Vascular Bone Disorders

Vascularity-related bone disorders of scinti-graphic interest include avascular necrosis, infarction, dysbaric necrosis, hyperemic or congestive osteoporosis, congestive periostitis, and periostitis in Burger's disease. 99mTc-MDP bone scintigraphy augmented with nuclear angiography and pinhole scanning appears to be the method of choice for dynamic biochemical study of these vascularity-related bone disorders because it is not only sensitive and often specific but also noninvasive, holistic, and easily repeatable in a day or two if necessary. In particular, pinhole bone scanning is highly valued for its ability to detect avascularity before radiography, and to subsequently assess the clinical course to revascularization (Fig. 14.1). On the other hand, nuclear angiography can diagnose regional osteoporosis or osteopenia that is related to hyperperfusion, hypoxia periostitis in Burger's disease, and chronic venous congestion.

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