This chapter covers individually some rare and interesting clinical cases, situations, and phenomena; the comprehension of which would help one to affirmatively contemplate the extended use of gamma correction pinhole bone scan in future for the study of nonskeletal diseases and conditions. Objectives include small or irregular bone structures including the hyoid bone, cricoid cartilage, and sternum and the critical situations such as the immobilization pressure enthesitis of the pelvis, the vascularity of osteochondritis dissecans and intracortical fracture fragment, and the halation and de-halation of pinhole bone scan image. Furthermore, the extended use of gamma correction pinhole scan in MRI and CT will be discussed. Lastly, conventional bone and joint radiography, benign epiperiosteal osteogenesis in osteosarcoma, and Codman’s triangle will be given special treatment from prospective viewpoints. Being universally available and economical, conventional radiography can earn us meritorious information on bone trabeculae and marrow edema and hemorrhage; it is highly recommended in the study of bone and joint diseases (Pulkkinen et al. 2013). We believe that plain radiograph is useful not just for screening purpose but for making precise, high-level diagnosis of trabecular pathologies which can be verified or supported by gamma correction pinhole scan. Actually, good conventional radiograph can visualize pearl seedlike microcallus and decalcified or softened trabeculae which may be termed trabeculolmalacia which represents decalcified state (Fig. 26.1). The tiny dots shown in Fig. 26.1b represent microcalluses and cryptic trabeculae due to decalcification of alive trabeculae. Figure 26.1c, d show normal trabeculae, the definition of which is not pencil-line sharp. It is the result of limited radiographic resolution. Sharper delineation is possible when an X-ray tube with microfocal spot (Gupta et al. 2012) or micro-CT is used.
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