Aseptic necrosis. A scintigraphic imitator of osseous involvement in Ga-67 avid lymphoma.

Based on the data by Armas et at, avascular necrosis, a not uncommon treatment-associated complication in patients with lymphoma, it should be easily distinguishable from osseous lymphomatous involvement in patients with Ga-67 avid lymphoma. In avascular necrosis, Ga-67 uptake will be either absent, decreased, or normal, whereas in lymphoma Ga-67 uptake will be increased. The authors present a patient with Hodgkin's disease who had new foci of simultaneously increased Ga-67 and Tc-99m MDP uptake because of avascular necrosis as proven by biopsy and long-term follow-up. The authors hypothesize that a possible explanation for the discrepancy between this patient report and the series by Armas et at may be that increased Ga-67 is a delayed phenomenon related to healing.