Abstract
The isotope bone scan was only performed on a limited scale prior to 1972, but since the introduction of the 99mTc-labelled phosphate and diphosphonate compounds (Subramanian et al., 1972; Castronovo, 1972) the value of this investigation in clinical practice has become increasingly recognized and it is now the most important and frequently requested study in any nuclear medicine department. Nowadays the bone scan is almost exclusively performed with 99mTc-labelled diphosphonate (methylene diphosphonate being the most popular) and the technique shows exquisite sensitivity for the detection of skeletal abnormality. However, there is the major limitation that scan appearances are non-specific. Nevertheless, in many clinical situations recognizable patterns of bone scan abnormality may be seen, which can often suggest a specific diagnosis. In this chapter, the current status of bone scanning in metastatic and benign skeletal disease will be discussed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Abrams, H. L., Spiro, R. and Goldstein, N. (1950) Mestastases in carcinoma: analysis of 1000 autopsied cases. Cancer, 3, 74–85.
Alexandre, C, Meunier, P. J., Edouard, C. et al. (1981) Effects of EHDP (5 mg/kg/day dose) on quantitative bone histology in Paget’s disease of bone. Metab. Bone Dis. Relat. Res., 23, 309–15.
Baker, F. R., Holmes, E. R., Alderson, P. O. et al. (1977) An evaluation of bone scans as screening procedures for occult metastases in primary breast cancer. Ann. Surg., 186, 363–8.
Beckerman, C, Genant, H. K., Hoffer, P. B. et al. (1976) Radionuclide imaging of the bones and joints of the hand. Radiology, 118, 653.
Biersack, H. J., Wegner, G., Distelmaier, W. and Krause, U. (1980) Ossare Metastasierung des Prosta-takerzinoms in Abhangigkeit von Tumorgrosse und Geschwulstdifferenzienung. Nuklearmedizin, 19, 29 – 32.
Brill, D. R. (1983) Sports nuclear medicine: bone imaging for lower extremity pain in athletes. Clin. Nucl. Med., 8, 101–6.
Burkett, M. E., Scanlon, E. C, Garces, R. F. and Khandekar, J. D. (1979) The value of bone scans in the management of patients with carcinoma of the breast. Surg. Gynecol. Obstet., 149, 523–35.
Burleson, R. L., Holman, B. L. and Tow, D. E. (1975) Scintigraphic demonstration of abscesses with radioactive gallium labelled leukocytes. Surg. Gynecol. Obstet., 141, 379–82.
Campbell, D. J., Banks, A. J. and Davis, G. D. (1976) The value of preliminary bone scanning in staging and assessing the prognosis of breast cancer. Br. J. Surg., 63, 811–16.
Castronovo F. P. and Callahan, W. J. (1972) New bone scanning agent: 99m-Tc-labelled I-hydroxy-ethylidene-1, 1-disodium phosphate. J. Nucl. Med., 13, 823–7.
Citrin, D. L. and McKillop, J. H. (1978) Atlas of Technetium Bone Scans. Saunders, Philadelphia.
Citrin, D. L., Furnival, C. M., Bessent, R. G. et al. (1976) Radioactive technetium phosphate bone scanning in preoperative assessment and follow up study of patients with primary cancer of the breast. Surg. Gynecol. Obstet., 143, 360–4.
Citrin, D. L., Bessent, R. G. and Greig, W. R. (1977) A comparison of the sensitivity and accuracy of the 99m-Tc-phosphate bone scan and skeletal radiography in the diagnosis of bone metastases. Clin. Radiol, 28, 107–17.
Clark, D. G., Painter, R. W. and Sziklas, J. J. (1978) Indications for bone scans in preoperative evaluation of breast cancer. Am. J. Surg., 135, 667–70.
Coleman, R. E., Rubens, R. D. and Fogelman, I. (1988) Reappraisal of the baseline bone scan in breast cancer. J. Nucl. Med., 29 (6), 1045–9.
Collier, B. D., Carrera, G. F., Johnson, R. P. etal. (1985) Detection of femoral head avascular necrosis in adults by SPECT. J. Nucl. Med., 26, 979–87.
Constable, A. R. and Cranage, R. W. (1981) Recognition of the superscan in prostatic bone scintigraphy. Br. J. Radiol, 54, 122–5.
Corcoran, R. J., Thrall, J. H. and Kyle, R. W. (1976) Solitary abnormalities in bone scans of patients with extraosseous malignancies. Radiology, 121, 663–7.
