Gamma Correction 99mTc-HDP Pinhole Scan Diagnosis of Trabecular Microfracture and Contusion

  • Yong-Whee BahkEmail author
  • Yong An Chung


Bone contusion was discussed in detail in the early 2010s under a subtitle of occult fracture in the 4th edition of this book and trabecular microfracture was therein mentioned in passing. However, with the latest advent of micro-CT (Klintström et al. 2014; Okazaki et al. 2014), micro-MRI (Song and Wehrli 1999; Rajapakse et al. 2012), and gamma correction pinhole bone scan (Bahk et al. 2016a, b), the diagnosis of bone edema and hemorrhage and contusion and trabecular microfracture has become to be comprehensively discussed here in the light of the gamma correction of tracer uptake at the level of trabeculae and molecule. Such is earnestly desired to start an explicit “seeing is believing” scintiscan diagnostics. Micro pinhole scan is popular in small animals (van der Have and Beekman 2004) but its clinical use in the form of gamma correction pinhole bone scan is newly attempted. The gamma correction pinhole bone scan, solely or in combination with micro-MRI and micro-CT, appears to have started to construct an avenue to 4D micrometric imaging of bone and joint diseases (Fig. 25.1a). Actually, 4D imaging has been already realized in the form of 3D microanatomy and 1D radiochemistry in terms of the washability or un-washability of accumulated bone tracer using the gamma correction algorithm. Fortunately indeed, we can now clearly image and see actively forming microcalluses as seed pearls in patients with trabecular microfractures (Fig. 25.2d, e; Bahk et al. 2016b) and the endosteal rimming in the contused trabeculae in rat (Fig. 25.3c; Bahk et al. 2016a) using in vivo gamma correction 99mTc-HDP pinhole bone scan. Such an image processing can be achieved utilizing ordinary gamma cameras provided with conventional hardware and software programs including gamma correction algorithm (Bahk et al. 2010). It is well to remember that until the advent of the gamma correction, MRI served as a gold standard of bone scan. However, now the situation of being helped and helper appears to be reversed as far as the imaging of injured bone trabeculae and bone marrow edema and hemorrhage is concerned (Fig. 25.4).


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Copyright information

© Springer Nature Singapore Pte Ltd. 2017

Authors and Affiliations

  1. 1.Department of Nuclear Medicine and RadiologySun Ae General HospitalSeoulSouth Korea
  2. 2.Department of Radiology and Nuclear MedicineThe Catholic University of Korea College of MedicineSeoulSouth Korea

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