Ga. Mandell et al., BONE-SCINTIGRAPHY IN THE DETECTION OF CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS, The Journal of nuclear medicine, 39(10), 1998, pp. 1778-1783
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.