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Nuclear Medicine Imaging Techniques of the Musculoskeletal System

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Clinical Nuclear Medicine

Abstract

Bone scintigraphy is used as a common screening test for suspected bone metastases because of its high sensitivity, availability, low cost and ability to scan the entire skeleton. Historical data and clinical experience has established bone scintigraphy as the reference standard in the search for skeletal metastatic disease, and many indications have become established for benign skeletal disorders (Table 10.1). Chiewitz and Hevesy first described the use of radionuclides to study the skeleton in 1935 [1] where 32phosphorus (32P) activity was measured in rat organs with a Geiger Muller counter and where uptake of 32P from blood to bone was noted suggesting that skeletal metabolism is a dynamic process. Fleming and colleagues produced the first radionuclide skeletal images in 1961 using 85Sr [2], and this radioisotope was commonly used for bone scanning and the study of skeletal kinetics. Although 87mSr was introduced as an alternative bone scanning agent with a more suitable gamma ray for imaging of 388 KeV and half-life of 2.8 h, the introduction of 18F-fluoride and then 99mTc-labeled compounds superseded this. In 1971 Subramanian and McAfee successfully prepared technetium-99m-polyphosphates. However, it was later found that the bone localizing properties were due to pyrophosphate [3, 4]. Since then there have been many developments in both radiopharmaceuticals and scanning techniques to aid evaluation of metastatic bone disease. In recent years technetium-99m (99mTc)-labeled diphosphonates have become the most widely used radiopharmaceuticals, particularly 99mTc-methylene diphosphonate (MDP). Improvements in gamma camera design, including the increased availability of tomographic scintigraphy (single photon emission computed tomography, SPECT), have also helped nuclear medicine techniques which provide functional information and maintain their clinical utility in spite of the major advances in cross-sectional anatomical imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). In recent years, there has been increasing interest in the use of positron emission tomography (PET) tracers in the investigation of various aspects of skeletal disease but especially in the diagnosis of bone metastases.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK

    Gopinath Gnanasegaran

  2. Department of Nuclear Medicine and PET, Guys & St. Thomas’ NHS Foundation Trust, London, UK

    Gary Cook

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  1. Gopinath Gnanasegaran
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Editors and Affiliations

  1. Department of Nuclear Medicine, Klinikum Westfalen - Knappschaftskrankenhaus Academic teaching hospital of the Ruhr University, Dortmund, Nordrhein-Westfalen, Germany

    Hojjat Ahmadzadehfar

  2. Department of Nuclear Medicine, Beta Klinik Bonn, Bonn, Germany

    Hans-Jürgen Biersack

  3. Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY, USA

    Leonard M. Freeman

  4. Albert Einstein College of Medicine, Bronx, NY, USA

    Lionel S. Zuckier

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Gnanasegaran, G., Cook, G. (2020). Nuclear Medicine Imaging Techniques of the Musculoskeletal System. In: Ahmadzadehfar, H., Biersack, HJ., Freeman, L., Zuckier, L. (eds) Clinical Nuclear Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-39457-8_10

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