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 osteom yelitis (CRMO) and in distinguishing it from unifocal acute hematogeno us osteomyelitis. Materials: The medical records and two-phase, whole- body bone scans of 14 patients (mean age 10.5 yr) with the diagnosis o f 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. R esults: The presentation of the disease was localized to one painful, tender and swollen periarticular site 86% of the time. The number of l esions detected by bone scan varied from 1-18 (mean 6). Most lesions w ere metaphyseal, proximal or distal tibial lesions. Purely sclerotic o r mixed (sclerosis and lysis) lesions were found on radiographs. Bilat eral 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 include d marked overgrowth (5), diffuse demineralization (1), angular deformi ty (1) and length discrepancy (1). Conclusion: The identification of t he multifocal configuration of the disease process by two-phase (soft- tissue and delayed) whole-body bone scintigraphy results in appropriat e diagnosis and therapy of CRMO. Additional sites for possible bone bi opsy become apparent for exclusion of other diagnoses. Supportive (non steroidal, anti-inflammatory medication) instead of antimicrobial ther apy can be initiated with significant cost savings.