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RADIONUCLIDE SCAN

RADIONUCLIDE SCAN

AKA BONE SCAN/BONE SCINTIGRAPHY

FUNCTIONAL SCAN

MEASURE METABOLIC ACTIVITY,


PERFUSION OF BONE

TECHNIQUE
INJECT PATIENT WITH RADIONUCLIDE MATERIAL SUCH AS
TECHNITIUM M-99 LABELLED DIPHOSPHANATE

LABELLED DIPHOSPHANATE BINDS TO HYDROXYAPATITTE OF BONE

TECNITIUM M-99 UNDERGOING RADIODECAY AND GIVES OUT GAMMA


RADIATION

RADIATION IS CAPTURED BY A GAMMA RAY SCANNER

INDICATION
Detection and follow up of metastatic disease
Differentiation between osteomyelitis and cellulitis
Determination of bone viability: infection or avascular necrosis
Evaluation of fractures difficult to assess on radiograph (stress fractures,
fractures of complex structures and possible fractures in nonaccidental injuries
of children)
Evaluation of prosthetic joints for infection or loosening
Determination of biopsy site
Evaluation of bone pain in patients with normal or equivocal radiographs
Evaluation of the significance of an incidental skeletal finding on radiographs

3 PHASES OF SCAN
1ST PHASE
- First Phase:
- demonstrates perfusion to a lesion;
- first phase, the nuclear angiogram or flow phase, consists of serial
2- to 5-sec images of the area of suspected osteomyelitis that are
obtained during injection of the radiopharmaceutical.
- classically, with cellulitis, diffuse increased uptake occurs in first
two phases, but uptake is normal or diffusely increased in third phase;
- osteomyelitis causes focally increased uptake in all three phases

- Second Phase:
- relative vascularity;
- second phase, the blood-pool image, is obtained within 5 min after injection;
- in areas of inflammation, capillaries dilate, causing increased blood flow and blood pooling.
- classically, with cellulitis, diffuse increased uptake occurs in first two phases, but uptake is nl or diffusely increased
in third phase;
- osteomyelitis causes focally increased uptake in all three phases;
- first phase characterizes the blood flow to the area, while the 2nd visualizes the blood pool;
- these 2 early phases act to characterize degree of inflammation and hyperemia that may be present;
- diseases such as degenerative disease, healing fractures, non- infected prosthesis with loosening, well treated
osteomyelitis, may have
little abnormal activity on the early phases in spite of increase uptake on delayed images;
- it may be difficult to distinguish osteomyelitis from diabetic osteoarthropathy, which are often abnormal on all 3
phases;
- in contrast, a soft tissue infection classically appears only in early phases, with little abnormal focal bone
activity seen on delayed images;

- Third Phase:
- demonstrates relative bone turnover associated w/ a lesion;
- 3rd phase, bone image, is obtained about 3 hr later, when urinary excretion has
decreased the amount of the radionuclide in soft tissues.
- if present, diffuse incr uptake in third phase is probably due to regional
hyperemia caused by cellulitis;
- osteomyelitis causes focally increased uptake in all three phases;

ADVANTAGE OX BONE SCAN

FRACTURE: IF DIAGNOSIS IS UNCERTAIN BY


X RAY.

CALLUS FORMATION TAKES WEEKS TO BE


SEEN IN A VERY SMALL FRACTURE

BUT OSTEOGENIC RESPONSE CAN BE


PICKED UP EARLIER