Bone scintigraphy

Last revised by Henry Knipe on 19 Sep 2022

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 that follow the intravenous tracer injection. Sometimes a fourth (delayed/delayed) phase is performed. 

  • 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 optimize renal function and ensure adequate patient hydration.

Tc-99m diphosphonate is administered intravenously, at a dose of 740 Mbq (20 mCi) in adults.

  • 2-to-5 second images are obtained for 60 seconds after injection
  • demonstrates perfusion
  • characterizes blood flow to a particular area
  • 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.

  • 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
  • obtained 24 hours after injection as a static image

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Cases and figures

  • Case 1: osteoid osteoma
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  • Case 2: metastases
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  • Case 3: secondary hyperparathyroidism
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  • Case 4: stress fracture
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  • Case 5: calcified hepatic metastases: prostate carcinoma
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  • Case 6: hypertrophic pulmonary osteoarthropathy
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  • Case 7: Paget disease of tibia
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  • Case 8: breast cancer skeletal metastases
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  • Case 9: breast cancer lytic metastasis
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  • Case 10: vertebral compression fracture
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  • Case 11: osteomyelitis
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  • Case 12: osteomyelitis
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  • Case 13: prostate cancer skeletal metatases
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  • Case 14: Paget disease of sternum
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