Bone scintigraphy: procedure guidelines for tumour imaging (original) (raw)
2003
A. Bone scintigraphy is a diagnostic study used to evaluate the distribution of active bone formation in the body. B. Whole-body bone scintigraphy produces planar images of the skeleton, including anterior and posterior views of the axial skeleton. Anterior and/or posterior views of the appendicular skeleton also are obtained. Additional views are obtained as needed. C. Limited bone scintigraphy records images of only a portion of the skeleton. D. Bone single-photon emission computed tomography (SPECT) produces a tomographic image of a portion of the skeleton. E. Multiphase bone scintigraphy usually includes blood flow images, immediate images, and delayed images. The blood flow images are a dynamic sequence of planar images of the area of greatest interest obtained as the tracer is injected. The immediate (blood pool or soft tissue phase) images include 1 or more static planar images of the areas of interest, obtained immediately after the flow portion of the study and completed wi...
The EANM practice guidelines for bone scintigraphy
European journal of nuclear medicine and molecular imaging, 2016
The radionuclide bone scan is the cornerstone of skeletal nuclear medicine imaging. Bone scintigraphy is a highly sensitive diagnostic nuclear medicine imaging technique that uses a radiotracer to evaluate the distribution of active bone formation in the skeleton related to malignant and benign disease, as well as physiological processes. The European Association of Nuclear Medicine (EANM) has written and approved these guidelines to promote the use of nuclear medicine procedures of high quality. The present guidelines offer assistance to nuclear medicine practitioners in optimizing the diagnostic procedure and interpreting bone scintigraphy. These guidelines describe the protocols that are currently accepted and used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patien...
Clinical uses of bone scanning
Skeletal Radiology, 1977
The skeleton is a frequent site of metastatic disease, Radiographic examination is not sufficiently reliable in early detection since an abnormality is unlikely to be observed until more than 50% of the bone material has been lost. Therefore, skeletal scanning represents a viable technique for demonstration of dynamic response of bone to tumor invasion. This technique provides a more sensitive method for detection of early skeletal metastatic disease. Technetium 99m labeled methylenediphosphonate seems to be the best technetium 99m labeled agent for skeletal images, although ethyline hydroxydiphosphonate may be equally good. The toxicity of the compounds is low and repetitive studies can be done for continued clinical evaluation of the patient without significant risk.
Observer variation in the interpretation of bone scintigraphy
Journal of Clinical Epidemiology, 1996
To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent K values were obtained for inter-and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, K values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.
Diagnostic bone scanning in oncology
Seminars in Nuclear Medicine, 1997
Over the last several decades bone scanning has been used extensively in the evaluation of oncology patients to detect bone involvement. It can provide information about disease location, prognosis, and the effect of therapy. Bone scanning offers the advantages of whole body evaluation and the detection of lesions earlier than other techniques. However, as newer diagnostic tools become available, indications for bone scanning must be revised and the results combined with these other tests in order to provide optimum patient care. Advances in instrumentation and the subsequent improvement in image quality have allowed nuclear medicine physicians to provide more accurate bone scan interpretations. By optimizing image acquisition, it is often possible to determine lesion characteristics, which are more likely to represent malignancy. Knowledge of disease psthophysiology and other specific properties of the patient's primary tumor, along with subsequent correlation of scan abnormalities to patient history, physical examination, previous studies, and other radiological examinations, is essential for determining lesion significance. The differential diagnosis of a scan abnormality should also include consideration of both false normal and abnormal causes. The final interpretation should be clearly communicated to the clinician with appropriate recommendations for further evaluation. Only through careful attention to the patient, the clinician, and appropriate study acquisition parameters will bone scanning maintain its place in the evaluation of oncology patients.
The quarterly journal of nuclear medicine : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), 2001
Skeletal metastases are one of the major clinical problems for the oncologist. Over the last several decades bone scintigraphy has been used extensively in detecting bone involvement since it can provide information about disease location, prognosis and the effectiveness of treatment. Bone scan offers the advantage of total body examination, and images bone lesions earlier than other techniques. In this paper the main clinical problems related to the most common applications of bone scan in breast, prostate, lung cancer and other tumours are discussed. The experience carried out at the National Cancer Institute of Milan by using bone SPECT to detect single bone metastases is reported. One hundred and eighteen patients with bone metastases (from different tumour types: breast, lung, prostate, lymphomas, etc.) were studied by planar scintigraphy, SPECT and other radiological modalities (CT, MRI or X-rays). The overall performances of bone SPECT were sensitivity: 90.5% (19/21), specifi...
