What is the role of nuclear imaging in the workup of sickle cell disease (SCD)?

Updated: Jul 24, 2019
  • Author: Ivan Ramirez, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Technetium-99m (99mTc) bone scanning can be used to detect early stages of osteonecrosis, and it is not as costly as MRI. Osteonecrosis can be detected on bone scans, appearing mostly as focal areas of increased activity. Occasionally, areas of decreased uptake can be seen; this is usually seen in early disease. Technetium-99m bone marrow scans demonstrate areas of decreased activity in marrow infarction. [24, 9]

Skeletal sickle cell anemia. Bone infarction in an Skeletal sickle cell anemia. Bone infarction in an infant (see also next image). Image shows a curvilinear area of sclerosis with central lucency in the metaphysis of the femur representing a bone infarct.
Skeletal sickle cell anemia. Bone scan of bone inf Skeletal sickle cell anemia. Bone scan of bone infarct shows an area of increased uptake in the distal femoral metaphysis corresponding to the infarct demonstrated on the previous plain radiograph.

Indium-111 (111In) white blood cell (WBC) scanning is useful to diagnose osteomyelitis, which appears as an area of increased activity within bone. However, areas of marrow proliferation, which are common in patients with sickle cell, would also demonstrate increased activity on 111In WBC scans. The combination of a bone scan and a bone marrow scan has been used to differentiate acute osteomyelitis from bone infarcts in patient with sickle cell, since the clinical presentation of these 2 conditions may be very similar. Areas of bone infarction may be identified by decreased activity on the bone marrow scan with corresponding abnormal uptake on the bone scan. Acute osteomyelitis demonstrates increased activity on the bone scan, with normal activity on the bone marrow scan. [9, 25]

Single-photon emission computed tomography (SPECT)/CT has become an important tool to evaluate the different bone lesions in SCD, such as osteopenia, osteoporosis, avascular necrosis, and pathologic fracture. [15]


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