By I. Fogelman (auth.), Ignac Fogelman BSc, MD, MRCP (eds.)
The most often asked research in any nuclear drugs division is still the technetium-99m (99mTc)-labelled diphosphonate bone test. regardless of swift advances in all imaging modalities. there was no severe problem to the position of bone scanning within the evaluate of the skeleton. the most explanation for this is often the beautiful sensitivity of the bone test for lesion detection. mixed with transparent visualisation of the entire skeleton. lately numerous new diphosphonate brokers became on hand with claims for improved imaging of the skeleton. basically. all of them have better affinity for bone. therefore permitting the conventional skeleton to be visualised all of the extra basically. besides the fact that. as may be dis stubborn. this can happen at a few rate to the vital position of bone scanning. lesion detection. the most important power of nuclear drugs is its skill to supply practical and physiological info. With bone scanning this ends up in excessive sensitivity for focal disorder if there was any disturbance of skeletal metabolism. notwithstanding. in lots of different medical events. and especially in metabolic bone sickness. extra generalised alteration in skeletal turnover may well happen. and quantitation of diphosphonate uptake by means of the skeleton delivers priceless medical information.
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Pelvis and hips of a 4-year-old child. There is high activity in the epiphyses of the femoral head. but the epiphyses of the greater trochanter are barely discernible. • Fig. 16. Pelvis of an 8-year-old child. The epiphyses of the greater trochanter on the right is clearly visible but is much less active than the head epiphyses. Note that at this age there is considerable activity in the triradiate cartilages. Fig. 15. Whole-body anterior and posterior images of a 5-year-old child . Note the substantial differential in count rate between the upper and lower limbs.
On rare occasions 24-h images may be useful in confirming lesions that appear equivocal at 4 h (Merrick 1975; Hardoff and Front 1978). Although scintigraphy is most commonly performed with a gamma camera, the appearance of the images obtained is influenced to only a minor extent by the type of instrumentation used. Any scanning gamma camera which produces a single image of the entire skeleton has a lower resolution than the same camera used in the static mode, when several images are required to include the whole skeleton.
1 contains approximately 50 000 counts. The difference between the two images is due to the difference in count rate. not the differences in resolution. Since diphosphonate is excreted by the kidneys, patients should be encouraged to drink fluids (at least a litre, ifpossible) in the interval between injection and imaging. This ensures faster clearance of non-skeletal tracer from the urinary tract, thereby decreasing soft tissue background and the absorbed radiation dose to the bladder, which is the critical organ.