Radiology, Vol 147, 221-226, Copyright © 1983 by Radiological Society of North America
Comparison of bone scan and radiograph sensitivity in the detection of steroid-induced ischemic necrosis of bone
JJ Conklin, PO Alderson, TM Zizic, DS Hungerford, JY Densereaux, A Gober and HN Wagner
A prospective study of bone scanning for detection of ischemic necrosis of
bone (INB) was performed in 36 patients (97% female, age range 16-36 yrs.)
with systemic lupus erythematosis (SLE). Since the hips, knees, and
shoulders are usually affected by INB in patients with SLE, 300 K
converging collimator images of these joints were obtained on film and in
digital format 2 to 3 hours after the injection of 20 mCi (740 MBq) of
Tc-99m methylene diphosphonate. All patients underwent radiography of the
joints, and 10 had intraosseous pressure determinations in the marrow space
of affected joints (n = 31) for independent assessment of INB. Scans showed
abnormally increased joint activity in 28 of the 36 patients. A total of 97
joints showed abnormalities, 19% in the hips, 34% in the knees, and 47% in
the shoulders. Twenty-four of 27 joints with elevated bone marrow pressure
(BMP) had abnormal scans (sensitivity = 89%), and scans were abnormal in 2
of 4 joints with normal pressures (specificity = 50%). The positive
predictive value of the scans compared with BMP measurements was 92%
(24/26). Eleven of 27 joints with abnormal BMP had abnormal radiographs, a
sensitivity of 41%.
