bone disease a diagnostic look. normal normal uptake sacroiliac joints hip joints glenoid fossa ...
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BONE DISEASEA Diagnostic Look
NORMAL
Normal uptake Sacroiliac joints
Hip joints
Glenoid fossa
Acromioclavicular joints
Sternoclavicular joints
Ends of long bones
Growing epiphyses
Vertebral column
What is the hot spot
in the patient’s left arm?
LABEL THE SCAN – ANT/POST – L/R
NORMAL SPECT BONE AND WHOLE BODY
On the left is a WWB
On the right are the
Views generated from aSPECT
Display may be comparedTo Maximum-Intensity
Projection (MIP)
MIP allows for “dynamic triangulation of the Le
vertebra
Bone Examples - Prostate MetsBone Examples - Prostate Mets
Hx. prostate cancer serum PSA
Widespread foci uptake
Spine, most ribs, skull, pelvis, proximal femurs, and both humeri
Pattern consistent of widespread metastatic disease
Images Courtesy of: J e r o l d W a l l i s , M . D w a l l i s @ n u c s 3 d . w u s t l . e d u
BONE EXAMPLES - PROSTATE METS
69 year old man
Prostatic carcinoma with radical prostatectomy, treated with leuprolide (Lupron®), hepatic and osseous metastatic disease.
Right femoral neck, L2, the left scapula, and pelvis
Abnormal activity in the RUQ abdomen diffuse hepatic metastases abnormal soft tissue Images Courtesy of: J e r o l d W a l l i s , M . D
w a l l i s @ n u c s 3 d . w u s t l . e d u
BONE EXAMPLES - LUNG CANCER
• Lung cancer
• Pelvic metastasis
• Lesion in the left ileum
• Tell me about the hot spots.
Bone Examples - Prostate MetsBone Examples - Prostate Mets
Hx. prostate cancer
Widespread foci uptake
Spine, most ribs, skull, pelvis, proximal femurs, and both humeri
Pattern consistent of widespread metastatic disease
Images Courtesy of: J e r o l d W a l l i s , M . D w a l l i s @ n u c s 3 d . w u s t l . e d u
BONE EXAMPLES - RENAL CA
59 year old female
Hx renal cell carcinoma
Absence left kidney post nephrectomy
Uptake vertex of the skull
The next page has several spot views
Images Courtesy of: J e r o l d W a l l i s , M . D .
w a l l i s @ n u c s 3 d . w u s t l . e d u
BONE EXAMPLES - RENAL CA
Vertex View
Images Courtesy of: J e r o l d W a l l i s , M . D .
w a l l i s @ n u c s 3 d . w u s t l . e d u
• Right lateral Anterior Left lateral
Vertex view of skull shows a lesion with a rim of activity and aVertex view of skull shows a lesion with a rim of activity and a central area of no activitycentral area of no activity
BONE EXAMPLES - BREAST CANCER
61 year old female
Hx. Infiltrating ductal CA
Patient refused surgery
Large mass right breast partially calcified tumor mass
MVA 2 years prior - multiple pelvic fractures
Images Courtesy of: J e r o l d W a l l i s , M . D .
w a l l i s @ n u c s 3 d . w u s t l . e d u
METASTASES
This is a patient with metastatic prostate cancer. Note the widespread increased activity. The marked uptake in the tumor makes the normal bone appear faint. While this picture looks dramatic, this patient was alive 1.5 years after this study.
Known as a Super Scan
http://gamma.wustl.edu/bs119te143.html
BONE SPECT OF METS
BONE EXAMPLES - PAGET’S DISEASE
65 year old man
Paget's Disease
New prostate cancer
R/O metastatic disease
High activity deformed left lower extremity
High activity in the 3rd lumbar vertebrae & manubrium.