Davies, C. J., Griffiths, P. A., Preston, B. J. et al (1977) Staging breast cancer: role of scanning. Br. Med. J., 2, 603–5.
Davis, M. C., Turner, D. A., Charters, J. R. et al. (1984) Quantitative sacroiliac scintigraphy: the effect of method of selection of region of interest. Clin. Nucl. Med., 9, 334–40.
Edelstyn, G. A., Gillespie, P. J. and Grebell, F. S. (1967) The radiological demonstration of osseous metastases: experimental observations. Clin. Radiol., 18, 158–62.
El Domeiri, A. A. and Shroff, S. (1976) Role of preoperative bone scan in carcinoma of the breast. Surg. Gynecol. Obstet., 142, 722–4.
Espinasse, D., Mathieu, L., Alexandre, C. et al. (1981) The kinetics of Tc99m labelled EHDP in Pagefs disease before and after dichloromethylene-diphosphonate treatment. Metab. Bone Dis. Relat. Res., 2, 321–4.
Fogelman, I. (1980) Skeletal uptake of diphosphonate: a review. Eur. J. Nucl. Med., 3, 224–5.
Fogelman, I. (ed) (1987) in Bone Scanning in Clinical Practice. Springer-Verlag, London, pp. 73–87.
Fogelman, I. (1989) An evaluation of the contribution of bone mass measurements to clinical practice. Sem. Nucl. Med., xix, 62–8.
Fogelman, I. and Bessent, R. G. (1982) Age-related alterations in skeletal metabolism: 24 hour whole-body retention of diphosphonate in 250 normal subjects: concise communication. J. Nucl. Med., 23, 296–300.
Fogelman, I. and Carr, D. (1980a) A comparison of bone scanning and radiology in the evaluation of patients with metabolic bone disease. Clin. Radiol, 31, 321–6.
Fogelman, I. and Carr, D. (1980b) A comparison of bone scanning and radiology in the assessment of patients with symptomatic Pagefs disease. Eur. J. Nucl. Med., 5, 417–21.
Fogelman, I. and Citrin, D. L. (1981) Bone scanning in metabolic bone disease: a review. Appl. Radiol, 10, 158–66.
Fogelman, I. and Coleman, R. E., (1988) Breast cancer and bone scanning, in Nuclear Medicine Annual (eds L. M. Freeman and H. S. Weissmann) Raven Press, New York.
Fogelman, I., McKillop, J. H., Greig, W. R. and Boyle, I. T. (1977a) Absent kidney sign associated with symmetrical and uniformly increased uptake of tracer by the skeleton. Eur. J. Nucl. Med., 2, 257–60.
Fogelman, I., McKillop, J. H., Greig, W. R. and Boyle, I. T. (1977b) Pseudo-fracture of the ribs detected by bone scanning. J. Nucl. Med., 18, 1236–7.
Fogelman, I., Citrin, D. L., Turner, J. G. et al (1979) Semi-quantitative interpretation of the bone scan in metabolic bone disease. Eur. J. Nucl Med., 4, 287–9.
Fogelman, I., Bessent, R. G., Turner, J. G. et al (1978) The use of whole-body retention of Tc-99m diphosphonate in the diagnosis of metabolic bone disease. J. Nucl. Med., 19, 270–5.
Frank, J. W. (1981) The value of radionuclide bone imaging in atypical Pagefs disease. Nucl. Med. Comm., 2, 302–6.
Freeman, M. H. and Tonkin, A. K. (1976) Manifestations of hyertrophic pulmonary osteoarthrophy in patients with carcinoma of the lung: demonstration by 99mTc pyrophosphate bone scans. Radiology, 120, 363–5.
Freeman, M. L., Van Drunen, M., Gergans, G. and Kaplan, E. (1984) Accumulation of bone scanning agent in multiple myeloma. Clin. Nucl. Med., 9, 49.
Front, D., Schneck, S. O., Frankel, A. and Robinson, E. (1979) Bone metastases and bone pain in breast cancer. JAMA, 242, 1747–8.
Gerber, F. H., Goodreau, J. J., Kirchner, P. T. and Fonty, W. J. (1977) Efficacy of preoperative and postoperative bone scanning in the management of breast carcinoma. N. Engl J. Med., 297, 300–3.
