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Collar Osteophytes: A Cause of False-Positive Findings in Bone Scans For Hip Fractures

¹ All authors: Department of Radiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Box 648, Rochester, NY 14642.

View larger version (133K): [in a new window]   Fig. 1A. —72-year-old woman seen at emergency department for acute onset of left hip pain. MR images (not shown) did not indicate fracture. She had hip replacement 6 months later for rapidly progressive osteoarthritis. Frontal radiograph of left hip shows mild superolateral joint space narrowing, and large osteophytes (arrowheads) are present around femoral neck.

View larger version (108K): [in a new window]   Fig. 1B. —72-year-old woman seen at emergency department for acute onset of left hip pain. MR images (not shown) did not indicate fracture. She had hip replacement 6 months later for rapidly progressive osteoarthritis. Technetium-99m bone scan image of pelvis (anterior view) shows linear increased uptake (arrows) around left femoral neck simulating femoral neck fracture.

View larger version (119K): [in a new window]   Fig. 2A. —65-year-old woman who was seen at emergency department for acute exacerbation of hip pain with no history of acute trauma. She is being followed up in rheumatology clinic for osteoarthritis. Lateral radiograph of right hip shows large osteophytes around subcapital area of femoral neck (arrows).

View larger version (109K): [in a new window]   Fig. 2B. —65-year-old woman who was seen at emergency department for acute exacerbation of hip pain with no history of acute trauma. She is being followed up in rheumatology clinic for osteoarthritis. Anterior view of pelvis on technetium-99m bone scan shows band of increased uptake (arrows) across femoral neck that is reminiscent of femoral neck fracture.

View larger version (160K): [in a new window]   Fig. 2C. —65-year-old woman who was seen at emergency department for acute exacerbation of hip pain with no history of acute trauma. She is being followed up in rheumatology clinic for osteoarthritis. CT image shows osteophytes around femoral neck in greater detail.

View larger version (182K): [in a new window]   Fig. 2D. —65-year-old woman who was seen at emergency department for acute exacerbation of hip pain with no history of acute trauma. She is being followed up in rheumatology clinic for osteoarthritis. T1-weighted MR image shows osteophytes (arrows) around femoral neck.

View larger version (166K): [in a new window]   Fig. 2E. —65-year-old woman who was seen at emergency department for acute exacerbation of hip pain with no history of acute trauma. She is being followed up in rheumatology clinic for osteoarthritis. Fat-saturated T2-weighted MR image shows osteophytes (short arrow) around femoral neck. Note large paralabral cyst (long arrow) seen as focus of high signal at lateral aspect of hip.

View larger version (123K): [in a new window]   Fig. 3A. —72-year-old woman with known ostearthritis in right hip who presented to emergency department with acute exacerbation of pain and inability to bear weight on right hip. SPECT images were determined to be compatible with femoral neck fracture. MR images did not show fracture. Patient is still being followed up at our orthopedic clinic for osteoarthritis. Radiograph shows narrowed hip joint space and subchondral acetabular cyst, but no fracture. Note increased new bone along femoral neck.

View larger version (130K): [in a new window]   Fig. 3B. —72-year-old woman with known ostearthritis in right hip who presented to emergency department with acute exacerbation of pain and inability to bear weight on right hip. SPECT images were determined to be compatible with femoral neck fracture. MR images did not show fracture. Patient is still being followed up at our orthopedic clinic for osteoarthritis. Anterior image from technetium-99m bone scan shows increased uptake (arrow) in right femoral neck suggesting fracture. Increased uptake in acetabular roof is due to degenerative change.

View larger version (55K): [in a new window]   Fig. 3C. —72-year-old woman with known ostearthritis in right hip who presented to emergency department with acute exacerbation of pain and inability to bear weight on right hip. SPECT images were determined to be compatible with femoral neck fracture. MR images did not show fracture. Patient is still being followed up at our orthopedic clinic for osteoarthritis. Selected image from series of SPECT images shows band of increased uptake (arrows) across femoral neck.

View larger version (63K): [in a new window]   Fig. 3D. —72-year-old woman with known ostearthritis in right hip who presented to emergency department with acute exacerbation of pain and inability to bear weight on right hip. SPECT images were determined to be compatible with femoral neck fracture. MR images did not show fracture. Patient is still being followed up at our orthopedic clinic for osteoarthritis. Another image from series of SPECT images (four slices from C) reiterates continuous band of increased uptake (arrows) across femoral neck, suggesting uptake traverses depth of femoral neck. This was interpreted as nondisplaced femoral neck fracture.

View larger version (175K): [in a new window]   Fig. 3E. —72-year-old woman with known ostearthritis in right hip who presented to emergency department with acute exacerbation of pain and inability to bear weight on right hip. SPECT images were determined to be compatible with femoral neck fracture. MR images did not show fracture. Patient is still being followed up at our orthopedic clinic for osteoarthritis. Coronal T1-weighted MR image shows osteophytes (arrowhead) in femoral neck. No abnormal signals suggest femoral neck fracture.

View larger version (186K): [in a new window]   Fig. 3F. —72-year-old woman with known ostearthritis in right hip who presented to emergency department with acute exacerbation of pain and inability to bear weight on right hip. SPECT images were determined to be compatible with femoral neck fracture. MR images did not show fracture. Patient is still being followed up at our orthopedic clinic for osteoarthritis. Coronal contrast-enhanced fat-saturated T1-weighted MR image shows enhancing subchondral cysts in acetabular roof (arrows) corresponding to increased uptake on bone scans. T2-weighted MR images (not shown) did not show femoral neck fracture.

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