic ON. Considering the cost, examination time, and radiation exposure, WB-MRI might be useful for evaluating multifocal ON. Larger longitudinal studies evaluating the benefits of WB-MRI for detecting the risk factors for multifocal ON are required.
Highlights
This study aimed to investigate the ability of whole-body bone scintigraphy (WB-BS) in the detection of multifocal osteonecrosis (ON) compared to whole-body magnetic resonance imaging (WB-Magnetic resonance imaging (MRI)) and to clarify the characteristics of patients with multifocal ON among those with ON of the femoral head (ONFH) using WB-MRI
To clarify if WB-BS uptake lesions are useful for diagnosing the multifocal ON, this study aimed to compare the detection of ON by WB-MRI and WB-BS
WB-MRI has been recently reported to detect multifocal ON in 20% (3 of 15) of the patients with polymyositis/dermatomyositis (PM/DM) [19] and in 86% (6 of 7) of the patients with Hodgkin’s lymphoma treated by chemotherapy [25]. Consistent with these reports, this current study showed that the WB-MRI whole-body magnetic resonance imaging, WB-BS whole-body bone scintigraphy, Sympt symptomatic, Asympt asymptomatic, “#” number
Summary
This study aimed to investigate the ability of whole-body bone scintigraphy (WB-BS) in the detection of multifocal osteonecrosis (ON) compared to whole-body magnetic resonance imaging (WB-MRI) and to clarify the characteristics of patients with multifocal ON among those with ON of the femoral head (ONFH) using WB-MRI. Various joints can be affected, including the shoulders, knees, and ankles, ON of the femoral head (ONFH) is most common, with an annual incidence rate of 10,000 to 20, 000 new cases in the USA and 2000 to 3000 new cases in Japan, which is expected to increase continuously [2,3,4]. A whole-body bone scan (WB-BS) is more sensitive than a simple X-ray scan for the diagnosis of ON [8,9,10] and can be used to screen for multifocal ON [7, 11]. The advantages of WB-BS for screening multifocal ON remain debatable
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