(99m)Tc-MIBI Whole Body Scan: A Potentially Useful Technique for Evaluating Metabolic Bone Disease.

Metabolic bone disease due to hyperparathyroidism is characterized by increased bone resorption and new bone formation. (99m)Tc- hexakis-2-methoxyisobutylisonitrile ((99m)Tc MIBI) accumulation is controlled by metabolic function and cell viability. To investigate, for the first time, the potential of whole body (99m)Tc MIBI scan for detecting, visually and with the aid of quantitative analysis, bony changes associated with hyperparathyroidism. Eighty-six patients with hyperparathyroidism, referred routinely for parathyroid localization, were included in this case-control prospective study. Each patient was injected with 20-25 mCi of (99m)Tc MIBI. Routine anterior cervico-thoracic images were obtained for parathyroid localization. Two extra whole body images were acquired and assessed visually and by drawing regions of interest over the mandible, sternum, femur, humeri, spine, and the soft tissue adjacent to the bone. The ratios of bone to soft tissue were calculated and compared to ratios drawn in a control group routinely referred for cardiac imaging and injected with (99m)Tc MIBI, after confirming the absence of any bone disease. The visual interpretation of the scans showed 48 patients to have increased bone uptake. Quantitative assessment showed significant difference between the mean ratios of the case and control groups. The Kruskal-Wallis test showed significant agreement between visual and quantitative ratios drawn from delayed right and left femora and left humerus images (P < 0.05). (99m)Tc MIBI whole body imaging is a potentially useful technique for assessing metabolic bone disease associated with hyperparathyroidism. Quantitative analysis helped in confirming the visual findings.

Chronic Recurrent Multifocal Osteomyelitis in Children: A Multidisciplinary Approach is needed to establish a Diagnosis.

Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory disease of unknown cause. In general, CRMO follows a characteristic clinical course and is regarded at present as a distinct entity. It affects bone and occurs predominantly in children and adolescents. The clinical, radiologic and pathologic findings are non-specific. The recognition of this rare entity is often delayed and difficulties in patient management sometimes emerge from its usual protracted course. We present a 6-year-old girl diagnosed with CRMO involving tibia and lumbar vertebra where a multidisciplinary approach was essential in making the diagnosis.