Bone, bone marrow, and MIBI scintigraphic findings in Gaucher's disease "bone crisis"'

Purpose: The authors report the utility of Tc-99m MIBI imaging in Gaucher's disease, which results in the accumulation of glucocerebroside in macropha ges. Inflated macrophages, or Gaucher's cells, involve the reticuloendothel ial organs. Materials and Methods: A 38-year-old man with type I Gaucher's disease, spl enectomy, and early bone involvement was examined for a low back "bone cris is." He had a history of total left hip replacement. Results of pelvic radi ographs were normal. Magnetic resonance imaging showed complete infiltratio n of the bone marrow in the lumbar spine and the sacrum. The left iliac bon e, the sacrum, and the adjacent part of L5 showed heterogeneously decreased uptake on bone scintigraphs. Hematopoietic bone marrow was absent in these regions and in the left femur. No infection of the prosthesis was revealed with labeled granulocytes. Results: Avascular necrosis in the left iliac bone was diagnosed, which is a very unusual location. There was no uptake of MIBI in the iliac bones or the femurs. Conclusion: These findings suggest that MIBI may not be a good tool for the evaluation of medullary infiltration by Gaucher's cells.