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June 25, 1982

Diagnosis of Ischemic Necrosis of the Hip-Reply

JAMA. 1982;247(24):3314. doi:10.1001/jama.1982.03320490017018

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In Reply.—  I would like to make a brief comment on the use of radionuclides in the early diagnosis of avascular necrosis from any cause. There is no consensus on which is the best way to image a femoral head. Dr Easton uses technetium Tc 99m sulfur colloid scanning and gives a reference to one article published in 1977. Although it appears that few other people use this technique, I am grateful that he drew our attention to it. In the two years since I originally wrote my article, nuclear medical techniques have advanced considerably. In our institution we are now using technetium Tc 99m pyrophosphate and taking blood pool types of image using pinhole views immediately after injection as well as taking delayed images. This technique seems to be much more accurate than the previously used techniques in the early diagnosis of avascular necrosis of the femoral head.