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Radiology
Skeletal System Scintigraphy
Built from Fundamentals of Diagnostic Radiology
What’s inside
6 sections · 86 slides
Overview
- Scope of skeletal scintigraphy
- Skeletal scintigraphy roadmap
Technique
Radiopharmaceuticals, biodistribution, and how the images are acquired
- What the bone scan measures
- Tc-99m MDP workhorse
- Radionuclides used in skeletal scintigraphy
- F-18 sodium fluoride
- Therapy radionuclides at a glance
- Biodistribution and excretion
- Four-phase bone scan
- Tracer mechanism and radiation dose
- FDG in bone imaging
- Imaging technique and resolution
- Collimation and SPECT
- SPECT-CT value
- SPECT-CT of the foot
Interpretation
Normal patterns, then trauma, infection, tumors, and metabolic bone disease
- Normal skeletal scintigram
- Trauma detection
- Fracture healing on bone scan
- Multiple rib fractures
- Occult sacral fracture
- Fracture healing over time
- Shin splints vs stress fractures
- Wrist and multitrauma
- Prosthetic joint evaluation
- Toggle sign and infection workup
- Hip prosthesis loosening
- Joint inflammation
- Early osteoarthrosis and neuropathic joints
- L4-L5 facet degenerative arthropathy
- Osteomyelitis detection
- Osteomyelitis pitfalls
- Osteomyelitis of the second toe
- SPECT-CT of second toe osteomyelitis
- Cellulitis vs osteomyelitis
- Vascular influence on labeling
- Reflex sympathetic dystrophy
- Reflex sympathetic dystrophy
- Avascular necrosis and grafts
- Radiation therapy changes
- Radiation therapy changes
- Abnormal soft tissue uptake
- Heterotopic bone
- Metastatic calcification and HOA
- Hypertrophic osteoarthropathy
- Benign bone dysplasias
- Paget disease
- Paget disease of bone
- Detecting primary bone tumors
- How primary bone tumors appear
- Cold defects and aggressive tumors
- Benign bone tumors
- Low-grade chondrosarcoma
- Osteogenic sarcoma with metastases
- Metastatic bone disease basics
- Solitary hot spots
- Flare response
- Aggressive metastases
- Superscan of metastases
- Aggressive metastasis in the talus
- Resection of a solitary metastasis
- Particle disease
- Particle disease cascade
F-18 NaF PET-CT
A faster PET bone tracer with high specific uptake
- Why F-18 NaF
- F-18 NaF advantages and limits
- F-18 fluoride PET-CT
Systemic Radionuclide Palliative Pain Therapy
Relieving bone pain from skeletal metastases
- Bone pain burden
- 65%
- Systemic radionuclide therapy
- Radium-223 mechanism
- Patient selection
- Absolute contraindications
- Relative contraindications
- Transfusion and marrow reserve
Bone Mineral Densitometry
DEXA measurement and the T score classification
- DEXA technique
- Exclusions and surrogate sites
- Z score and T score
- ≥ -1
- Fracture risk and CT densitometry
- Bone mineral densitometry with DEXA
- Key takeaways
- Suggested Readings
- Suggested Readings (continued)
- Suggested Readings (continued)
- Suggested Readings (continued)
- Suggested Readings (continued)
- Brant and Helms' Fundamentals of Diagnostic Radiology