technetium-tc-99m-medronate and Anemia--Sickle-Cell

We present a patient with spleen uptake on bone scanning that was due to sickle cell disease. We also discuss other etiologies for this finding.

Topics: Anemia, Sickle Cell; Bone and Bones; Female; Humans; Incidental Findings; Radiopharmaceuticals; Spleen; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Young Adult

To demonstrate the combined use of scintigraphy and ultrasonography (US) in differentiating osteomyelitis from bone infarction in sickle cell disease.. Two patients with sickle cell disease were examined with a combination of bone, bone marrow, white blood cell and/or gallium scintigraphy and US.. The scintigraphic studies demonstrated areas of suspected osteomyelitis at the distal femur in both patients and at the proximal right tibia in one of them. US revealed subperiosteal fluid collections in these areas. Aspiration guided by US established the presence of pus at the femur in both instances, which was successfully treated with the US-guided insertion of a drainage catheter and aspiration only, respectively. Thick blood, due to bone infarction, was aspirated at the tibia.. The scintigraphic studies were useful in locating all areas of suspected osteomyelitis. The role of US was to confirm the presence of a subperiosteal fluid collection and to guide aspiration, which can show the distinction between a haematoma and an abscess.

Topics: Abscess; Adult; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Diagnosis, Differential; Female; Gallium Radioisotopes; Hematoma; Humans; Infarction; Male; Organotechnetium Compounds; Osteomyelitis; Oximes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Ultrasonography

Orbital wall infarctions resulting in orbital and epidural hematomas are rare manifestations of sickle cell disease (SCD). We report orbital compression syndrome associated with an epidural hematoma and wide cephalohematoma in a 15-year-old boy with SCD. An infarcted orbital bone was observed on magnetic resonance imaging and three-phase bone scintigraphy with Technetium-99m methylene diphosphonate. The patient recovered completely without surgical intervention at the end of the fourth week. Prompt diagnosis and proper management are critical for complete recovery.

Topics: Adolescent; Anemia, Sickle Cell; Bone Marrow; Hematoma; Hematoma, Epidural, Cranial; Humans; Infarction; Magnetic Resonance Imaging; Male; Orbital Diseases; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Sickle cell anemia is an inherited disorder caused by abnormal hemoglobin, the S hemoglobin. Although vaso-occlusive crises can occur virtually in any organ, they are particularly common in the bony skeleton of affected patients. Bone marrow necrosis, bone infarcts, osteomyelitis, and aseptic necrosis are common complications in patients with sickle cell disease. Beside these abnormalities of the skeletal system, diffuse micro or macro calcification resulting from both splenic infarction and repeated vaso-occlusive episodes in the kidneys can be shown by technetium-99m methylenediphosphonate (Tc-99m MDP) bone scintigraphy. We present here the different osseous and extraosseous abnormalities noted on bone scintigraphies of three patients with sickle cell anemia.. Whole-body bone scan was performed after injecting 740 MBq of Tc-99m MDP in three patients with sickle cell disease.. Tc-99m MDP whole-body image of the first patient showed non-uniform uptake in the anterior and posterior aspects of multiple ribs and bilateral femurs and tibias that was attributed to repetitive infarcts. Additionally, increased activity in shoulders, right elbow, and right knee was consistent with arthritis. Tc-99m MDP image of the second patient demonstrated avascular necrosis of the left femoral head and diffuse activity in the enlarged kidneys. Increased activity in the spleen that was attributed to repetitive infarcts was visualized in bone scan of the third patient.. In light of the findings in these cases, bone scintigraphy is a reliable imaging method in detecting both osseous and extraosseous abnormalities of sickle cell disease and may be used initially.

Topics: Adult; Anemia, Sickle Cell; Bone and Bones; Female; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate; Whole Body Imaging

A 52-year-old woman with nonspecific left leg pain was examined by Tc-99m methylene diphosphonate (MDP) bone scintigraphy. The patient had been a marble quarry worker for 10 years and had developed chronic congestive heart failure secondary to pneumoconiosis. Her hemoglobin analysis and hematologic findings were interpreted as being consistent with sickle cell beta+ thalassemia and also hypersplenism. Bone scintigraphy showed intense and diffuse MDP accumulation in the enlarged spleen without ultrasonographic or radiologic evidence of calcification.

