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May 8, 1981

Osteonecrosis and Scintigraphic Evaluation

Author Affiliations

The University of Texas Health Science Center at San Antonio

JAMA. 1981;245(18):1817. doi:10.1001/jama.1981.03310430011003

To the Editor.—  The article "Osteonecrosis of the Femoral Head During Pregnancy" contributes to the knowledge of this infrequent cause of osteonecrosis. I am, however, concerned that the authors' Fig 2 (the comparative hip scintigram) may have been unwittingly offered as the optimal noninvasive technique for demonstrating osteonecrosis of the hip.Cortical bone-seeking radiopharmaceuticals (one of which was used to generate the image in the cited article) will localize in any osseous site of hyperperfusion or increased osteoblastic activity. Hence, cortical images are extremely sensitive but nonspecific and may represent a broad spectrum of causes. In the early stages of some bone diseases, roentgenographic studies may not detect, let alone differentiate, these disorders, eg, osteomyelitis, stress fracture, and osteonecrosis. In medullary osteonecrosis, cortical imaging may demonstrate either increased or decreased activity depending on the combination of vessels that are occluded.1 Thus, the cortical image shown in the article is