Bone scan indications in patients under 30 years of age
Journal
European journal of nuclear medicine and molecular imaging
Date Issued
2020
Author(s)
Bozinovska N
DOI
10.1007/s00259-020-04988-4
Abstract
Aim/Introduction: Bone scintigraphy can be a useful tool
in evaluating bone disorders in young adults. Although it
has a low specificity, combining planar dual phase bone
scan (DPBS) and hybrid imaging (SPECT/CT), can help in
detecting metabolic activity of bone lesions (BL) of various
etiology. Materials and Methods: Bone scan indications
in young patients under 30 years were retrospectively
evaluated in a two-year period at our Nuclear Medicine
Department. The DPBS and afterwards SPECT/CT procedure
on the region of interest was performed 3 hours after i.v
application of 99mTc-MDP in dose calculated by age.
Results: We evaluated 65 patients (27 males, 38 females),
average - 15.32±7.25y. The most frequent indication was
metabolic activity of primary BL of non-malignant etiology
(38/65, 58.46%), followed by primary malignant BL (12/65
patients, 18.46%). In 10 (15.38%) patients the indication
was to detect bone mets due to non-bone malignancies
(Malignant Melanoma, Neuroblastoma, Nephroblastoma,
Medulloblastoma, Hodgkin Lymphoma, Histiocytosis). The
non-malignant etiology was predominantly due to primary
benign bone tumors (22/38, 57.89%) including Osteoid
osteoma - 8, Fibroma Non-Ossificans - 4, Enchondroma
- 1, Osteochondroma - 1, followed by Aneurysmal Bone
Cyst-7, Exostosis-1. Other rare indications were trauma,
sacroiliitis, rheumatologic diseases and fibrous dysplasia.
In suspected malignant bone tumors histopathology
revealed Osteosarcoma in 4 patients, Chondrosarcoma - 2,
Ewing sarcoma - 1, Histiocytosis - 3, Malignant Lymphoma
- 1, NET - 1. More than 2/3 of the patients complained of
bone pain and in 23% the pain was associated with an
injury. In 50/55 patients, BL presented in the appendicular
skeleton, mainly in the inferior extremities. DPBS was
performed in all except 9 patients (with malignancy of
non-bone etiology), where indication was detecting distant
mets. From 56 patients, DPBS was positive in 36.92%, while
negative in the pool phase and positive only on the late
phase in 27.69%. Positive both planar and SPECT/CT were
detected in more than half of the patients (52.31%), while 4
patients had negative planar and positive SPECT/CT (ABC-1,
Ewing - 1, Sacroiliitis - 1, Nephroblastoma - 1). Conclusion:
Bone scintigraphy is still a valuable nuclear method
complementary to other diagnostic modalities. In young
adults the main clinical indication is evaluation of primary
BL of non-malignant etiology. Because of its high sensitivity,
it can detect metabolic activity of BL and their turnover
(osteoblastic reactions) of various etiologies (benign,
malignant, traumatic, inflammatory, rheumatic) and assists
in further management of the patient.
in evaluating bone disorders in young adults. Although it
has a low specificity, combining planar dual phase bone
scan (DPBS) and hybrid imaging (SPECT/CT), can help in
detecting metabolic activity of bone lesions (BL) of various
etiology. Materials and Methods: Bone scan indications
in young patients under 30 years were retrospectively
evaluated in a two-year period at our Nuclear Medicine
Department. The DPBS and afterwards SPECT/CT procedure
on the region of interest was performed 3 hours after i.v
application of 99mTc-MDP in dose calculated by age.
Results: We evaluated 65 patients (27 males, 38 females),
average - 15.32±7.25y. The most frequent indication was
metabolic activity of primary BL of non-malignant etiology
(38/65, 58.46%), followed by primary malignant BL (12/65
patients, 18.46%). In 10 (15.38%) patients the indication
was to detect bone mets due to non-bone malignancies
(Malignant Melanoma, Neuroblastoma, Nephroblastoma,
Medulloblastoma, Hodgkin Lymphoma, Histiocytosis). The
non-malignant etiology was predominantly due to primary
benign bone tumors (22/38, 57.89%) including Osteoid
osteoma - 8, Fibroma Non-Ossificans - 4, Enchondroma
- 1, Osteochondroma - 1, followed by Aneurysmal Bone
Cyst-7, Exostosis-1. Other rare indications were trauma,
sacroiliitis, rheumatologic diseases and fibrous dysplasia.
In suspected malignant bone tumors histopathology
revealed Osteosarcoma in 4 patients, Chondrosarcoma - 2,
Ewing sarcoma - 1, Histiocytosis - 3, Malignant Lymphoma
- 1, NET - 1. More than 2/3 of the patients complained of
bone pain and in 23% the pain was associated with an
injury. In 50/55 patients, BL presented in the appendicular
skeleton, mainly in the inferior extremities. DPBS was
performed in all except 9 patients (with malignancy of
non-bone etiology), where indication was detecting distant
mets. From 56 patients, DPBS was positive in 36.92%, while
negative in the pool phase and positive only on the late
phase in 27.69%. Positive both planar and SPECT/CT were
detected in more than half of the patients (52.31%), while 4
patients had negative planar and positive SPECT/CT (ABC-1,
Ewing - 1, Sacroiliitis - 1, Nephroblastoma - 1). Conclusion:
Bone scintigraphy is still a valuable nuclear method
complementary to other diagnostic modalities. In young
adults the main clinical indication is evaluation of primary
BL of non-malignant etiology. Because of its high sensitivity,
it can detect metabolic activity of BL and their turnover
(osteoblastic reactions) of various etiologies (benign,
malignant, traumatic, inflammatory, rheumatic) and assists
in further management of the patient.