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Scan Detection of Bone Marrow Infarcts in Sickle Cell Disorders

Abass Alavi, James P. Bond^*, David E. Kuhl and Richard H. Creech

University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Correspondence: For reprints contact: A. Alavi, Dept. of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa. 19104.

ABSTRACT

Bone marrow infarction is a common complication of sickle cell crisis, yet is seldom proved before autopsy. Bone marrow scanning now provides an atraumatic method of earlier confirmation. We have studied 29 patients with sickle cell disorders using scans of ^99mTc-sulfur colloid to demonstrate the distribution of reticuloendothelial activity within the bone marrow. All patients with S-S pattern showed increased marrow activity with expansion to the long bones and skull. Patients with S-C and S-Thal had less expansion of the marrow. Three groups of patients were studied. Group 1 was scanned while asymptomatic and had no crises during this study. In 8 out of 17 patients in this group, regions of decreased marrow uptake were noted which were considered due to previous infarction with subsequent fibrosis.

Group 2 was comprised of two patients who were scanned while asymptomatic and then during crisis. These scans showed no change from the previous baseline studies. We interpreted this to indicate that no infarcts had occurred during crisis.

Group 3 patients were scanned first during crises and then at subsequent intervals. Six out of ten patients in this group had areas of decreased activity on bone marrow scans corresponding to focal pain in the same area which were thought to suggest bone marrow infarction. Four of these patients repopulated their marrow in 3, 4, 6, and 12 months. One case is reported in detail. We conclude that the bone marrow scan is useful for detecting the presence of bone marrow infarction and in following the course of healing and complications.

FOOTNOTES

^* Present address: Dept. of Medicine, Bryn Mawr Hospital, Bryn Mawr, Pa.

Present address: Oncologic Hospital, Philadelphia, Pa.

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