Clinical Nuclear Medicine, 1998
Seventy-seven adult patients with suspected skeletal metastases were divided into two groups. In group A (n=30), following intravenous administration of 20 mCi (740 MBq) of technetium-99m methylene diphosphonate (99mTc-MDP), 3-and 24-h scintigraphy of bone lesions was performed. The 24/3 h lesion to bone background radiouptake ratio (RUR) was calculated for each lesion. In group B (n=47), the same procedure was followed with dexamethasone intervention (10 mg in 24 h) following the 3-h acquisition. In group A, after determination of the critical point, malignant and degenerative bone lesions could be separated with a sensitivity, specificity and accuracy of 0.76, 0.72 and 0.73, respectively. The mean RUR of the malignant lesions was 1.20+ 0.23, and that of the benign lesions, 0.95+ 0.15. In group B cases, significantly increased sensitivity, specificity and accuracy of 0.87, 0.94 and 0.92, respectively, were found (P<0.001). The mean RUR of the malignant lesions was 1.48+ 0.34, and that of degenerative lesions, 0.88_+ 0.19. Dexamethasone interventional bone scintigraphy seems to be a new cost-effective method for differentiating malignant from degenerative bone lesions using the RUR.
Nuclear medicine in primary bone tumors
European Journal of Radiology, 1998
Introduction: Conventional radiography is the method of choice to diagnose a primary bone tumor but in many cases it is necessary to integrate it with nuclear medicine scintigraphy using several radionuclides, including 67 Ga, 201 Tl, 99m Tc-MIBI and especially 99m Tc-diphosphonates. Recently a new technique has been recently introduced, that is positron emission tomography with 2(18 F) fluoro-2 deoxy-D-glucose as radiopharmaceutical. Objective: The specific purpose of this work is to show that nuclear medicine bone scanning is a very important method in the detection and diagnostic management of primary bone tumors. Diagnosis, staging and follow-up: Three-phase bone scintigraphy, integrated with SPECT, is clinically useful to confirm the radiologic diagnosis of bone tumor. These techniques conveniently related to each other and to radiographic findings, can evaluate the tumor's local aggressiveness, often differentiating benign from malignant lesions, to monitor treatment efficacy, to permit total body scanning for the detection of recurrences. Nuclear medicine diagnostic techniques are not in competition with radiographic tools as CT and MRI which are highly sensitive in detecting even small lesions thanks to their excellent anatomical resolution. In questionable cases, we can integrate radiologic imaging with dynamic studies, in particular with FDG-PET, increasing the specificity of diagnosis and permitting more accurate follow-up. Conclusions: Patient management optimization needs the integration between dynamic nuclear medicine findings and the anatomical patterns provided by conventional radiology to increase imaging sensitivity and specificity. Equipe work is determinant to customize the diagnostic work-up to the individual patient's needs to reduce the cost of patient management avoiding useless examinations.
SNMMI Procedure Standard for Bone Scintigraphy 4.0
Journal of nuclear medicine technology, 2018
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. Its 18,000 members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. In addition to publishing journals, newsletters, and books, the SNMMI also sponsors international meetings and workshops designed to increase the competencies of nuclear medicine practitioners and to promote new advances in the science of nuclear medicine. The SNMMI will periodically define new standards/ guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Since February 2014, the SNMMI guidelines have been referred...
The clinical significance of skeletal scintigraphy in the management of carcinoma
European Journal of Cancer (1965), 1977
The majority of skeletal metastases originate via localization in the bone marrow. A study of the various 99 T~ polyphesfate complexes available for skeletal .~dntigraphy suggests that the use of short chain polyphosphates with a significant bone marrow uptake is advantageous in detecting skeletal metastases at an early stage.
Radionuclide Bone Scintigraphy: An Interesting Case Report
Bangladesh Journal of Nuclear Medicine, 2015
It is well established that Technetium 99m methylene diphosphonate (Tc 99m MDP) whole body bone scintigraphy (WBBS) can demonstrate multiple lesions with increased radiotracer concentration in involved bone. But it is hard to differentiate multiple benign osteolytic lesions from disseminated bone metastases. Even combined with medical history and multiple imaging results, clinical diagnosis of metastatic lesion remains a challenge. This can affect the treatment procedure. Here the role of skeletal scintigraphy in a case of eosinophilic granuloma is evaluated and concluded that additional attention should be given before diagnosing any case as bone metastases.
