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. 2015 Dec 6;47(2):241-5.
doi: 10.1016/S2255-4971(15)30093-8. eCollection 2012 Mar-Apr.

THE BONE SCINTIGRAPHY AS A COMPLEMENTARY EXAM IN THE DIAGNOSIS OF THE AVASCULAR NECROSIS OF THE SESAMOID

Carlyle Marques Barral  1 , Arnóbio Moreira Félix  2 , Leonardo Neuenschwander Magalhães  3 , Luciana Araújo Carvalho  1 , Fernando Santana Machado  4
Affiliations

THE BONE SCINTIGRAPHY AS A COMPLEMENTARY EXAM IN THE DIAGNOSIS OF THE AVASCULAR NECROSIS OF THE SESAMOID

Carlyle Marques Barral et al. Rev Bras Ortop. .

Abstract

Objective: This study aimed to present seven cases of avascular necrosis of the sesamoid and report the role of bone scintigraphy in the diagnosis of these patients.

Methods: Seven patients with clinical suspicion of avascular necrosis of the sesamoid underwent three-phase bone scintigraphy with 30 mCi of (99m)Tc-MDP.

Results: Most of the patients were young female adults with complaints of limiting pain in the forefoot, who were making use of inappropriate footwear and/or had a history of injury with or without fracture. There was no predominance of either of the feet or between the femoral or tibial sesamoid. Two patients (28.57%) had a bipartite tibial sesamoid and one (14.29%) had splitting of the tibial and fibular sesamoids. In 100% of the patients, three-phase bone scintigraphy, combined with other propaedeutic methods, proved to be crucial for the diagnosis. The initial procedure in all cases was conservative. In four cases (57.14%), there was no remission of symptoms, and surgical excision of the necrotized sesamoid tissue was performed. In all the patients, the therapy used was effective, with complete remission of symptoms, without complications or deformities of the forefoot.

Conclusions: Three-phase bone scintigraphy becomes a cornerstone of the propaedeutics when avascular necrosis of the sesamoid is suspected, through contributing towards early and accurate diagnosis and enabling allowing appropriate specialized treatment.

Keywords: Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate.

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Figures

Figure 1
Figure 1
Images of blood flow in the feet in anterior and posterior projections, showing slightly increased flow in the projection of the medial bone of the right metatarsal.
Figure 2
Figure 2
Images at equilibrium (vascular permeability) with the feet in anterior, posterior and plantar projections of the medial sesamoid of the right metatarsal.
Figure 3
Figure 3
Late-stage images of the whole body and static images of the feet in anterior, posterior and plantar projections, showing heterogenous distribution of the radiopharmaceutical, with focal high uptake of the drug in the medial sesamoid of the right metatarsal.
See this image and copyright information in PMC

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