Bone scintigraphy

Changed by Vikas Shah, 15 Aug 2018

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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 ~~certainly known~~known with certainty
degree of uptake depends on blood flow and rate of new bone formation

Delayed/delayed

obtained 24 hours after injection as a static image

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