Gilbert, H. A. and Kagan, A. R. (1976) in Fundamental Aspects of Metastases (ed. L. Weiss), Elsevier, Amsterdam, pp. 385–405.
Goldmann, A. B., Becker, M. H., Braunstein, P. et al (1975) Bone scanning — osteogenic sarcoma: correlation with surgical pathology. Radiology, 124, 83–90.
Goldstein, H., McNeil, B. J., Zufall, E. and Treves, S. (1980) Is there still a place for bone scanning in Ewing’s sarcoma? J. Nucl Med., 21, 10–12.
Gravenstein, S., Peltz, M. A. and Poreis, W. (1979) How ominous is an abnormal scan in bronchogenic carcinoma? JAMA, 241, 2523–4.
Haase, G. M., Ovitz, V. N., Sfakianakis, G. N. and Morse, T. S. (1980) The value of radionuclide bone scanning in the early recognition of deliberate child abuse. J. Trauma, 20, 873–5.
Hamdy, R. C. (1981) Pagefs Disease of Bone. Praeger, Eastbourne, pp. 13–21, 37–46.
Hammond, N., Jones, S. E., Salmon, S. E. et al (1978) Predictive value of bone scans in an adjuvant breast cancer program. Cancer, 41,138–42.
Handmaker, H. and Leonards, R. (1976) The bone scan in inflammatory osseous disease. Semin. Nucl. Med., 6, 95.
Hoffer, P. B. and Genant, H. K. (1976) Radionuclide joint imaging. Semin. Nucl. Med., 6, 121.
Holder, L. E. and Matthews, L. S. (1984) in Nuclear Medicine Annual (eds L. M. Freeman and H. S. Weissmann), Raven Press, New York, pp. 81–140.
Khairi, M. R. A., Robb, J. A., Wellman, H. N. and Johnston, C. C. (1974) Radiographs and scans in diagnosing symptomatic lesions of Pagefs disease of bone (osteitis deformans). Geriatrics, 29, 49–54.
Kim, E. E., Bledin, A. G., Gutierrez, C. and Haynie, T. P. (1983) Comparison of radionuclide images and radiographs for skeletal metastases from renal cell carcinoma. Oncology, 40, 184–6.
Komaki, R., Donegan, W., Manoli, R. and Teh, E. L. (1979) Prognostic value of pretreatment bone scans in breast carcinoma. Am. J. Roentgenol. Radium Ther. Nucl. Med., 132, 877–81.
Kunkler, I. H., Merrick, M. V. and Rodger, A. (1985) Bone scintigraphy in breast cancer: a nine year follow up. Clin. Radiol, 36, 279–282.
Lentle, B. C, Russell, A. S., Percy, J. S. and Jackson, F. I. (1977a) Scintigraphic finding in ankylosing spondylitis. J. Nucl Med., 18, 524–8.
Lentle, B. C, Russell, A. S., Percy, J. S. and Jackson, F. I. (1977b) The scintigraphic investigation of sacroiliac disease. J. Nucl. Med., 18, 529–33.
Lichtenstein, L. (1977) Bone tumours (5th edn), Mosby, St Louis.
Lindholm, A., Lundell, L., Martenson, B. and Thulin, A. (1979) Skeletal scintigraphy in the initial assessment of women with breast cancer. Acta Chir. Scand., 145,65–71.
Lopez-Majano, V. and Sobti, P. (1984) Early diagnosis of pulmonary osteoarthropathy in neoplastic disease. J. Nucl. Med. Allied Sci. 28, 69–76.
Lund, F., Smith, P. H. and Suciu, S. (1984) Do bone scans predict prognosis in prostatic cancer? Br. J. Urol, 56, 58–63.
Martin, P. (1979) The appearance of bone scans following fractures, including immediate and long-term studies. J. Nucl. Med., 20,1227–31.
Martin, P. (1988) Basic principles of nuclear medicine techniques for detection and evaluation of trauma and sports medicine injuries, 18, 90–112.
McDougall, I. R., Baumert, J. E. and Lantieri, R. L. (1979) Evaluation of In-Ill leukocyte-whole body scanning. Am. J. Roentgenol. Radium Ther. Nucl. Med., 133, 849–54.
McGregor, B., Tulloh, A. G. S., Quinlin, M. F. and Lovegrove, F. (1978) The role of bone scanning in the assessment of prostatic carcinoma. Br. J. Urol., 50, 178–81.
