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Scintigraphic assessments of the reparative process in osteonecrosis of the femoral head using SPECT/CT with 99mTc hydroxymethylene diphosphonate

Motomura, Goroa; Yamamoto, Takuakia; Abe, Koichirob; Nakashima, Yasuharua; Ohishi, Masanobua; Hamai, Satoshia; Doi, Toshioc; Honda, Hiroshib; Iwamoto, Yukihidea

doi: 10.1097/MNM.0000000000000166
Original Articles

Objective The aim of the study was to assess the degree and location of the reparative process in early osteonecrosis of the femoral head on the basis of single-photon emission computed tomography/computed tomography (SPECT/CT) with technetium-99m hydroxymethylene diphosphonate.

Materials and methods This study was approved by the institutional review board. We retrospectively evaluated SPECT/CT scans of 23 consecutive hips. On the basis of the classification system used, 12 hips were classified as stage 1 (no radiographic abnormality), six hips as stage 2 (demarcating sclerosis without femoral head collapse), and five hips as stage 3A (<3 mm femoral head collapse). In each femoral head, the area with the maximum uptake count was defined as the region of maximum uptake. The degree of maximum uptake was assessed by the count ratio, which was defined as the maximum count within the femoral head divided by the mean uptake count of the cross-sectional region of the ipsilateral femur at the level of the distal end of the lesser trochanter.

Results In stage 1, the maximum uptake count tended to occur in the anterior region of the femoral head. Meanwhile, in both stage 2 and stage 3A, the maximum uptake count was more likely to be observed in the lateral region. The mean count ratio of stage 2 was significantly higher than that of stage 1.

Conclusion We speculate that osteoblastic activity in the precollapsed stage may gradually increase around the necrotic lesion, with a tendency to advance toward the lateral region of the femoral head.

Departments of aOrthopaedic Surgery

bClinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka

cDepartment of Orthopaedic Surgery, Kyushu University Beppu Hospital, Oita, Japan

Data presented previously at Radiological Society of North America 99th Scientific Assembly and Annual Meeting and published as an abstract in

Correspondence to Goro Motomura, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan Tel: +81 92 642 5488; fax: +81 92 642 5507; e-mail:

Received December 11, 2013

Accepted June 9, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins