Bone Scintigraphy Scanning Safety and Necessity for Silent and Multifocal Osteonecrosis in Sickle Cell Disease

Abstract

Sickle cell disease is a congenital autosomal recessive disease. The predominant pathophysiological feature is vaso cclusion, which leads to acute and chronic complications. Multifocal and silent progressive osteonecrosis over the whole skeleton is one of the major complications of this disorder, requiring follow-up, prophylaxis, and treatment. Bone scintigraphy scanning is widely used, relatively inexpensive, well-tolerated, and has an accuracy of over 90%. MRI is the gold standard imaging technique, however, it has a higher specificity than bone scintigraphy, but it may require contrast dye, which could be nephrotoxic, as sickle cell disease nephropathy is a common complication in such patients. For screening purposes and follow-up of bone integrity, a bone scan can detect silent and multifocal osteonecrosis without the need for contrast dye, which makes it a safe and necessary tool for bone complication follow-up before the osteonecrotic asymptomatic joints develop to advance stages without being noticed by the patient.