bone disease a diagnostic look. normal normal uptake sacroiliac joints hip joints glenoid fossa ...

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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