Current state of bone scintigraphy protocols and practice in Japan
Asia Oceania journal of nuclear medicine & biology, 2020
Objectives Nuclear medicine technologists in Japan often perform additional single-photon emission computed tomography (SPECT) with or without computed tomography (CT) after whole-body imaging for bone scintigraphy. In this study, we wanted to identify the bone scanning protocols used in Japan, together with the current clinical practices. Methods The study was conducted between October and December 2017. We created a web survey that was hosted by the Japanese Society of Radiological Technology. The questionnaire included 12 items regarding the demographics of the responders, their scan protocols, and the imaging added to, or omitted from, routine protocols. Results In total, 228 eligible responses were collected from participants with a mean of 11.6±8.4 years' experience in nuclear medicine examination. All responders reported using routine scan protocols that included whole-body imaging. However, only 2%, 4%, 20%, and 14% of the responders also acquired single-field SPECT, sin...
Revista Española de Medicina Nuclear (English Edition), 2007
To determine the percentage of bone scintigraphy examinations (BS) requested according to established indications and to assess the clinical impact of the scintigraphic results. Materials and methods. A retrospective study was performed including BS in 117 patients (70 women and 47 men) carried out in our department during the year 2001. All patients had a primary extraosseous malignancy. The correctness of the indication of each study requested was analyzed according to established criteria from the literature. BS results were classified as positive, negative, and equivocal for metastatic disease. Results. 96 out of the 117 BS were performed in patients affected with the most prevalent primary malignancies: breast (57), prostate (21), and lung (18). The remaining studies were included in a miscellaneous group (gynecological [3], colorectal [4], oropharyngeal [4], and renal malignancies [4]; lymphoma [2], melanoma [2], hemangioendothelioma [1]; and cancer of the bladder [1] or pancreas [1]). Ninety-nine (85%) of the 117 BS performed met the criteria for appropriate indication. The indication was correct in 75% of breast, 90% of prostate (19/21), and 100% of lung cancers. The indication was correct in 90% of the cases in the miscellaneous group. BS were positive in 21 patients (20 of which were confirmed). BS were equivocal in 24 patients (in 5 of whom bone metastases were confirmed). BS were negative in 72 patients (one of whom had bone metastases). The BS findings changed staging in 9 % (9/99) of the correctly indicated cases. Conclusion. Most BS (85%) were indicated according to the established criteria and the clinical impact was greater in this group.
Bone and marrow imaging: do we know what we seeand do we see what we want to know?
European Journal of Nuclear Medicine and Molecular Imaging, 2007
remind us that [ 18 F] fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scintigraphy (BS) provide different information and this is the reason why skeletal scintigraphy detects metastatic skeletal involvement later than FDG-PET . In fact, FDG-PET detects metastases located in the bone marrow, while bone scintigraphy depicts the osteoblastic reaction. Indeed, the skeletal regions where red marrow is distributed are also the most common locations for the spread of cancer cells as eventually seen by BS. The authors remark that bone marrow is the primary site for the initial metastasis and should therefore be the main focus when assessing skeletal disease and that in the twenty-first century we should start emphasising the concept that the bone marrow rather than the bone is the primary location for cancer spread. They point out the possibility of distinguishing between bone marrow metastases with FDG-PET and reactions to pathological fractures with BS in patients with cancer, as well as the added value of tomography endowed with a higher spatial resolution than planar scintigraphy. Furthermore, they observe that response to therapy can be best evaluated by assessing disease activity in the marrow space, which is the primary location for metastatic lesions from lung cancer, melanoma and breast cancer. They also point out that osteolytic lesions (including those due to multiple myeloma), which are commonly missed by bone scintigraphy because of the lack of osteoblastic reaction, will be readily detected by FDG-PET. In contrast, osteoblastic metastasis from slowly growing tumours, such as prostate and thyroid cancer, should be assessed with radiolabelled amino acids and other PET tracers. Finally, it is worth noting that whereas BS depicts exclusively the diffusion of the disease in the bones, FDG-PET provides information on the possible metastatic involvement of any body part.
Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2005
Detection of bone involvement is essential for optimal therapy of oncologic patients. The purpose of imaging is to identify early bone involvement, to determine the full extent of the skeletal disease, to assess the presence of accompanying complications-such as fractures and cord compression-and to monitor response to therapy. Detection of bone involvement by various imaging modalities is based on either direct visualization of tumor infiltration or detection of the reaction of bone to the malignant process. MRI can identify early involvement of bone marrow. CT, which depends mainly on bone destruction, provides detailed bone morphology. In nuclear medicine, uptake of (18)F-FDG is directly into tumor cells, thus allowing for early detection and monitoring the response to therapy of tumor sites in the marrow, bone, and soft tissue, whereas increased uptake of (18)F-fluoride and (99m)Tc-methylene diphosphonate reflects the osteoblastic reaction of bone to the presence of tumor cells....