Topics: Anemia, Sickle Cell; Female; Humans; Hypersplenism; Incidental Findings; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Anemia, Sickle Cell; Bone and Bones; Child; Femur Head Necrosis; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Over a period of 11 y, 50 patients (22 males, 28 females; age range, 8 mo to 22 y) presenting with sickle cell-associated bone pain underwent 93 sequential examinations with 99mTc-sulfur colloid bone marrow scanning and 99mTc-diphosphonate bone scanning. Multiple examinations were performed on 21 patients. The number and distribution of total acute, healed, and nonhealed infarcts by location were recorded on a skeletal homunculus.. For this population, the total number of sites of bone and bone marrow infarction was 464. Of these, 175 were classified as acute by clinical and scintigraphic findings. There were a total of 61 nonhealed sites and 162 healed sites.. Knowledge of the distribution and natural history of sites of bone and bone marrow infarction is of considerable clinical and diagnostic import in the ongoing evaluation and treatment of sickle hemoglobinopathies.

Topics: Adolescent; Adult; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Child, Preschool; Female; Humans; Infant; Infarction; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Wound Healing

We studied six patients with sickle cell disease (SSD), five homozygous for sickle cell anemia and one with sickle beta-thalassemia, in whom rounded intrasplenic masses proved to be preserved functioning splenic tissue.. Available images including computed tomography, ultrasonography, bone scans (Tc-99m MDP), liver spleen scans (Tc-99m sulfur colloid), and MRI were evaluated.. The masses were low density on CT (in an otherwise calcified spleen), hypoechoic relative to the echogenic spleen on US, and had the imaging characteristics of normal spleen on MRI. They failed to accumulate Tc-99m MDP but did demonstrate uptake of Tc-99m sulfur colloid.. In a patient with SSD and intrasplenic masses, proper correlation of multiple imaging modalities will establish the diagnosis of functioning splenic tissue and avoid mistaken diagnosis of splenic abscess or infarction.

Topics: Adolescent; Adult; Anemia, Sickle Cell; Bone and Bones; Female; Humans; Magnetic Resonance Imaging; Spleen; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed; Tomography, X-Ray Computed; Ultrasonography

The authors present a cases of acute chest syndrome that was originally thought to be due to pneumonia, in which bone imaging obtained 4 weeks later for knee pain showed a secondary finding of multiple rib infarcts that clarified the etiology of the patient's chest manifestations and led to a change in the management of the patient. Bone scintigraphy should be considered in the work-up of patients with sickle cell anemia and concurrent chest symptoms.

Topics: Adult; Anemia, Sickle Cell; Bone and Bones; Chest Pain; Diagnosis, Differential; Female; Gallium Radioisotopes; Humans; Infarction; Pneumonia; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

Topics: Adult; Anemia, Sickle Cell; Calcaneus; Female; Humans; Infarction; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Anemia, Sickle Cell; Bone and Bones; Diagnosis, Differential; Female; Humans; Infarction; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

Topics: Anemia, Sickle Cell; Child; Female; Humans; Kidney; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Technetium Tc 99m Medronate

This article describes a 28-yr-old black man with sickle cell anemia who presented with severe chest pain secondary to acute infarction of the body of the sternum, hypoventilation, and hypoxemia with no evidence of acute chest syndrome. A bone scan performed 5 days after admission revealed increased uptake in the sternum, suggesting sternal infarction. Repeat bone scan performed 2 mo later demonstrated normal concentration in the sternum.

Topics: Acute Disease; Adult; Anemia, Sickle Cell; Chest Pain; Humans; Hypoxia; Infarction; Male; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

Topics: Anemia, Sickle Cell; Bone and Bones; Cerebral Infarction; Child, Preschool; Gallium Radioisotopes; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

