Bone Scanning in Clinical Practice by I. Fogelman (auth.), Ignac Fogelman BSc, MD, MRCP (eds.)

By I. Fogelman (auth.), Ignac Fogelman BSc, MD, MRCP (eds.)

The most often asked research in any nuclear medication division is still the technetium-99m (99mTc)-labelled diphosphonate bone test. regardless of swift advances in all imaging modalities. there was no critical problem to the function of bone scanning within the review of the skeleton. the most explanation for this can be the beautiful sensitivity of the bone experiment for lesion detection. mixed with transparent visualisation of the total skeleton. in recent times a number of new diphosphonate brokers became to be had with claims for more suitable imaging of the skeleton. basically. all of them have better affinity for bone. therefore permitting the conventional skeleton to be visualised all of the extra basically. even though. as should be dis­ stubborn. this can happen at a few expense to the primary function of bone scanning. lesion detection. the main energy of nuclear drugs is its skill to supply useful and physiological info. With bone scanning this ends up in excessive sensitivity for focal affliction if there was any disturbance of skeletal metabolism. even if. in lots of different scientific events. and especially in metabolic bone ailment. extra generalised alteration in skeletal turnover might take place. and quantitation of diphosphonate uptake via the skeleton promises important medical information.

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Connective and soft tissues. CalcifTissue Res 20: 303-311 Francis MD. Tofe AJ. Benedict JJ. Bevan JA (1979) Imaging the skeletal system. In: Sorenson JA (ed) Radiopharmaceuticals n. proceedings of the 2nd international symposium on radiopharmaceuticals. New York. Society of Nuclear Medicine. pp 603-614 Francis MD. Ferguson DL. Tofe AJ. Bevan JA. Michaels SE (1980) Comparative evaluation of three diphosphonates: in vivo adsorption (C_'4 labelled) and in vivo osteogenic uptake (Tc99mcomplexed). J Nucl Med 21: 1185-1189 Francis MD.

Francis 1981. unpublished work). In mechanism 1. the skeletal complex adsorbs to the surface intact and remains there in the ratio of administered •• mTc-p*. In mechanism 2 at the surface. the complex breaks and the diphosphonate adsorbs to the calcium phosphate surface separately (see Fig. 9) while the released "mTc(IV) ion would hydrolyse. migrate and adsorb separately on the bone surface as highly insoluble "mTC02' n. Benedict Van Duzee BF (1982) A structurefbiodistribution study of •• mTc-diphosphonate skeletal imaging agents.

Highresolution images are undoubtedly aesthetically more attractive, but a fundamental problem with all the diphosphonates currently in general use is the high uptake in normal bone, with correspondingly relatively low contrast between normal and abnormal areas. For maximal diagnostic accuracy the number of counts collected is more important than the resolution of the imaging device. Although a number of workers have advocated rapid images with low count densities, there is ample evidence that this is an unreliable technique and should not be employed under any circumstances.

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