Advantages of the clinical application of nuclide imaging in the osteoarticular system.
1.High sensitivity
—— is mostly used for the early diagnosis and efficacy observation of bone and joint diseases
2, whole body bone imaging can show the pathological changes of whole body bones in one examination
3, can reflect the blood supply and metabolic changes of each local bone
4.It can show the morphological changes of bones
Disadvantages of the clinical application of nuclide imaging in bone and joint system.
*Non-specificity:Tian Xinliang, Department of Diagnostic Imaging, Baoding Fifth Hospital
Showing structural changes in bone tissue is not as fine and accurate as X-ray, CT and MRI.
Imaging agent: 99mTc-MDP
99mTc-MDP
Imaging principle
Combine with hydroxyapatite crystal surface through chemisorption
Binding to organic matter, stronger binding to immature collagen
Aggregation of contrast agent in bone
Related to the degree of metabolic activity of the bone
Related to its local blood flow condition
Associated with sympathetic excitability
99mTc-MDP is stable in vivo, with rapid blood clearance and rapid bone uptake
Percentage of bone uptake in 2-3 hours is about 50-60%
99mTc-MDP is mainly excreted by the kidneys
30-40% excreted by urine in 3 hours, 50-75% excreted in 24 hours
Virtually no excretion through the intestine
Dose of 99mTc-MDP
Adults: 20-30 m Ci
Varies with different instruments and imaging conditions
Imaging methods
Bone Dynamic Imaging
3 Phase Bone
4 Phase Bone
Bone Static Imaging
Regional Bone
Whole Body Bone Scan
Bone Tomography
Normal Imaging
The bones of the whole body are symmetrically radiographed, and the distribution of radioactivity varies in different parts of the body depending on their structure, metabolic activity and blood supply.
In elderly patients, radioactive concentrations can be seen in the lower part of the cervical spine, mainly caused by degenerative disease of the cervical spine.
The relative concentration of radioactivity at the knee joint in elderly patients is mainly due to the degenerative trend of the joint.
The presence of radioactive concentrations in the lower corner of the scapula, bilateral sacroiliac joints, sternoclavicular joints and sciatic bones may be due to “gravitational” causes
Abnormal images
Abnormal concentration of radioactive distribution
Abnormally low radiological distribution
Super Bone Scan
Scintillation imaging
Indications
Early diagnosis of metastatic bone tumors
—Staging and grading of tumors, selection of treatment options and evaluation of efficacy
Diagnosis of primary bone tumors and determination of the extent of lesion invasion
Bone pain of unknown origin, excluding bone tumors
Diagnosis of ischemic necrosis of the femoral head
Diagnosis of various metabolic bone diseases and bone and joint diseases
Diagnosis of osteomyelitis and differentiation of osteomyelitis from cellulitis
Observe the blood supply and survival of transplanted bone
Follow-up after artificial joint replacement
Determination of small fractures that are difficult to detect by conventional radiographs
Clinical applications
Early diagnosis of metastatic bone tumors;
Primary bone tumors;
Bone trauma.
Diagnosis of fractures
Graft bone monitoring
Osteonecrosis :
Ischemic necrosis of the femoral head
Early diagnosis of acute osteomyelitis
Metabolic bone disease:
Deformational osteitis (Paget’s disease)
Osteoporosis
Early diagnosis of malignant metastatic bone tumors
Abnormalities are usually detected 3-6 months prior to X-ray detection of lesions
Often abnormal changes can be detected on bone imaging in the absence of bone pain symptoms
It is the first choice for the diagnosis of malignant bone metastases
It should be closely combined with other imaging examinations
The highest rate of bone metastasis is found in lung cancer, breast cancer and prostate cancer
Theoretically, any malignant tumor has the possibility of bone metastasis
Prevalent sites: spine, ribs, pelvic bone
Distal bone metastasis is rare in the extremities
It has important clinical significance for disease staging, selection of treatment plan, efficacy and prognosis
Nuclear medicine classic examination items
Typical case 1
Patient, male, 67 years old, six months after prostate cancer surgery. He had pain all over his body.
2001.05.25 whole-body bone scan showed multiple abnormal focal concentrated skeletal shadows, suggesting multiple bone metastases of the tumor.
**Recommended 89Sr internal irradiation treatment.
Typical case 2
Patient, male, preoperative prostate cancer. 2003.01.06 whole-body bone scan showed multiple focal radioactive concentrations in the skull, spine, ribs and pelvic bones, with poorly defined bilateral kidney visualization. Diagnosis: multiple bone metastases of tumor.