McKillop, J. H. (1987) in Bone Scanning in Clinical Practice (ed. I. Fogelman), Springer-Verlag, London, pp. 41 – 60.
McKillop, J. H., Blumgart, L. H., Wood, C. B. et al. (1978) The prognostic and therapeutic implications of the positive radionuclide bone scan in clinically early breast cancer. Br. J. Surg., 65, 649–52.
McNeill, B. J., Pace, P. D., Gray, E. B. et al. (1978) Preoperative and follow up bone scans in patients with primary carcinoma of the breast. Surg. Gynecol Obstet., 147, 745–8.
Merrick, M. V. (1987) in Bone Scanning in Clinical Practice (ed. I. Fogelman), Springer-Verlag, London, pp. 19 – 29.
Nair, N. (1985) Bone scanning Ewing7s sarcoma. J. Nucl. Med., 26, 349–52.
Namey, T. C., Mclntyre, J., Buse, M and Le Roy, E. C. (1977) Nucleographic studies of axial spondarthri-tides. I. Quantitative sacroiliac scintigraphy in early HLA-B27-associated sacroiliitis. Arthritis Rheum., 20, 1058.
Nisbet, A. P., Mashiter, G., Winn, P. et al. (1983) Quantitation of 99mTcMDP retention during routine bone scanning. Nucl. Med. Comm., 4, 67–71.
Nisbet, A. P., Edwards, S., Lazarus, C. R. et al. (1984) Chromium 51 EDTA/technetium 99m MDP plasma ratio to measure total skeletal function. Br. J. Radiol, 57, 677–80.
O’Connell, M. J., Wahner, H. J., Ahmann, D. L. et al. (1978) Value of preoperative radionuclide bone scans in suspected primary breast carcinoma. Mayo Clin. Proc, 53, 221–6.
O’Donoghue, E. P., Constable, A. R., Sherwood, T. et al. (1978) Bone scanning and plasma phosphatases in carcinoma of the prostate. Br. J. Urol, 50, 172–177.
Omjola, M. F., Cockshott, W. P. and Beatty, E. G. (1981) Osteoid osteoma: an evaluation of diagnostic modalities. Clin. Radiol, 132,199–204.
Papanicolaou, N., Kozakewich, H., Treves, S. et al (1982) Comparison of the extent of osteosarcoma between surgical pathology and skeletal scintigraphy. J. Nucl Med., 23, P7 (abstract).
Paulson, D. F. and the Uro-Oncology Research Group (1979) The impact of current staging procedures in assessing disease extent of prostatic adenocarcinoma. J. Urol, 121, 300–2.
Peters, A. M. and Lavender, J. P. (1990) Diagnosis of bone infection. Nucl Med. Commun., 11, 463–7.
Pistenma, D. A., McDougall, I. R. and Kriss, J. P. (1975) Screening for bone metastases: are only scans necessary? JAMA, 231, 46–50.
Ralston, S., Fogelman, I., Gardner, M. D. and Boyle, I. T. (1982) Hypercalcaemia and metastatic bone disease: is there a causal link? Lancet, ii, 903–5.
Rappaport, A. H., Hoffer, P. B. and Genant, H. K. (1978) Unifocal bone findings by scintigraphy: clinical significance in patients with known primary cancer. West. J. Med., 129, 188–92.
Rausch, J. M., Resnick, D., Goergen, T. G. and Taylor, A. (1977) Bone scanning on osteolytic Paget’s disease: case report. J. Nucl. Med., 18, 699–701.
Rosenthall, L. (1987) in Bone Scanning in Clinical Practice (ed. I. Fogelman), Springer-Verlag, London, pp. 151–74.
Rosenthall, L. and Hawkins, D. (1977) Radionuclide joint imaging in the diagnosis of synovial disease. Semin. Arthr. Rheum., 7, 49–61.
Rosenthall, L. and Lisbona, R. (1980) in Nuclear Medicine Annual (eds L. M. Freeman and H. S. Weissmann), Raven Press, New York.
Rossleigh, M. A., Lovegrove, F. T. A., Reynolds, P. M. and Byrne, M. J. (1982) Serial bone scans in the assessment of response to therapy in advanced breast carcinoma. Clin. Nucl Med., 7, 397–402.
Rossleigh, M. A., Lovegrove, F. T. A., Reynolds, P. M. et al (1984) The assessment of response to therapy of bone metastases in breast cancer. Aust. NZ J. Med., 14, 19–22.
Russell, A. S., Lentle, B. D. and Percy, J. S. (1975) Investigations of sacroiliac joint: comparative evaluation of radiological and radionuclide techniques. J. Rheumatol, 2, 45–51.
Schubert, F., Siddle, K. J. and Harper, J. S. (1984) Diaphyseal Paget’s disease: an unusual finding in the tibia. Clin. Radiol, 35, 71–4.
Serafini, A. N. (1976) Paget’s disease of the bone. Semin. Nucl. Med., 6, 47–58.
Shafer, R. B. and Reinke, D. B. (1977) Contribution of the bone scan, serum acid and alkaline phosphatase and radiographic bone survey to the management of newly diagnosed carcinoma of the prostate. Clin. Nucl. Med., 2, 200–3.
Shirazi, P. H., Ryan, W. G. and Fordham, E. W. (1974) Bone scanning in evaluation of Paget’s disease of bone. CRC Crit. Rev. Clin. Radiol. Nucl Med., 5, 523–58.
Smith, F. W. and Gilday, D. L. (1980) Scintigraphic appearances of osteoid osteoma. Radiology, 137, 191 – 5.
Stadalnik, R. C. (1979) ‘Cold spot’: bone imaging. Semin. Nucl. Med., 9, 2–3.
Stevenson, J. S., Bright, R. W., Dunson, G. L. and Nelson, F. R. (1984) Technetium-99m phosphate bone imaging: a method of assessing bone graft healing. Radiology, 110, 391–4.
Subramanian, G., McAfee, J. G., Blair, R. J. et al. (1972) 99m-Tc-EHDP: a potential radiopharmaceutical for skeletal imaging. J. Nucl. Med., 13, 947–50.
Swee, R. G., McLeod, R. A. and Beabout, J. W. (1979) Osteoid osteoma: detection, diagnosis and localisation. Radiology, 132,117–23.
Thomas, R. H., Resnick, D., Alazraki, N. P. et al. (1975) Compartmental evaluation of osteoarthritis of the knee. Radiology, 116, 585.
Tofe, A. J., Francis, M. A. and Harvey, W. J. (1975) Correlation of neoplasms with incidence and localisation of skeletal metastases: an analysis of 1355 diphosphonate bone scans. J. Nucl Med., 16, 986.
Vellenga, C. J., Pauwels, E. K. J., Bijvoet, E. O. and Hosking, D. J. (1976) Evaluation of scintigraphic and roentgenologic studies in Paget’s disease under treatment. Radiol Clin., 45, 292–301.
Vellenga, C. J. L. R., Pauwels, E. K. J. and Bijvoet, O. L. M. (1984a) Comparison between visual assessment and quantitative measurement of radioactivity on the bone scintigram in Paget’s disease of bone. Eur. J. Nucl. Med., 9, 533–7.
Vellenga, C. J. L. R., Pauwels, E. K. J., Bijvoet, O. L. M. et al. (1984b) Untreated Paget’s disease of bone studied by scintigraphy. Radiology, 153, 799–805.
Wahner, H. W., Kyle, R. A. and Beabout, J. W. (1980) Scintigraphic evaluation of the skeleton in multiple myeloma. Mayo Clin. Proc, 55, 739–46.
Waxman, A. D., Siemsen, J. K., Levine, A. M. et al. (1981) Radiographic and radionuclide imaging in multiple myeloma: the role of gallium scintigraphy. J. Nucl. Med., 22, 232–6.
Weissberg, D. L. et al. (1978) Am. J. Roentgenol, 131, 665.
Wilson, G. S., Rich, M. A. and Brennan, M. J. (1980) Evaluation of bone scan in preoperative clinical staging of breast cancer. Arch. Surg., 115, 415–19.
Wollfenden, J. M., Pitt, M. J., Durie, B. G. M. and Moon, T. E. (1980) Comparison of bone scintigraphy and radiology in multiple myeloma. Radiology, 134, 723–8.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1991 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
Fogelman, I. (1991). Bone scanning. In: Maisey, M.N., Britton, K.E., Gilday, D.L. (eds) Clinical Nuclear Medicine. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-3358-4_6
Download citation
DOI: https://doi.org/10.1007/978-1-4899-3358-4_6
Publisher Name: Springer, Boston, MA
Print ISBN: 978-0-412-27900-3
Online ISBN: 978-1-4899-3358-4
eBook Packages: Springer Book Archive