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Bone Scan

This document provides an overview of bone scans and the radiopharmaceuticals used. It discusses how radioisotopes are used to detect orthopedic abnormalities through differences in physiological activity between normal and abnormal bone areas. Bone scans involve intravenous injection of technetium-99m labeled phosphonate complexes, with imaging performed hours later to map osteogenic activity. Abnormal areas like fractures, tumors, and infections show increased uptake. Common uses of bone scans include evaluating bone tumors, metastases, avascular necrosis, infections, and stress fractures.

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Ananta Naufal
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1K views

Bone Scan

This document provides an overview of bone scans and the radiopharmaceuticals used. It discusses how radioisotopes are used to detect orthopedic abnormalities through differences in physiological activity between normal and abnormal bone areas. Bone scans involve intravenous injection of technetium-99m labeled phosphonate complexes, with imaging performed hours later to map osteogenic activity. Abnormal areas like fractures, tumors, and infections show increased uptake. Common uses of bone scans include evaluating bone tumors, metastases, avascular necrosis, infections, and stress fractures.

Uploaded by

Ananta Naufal
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Bone Scan

Introduction
Radioisotopes are used in the diagnosis of orthopaedic conditions to detect abnormalities and to determine the extent of disease. Diagnosis with radioisotopes is based on differences in physiologic activity between normal and abnormal areas of the skeleton. Thus, lesions may be detected with radioisotope scanning even when anatomic abnormalities cannot be detected radiographically.

Abnormalities such as recent fractures, tumors, and osteomyelitis show increased vascularity on images obtained immediately after injection of radioisotopes. Delayed images show increase in uptake of radioisotope over time in these lesions. New and rapid bone turnover as seen in fractures, tumors, and osteomyelitis produce woven bone that tightly binds the 99mTc phosphonate complexes to the bone.

Bone scans are performed with intravenous injection of 20 to 30 mCi (740 to 1010 MBq) of 99mTc-labeled phosphonate complex.

The first phase


A dynamic flow study, a radionuclide angiogram in which scans are done every 2 to 5 seconds after injection for 1 to 2 minutes. This shows the radionuclide in the blood vessels, including the arterial, capillary, and venous phases.

The second phase


A blood pool scan, or a static image done immediately after the flow study and within 5 minutes after injection, which shows radionuclide in the extravascular space before bone uptake occurs.

The third phase


Consists of static images done 2 to 4 hours after injection that show radionuclide uptake by the bone.

Radio Pharmaceuticals
I. Technetium MDP (Methylene Diphosphonate) II. Thallium - 201

III. Gallium - 67
IV. I-131 /-MIBG, I-123 V. Tc-99m labeled leucocyte scan

Tc - 99 MDP Bone Scan


The Tc99m phosphate bone seeking agents depend on intact blood supply & osteogenic activity of the bone for lcoalization Images made several hours after injection provide a physiologic map of the distribution of osteogenic activity in the body & allow early detection due to an underlying feature of skeletal pathology that the bones react to a wide variety of disease & conditions with an osteogenic response

Primary bone tumors e.g. Osteosarcoma, Ewings sarcoma etc. To rule out metastatic bone disease following primary Ca e.g. Cabreast, Ca lung, Ca prostate etc. Avascular necrosis of femoral head. Bonecyst. Bone infection such as osteomyelitis. Stress fracture or following vehicular accident with normal conventional x-ray findings. Metabolic bone disease such as Paget's disease, Osteomalacia, Hyperparathyroidism, renal osteodystrophy, hypertrophic pulmonary osteoarthropathy. Compression fracture of the spine. Leg perthe's disease. Sacroillitis.

Thallium-201 Whole Body Imaging


THALLIUM-201 is a potassium analogue & is take by active tumor cells. It is particularly useful in detecting brain tumors in equivocal MRI scans & differentiate tumor recurrence from radiation necrosis

L-131 MIBG Whole Body Scan Imaging


500-600 micro curie I-131 MIBG ( Metaiodo Benzyl guanidine ) is injected in I. V. Route & 24 hrs, 48 hrs following injection the whole body imaging is carried out. If any lesion especially in the diagnosis of disseminated malignant pheochrocytoma affecting the bones can be revealed with greater specificity & sensitivity.

Gallium-67 Whole Body Imaging


Gallium is useful for imaging areas of infection, inflammation & tumors. Patients may be imaged at 24 hrs., 48 hrs. & 72 hrs. post injection.

Tc-99 m HMPAO Labeled Leucocyte Scan


This is a novel technique of labeling white blood cells in vitro with Tc99m pertechnetate by the help of lipophilic compound i.e. HMPAO (Hexamethy1 propylene amine oxime). the invitro labeling procedure takes about 40-45 mins. After which it is injected in slow IV infusion which can localize the focus of active infection such as Acute from chronic osteomyelitis, prosthetic infection from loosening in hip or knee replacement surgery etc. The sensitivity & specificity in localising the focus of infection is 98% & 99% respectively.

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