Baseline patterns of bone scintigraphy in patients with established post-poliomyelitis paralysis

Post-poliomyelitis syndrome causes variable musculoskeletal manifestations including pain, muscle weakness and fatigue. These manifestations are commonly secondary to overuse and misuse of muscles and joints and could follow a fall. Bone scan can be useful in determining the underlying cause and follow-up. The objective of this study was to describe the late scintigraphic patterns on bone scan following poliomyelitis.

Bone scans of 8 adult patients (7 female and 1 male), aged 35 to 53 years, who were known to have paralytic poliomyelitis, were retrospectively studied. Six patients had unilateral while 1 had bilateral disease. All patients had three-phase bone scan and 5 had SPECT study as well. Studies were reviewed by two qualified nuclear medicine physicians and findings were recorded and analyzed.

Several patterns were consistently identified: decreased blood pool activity in the affected lower limb of all patients; deformed ipsilateral hemi-pelvis with reduced uptake on the affected side in all patients with unilateral disease; stress changes with increased uptake in the bones of the contra-lateral lower extremity; and degenerative changes in multiple joints (shoulder, knee, hip, ankle and spine). Significant scoliosis was only noted in the patient with bilateral disease.

Scintigraphic patterns on bone scan associated with the post-poliomyelitis syndrome and persistent weakness following a distant episode of poliomyelitis have been described. Awareness of these characteristic scintigraphic findings may facilitate an accurate diagnosis and lead to more appropriate patient management.