To determine whether imaging techniques can differentiate osteomyelitis from bone infarction in sickle cell disorders, 39 sets of bone scans (BS) and bone marrow scans (BMS) were performed on 31 patients with sickling disorders and bone pain. In addition, three patients who had either a BS or a BMS were included. Results were analyzed according to whether scans were performed three days or less (Period 1), four to six days (Period 2), or seven or more days (Period 3) after the onset of pain. Regardless of the period, all but five BMS for 34 episodes of assumed infarction showed decreased uptake. BS findings varied depending on the time interval, with none of the ten in Period 1 showing increased uptake, but all 11 in Period 3 showing increased uptake. However, in Period 2, about half of the 13 BS showed increased uptake. All three patients with osteomyelitis in Period 3 had increased uptake on BS. The BMS done in one of these patients showed decreased uptake. Three patients with cellulitis had normal BS and BMS. One patient with septic arthritis had normal BMS, but slightly increased uptake on BS. Although typical imaging patterns are present in early and late infarction (Periods 1 and 3), the patterns for late infarction may not differ from those of advanced osteomyelitis. Therefore, imaging studies are only of value in differentiating infarction from osteomyelitis when both BS and BMS are performed soon after the appearance of symptoms.

Topics: Adolescent; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infarction; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

The authors report a case of sickle cell anemia associated osteomyelitis where the Tc-99m white blood cell imaging was negative, and bone imaging showed increased uptake in the region in question. The reasons for the possible false-negative image are discussed.

Topics: Anemia, Sickle Cell; False Negative Reactions; Female; Femur; Humans; Leukocytes; Middle Aged; Osteomyelitis; Radionuclide Imaging; Salmonella Infections; Technetium; Technetium Tc 99m Medronate

We reviewed the nuclear medicine files of all patients enrolled in the sickle cell disease clinic who had had scans performed within the previous 5 years. We specifically looked for patterns of tracer uptake in these scans that would correlate with the severe anemia and consequent bone marrow hyperactivity of sickle cell patients. Thirty-three patients were included (21 men and 12 women) with a mean age of 26.8 years (range 17-48 years). The appearance of each of these patients' most recent scans was examined in the areas of the distal femurs, the proximal tibias and the distal tibias; a distinct triangular shaped pattern of increased activity was identified in these areas in a majority of patients. Thirty-three patients without sickle cell disease served as age-matched controls. This pattern was seen in 65.1% (95 out of 146 images) of the sickle cell patients' delayed images and 80.4% (82 out of 102 images) of their blood pool images. In contrast, the control patients demonstrated the triangular pattern in none of their blood pool studies (0%) and only 10.9% of their delayed bone images (P less than 0.001). The mean age of sickle cell patients with this pattern is 25.6 years which was significantly lower than that of those without this pattern (mean = 37.5 years, P less than 0.05). Given the high prevalence of this unique scintigraphic pattern in a group of patients with known accelerated bone marrow function, these findings may be scintigraphic evidence of bone marrow expansion. The patient's age appears to be an important factor in visualization of this pattern.

Topics: Adult; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The osteoarticular complications of drepanocytosis-thalassemia (DT) include: 1) bone infarction, or avascular necrosis (AVN), common at all ages; 2) acute septic arthritis and hematogenous osteomyelitis, that usually affect infants and children. Early diagnosis and treatment of the osteoarticular infectious complications is imperative, to maximize the chances of a favorable outcome, and to prevent the sequelae, ie pathological fractures, chronic osteomyelitis. Early roentgenographic features of involved areas are similar in acute osteomyelitis and in AVN--both of which cause painful bone crises, so as to make osteomyelitis (OM) a diagnostic challenge. Four cases of DT are reported. The patients, 17 to 37 years old, presented with bone infarcts. One of them (the youngest) had also multiple osteomyelitis of long bones. The 99m-Tc-MDP bone scans, performed only on the youngest patient, affected by OM, revealed increased uptake in both AVN and in OM locations, without differential diagnostic features. After a review of the literature, a diagnostic protocol is suggested, based on 99m-Tc colloid marrow scintigraphy for the early differential diagnosis between acute OM (normal or slightly-increased uptake), chronic OM (markedly increased uptake), and AVN (decreased uptake). Furthermore, MR imaging is stressed as the most promising tool, in the next future, for this kind of differential diagnosis.

Topics: Adolescent; Adult; Anemia, Sickle Cell; Arthritis, Infectious; Bone and Bones; Diagnosis, Differential; Humans; Infarction; Joint Diseases; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thalassemia; Tomography, X-Ray Computed

A patient with sickle cell disease developed bi-parietal calvarial infarctions, and subsequently developed bi-frontal calvarial infarctions. The findings on [99mTc]MDP bone imaging showed decreased activity in the parietal and frontal regions during the phase of acute infarction and increased activity in the parietal region during the later healing phase. Thus the findings on radionuclide bone imaging in cortical infarcts will depend upon the stage of the condition.

