Incidence and radio-uptake patterns of femoral head avascular osteonecrosis at 1 year after renal transplantation: a prospective study with planar bone scintigraphy.
OBJECTIVE
We prospectively investigated the incidence of femoral head avascular osteonecrosis (AVN) and radio-uptake patterns of femoral heads on bone scintigraphy at 1 year after renal transplantation.


METHODS
A total of 237 subjects (473 femoral heads) were included. A bone scintigraphy was performed at 12 +/- 1.1 months after renal transplantation, and 17 hips were painful at the time of bone scintigraphy. We graded the radioactivity in each femoral head as normal (grade 0), mildly increased (grade I), and definitely increased (grade II). Typical photon defects in the upper lateral femoral heads were evaluated separately. AVN was confirmed with clinical follow-up of more than 1 year and MRI and/or plain radiography findings.


RESULTS
Femoral head AVN was detected in 15 of the 237 patients and 23 of the 473 femoral heads. When grade I and II activities were used as positive criteria, bone scintigraphy had a sensitivity of 91.3% (100% with pain) and specificity of 74.0% (100% with pain) for AVN diagnosis. When only grade II activity was considered positive, the rates were 56.5% (80.0% with pain) and 99.5% (100% with pain), respectively. The presence of a typical photon defect had a low sensitivity of 47.8%, although the specificity was high (99.1%).


CONCLUSIONS
The incidence of femoral head AVN was low among a prospective cohort of renal transplantation recipients at the time of 1 year after engraftment. Planar bone scintigraphy is sufficient to diagnose AVN in symptomatic patients at risk for femoral head AVN using grade I and II activities as positive criteria.
Lee
Eun Jeong
EJ
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Lee
Kyung-Han
KH
Huh
Woo Seong
WS
Yoon
Joon-Kee
JK
Chung
Hyun Woo
HW
Choi
Joon Young
JY
Choe
Yearn Seong
YS
Choi
Yong
Y
Oh
Ha Young
HY
Kim
Byung-Tae
BT
D000328:Adult; D005260:Female; D005271:Femur Head Necrosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000378:metabolism / Q000534:rehabilitation*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D007723:Korea / Q000453:epidemiology; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate / Q000493:pharmacokinetics
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate