Bone Marrow and Bone Mineral Scintigraphic Studies in Sickle Cell Disease

S ummary . Using discriminating radioisotopic techniques, a consistent pattern of abnormalities of both bone marrow and mineral was demonstrated in a series of patients with acute bone pain of sickle cell disease in which no roentgenographic evidence of infarction or infection was present. Bone scans utilizing reticulo-endothelial uptake of ^99mTc sulphur colloid showed discrete lesions of decreased radioisotopic localization in regions of acute pain suggesting decreased marrow blood flow. In these same areas, ⁸⁵Sr bone scans showed markedly increased uptake whereas ¹⁸F bone scans showed little or no alteration. The strontium findings are consistent with accelerated calcium turnover while the fluorine studies suggest that bone blood flow, in contrast to marrow blood flow, remains nearly normal. In one patient, ⁵²Fe positron scans confirmed an absence of effective erythropoiesis in those areas of involvement demonstrated by ^99mTc and ⁸⁵Sr. Marrow aspiration from one such area demonstrated sterile necrotic bone. These studies demonstrate that acute bone pain of sickle cell disease is associated with bone marrow death and increased bone mineral turnover.