title: THE BONE SCINTIGRAPHY AS A COMPLEMENTARY EXAM IN THE DIAGNOSIS OF THE AVASCULAR NECROSIS OF THE SESAMOID.
abstract: OBJECTIVE
  This study aimed to present seven cases of avascular necrosis of the sesamoid and report the role of bone scintigraphy in the diagnosis of these patients.
  
  
  METHODS
  Seven patients with clinical suspicion of avascular necrosis of the sesamoid underwent three-phase bone scintigraphy with 30 mCi of (99m)Tc-MDP.
  
  
  RESULTS
  Most of the patients were young female adults with complaints of limiting pain in the forefoot, who were making use of inappropriate footwear and/or had a history of injury with or without fracture. There was no predominance of either of the feet or between the femoral or tibial sesamoid. Two patients (28.57%) had a bipartite tibial sesamoid and one (14.29%) had splitting of the tibial and fibular sesamoids. In 100% of the patients, three-phase bone scintigraphy, combined with other propaedeutic methods, proved to be crucial for the diagnosis. The initial procedure in all cases was conservative. In four cases (57.14%), there was no remission of symptoms, and surgical excision of the necrotized sesamoid tissue was performed. In all the patients, the therapy used was effective, with complete remission of symptoms, without complications or deformities of the forefoot.
  
  
  CONCLUSIONS
  Three-phase bone scintigraphy becomes a cornerstone of the propaedeutics when avascular necrosis of the sesamoid is suspected, through contributing towards early and accurate diagnosis and enabling allowing appropriate specialized treatment.
authors.affiliation: Nuclear Physician at ECOAR Diagnostic Medicine, Belo Horizonte, MG, Brazil.
authors.forename: Carlyle Marques
authors.initials: CM
authors.lastname: Barral
authors.affiliation: Orthopedist at the Vera Cruz and Life Center Hospitals, Belo Horizonte, MG, Brazil.
authors.forename: Arnóbio Moreira
authors.initials: AM
authors.lastname: Félix
authors.affiliation: Cardiologist at the Nuclear Medicine Service, ECOAR Diagnostic Medicine, Belo Horizonte, MG, Brazil.
authors.forename: Leonardo Neuenschwander
authors.initials: LN
authors.lastname: Magalhães
authors.affiliation: Nuclear Physician at ECOAR Diagnostic Medicine, Belo Horizonte, MG, Brazil.
authors.forename: Luciana Araújo
authors.initials: LA
authors.lastname: Carvalho
authors.affiliation: Cardiologist and Director of ECOAR Diagnostic Medicine, Belo Horizonte, MG, Brazil.
authors.forename: Fernando Santana
authors.initials: FS
authors.lastname: Machado
keywords: Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate