Abstract
Radionuclide bone scintigraphy is a highly sensitive investigative tool, routinely used in the evaluation of patients with cancer for suspected bone metastases and in various benign musculoskeletal conditions. Technological innovations such as single photon emission computed tomography (SPECT), positron emission tomography (PET), PET/CT and SPECT/CT have been incorporated into the assessment of various musculoskeletal diseases. One of the limitations of bone scintigraphy is its relatively reduced specificity. Some of the limited specificity can be addressed with a thorough knowledge and experience of normal variants, as well as common patterns of disease, in order to avoid misinterpretation. In this chapter, we discuss the common patterns, variants, artefacts and pitfalls in conventional radionuclide planar, SPECT and hybrid bone SPECT/CT Imaging.
Keywords
- Single Photon Emission Compute Tomography
- Bone Metastasis
- Bone Scintigraphy
- Renal Osteodystrophy
- Reflex Sympathetic Dystrophy
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Al-Enizi E, Kazem N, Owunwanne A, Collier BD, Mathew M (2003) Dextrose solutions yield radiochemical impurities: the “sweet” scans. J Nucl Med Technol 31(1):33–36
Baxter AD, Coakley FV, Finlay DB, West C (1995) The aetiology of solitary hot spots in the ribs on planar bone scans. Nucl Med Commun 16(10):834–837
Bombardieri E, Aktolun C, Baum RP, Bishof-Delaloye A, Buscombe J, Chatal JF et al (2003) Bone scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 30(12):BP99–BP106
Bunker SR, Handmaker H, Torre DM, Schmidt WP (1990) Pixel overflow artifacts in SPECT evaluation of the skeleton. Radiology 174(1):229–232
Bushnell DL, Kahn D, Huston B, Bevering CG (1995) Utility of SPECT imaging for determination of vertebral metastases in patients with known primary tumors. Skeletal Radiol 24(1):13–16
Chaudhuri TK (1976) The effect of aluminum and pH on altered body distribution of 99mTc-EHDP. Int J Nucl Med Biol 3(1):37
Citrin DL (1977) Problems and limitations of bone scanning with the 99Tcm-phosphates. Clin Radiol 28(1):97–105
Coakley FV, Jones AR, Finlay DB, Belton IP (1995) The aetiology and distinguishing features of solitary spinal hot spots on planar bone scans. Clin Radiol 50(5): 327–330
Cook GJ, Fogelman I (1999) Skeletal metastases from breast cancer: imaging with nuclear medicine. Semin Nucl Med 29(1):69–79
Cook GJ, Fogelman I (2001) The role of nuclear medicine in monitoring treatment in skeletal malignancy. Semin Nucl Med 31(3):206–211
Cook GJ, Gnanasegaran G, Chua S (2010) Miscellaneous indications in bone scintigraphy: metabolic bone diseases and malignant bone tumors. Semin Nucl Med 40(1):52–61
D’Sa S, Abildgaard N, Tighe J, Shaw P, Hall-Craggs M (2007) Guidelines for the use of imaging in the management of myeloma. Br J Haematol 137(1):49–63
Damgaard M, Nimb L, Madsen JL (2010) The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices. Clin Nucl Med 35(4):234–236
Delpassand ES, Garcia JR, Bhadkamkar V, Podoloff DA (1995) Value of SPECT imaging of the thoracolumbar spine in cancer patients. Clin Nucl Med 20(12):1047–1051
Dogan AS, Rezai K (1993) Incidental lymph node visualization on bone scan due to subcutaneous infiltration of Tc-99m MDP. A potential for false positive interpretation. Clin Nucl Med 18(3):208–209
Even-Sapir E, Flusser G, Lerman H, et al (2007) SPECT/multislice low-dose CT: a clinically relevant constituent in the imaging algorithm of nononcologic patients referred for bone scintigraphy. J Nucl Med 48:319–24.
Eisner RL, Nowak DJ, Pettigrew R, Fajman W (1986) Fundamentals of 180 degree acquisition and reconstruction in SPECT imaging. J Nucl Med 27(11):1717–1728
Fink-Bennett DM, Shapiro EE (1984) The Angle of Louis. A potential pitfall (“Louie’s Hot Spot”) in bone scan interpretation. Clin Nucl Med 9(6):352–354
Fogelman I, Maisey M (1988) An atlas of clinical nuclear medicine. Dunitz/C.V. Mosby, London/St. Louis
Fogelman I, Bessent RG, Turner JG, Citrin DL, Boyle IT, Greig WR (1978) The use of whole-body retention of Tc-99m diphosphonate in the diagnosis of metabolic bone disease. J Nucl Med 19(3):270–275
Fogelman I, McKillop JH, Gray HW (1983) The “hot patella” sign: is it of any clinical significance? Concise communication. J Nucl Med 24(4):312–315
Forstrom LA, Dunn WL, O’Connor MK, Decklever TD, Hardyman TJ, Howarth DM (1996) Technical pitfalls in image acquisition, processing, and display. Semin Nucl Med 26(4):278–294
Fournier RS, Holder LE (1998) Reflex Sympathetic Dystrophy: diagnostic controversies. Seminars in Nuclear Medicine 28:116–123
Gates GF, Dore EK (1975) Detection of craniosynostosis by bone scanning. Radiology 115(3):665–671
Gentili A, Miron SD, Bellon EM (1990) Nonosseous accumulation of bone-seeking radiopharmaceuticals. Radiographics 10(5):871–881
Gentili A, Miron SD, Adler LP (1994) Review of some common artifacts in nuclear medicine. Clin Nucl Med 19(2):138–143
Gnanasegaran G, Cook GJ, Fogelman I (2007) Musculoskeletal system. In: Biersack HJ, Freeman LM (Eds) Nuclear Medicine Concise. New York Springer
Gnanasegaran G, Cook G, Adamson K, Fogelman I (2009) Patterns, variants, artifacts, and pitfalls in conventional radionuclide bone imaging and SPECT/CT. Elsevier Inc. Semin Nucl Med 39(6):380–395
Han LJ, Au-Yong TK, Tong WC, Chu KS, Szeto LT, Wong CP (1998) Comparison of bone single-photon emission tomography and planar imaging in the detection of vertebral metastases in patients with back pain. Eur J Nucl Med 25(6):635–638
Harbert J, Desai R (1985) Small calvarial bone scan foci – normal variations. J Nucl Med 26(10):1144–1148
Hassan FU, Mohan HK, Gnanasegaran G, Vijayanathan S, Fogelman I (2011) Beware of the focal uptake at the ischium on the bone scan in prostate cancer. Nucl Med Commun 32(4):320–323
Hayward JL, Rubens RD, Carbone PP, Heuson JC, Kumaoka S, Segaloff A (1978) Assessment of response to therapy in advanced breast cancer. A project of the programme on clinical oncology of the International Union against Cancer, Geneva, Switzerland. Eur J Cancer 14(11):1291–1292
Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF (2011) Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty – a new dimension of diagnostics? BMC Musculoskelet Disord 12:36
Holder LE, Michael RH (1984) The specific scintigraphic pattern of “shin splints in the lower leg”: concise communication. J Nucl Med 25(8):865–869
Horger M, Eschmann SM, Pfannenberg C, Vonthein R, Besenfelder H, Claussen CD et al (2004) Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR Am J Roentgenol 183(3):655–661
Horger M, Eschmann SM, Pfannenberg C, Storek D, Vonthein R, Claussen CD et al (2007) Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg 127(3):211–221
Howarth DM, Forstrom LA, O’Connor MK, Thomas PA, Cardew AP (1996) Patient-related pitfalls and artifacts in nuclear medicine imaging. Semin Nucl Med 26(4):295–307
Hughes S, Khan R, Davies R, Lavender P (1978) The uptake by the canine tibia of the bone-scanning agent 99mTc-MDP before and after an osteotomy. J Bone Joint Surg Br 60-B(4):579–582
Hung JC, Ponto JA, Hammes RJ (1996) Radiopharmaceutical-related pitfalls and artifacts. Semin Nucl Med 26(4):208–255
Johns WD, Garnick MB, Kaplan WD (1990) Leuprolide therapy for prostate cancer. An association with scintigraphic “flare” on bone scan. Clin Nucl Med 15(7):485–487
Kaye J, Hayward M (2002) Soft tissue uptake on 99mTc methylene diphosphonate bone scan imaging: pictorial review. Australas Radiol 46(1):13–21
Kessler JR, Wells RG, Sty JR (1992) Skeletal scintigraphy. Radiographic artifacts. Clin Nucl Med 17(6):511–512
Kipper MS, Alazraki NP, Feiglin DH (1982) The “hot” patella. Clin Nucl Med 7(1):28–32
Kwai AH, Stomper PC, Kaplan WD (1988) Clinical significance of isolated scintigraphic sternal lesions in patients with breast cancer. J Nucl Med 29(3):324–328
Loutfi I, Collier BD, Mohammed AM (2003) Nonosseous abnormalities on bone scans. J Nucl Med Technol 31(3):149–153; quiz 54–56
Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ (2003) Radionuclide bone imaging: an illustrative review. Radiographics 23(2):341–358
Matin P (1979) The appearance of bone scans following fractures, including immediate and long-term studies. J Nucl Med 20(12):1227–1231
McAfee JG, Singh A, Roskopf M, Ritter C, Lyons B, Schoonmaker JE et al (1983) Experimental drug-induced changes in renal function and biodistribution of 99mTc-MDP. Invest Radiol 18(5):470–478
McAfee JG, Reba RC, Majid M (1995) The musculoskeletal system. In: Wagner HN, Szabo Z, Buchanan JW (eds) Principles of nuclear medicine, 2nd edn. Saunders, Philadelphia/London
McCormick WF (1981) Sternal foramena in man. Am J Forensic Med Pathol 2(3):249–252
McKillop JH, Fogelman I (1984) Bone scintigraphy in benign bone disease. Br Med J (Clin Res Ed) 288(6413):264–266
Murray IPC (1998) Vascular Manifestations. In:Murray IPC, Ell PJ (eds) Nuclear medicine in clinical diagnosis and treatment, 2nd edn. Churchill Livingstone, Edinburgh
O’Connor MK (1996) Instrument- and computer-related problems and artifacts in nuclear medicine. Semin Nucl Med 26(4):256–277
O’Connor MK, Kelly BJ (1990) Evaluation of techniques for the elimination of “hot” bladder artifacts in SPECT of the pelvis. J Nucl Med 31(11):1872–1875
O’Connor MK, Brown ML, Hung JC, Hayostek RJ (1991) The art of bone scintigraphy – technical aspects. J Nucl Med 32(12):2332–2341
O’Sullivan JM, Cook GJ (2002) A review of the efficacy of bone scanning in prostate and breast cancer. Q J Nucl Med 46(2):152–159
Ogawa K (2004) Image distortion and correction in single photon emission CT. Ann Nucl Med 18(3):171–185
Oswald SG, Vannostrand D, Savory CG et al (1990) The acetabulum, a prospective study of three phase bone and indium white blood cell scintigraphy following coated hip arthroplasty. J Nucl Med 31:274–280
Pagenstert GI, Barg A, Leumann AG, Rasch H, Muller-Brand J, Hintermann B et al (2009) SPECT-CT imaging in degenerative joint disease of the foot and ankle. J Bone Joint Surg Br 91(9):1191–1196
Paterson DC (1970) Myositis ossificans circumscripta. Report of four cases without history of injury. J Bone Joint Surg Br 52(2):296–301
Romer W, Nomayr A, Uder M, Bautz W, Kuwert T (2006) SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med 47(7):1102–1106
Rausch JM, Resnick D, Goergen TG, Taylor A (1977) Bone scanning in osteolytic Paget’s disease: case report. J Nucl Med 18:699–701
Scharf S (2009) SPECT/CT imaging in general orthopedic practice. Semin Nucl Med 39(5):293–307
Schneider JA, Divgi CR, Scott AM, Macapinlac HA, Seidman AD, Goldsmith SJ et al (1994) Flare on bone scintigraphy following Taxol chemotherapy for metastatic breast cancer. J Nucl Med 35(11):1748–1752
Senda K, Itoh S (1987) Evaluation of diffusely high uptake by the calvaria in bone scintigraphy. Ann Nucl Med 1(1):23–26
Stokkel MP, Valdes Olmos RA, Hoefnagel CA, Richel DJ (1993) Tumor and therapy associated abnormal changes on bone scintigraphy. Old and new phenomena. Clin Nucl Med 18(10):821–828
Storey G, Murray IPC (2004) Bone Scintigraphy:The procedure and interpretation In: Ell PJ, Gambhir SS (eds) Nuclear medicine in clinical diagnosis and treatment, 3rd edn. Churchill Livingstone, New York, Elsevier
Tofe AJ, Francis MD, Harvey WJ (1975) Correlation of neoplasms with incidence and localization of skeletal metastases: an analysis of 1,355 diphosphonate bone scans. J Nucl Med 16(11):986–989
Tumeh SS, Beadle G, Kaplan WD (1985) Clinical significance of solitary rib lesions in patients with extraskeletal malignancy. J Nucl Med 26(10):1140–1143
Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S et al (2006) Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 238(1):264–271
Wilson MA, Pollack MJ (1981) Gastric visualization and image quality in radionuclide bone scanning: concise communication. J Nucl Med 22(6):518–521
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Nathan, M., Gnanasegaran, G., Adamson, K., Fogelman, I. (2012). Bone Scintigraphy: Patterns, Variants, Limitations and Artefacts. In: Fogelman, I., Gnanasegaran, G., van der Wall, H. (eds) Radionuclide and Hybrid Bone Imaging. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02400-9_15
Download citation
DOI: https://doi.org/10.1007/978-3-642-02400-9_15
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-02399-6
Online ISBN: 978-3-642-02400-9
eBook Packages: MedicineMedicine (R0)