The Influence of Differences in Hydration on Bone-to-Soft Tissue Ratios and Image Quality in Bone Scintigraphy

Abstract

This prospective study evaluated the effects of different amounts of fluid intake on the bone-to-soft tissue (B:ST) ratio and image quality of bone scans performed using Tc-99m MDP. One hundred sixty patients with no renal disease were divided into three groups with different degrees of hydration in liters (group 1, 0.25 I; group 2, 1 I; group 3, 1.5 I), and image quality was assessed with a semiquantitative score. The B:ST ratio was calculated over the femoral diaphysis and adductor area, respectively. No significant differences in the B:ST ratio or image quality were demonstrated in all three patient groups with median values of 1.90 (group 1), 1.93 (group 2), and 1.84 (group 3). A filled urinary bladder was associated with greater fluid intake. The B:ST and image quality were correlated directly with the postinjection time interval and inversely with age. When patients drink a large volume of fluid, B:ST ratios do not necessarily increase and bone scintigraphy image quality does not improve.

Evaluation and optimization of administered activity, scanning parameters and hydration at 99mTc hydroxymethylene diphosphonate adult whole‐body bone imaging

“…() and Klementz et al . (); there was no improvement of bone soft‐tissue contrast and image quality in well‐hydrated patients which is in concordance with our study. Ferreira et al .…”

“…In this group, the hydration reduces the activity in the background and preserves it in the skeleton, which gives a comparable image quality with a reduced effective dose to the patient. In two published studies by Cronhjort et al (1997) and Klementz et al (1999); there was no improvement of bone soft-tissue contrast and image quality in well-hydrated patients which is in concordance with our study. Ferreira et al (2009) found, however, an improvement of bone-to-soft-tissue ratio in a published abstract.…”

“…A high fluid intake also has an importance to reduce the absorbed or effective dose to the patient through faster and more frequent bladder emptying. To the best of our knowledge, there are only a few older studies to test this hypothesis (Cronhjort et al, 1994(Cronhjort et al, , 1997Klementz et al, 1999;Ferreira et al, 2009). These studies showed dissimilar results.…”

Furosemide administration onehour before bone scintigraphy examination in horses does not improve the image quality or reduce the radiation dose rate

“…Variation in this ratio is a well‐known dilemma and in practice, considerable deviations in image quality are accepted 5 . The B:S ratio increases with time post radiolabeled bisphosphonate administration due to increase the bone uptake and wash‐out of the extracellular activity through urinary excretion 6,7 . In humans, it has been estimated circa 34% of the 99m Tc‐diphosphonate 4 h post injection remains unbounded 2 .…”

The impact of different bone tracers and acquisition times on image quality of equine bone scintigraphy

“…However, many studies reject this theory. 23,24 The renal function of the included horses was not assessed. For this reason, we cannot exclude subclinical renal dysfunction, which may influence the urinary extraction of 99m Tc-disphosphonates.…”