BONE SCINTIGRAPHY

Bone scintigraphy is a scan technique that allows functional diagnostics of bone metabolism and visualization of some bone abnormalities.

This diagnostic method is highly informative and is commonly used to diagnose the following skeletal system diseases:

• Acute and chronic osteomyelitis
• Joint inflammations of diverse etiology
• Bone metastases
• Primary bone tumors
• Bone  injuries (diagnostics of bone fractures

which are not visible on an x-ray image)

• Chronic bone pain of unclear etiology
• Ongoing pain after replacement arthroplasty

(identification of pain cause, e.g. loose joint

prostheses or inflammatory process)

• Primary and secondary hypoparathyroidism
• Paget’s disease
• Bone tissue necrosis

INFORMATION ON THE DIAGNOSTIC PROCEDURE

Bone scintigraphy does not require any specific patient preparation. The test takes about 4 hours in total and is usually performed with the patient lying on their back.

The patient is placed on the scanning bed and receives an intravenous injection of a small amount of the radiopharmaceutical. Bone scintigraphy is usually performed using technetium-99m-labelled hydroxymethylene diphosphonate or methylene diphosphonate (HMDP-Tc99m, MDP-Tc99m). The radiotracer accumulates in the bone cells.

Multiphase bone scintigraphy usually includes blood flow images (I), blood pool images (II) and delayed images (III). They are obtained within 10 min after the tracer injection (phases I and II), as well as                    2-4 h after injection (phase III). The blood flow and blood pool images are limited to the areas of interest (e.g. the knee in case of suspected synovitis). Delayed images (III) may be limited to the area of interest, or may additionally include the whole body. Static bone scan images are obtained only 2-4 h after injection. The patient can eat and drink normally before the appointment and take all medication as usual. It is necessary to drink 1-2 liters of fluids after the radiotracer injection in order to speed up tracer elimination from non-skeletal tissues, as well as enhance quality of the obtained images. Increased fluid intake also lowers patient radiation exposure, since the trace which is not bound in the bones is excreted in urine and thus is found in the patient’s body for a shorter time.

It is not required to undress for the test, however it is recommended to wear comfortable loose clothes, if possible without metallic accessories (e.g. buckles, big buttons, braces etc.). Proximity of metal elements weakens the quantum radiation beam and may interfere with the procedure. The patient must remove metallic jewelry due to the same reason. It is prohibited to use a mobile phone during the test, so the patient will be asked to switch it off.

Patients with back deformities or intense back pain should inform the personnel about it while scheduling the appointment. It is necessary to inform the clinic personnel about localization of the skeletal system disease before the radiopharmaceutical administration, in order to avoid isotope injection near the disease localization (e.g. if the patient suffers from joint pain in the left hand, the radiopharmaceutical should be injected in the right basilic vein etc.).

The given diagnostic procedure is very safe – neither tracer nor vector molecule in the radiopharmaceutical cause allergic reactions. Since technetium isotope has low radiation energy and a short half-life (about 6 h), it has been widely used in the nuclear imaging throughout the world since 50 years. The patient poses no risk of radiation exposure for the surrounding people after the test!

The radiation dose received by the patient during scintigraphy is negligibly small, it’s lower than the radiation dose from e.g. CT scan. This exam can be offered to patients of all ages (even several weeks old babies) and repeated multiple times.

Similar to conventional radiographic techniques, scintigraphy is contraindicated during pregnancy. Women of reproductive age must undergo scintigraphy within the first 10 days of the menstrual cycle (i.e. up to the 10-th day from the first day of the period).

Scintigraphic diagnostics is always performed with the patient or their legal guardian’s consent. Decision to undergo this test is always voluntary, and possible refusal to be subject to it has absolutely no effect on the further diagnostics and treatment procedures.

None of the diagnostic tests performed at NUKLEOMED nuclear medicine center require general anesthesia.