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Bone agents such as HDP localise in regions of increased bone blood flow and increased bone turnover. Almost all significant pathologic processes cause alteration in these physiological parameters, causing increased or occasionally decreased tracer localisation.
Combining the delayed scan with blood flow and pool study and/or SPECT/CT imaging usually enables a definite aetiological diagnosis to be made.SPECT/CT provides better classification of indeterminate non-diagnostic bone lesions and it enables precise anatomical localization of bone turnover abnormalities.
Bone scanning is a well-established technique, and is one of the most reliable, sensitive and valuable procedures in nuclear medicine. The scan can detect abnormalities weeks to months before routine skeletal x-rays. It is particularly useful for assessing patients with pain suspected of bony origin, and evaluating sports injuries. It remains the most cost-effective imaging procedure for assessing skeletal metastatic burden.
Detection, evaluation and follow up of skeletal metastases.
Detection, evaluation and follow up of primary bone tumours.
Early diagnosis of osteomyelitis and infected joints.
Evaluation of hip and knee prostheses and degenerative joint disease.
Diagnosis of stress fractures or occult fractures.
Diagnosis of avascular necrosis, particularly when the condition is post-traumatic.
Establishment of the extent and activity of Paget's disease.
Evaluation of elevated alkaline phosphatase.
Evaluation of bone pain of uncertain cause.
Diagnosis of enthesopathy, bursitis and reflex sympathetic dystrophy.
Patients need to have a good fluid load between injection and scanning (6 glasses of fluid).
Scanning is performed 2 – 4 hours after IV injection of 99mTc-HDP and takes approximately 45 minutes. A 10 minute scan may also be performed at the time of injection to determine blood flow to a region of interest.
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