Young Population Attending for Whole Body Technetium 99MDP Bone Scintigraphy: A Single Institution Experience (original) (raw)
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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.
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.
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.
Correlation Study between Skeletal Scintigraphy and CT Scan in Diagnosing Bone Metastases
A retrospective study for 98 patient suspected to bone scan at department of radiology take place, to find out which imaging modality is more sensitive between computed tomography (CT) and bone scan; age group of patient was from 1 year to 90 year, the highest Site of Metastases for both Bone scan & CT was at vertebra with 31%, and the positive finding was also 31% for bone scan, while for CT the highest Site of Metastases was at forearm with 34%, and the sensitivity for CT was 44%, and 56% for bone scan. The study recommends that patients with bone metastases are kindly recommended to bone scan investigation rather than CT scan.
Rationale for the use of bone scans in selected metastatic and primary bone tumors
Seminars in Nuclear Medicine, 1978
Since the introduction of bone scans in 1951, there have been many studies comparing biologic and physical characteristics of new bone-imaging agents and the results of scintigraphy and radiology in large numbers of patients. Relatively speaking, there have been fewer studies detailing the health benefits and financial cost associated with the use of skeletal scintigraphy. This review concerns these aspects in patients with malignancies of various sites and stages. About 2% of patients with stage I or II breast cancer have bone metastases at the time they first present, whereas nearly 28% of patients with stage III disease have bone metastases. A large percentage of patients with initially negative scans develop bone metastases during the first 3-4 yr; many of them develop them within the first 12-18 mo after initial diagnosis, For patients with lung cancer, the use of bone scans in staging their disease is somewhat controversial. Several studies indicate that the yield of positive bone scans may range from as low as 2% to as high as 35%. Data on the use of bone scans in staging prostatic cancer initially are similar to those in patients with breast cancer, that is, yields of 7% in patients with stage I or II disease and a yield of about 20% with stage III disease. Children with osteosarcoma or Ewing's sarcoma rarely have bone disease distant from the site of their primary bone lesion at presentation. However, a large percentage of them (30%-40% or so) develop bone metastases during the follow-up period. As in the case with patients with breast cancer, about half of these bone metastases are evident by 12-18 too.
Value of bone scanning in neoplastic disease
Seminars in Nuclear Medicine, 1984
This article reviews recent literature on a variety of primary and secondary bone tumors in an attempt to indicate the use of bone scans in the peri-and posttreatment phases. The data indicate that the yields and value of bone scans are tumor specific and that for some tumors (particularly breast and pros-T HE DETECTION of malignant bone disease has been of interest and concern to physicians for nearly 100 years. More recently, the concern has heightened because of the rising incidence of cancer in this country. In 1983 there will be an estimated 855,000 new cancers and 440,000 deaths from cancer] New cancers of the breast, colon/rectum, and uterus are the most common in women, and cancers of the lung, colon/rectum, and prostate are the most common in men. This fact coupled with increasing financial pressures to optimize the use of diagnostic resources has led third party payers to scrutinize the use of many radiologic procedures and radiologists and oncologists to look systematically at the benefits of a variety of staging procedures. Much information has been obtained since Treadwell and coworkers first explored the use of radiotracers for studying the metabolism of metastatic bone disease, 2 and since Lusted proposed the first formalism for evaluating the information content and the impact of diagnostic tests) This article will review briefly basic facts about bone metastases and will then summarize data on the usefulness of bone scans in several tumors. It is based, in part, on three previous review articles. 4 6 DISTRIBUTION OF METASTASES The maximum percentage of patients having bone metastases that can be detected either initially or during the follow-up of a malignancy is generally no greater than the percentage found at autopsy. For the most common tumors, the percentage of patients with metastases at autopsy is high (Table 1).7-9 Nearly 80% of all metastatic lesions discovered during life are in the central skeleton, 28% in the ribs and sternum, 39% in the vertebrae, and 12% in the pelvis] ~ Only 10% are in the cranium, and a similar percentage is in the long tate) interpretation of studies on patients undergoing hormonal or chemotherapy can be complicated by the "flare phenomenon," Data are still needed on the rate of development of bone metastases in the follow-up period on a stage-specific and therapyspecific basis.
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.
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.
Accuracy of plain radiographs in diagnosing biopsy-proven malignant bone lesions
South African Journal of Radiology
Background: The diagnosis of primary bone tumours is a threefold approach based on a combination of clinical, radiological and histopathological findings. Radiographs form an integral part in the initial diagnosis, staging and treatment planning for the management of aggressive/malignant bone lesions. Few studies have been performed where the radiologist's interpretation of radiographs is compared with the histopathological diagnosis. Objectives: The study aimed to determine the frequency of bone tumours at a tertiary hospital in South Africa, and, using a systematic approach, to determine the sensitivity and specificity of radiograph interpretation in the diagnosis of aggressive bone lesions, correlating with histopathology. We also determined the inter-observer agreement in radiograph interpretation, calculated the positive and negative predictive values for aggressive/malignant bone tumours and computed the cumulative effect of multiple radiological signs to determine the yield for malignant bone tumours. Method: A retrospective, descriptive and correlational study was performed, reviewing the histopathological reports of all biopsies performed on suspected aggressive bone lesions during a 3-year period from 2012 to 2014. The radiographs were interpreted by three radiologists using predetermined criteria. The sensitivity and specificity of the readers' interpretation of the radiograph as 'benign/non-aggressive' or 'aggressive/malignant' were calculated against the histology, and the inter-rater agreement of the readers was computed using the Fleiss kappa values. Results: Of the 88 suspected 'aggressive or malignant' bone tumours that fulfilled the inclusion criteria, 43 were infective or malignant and 45 were benign lesions at histology. Reader sensitivity in the diagnosis of malignancy/infective bone lesions ranged from 93% to 98% with a specificity of 53%-73%. The average kappa value of 0.43 showed moderate agreement between radiological interpretation and final histology results. The four radiological signs with the highest positive predictive values were an ill-defined border, wide zone of transition, cortical destruction and malignant periosteal reaction. The presence of all four signs on radiography had a 100% yield for a malignant bone tumour or infective lesion. Conclusion: The use of a systemic approach in the interpretation of bone lesions on radiographs yields high sensitivity but low specificity for malignancy and infection. The presence of benign bone lesions with an aggressive radiographic appearance necessitates continuation of the triple approach for the diagnosis of primary bone tumours.