SCINTIGRAPHIC DETECTION OF BONE AND BONE MARROW IN-FARCTS IN SICKLE CELL DISORDERS

Abstract

Differentiation of osteomyelitis (OSTEO) from bone infarction (BI) in patients with sickling disorders is a difficult clinical problem. In patients with OSTEO there is increased uptake of isotope on bone scan (BS) soon after onset of symptoms. We have used 99mTc suifur colloid for bone marrow scan (BMS) and 99mTc diphosphonate for BS to evaluate acute bone pain in 26 patients with sickling disorders. 99mTc tagged agents are readily available, and radiation is within the acceptable range for repeated diagnostic tests. In all 22 patients whose course subsequently indicated BI, the area of infarction had decreased or absent uptake on BMS. The corresponding area on BS varied in appearance depending on the interval between onset of pain and scanning. Of 7 patients studied within 5 days of onset, 6 had decreased uptake and 1 had increased uptake on BS in the area of the marrow infarct. Of 15 patients evaluated 5 days or more after onset, 4 had decreased and 11 had increased uptake on BS in the area of infarct due to reactive bone formation. One patient had diffuse increased uptake on BS with normal BMS, ruling out infarction and consistent with the clinical diagnosis of septic arthritis. Three patients with cellulltis had normal BS and BMS. In patients with BI extensive abnormality on BMS with minimal abnormality on BS indicates primary involvement of the marrow. Since these typical patterns are present at any stage of BI, the combination of BS and BMS may be useful in differentiating BI from early OSTEO.