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Tracer Accumulation in Femoral Head During Early Phase of Bone Scintigraphy After Renal Transplantation

Departments of Radiology and Orthopaedic Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

Nontraumatic osteonecrosis of the femoral head (ONF) is a complication of renal transplantation. The pathogenic mechanism of ONF is thought to be an ischemic event. The purpose of this study was to investigate whether 3-phase bone scintigraphy can reveal early hemodynamic changes associated with ONF after renal transplantation. Methods: We performed 3-phase bone scintigraphy on 19 renal allograft recipients between 3 and 9 wk after they underwent renal transplantation. Regions of interest (ROI) were assigned bilaterally in the femoral heads, diaphyses, and soft tissue. The head-to-diaphysis ratio (HD) in each phase was then calculated. Results: ONF occurred in 8 femoral heads of 4 patients. Three of the 4 ONF patients had no abnormal MRI findings at the time of bone scintigraphy. In phase 1, no significant difference in HDs was observed between the ONF patients (mean HD ± SD, 0.62 ± 0.44) and the non-ONF patients (0.31 ± 1.40). The difference between the mean counts for bone and soft tissue was small in both instances, and the HD had a large dispersion. In phase 2, the HDs for the ONF patients (0.70 ± 0.27) and the non-ONF patients (1.31 ± 0.43) were significantly different (P = 0.0005). The HD was <1.00 in all femoral heads of the ONF patients, whereas 9 non-ONF heads had an HD that was <1.00. In phase 3, the HD of the ONF patients was significantly lower than that of the non-ONF patients (ONF patients, 0.92 ± 0.17; non-ONF patients, 1.62 ± 0.46; P = 0.0002). Conclusion: All ONF patients were in the group with a low HD in phase 2, suggesting a reduction in blood flow or blood pool. Phase 2 accumulation in 3-phase bone scintigraphy can be used to estimate early hemodynamic changes in patients with ONF after renal transplantation.

Key Words: 3-phase bone scintigraphy • renal transplantation • osteonecrosis