Bone scan

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Three Phase Bone Scan

  • Tc99m MDP 20mCi
  • Image dynamic (flow), immediate (blood pool) and delay (3 hours)
  • Increased on all three phases for Osteomyelitis, trauma, tumor (osteoblastic remodeling or tumor itself), and Reflex sympathetic dystrophy
  • Increased on immediate images but not on delays with cellulitis
  • Cold lesions - myeloma, thyroid and renal metastasis, Avascular necrosis
  • Flare phenomenon - increased uptake or number of lesions due to treatment, does not persist beyond 6-9 months
  • Fractures - cold within 24hrs, but can remain abnormal for years
  • Shin Splints - linear uptake in tibia
  • Prosthesis - THR after 1 year is abnormal (infection or loosening), TKA can be hot indefinately

Fluorine 18 PET - investigaional, not FDG (a glucose analog, with the positron-emitting radioactive isotope fluorine-18)

Whole Body Bone Scan - typically screen for metastasis

Diffuse Uptake Differential (Superscan)

  • Renal osterodystrophy
  • Hyperparathyroidism
  • Diffuse metastasis
  • Myelofibrosis
  • Hypertrophic osteoarthopathy
  • Vit A toxicity
  • Thyroid acropachy
  • Melorheostosis

Tagged WBC study

Radionuclide Bone Imaging: An Illustrative Review