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. 2001 Jan;60(1):14–20. doi: 10.1136/ard.60.1.14

Bone scintigraphy for osteonecrosis of the knee in patients with non-traumatic osteonecrosis of the femoral head: comparison with magnetic resonance imaging

T Sakai 1, N Sugano 1, T Nishii 1, K Haraguchi 1, H Yoshikawa 1, K Ohzono 1
PMCID: PMC1753361  PMID: 11114276

Abstract

OBJECTIVE—To determine whether technetium bone scintigraphy (BS) is useful for screening of non-traumatic osteonecrosis of the knee (ONK), which was a major affected site, secondary to the femoral head, among multiple osteonecrosis, in patients with non-traumatic osteonecrosis of the femoral head (ONFH).
METHODS—A total of 214 knee joints in 107 patients with ONFH were evaluated by BS and a comparison made with magnetic resonance imaging (MRI). ONK was classified into five sites, including the femoral condyles (ONFC), distal femoral metaphysis (ONFM), tibial plateau (ONTP), proximal tibial metaphysis (ONTM), and patella (ONP).
RESULTS—Based on the diagnosis by MRI, ONK was detected in 103 knees of 62 patients (48%). ONFC was most common (86 knees, 40%), ONFM (15%), followed by ONTM (10%), ONP (3%), and ONTP (0.9%). Sensitivity, specificity, and accuracy of BS for ONFC detection were 63%, 71%, and 68%, respectively. When the ONFC lesions on the coronal views of MRI were large or medium sized and occupied two thirds, or the entire anteroposterior joint surface on the sagittal views, the sensitivity of BS for ONFC detection increased to 89% (34/38 knees). The sensitivity of BS for ONFM, ONTM, and ONP detection was 3%, 0%, and 0%, respectively, but these lesions showed a low likelihood of collapse.
CONCLUSION—BS is useful for screening large ONK in patients with ONFH given that 89% of patients with ONFC who had a high risk of collapse of the knee were identified.



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Figure 1  .

Figure 1  

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Seven areas of the knee (right knee). a: Lateral femoral condyle; b: medial femoral condyle (a, b: ONFC); c: lateral tibial plateau; d: medial tibial plateau (c, d: ONTP); e: patella (ONP); f: distal femoral metaphysis (ONFM); g: proximal tibial metaphysis (ONTM).

Figure 2  .

Figure 2  

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Diagram showing the sensitivity, specificity, and accuracy of the bone scintigraphy (BS). a: true positive; b: false negative; c: false positive; d: true negative.

Figure 3  .

Figure 3  

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(A) A coronal MR image on spoiled gradient recalled echo pulse sequences (SPGR, TR/TE = 14/2.3 ms) of bilateral knees in a 21 year old woman who underwent bone marrow transplantation for acute lymphatic leukaemia and steroid treatment, showing osteonecrosis in bilateral femoral condyles (ONFC), distal femoral metaphysis (ONFM), tibial plateau (ONTP), and proximal tibial metaphysis (ONTM). (B) Anteroposterior and (C) posteroanterior bone scintigrams of bilateral knees showing focal increased bone uptake in bilateral femoral condyles, distal femoral metaphysis, tibial plateau, and proximal tibial metaphysis.

Figure 4  .

Figure 4  

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(A) Anteroposterior and (B) posteroanterior bone scintigrams of bilateral knees in a 61 year old man with alcohol abuse, showing increased bone uptake in the whole area of the patella (hot patella pattern). Bilateral knees showed no osteoarthritic changes radiologically and no osteonecrosis on MRI.

Selected References

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