Comparison of bone scan and radiograph sensitivity in the detection of steroid-induced ischemic necrosis of bone.

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Abstract
A prospective study of bone scanning for detection of ischemic necrosis of bone (INB) was performed in 36 patients (97% female, age range from 16-36 yr) with systemic lupus erythematosis (SLE). Since the hips, knees and shoulders are usually affected by INB in patients with SLE, 300 K converging collimator images of these joints were obtained on film and in digital format 2-3 h after the injection of 20 mCi (740 MBq) of 99mTc methylene diphosphonate. All patients underwent radiography of the joints, and 10 had intraosseous pressure determinations in the marrow space of affected joints (no. = 31) for independent assessment of INB. Scans showed abnormally increased joint activity in 28 of the 36 patients. A total of 97 joints showed abnormalities, 19% in the hips, 34% in the knees and 47% in the shoulders. Of 27 joints with elevated bone marrow pressure (BMP), 24 had abnormal scans (sensitivity = 89%), and scans were abnormal in 2 of 4 joints with normal pressures (specificity = 50%). The positive predictive value of the scans compared with BMP measurements was 92% (24/26). Of 27 joints with abnormal BMP, 11 had abnormal radiographs, a sensitivity of 41%.