Moderately right knee, shoulders bilaterally- pattern of degenerative changes
Images Courtesy of: J e r o l d W a l l i s , M . D .
w a l l i s @ n u c s 3 d . w u s t l . e d u
OTHER EXAMPLES OF PAGET’S DISEASE
Patient 1Patient 2
EWING’S SARCOMA
The child underwent 3-months of treatment. Exact typewas not identified.
http://www.nucmed.com/nucmed/cases/edited/Bone_31143555332.htm
OSTEOSARCOMA
11 Year old male with knee pain
Palpable mass in R proximal Tibia
Bone scan reveals primary bone cancer
Images Courtesy of: J e r o l d W a l l i s , M . D . w a l l i s @ n u c s 3 d . w u s t l . e d u
OSTEOMYELITISBlood flow and blood pools images demonstrated increased vascularity of the metaphysis of the left proximal tibia. Bone scan consistent with osteomyelitis involving the left proximal tibia..
CELLULITIS
A and B are blood pooling images where the Left hand has increase uptake
Delayed images show relatively normal tracer distribution
AVASCULAR NECROSIS
•Initially absence of uptake in the avascular and infarcted bone.
•Later in the healing phase, bone repair with activation of osteoblasts there is an increased accumulation of nuclide.
•Seen in fractures, sickle-cell disease, alcoholism, steroid administration, or can occur spontaneously.
http://www.med.harvard.edu/JPNM/BoneTF/Case13/WriteUp13.html
ARTHRITIS
Blood pooling shows normal flow
Delayed images indicate increased uptake in the articulating processes (joints)
STRESS FRACTURE
This patient was a long distance runner who presented with unilateral lower extremity pain. A plain film x-ray the day before was normal. This bone scan demonstrates a focus of increased activity in the proximal tibia on the left. This is typical of a stress fracture. The plain film will not be positive for about 10 days.
FRACTURE TRAUMA
Dropped a steel drawer on her left foot 3 months ago. X-rays were negative (Upper row are immediate images and lower row are delayed images)
BONE EXAMPLES - RSD
Reflex sympathetic dystrophy (Sudeck¹s atrophy and causalgia)
Sympathetic mediated disorder of the extremities
Symptoms: pain, stiffness, swelling, weakness, skin changes, vasomotor instability
3 Phase study - usually increase activity in all phases
Images Courtesy of: J e r o l d W a l l i s , M . D .
w a l l i s @ n u c s 3 d . w u s t l . e d u
BONE EXAMPLES - RSD WRISTS Wrists are another common area
for RSD Also Carpel Tunnel Disease 3 - Phase Inj. in opposite arm or foot 0-20 wks all 3 phases 20-60 wks normal uptake in 1st
& 2nd and in 3rd 60-100 wks normal or uptake
1st & 2nd, normal bone 3rd References: Diagnostic Nuclear
Medicine. 1996, 3rd edition. ed., Sandler, et al
Images Courtesy of: J e r o l d W a l l i s , M . D w a l l i s @ n u c s 3 d . w u s t l . e d u
PAGET’S DISEASE
This individual has Paget's disease that has invaded the pelvis and both hips. In addition, disease can be noted in the skull.
Stolen From MB Nuker’s Website
OSTEOSARCOMA WITH SOFT TISSUE UPTAKE
Patient with Osteosarcoma Of the left parietal and surroundingbone
Soft tissue uptake is further notedIn the left lung
Further investigation via CT showed“gross” plueral effusion with coplaseof underlying left lung parenchyma
http://www.cancerjournal.net/viewimage.asp?img=JCanResTher_2012_8_4_655_106594_f1.jpg
FINAL THOUGHT – ROLE OF FUSING CT WITH SPECT
A primary role with CT is to Add attenuation correction.
However, there is so much more!Look how the CT assists in identifying The exact location of disease.
Diease is facet joint arthropathy
www.ijnm.in/article.asp?issn=0972-3919;year=2012;volume=27;issue=3;spage=156;epage=163;aulast=Harisankar
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