Topics: Adolescent; Anemia, Sickle Cell; Humans; Infarction; Male; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

Bone infarction is common in sickle cell disease; however, involvement of the orbit is not. Only four cases have been reported in the English literature. We describe a patient who presented with headache, proptosis and lid edema due to infarction of the sphenoid bone. The combination of radionuclide bone imaging and computed tomography (CT) of the orbit were useful in differentiating bone infarction from other etiologies of proptosis.

Topics: Adult; Anemia, Sickle Cell; Diphosphonates; Humans; Infarction; Male; Orbital Diseases; Sphenoid Bone; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone scans or bone marrow scans or both were obtained during 42 episodes of bone pain in 40 children with sickle cell disease, and the usefulness of these procedures was compared. On the basis of the subsequent clinical course, a diagnosis of bone infarction was made in 34 episodes, and osteomyelitis in eight. Among 22 patients with bone infarction, uptake on bone scan was increased in 14, decreased in three, and normal in five. Seven of eight patients with osteomyelitis had increased uptake on bone scan; one had normal uptake. In contrast, marrow scan uptake was markedly decreased in 15 of 16 patients with bone infarction, and was normal in five of five patients with osteomyelitis. Thus, decreased uptake on bone marrow scan in a patient with sickle cell disease and bone pain almost invariably indicates infarction, whereas normal uptake strongly suggests the diagnosis of osteomyelitis. We found marrow scans more useful than bone scans for this differential diagnosis.

Topics: Adolescent; Anemia, Sickle Cell; Bone and Bones; Bone Marrow; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Infarction; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

An early differential diagnosis between bone infarction and osteomyelitis in sickle cell patients is practically impossible using routine laboratory methods. Twenty radioisotope studies in sickle cell patients during vaso-occlusive crises, were analyzed. A three stage process can be described. In the first stage a decreased uptake can be demonstrated by Tc 99m methylene diphosphonate (MDP) bone scanning. In osteomyelitis, an increased uptake area is usually seen at this early stage, corresponding to increased uptake in Ga-67 citrate scanning. At the second stage, approximately a week later, normal uptake can be seen. Two to four weeks later an area of increased uptake is recorded that corresponds to the healing process, stage three. We recommend therefore Tc 99m MDP bone scanning in the early stages if clinical signs and symptoms suggest a vaso occlusive crisis or osteomyelitis in a sickle cell patient. This study can be followed by a Ga-67 citrate scintigraphy in doubtful cases. Later studies should be used for the assessment of the healing process. Two illustrative case reports are included.

Topics: Anemia, Sickle Cell; Bone and Bones; Child; Child, Preschool; Diagnosis, Differential; Diphosphonates; Female; Humans; Infarction; Lumbar Vertebrae; Male; Osteomyelitis; Radionuclide Imaging; Sickle Cell Trait; Technetium; Technetium Tc 99m Medronate; Tibia

Two cases of unilateral and bilateral periorbital hematomas occurred in patients with sickle cell anemia. The cause of periorbital swelling in these cases was found to be orbital and frontal bone infarctions, respectively, diagnosed by technetium Tc 99m medronate bone scintigraphy. To our knowledge, periorbital bone infarction, as a part of the differential diagnosis of periorbital hematoma and as part of the possible ocular manifestations in patients with sickle cell anemia, has not previously been described.

Topics: Anemia, Sickle Cell; Child; Diphosphonates; Female; Frontal Bone; Hematoma; Humans; Infarction; Male; Orbit; Orbital Diseases; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Anemia, Sickle Cell; Child; Diphosphonates; Humans; Infarction; Male; Orbit; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Anemia, Sickle Cell; Diphosphonates; Female; Humans; Radionuclide Imaging; Spleen; Technetium; Technetium Tc 99m Medronate; Thalassemia

Topics: Anemia, Sickle Cell; Bone and Bones; Child; Diagnosis, Differential; Diphosphonates; Female; Humans; Infarction; Male; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Amphotericin B; Anemia, Sickle Cell; Bone and Bones; Diphosphonates; Female; Humans; Hypercalcemia; Kidney; Lupus Erythematosus, Systemic; Male; Middle Aged; Nephritis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate