Scintigraphic localization of bone lesions during surgery

Abstract

Nuclear medicine provides several methods for increasing the accuracy of surgical removal of bone lesions with focally increased uptake. In this paper, three intraoperative procedures are discussed: remote control by imaging, intraoperative control by imaging, and intraoperative control by scintillation probe. All techniques require preoperative injection of bone imaging tracer. Remote operative control calls for a gamma camera to mark the skin over the lesion prior to surgery, providing optimal preoperative localization and imaging of the excised lesion to ensure complete removal. Intraoperative control procedures require that a portable camera or a scintillation probe be used in the operating room; these permit direct monitoring of localization and resection. Our experience with 18 procedures performed on 15 patients suggests that these techniques are worthy of continued use.

Intraoperative localization of an osteoid-osteoma using a gamma probe

“…Yildiz et al [22] recommended in-block resection of femoral neck and talar osteoid-osteomas due to difficulties in finding the nidus. Intraoperative guides would be mostly indicated in these locations in order to perform an economic resection and avoid complications [1,3,[6][7][8][12][13][14][15].…”

Osteoid osteoma: localization by intraoperative magnification scintigraphy

“…Its use was first reported by Rinski et al in one patient [3] and the technique further modified by Sty and Simmons with three additional patients [4,5]. Both groups and others [6,7] found intraoperative imaging to be useful where preoperative radiographic examinations were normal, as well as in guiding the surgeon to areas of incomplete resection. Our experience confirms the utility of this technique.…”

Intraoperative radioactive localization of small bone tumours

“…Bone scanning with technetium-99m methylene disphosphonate is a well established diagnostic procedure which permits visualization of obscure and small bone lesions [6,11,13,17,18,23,25]. A gamma-camera can be used during operation [21,22] but these cameras are cumbersome for intraoperative use [11] and only demonstrate whether an area of increased uptake has been completely removed or not.…”

“…A gamma-camera can be used during operation [21,22] but these cameras are cumbersome for intraoperative use [11] and only demonstrate whether an area of increased uptake has been completely removed or not. Colton and Hardy designed a portable gamma-ray detection probe for intraoperative use [3].…”

“…The excellent sensitivity of radionuclide bone scanning in localization of osteoid osteoma (Fig. 1 c) proved to be very helpful intraoperatively [4,7,10,11,17,21,22,26]. By preoperative injection of technetium99m methylene diphosphonate and intraoperative detection with a radiation-sensitive probe, connected to a portable scaler rate-metre, scintigraphic localization becomes readily available during surgery.…”