Splenic visualization using 99mTc-methylene diphosphonate in a patient with sickle cell disease

Area of Science:

• Nuclear medicine
• Radiopharmaceuticals
• Pediatric imaging

Background:

• Sickle cell disease (SCD) frequently leads to splenic dysfunction and infarction, a process termed functional auto-splenectomy.
• Standard liver/spleen scans using sulfur colloid may fail to visualize the spleen in advanced SCD.
• Assessing splenic status is crucial for managing SCD complications.

Observation:

• A 15-year-old boy with sickle cell crisis showed splenic uptake of 99mTc-methylene diphosphonate (99mTc-MDP), a bone-seeking agent.
• Simultaneously, there was an absence of splenic uptake on a sulfur colloid liver/spleen scan.
• This discrepancy suggests splenic infarction and calcification.

Findings:

• Splenic visualization with 99mTc-MDP in SCD indicates splenic infarction and calcification.
• This finding may represent splenic tissue not detected by conventional sulfur colloid scans.
• The uptake pattern is likely due to microvascular occlusion and subsequent calcification within the spleen.

Implications:

• 99mTc-MDP splenic visualization offers a sensitive method for monitoring the progression of functional auto-splenectomy in sickle cell disease.
• It can help detect residual splenic tissue when standard scans are negative.
• This technique should be differentiated from skeletal lesions or abdominal masses to avoid misdiagnosis.