**The patient cannot receive surgical treatment.
Typical case 3
Patient, female, preoperative right lung cancer.
A whole-body bone scan suggested multiple bone metastases.
**Non-surgical treatment is recommended.
Typical case 4
Patient, male, 76 years old, wasting to be investigated. Multiple abnormal foci of radioactive concentration were seen on bone imaging, suspicious of malignant tumor bone metastases. No primary lesions were found at that time, and clinical search for primary lesions was recommended.
**The final clinical diagnosis was esophageal cancer.
Primary bone tumor
The correct diagnosis of primary bone tumor must rely on the combination of clinical, pathology and imaging, among which radiological examination, including X-ray plain film, CT and MRI, occupies an important position.
In primary bone tumors, the uptake of bone imaging agents is often strong. In primary bone tumors, nuclide bone imaging is not a necessary test because it can neither accurately depict the tumor margins nor clarify the extent of soft tissue invasion.
The value of nuclear imaging is
Early detection of lesion location
whether there are lung and soft tissue metastases
whether there are distant bone metastases
Case 1
Patient, female, 50 years old. The diagnosis of right femoral fibroblastic osteosarcoma was confirmed by clinicopathology. A whole-body bone scan was performed to understand the extent of the lesion and the presence of distant metastases. Whole-body bone imaging suggested a limited lesion with no other metastases.
Bone trauma
Fracture
Occult fracture
Medically induced injury
Bone transplantation
Sports injuries
Stress fracture
External shin splints
Rhabdomyolysis
Typical case 1 Occult fracture
The patient, a 48-year-old male, experienced pain in the left hip after trauma. x-ray was suggestive of “rib fracture with negative pelvis and bilateral hips”. The whole-body bone scan showed a linear abnormal radiolucent shadow at the junction of the left rib with the rib cartilage and at the junction of the right rib with the sternum, which was caused by trauma. The left acetabulum and femoral neck showed an abnormal radiological concentration area, which was considered to be an occult fracture of the left femoral neck. It was later confirmed by CT.
Osteonecrosis
Ischemic necrosis of the femoral head
Juvenile deforming osteochondritis
Osteonecrosis caused by steroids
Sickle cell anemia
Typical case 1 Bilateral ischemic necrosis of the femoral head.
Patient, male, 30 years old.
Focal radiological defects of the femoral head were seen bilaterally in the anterior-posterior position on local bone radiographs, with “circle”-like changes.
X-rays of this patient suggest “pathological fracture of both femoral necks”.
Metabolic bone disease
Metabolic bone disease is a group of diseases with abnormal bone metabolism as the main manifestation.
They are usually associated with endocrine and bone nutrient metabolism dysfunction.
The common ones are primary hyperparathyroidism, renal osteodystrophy, osteoporosis, osteochondrosis and Paget’s disease
Rarely, hypervitaminosis D, hyperthyroidism, etc.
Metabolic bone disease imaging features
Increased radioactivity in the skull and mandible;
Increased radiopacity of the medial bones;
There is a clear radiological uptake at the cartilage junction of the ribs, which is beading-like;
The sternal shadow is obvious, showing the tie sign;
Increased symmetrical radiological uptake in long bones;
Increased radioactivity in periarticular tissue;
Faint or no kidney shadow;
Typical case 1
Patient, male, 51 years old. He had multiple stones in both kidneys for 7 years, renal insufficiency for 2 years, and back and leg pain for 1 month. CT and MRI suggested a right upper mediastinal mass and clinical suspicion of malignant bone metastasis? The whole body bone scan showed more radioactive concentration in the skull, enhanced bone shadow in the extremities, and faint shadow in both kidneys. Both lungs and stomach were visible, and there were obvious radioactive concentrations in the left hip, left femur and left knee at the lateral elevated nodes, which was typical of ectopic calcification. The surgical pathology diagnosed “parathyroid adenoma”. A whole-body bone scan performed 3.5 years after parathyroidectomy showed the disappearance of the former bilateral lung, gastric and subcutaneous nodal concentrations, but there were widespread concentrations in the skull, medial bones and limb bones, and both kidneys were barely visible, and the focal dotted concentrations in the right anterior 7th rib and the left anterior 3rd, 6th and 7th ribs were rib fractures.