Radionuclide Bone Imaging: An Illustrative Review

Abstract

Bone scintigraphy with technetium-99m-labeled diphosphonates is one of the most frequently performed of all radionuclide procedures. Radionuclide bone imaging is not specific, but its excellent sensitivity makes it useful in screening for many pathologic conditions. Moreover, some conditions that are not clearly depicted on anatomic images can be diagnosed with bone scintigraphy. Bone metastases usually appear as multiple foci of increased activity, although they occasionally manifest as areas of decreased uptake. Traumatic processes can often be detected, even when radiographic findings are negative. Most fractures are scintigraphically detectable within 24 hours, although in elderly patients with osteopenia, further imaging at a later time is sometimes indicated. Athletic individuals are prone to musculoskeletal trauma, and radionuclide bone imaging is useful for identifying pathologic conditions such as plantar fasciitis, stress fractures, "shin splints," and spondylolysis, for which radiographs may be nondiagnostic. A combination of focal hyperperfusion, focal hyperemia, and focally increased bone uptake is virtually diagnostic for osteomyelitis in patients with nonviolated bone. Bone scintigraphy is also useful for evaluating disease extent in Paget disease and for localizing avascular necrosis in patients with negative radiographs. Radionuclide bone imaging will likely remain a popular and important imaging modality for years to come.

Preparation and evaluation of a radiogallium complex-conjugated bisphosphonate as a bone scintigraphy agent

“…Over the last thirty years, complexes of 99m Tc with bisphosphonate, such as methylene diphosphonate ( 99m Tc-MDP) and hydroxymethylene diphosphonate ( 99m Tc-HMDP), have been widely used as radiopharmaceuticals for the imaging of bone disorders such as metastatic bone disease, Paget's disease, osteoporotic fractures, etc [1][2][3][4].…”

11C-Acetate-PET/CT Compared to 99mTc-HDP Bone Scintigraphy in Primary Staging of High-risk Prostate Cancer

“…BS is the current standard method for diagnosing bone metastases in PC (15). In our study, ACE-PET/CT gave a superior detection rate of suspected bone metastases in highrisk PC compared to planar BS.…”

Metabolic Bone Disease and Bariatric Surgery

“…Dual-Energy X-ray Absorptiometry (DEXA) is also useful and frequently shows reduced Bone Mineral Density (BMD) throughout the skeleton, reflecting the osteopaenia seen in plain radiographs. Radionuclide uptake displays more widespread patterns; these can be diffuse (a super scan) or be discrete (hotspots) [22,25]. However, these changes can frequently be mistaken for metastatic disease, limiting its use in isolation [24,26].…”