Bone scintigraphy

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Bone scans are a nuclear medicine (scintigraphic) study that makes use of Technetium ⁹⁹m (commonly Tc⁹⁹m-methylene diphosphonate (MDP)) as the active agent.

The study has three phases which follow intravenous injection of the tracer. Sometimes a fourth (delayed/delayed) phase is performed.

Clinical indications

malignancy: detection and follow-up of skeletal metastases
detection of radiographically occult fractures, e.g. stress or insufficiency fractures
osteomyelitis
reflex sympathetic dystrophy
hip joint prosthesis: evaluation for infection or loosening
Paget's disease

Patient preparation

hydration
remove metal objects
void immediately before study

Tracer dose and route of administration

Tc99m diphosphonate is administered intravenously, at a dose of 20 mCi.

Phases

Flow phase

2-to-5 second images are obtained for 60 seconds after injection
demonstrates perfusion and characterises the blood flow to a particular area

Blood pool phase

the blood-pool image is obtained 5 minutes after injection
demonstrates the blood pool, 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

the bone image is obtained 2-4 hours later
urinary excretion has decreased the amount of the radionuclide in soft tissue
mechanism of uptake is not uncertainly known
degree of uptake depends on blood flow and rate of new bone formation

Delayed/delayed

obtained 24 hours after injection as a static image

-<li>detection of radiographically occult fractures, e.g. <a title="Stress fracture" href="/articles/stress-fractures">stress</a> or <a title="Insufficiency fractures" href="/articles/insufficiency-fracture">insufficiency fractures</a>
+<li>detection of radiographically occult fractures, e.g. <a href="/articles/stress-fractures">stress</a> or <a href="/articles/insufficiency-fracture">insufficiency fractures</a>
+<li><a title="Paget's disease of bones" href="/articles/paget-disease-of-bone-2">Paget's disease</a></li>

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