^99mTc-Polyphosphate Bone Imaging in Legg-Perthes Disease

Abstract

99m-Tc--polyphosphate bone imaging was useful in distinguishing Legg-Perthes disease from other childhood hip disorders in 40 patients. In 33 Legg-Perthes patients, imaging provided earlier and more accurate information concerning the extent of the necrotic and revascularization process involving the hip than radiographs alone. This advantage could both facilitate treatment selection and provide a more objective baseline from which to judge treatment results. Preliminary experience also suggests that the technique may offer some insight into the pathogenesis of Legg-Perthes disease.

Transient ischaemia of the proximal femoral epiphysis in the child: Interpretation of bone scintimetry for diagnosis in hip pain

“…Previous investigators have reported normal or diffusely increased scintigraphic uptake in transient synovitis of the hip (Ash et al 1975, Danigelis et al 1975, Fasting et al 1978, Bensahel et al 1983. By contrast, Kloiber et al (1983) reported a series of 19 cases of transient synovitis with decreased PFE scintigraphy in six cases.…”

“…The correlation of the visual and quantitative estimation of PFE-uptake was good in this material (Figure 1). However, in the later stages of LCPD there is an increase in metaphyseal isotope-uptake (Bohr 1973, Danigelis et al 1975, Bensahel et al 1983). In the presence of this activity, due to an optical illusion, the epiphyseal activity may be visually underestimated.…”

“…(Danigelis et al 1975, Fasting et al 1978, Bensahel 1980, Sutherland et al 1980, Tachdjian 1980, LaMont et al 1981. However, this does not apply to the findings in early scintimetry in acute hip pain, where a typical PFE defect is potentially reversible and not followed by radiographic evidence of necrosis or clinical symptoms.…”

“…Departments of Orthopaedic Surgery and 'Diagnostic Radiology, University Hospital, S-22185 Lund, Sweden 99mTc-MPD-scintimetry in the early stages of Legg-Calve-Perthes' disease (LCPD) has revealed a characteristic pattern of defective uptake in the proximal femoral epiphysis (PFE) (Danigelis et al 1975, Fasting et al 1978, Bensahel 1980, Sutherland et al 1980, Tachdjian 1980, LaMont et al 1981, which was faintly displayed by 18-F scintigraphy (Bohr 1973). However the hope of establishing the diagnosis of LCPD by scintimetry in the radiographically silent stage of the condition has been contradicted by reports of cases of hip pain in whom a defective PFE uptake became normal without development of radiographic abnormalities (Sutherland et al 1980, Kloiber et al 1983.…”

Scintigraphic Evaluation of the Severity of Perthes' Disease in the Initial Stage

“…More recently 99mTc-labelled complexes have been the agents of choice in bone scintigraphy. Using 99mTc-pyrophosphate it has been possible to demonstrate a pathological image showing only decreased activity in the very early stage, even before radiological changes OOOl-6470/80/040655-06 $02.50/0 are visible (Danigelis et al 1975, Fasting et al 1978.…”