European Journal of

Nuclear Medicine Letter to the editor

Undeserved bad press for bone scans

Dear Sirs, References

The claim by the authors that.. . "Seven patients with diffuse mIBG uptake in the skele- ton appeared as normal on 99m Tc MDP scans (Fig. 2)" allows them to conlude that ..." 123 I mIBG is able to detect early tumoral diposits ... before 99m Tc MDP bone scans" [1] is unacceptable.

The illustrations of the bone scans (Figs. 2 and 3) are of poor quality. In neither figure can the fibula be distin- guished from the tibia, thus making evaluation of the knees rather difficult. Yet it is the knees that the earliest and most subtle changes of neuroblastoma invasion are seen [2]. In addition the appearances of the knees in Fig. 2 are not normal. For these reasons the claims made by the authors are unsubstantiated and can not be accepted.

These illustrations show the need for appropriate im- ages of the paediatric skeleton to be obtained before a very valuable, low cost examination i.e. the 99m Tc MDP bone scan is given a bad reputation because of poor images. The recent publication by Springer Verlag, Atlas of Bone Scintigraphy in the Developing Paediatric Skeleton, could go some way to improve the images ob- tained.

1. Osmanagaoglu K, Lippens M, Benoit Y, Obrie E, Schelstraete K, Simons M. A comparison of iodine 123 mIBG scintigraphy and single bone marrow aspiration biopsy in the diagnosis and follow up of 26 children with neuroblastoma. Eur J Nucl Med 1993; 20, 1153-1160.

2. Gordon I, Peters AM, Gutman A, Morony S, Dicks-Mireaux C, Pritchard J. Skeletal assessment in neuroblastoma - the pitfalls of Iodine 123 MIBG scans. J Nucl Med 1990; 31, 129-134.

Isky Gordon The Hospital for Sick Children Great Ormond Street London WC1N 3JH, UK

Eur J Nucl Med (1994) 21:466 Vol. 21, No. 5, May 1994 - © Springer-Verlag 1994