Osteomyelitis and infarction in sickle cell hemoglobinopathies: differentiation by combined technetium and gallium scintigraphy.

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Abstract
Clinical records and scintigrams were reviewed of 18 patients with sickle cell hemoglobinopathies who had undergone combined Tc and Ga scintigraphy during 22 separate episodes of suspected osseous infection. The combined scintigrams were correctly interpreted as indicating osteomyelitis in 4 studies. 67Ga [as 67Ga citrate] localization was abnormally increased in all of these studies, including 1 where the 99mTc MDP [methylene diphosphonate] bone scan showed decreased activity, another where the bone scan was normal at the site of 67Ga uptake, and 2 where the distribution of 99mTc MDP and 67Ga were incongruent. Of 18 studies in patients with infarction, the combined scintigrams were correctly interpreted in 16 and showed either no local accumulation of 67Ga or less accumulation than that of 99mTc MDP at symptomatic sites. In the other 2 studies, the scintigrams were falsely interpreted as indicating osteomyelitis and showed congruent, increased accumulation of both 99mTc MDP and 67Ga (with the latter of similar or greater intensity). This pattern must be considered indeterminate. The combination of Tc and Ga scintigraphy is an effective means to distinguish osteomyelitis from infarction in patients with sickle cell hemoglobinopathies.