Nuclear Medicine in Musculoskeletal Disorders: Clinical Approach

Looking Beyond the Indication: Bone Scan for Trauma Providing Unsuspected Initial Diagnosis of Acute Critical Lower Limb Arterial Compromise

“…Major factors determining radiotracer uptake in 3-phase bone scintigraphy are local blood flow, extraction efficiency, and osteoblastic activity. Impaired circulation, hydration level, renal function, and age also influence uptake (1,2). A bone scan is a useful adjunct to choose appropriate amputation level by aiding in distinguishing viable from nonviable tissue (3).…”

Skeletal scintigraphy for a patient with a hip fracture

“…A Technetium-99m-labelled diphosphonate tracer is used, which rapidly accumulates in bone following administration [1][2][3]. Radiotracer uptake is dependent on multiple factors including blood flow and bone formation as well as patient hydration, renal function and age [4]. In a single-phase scan, imaging is often delayed beyond 2-h to allow for improved soft tissue clearance and target to background contrast.…”

“…In a single-phase scan, imaging is often delayed beyond 2-h to allow for improved soft tissue clearance and target to background contrast. A triplephase acquisition obtains additional early blood flow and blood pool images to assess hyperaemia and articular permeability respectively [4]. Vascular injuries are a rare postoperative complication following hip replacement surgery, with a reported prevalence of 0.2-0.3% [5].…”

“…Conversely, during chronic ischaemia, collateral blood flow may normalise distal limb radiotracer uptake [8]. Increased radiotracer activity has a wide differential diagnosis and is useful during the evaluation of occult fracture, infection, inflammatory or metastatic diseases [4] as well as rarer conditions of bone avascular necrosis, such as osteochondrosis [9].…”