Lindsay Bryant

Nuclear Medicine

Radiopharmaceutical administered to
the patient and subsequently
recording its distribution in the body
over a defined period of time.
Used to detect pathology
Very sensitive
Nonspecific

Radiopharmaceuticals

No physiologic response when administered

for diagnostic or therapeutic purposes.
Selective uptake of these compounds by
various organs forms the basis for nuclear
imaging
Two components:
main component - distributed
radionuclide tagged to this component

Emits gamma rays which permit detection of the compound

Components localize by active transport, phagocytosis, etc.

Physiologic function can be assessed, but

spatial resolution is relatively poor

Common Nuclear Procedures

1.
2.
3.
4.
5.
6.

Cardiac studies
Skeletal studies
Renograms and renal scans
Ventilation-Perfusion studies
PET studies
Evaluation of neurodegenerative
disorders, brain tumor recurrence,
and myocardial viability.

Less Common Nuclear

Procedures

1.
2.
3.
4.
5.
6.
7.

Diagnostic thyroid studies

Hepatobiliary studies
Brain imaging
White blood cell studies
Gastrointestinal bleeding studies
Lymphoscintigraphy
Parathyroid scans

Tc bone scintigraphy

99m

Effective method for screening the

whole body for bone metastases
99mTc methylene diphosphonate
(MDP) is the most frequently used
isotope.
99mTc planar bone scintiscans help
identify tumors by detecting the
increased osteoblastic activity.

Scintigraphy Indications
1.
2.

3.

4.

Staging in asymptomatic patients

Evaluation of persistent pain (with
negative radiograph findings)
Determining the extent of bone
metastases ( with positive
radiograph findings)
Differentiating metastatic from
traumatic fractures

Indications continued

Routinely done as part of initial staging

of LUNG and BREAST cancer
The risk of presenting with metastatic brain
or bone disease is sufficiently high

Not routinely done as part of initial

staging of COLON cancer
The risk is relatively low for metastases to
bone or brain and bone scans are not done
unless symptoms or other findings indicate
a potential problem.

Scintigraphy

The classic
pattern appears
as the presence
of multiple
randomly
distributed focal
lesions
throughout the
skeleton

Bone Metastases
A 99mTc-MDP bone scan in the anterior
and posterior projections
demonstrates multiple foci of
increased radiopharmaceutical
accumulation (spine, ribs, pelvis,
and left clavicle) with the typical
appearance of bone metastases

Advantages

Low cost
Widely available
Useful in imaging entire skeleton
Sensitive
90% for FDG-PET (18- fluorodeoxyglucose )
82% for whole-body MRI
71% for 99mTc bone scintiscanning

Continues to be used as initial screening

investigation

Disadvantages

Findings are nonspecific in

determining the cause of increased
uptake, particularly in solitary lesions.
Poor spatial and contrast resolution.
Further imaging is required to
characterize regions of disseminated
abnormality.
CT or MRI is required to localize an area
of increased glucose metabolism

False Positives of of 99mTc bone

scintiscans

Sensitivities are reportedly 62-89%.

Many benign processes and normal
variants can produce an area of
increased isotope uptake that mimics
a metastatic deposit.
Solitary areas of abnormal uptake
benign processes occur in
approximately one third of patients
with malignant disease.

Differential Diagnosis of multiple

scintigraphic abnormalities
Metabolic problems (eg, Cushing syndrome)
Osteomalacia
Trauma
Arthritis
Osteomyelitis
Paget disease
Infarctions

False Negatives of 99mTc bone

scintiscans

Some metastases may produce

normal scintiscan findings.
Cold or photopenic metastases may
be found in association with lesions
of highly aggressive anaplastic
carcinomas

SUMMARY

Nuclear Imaging has an important

role in the detection, diagnosis,
prognostication, treatment planning,
and follow-up monitoring of bone
metastases. Further imaging or
imaging-guided techniques may be
required to confirm the diagnosis, to
establish the extent of the disease,
and to find the primary tumor.

References

Thomas, MB, Hoff, PM, Wolffe, RA.

Gastrointestinal Carcinomas in: The
MD Anderson Manual of Medical
Oncology. McGraw-Hill Companies.
2006
Wilfred, CG. Bone Metastases.
www.emedicine.com