Bone scintigraphy in the detection of chronic recurrent multifocal osteomyelitis.
In this study, we describe the importance of the whole-body bone scan in diagnosing the multifocality of chronic recurrent multifocal osteomyelitis (CRMO) and in distinguishing it from unifocal acute hematogenous osteomyelitis.


METHODS
The medical records and two-phase, whole-body bone scans of 14 patients (mean age 10.5 yr) with the diagnosis of CRMO, were retrospectively reviewed. The diagnosis of CRMO was based on bone biopsy in 9 patients and clinical course/laboratory findings in 5. Bone scans were evaluated for geographic and anatomic locations of their lesions. Correlative radiographs of areas of abnormal uptake were performed to assess the radiographic appearance of the lesions.


RESULTS
The presentation of the disease was localized to one painful, tender and swollen periarticular site 86% of the time. The number of lesions detected by bone scan varied from 1-18 (mean 6). Most lesions were metaphyseal, proximal or distal tibial lesions. Purely sclerotic or mixed (sclerosis and lysis) lesions were found on radiographs. Bilateral lesions were seen in 64% of patients. Biopsies were negative for organisms in all patients and exhibited subacute or chronic histologic changes in most instances. Complications of chronic hyperemia included marked overgrowth (5), diffuse demineralization (1), angular deformity (1) and length discrepancy (1).


CONCLUSIONS
The identification of the multifocal configuration of the disease process by two-phase (soft-tissue and delayed) whole-body bone scintigraphy results in appropriate diagnosis and therapy of CRMO. Additional sites for possible bone biopsy become apparent for exclusion of other diagnoses. Supportive (nonsteroidal, anti-inflammatory medication) instead of antimicrobial therapy can be initiated with significant cost savings.
Department of Medical Imaging, DuPont Hospital for Children, Wilmington, Delaware 19899, USA.
G A
GA
Mandell
S J
SJ
Contreras
K
K
Conard
H T
HT
Harcke
K W
KW
Maas
D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002648:Child; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012008:Recurrence; D012189:Retrospective Studies; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate