Bone scintigraphy
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Bone scintigraphy (a.k.a. bone scans) is a nuclear medicine (scintigraphic) study that makes use of technetium-99m (commonly Tc-99m-methylene diphosphonate (MDP)) as the active agent.
The study has three phases whichthat follow the intravenous tracer injection of the tracer. Sometimes a fourth (delayed/delayed) phase is performed.
Clinical indicationsIndications
- malignancy: detection and follow-up of skeletal metastases
- detection of radiographically occult fractures, e.g. stress or insufficiency fractures
- osteomyelitis
- complex regional pain syndrome
- hip joint prosthesis: evaluation for infection or loosening
- Paget disease
Patient preparation
- optimal hydration
- remove metal objects
- void immediately before the study
As 99mTc MDP is renally excreted, reduced renal function can result in poor image quality as the tracer is not cleared effectively from the soft tissues. It is therefore important to optimise renal function and ensure adequate patient hydration.
Tracer dose and route of administration
Tc-99m diphosphonate is administered intravenously, at a dose of 740 Mbq (20 mCi) in adults.
Phases (kinetic modelling)
Flow phase
- 2-to-5 second images are obtained for 60 seconds after injection
- demonstrates perfusion
- characterises blood flow to a particular area
Blood pool phase
- obtained 5 minutes after injection
- demonstrates the blood pool (balance between plasma and interstitium), not the blood flow
- inflammation causes capillary dilatation and increased blood flow
If the study is going to be a triphasic bone scan, a third phase is added.
Delayed phase
- obtained 2-4 hours later
- urinary excretion has decreased the amount of the radionuclide in soft tissue
- mechanism of uptake is not known with certainty, although it has been proposed that the radiotracer attaches to hydroxyapatite crystals (chemisorption) 5
- degree of uptake depends on blood flow and rate of new bone formation
Delayed/delayed
- obtained 24 hours after injection as a static image
See also
-<p><strong>Bone scintigraphy</strong> (a.k.a. <strong>bone scans</strong>) is a nuclear medicine (scintigraphic) study that makes use of technetium-99m (commonly <a href="/articles/technetium-99m-methyl-diphosphonate">Tc-99m-methylene diphosphonate (MDP)</a>) as the active agent.</p><p>The study has three phases which follow intravenous injection of the tracer. Sometimes a fourth (delayed/delayed) phase is performed. </p><h4>Clinical indications</h4><ul>- +<p><strong>Bone scintigraphy</strong> (a.k.a. <strong>bone scans</strong>) is a nuclear medicine (scintigraphic) study that makes use of technetium-99m (commonly <a href="/articles/technetium-99m-methyl-diphosphonate">Tc-99m-methylene diphosphonate (MDP)</a>) as the active agent. The study has three phases that follow the intravenous tracer injection. Sometimes a fourth (delayed/delayed) phase is performed. </p><h4>Indications</h4><ul>
-<li>detection of radiographically occult fractures, e.g. <a href="/articles/stress-fracture-2">stress</a> or <a href="/articles/insufficiency-fracture">insufficiency fractures</a>- +<li>detection of radiographically <a title="Occult fractures" href="/articles/occult-fracture">occult fractures</a>, e.g. <a href="/articles/stress-fracture-2">stress</a> or <a href="/articles/insufficiency-fracture">insufficiency fractures</a>
-<li>hip joint prosthesis: evaluation for infection or <a href="/articles/aseptic-loosening-of-hip-joint-replacements">loosening</a>- +<li>
- +<a title="Complications of hip arthroplasties" href="/articles/complications-of-total-hip-arthroplasty">hip joint prosthesis</a>: evaluation for infection or <a href="/articles/aseptic-loosening-of-hip-joint-replacements">loosening</a>
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