BONE SCINTIGRAPHY

dr.Yulia Kurniawati,SpKN
 OSTEOBLASTIC MAPPING
Tc-99m LABELLED DIPHOSPONATES (MDP)
WHOLE BODY SCINTIGRAPHY
SKULL

FIGURE 1 Anterior view of skull

FIGURE 4 Posterior view of skull
FIGURE 2 Right lateral view of skull
FIGURE 4 Left lateral view of skull
THORAX AND
PELVIS

FIGURE 1 THORAX ANTERIOR

FIGURE 4 THORAX POSTERIOR
FIGURE 2 PELVIS ANTERIOR
FIGURE 5 PELVIS POSTERIOR
 LOWER LIMBS

FIGURE 1 ANTERIOR VIEW OF FEMUR

FIGURE 2 POSTERIOR VIEW OF TIBIA,
FIBULA AND ANKLES
GENU AND
ANKLE

FIGURE 1 ANTERIOR VIEW OF GENU

FIGURE 4 POSTERIOR VIEW OF GENU
FIGURE 1,5 ANT AND POST VIEW OF ANKLE
STEIJING
A 55 YEARS OLD MALE PATIENT WITH PROSTAT
CANCER;INITIAL STAGING
STEIJING
A 70 YEARS OLD MALE PATIENT WITH HIGH GRADE PROSTAT CANCER (GS 9).THE
PATIENT HAD TUR OF PROSTAT.THERE IS NO RECENT HISTORY OF ANY
SIGNIFICANT TRAUMA TO THE PELVIS
Extensive osseous metastases from lung
carcinoma. Anterior (left) and posterior
(right) wholebody
bone scintigrams show multiple, randomly
distributed foci of abnormal radiotracer
uptake. The foci vary in size and intensity.
Bone metastases from gastric carcinoma.
Anterior (left) and posterior (right) whole-body
Scintigrams show diffuse, irregularly increased
activity throughout the appendicular and axial
skeleton. There is minimal soft-tissue activity
and virtually no renal or bladder activity.
This pattern is indicative of diffuse bone
metastases and is often referred to as
a superscan
Anterior (left) and posterior (right)
wholebody scintigrams obtained in a
patient who fell demonstrate
multiple foci of increased radiotracer
uptake.The linearly distributed rib foci
and H-shaped sacral activity indicate
trauma as the cause of these foci. The
increased activity in the right proximal
humerus is due to a fracture.
(a) Posterior planar
scintigram demonstrates a focus of increased
radiotracer
uptake in the right side of a lower thoracic vertebra.
(b–d) Transaxial
(b), coronal
(c), and sagittal
(d) Tomograms demonstrate that this
eccentric activity extends from the body of the
vertebra into the pedicle, a pattern that is consistent
with metastatic disease.
RESTAGING
A 64 YEARS OLD WOMAN WITH HISTORY OF BREAST CANCER.THE
PATIENT HAD UNDERGONE MASTECTOMY FOLLOWED BY
CHEMOTHERAPY AND RADIOTHERAPY 5 YEARS EARLIER.

A B
DESKRIPSI

 Dari citra planar (A),tidak tampak penangkapan radioaktivitas yang

meningkat patologis (lesi osteoblastik)pada tulang-tulang

Kesimpulan
Sidik tulang dalam batas normal
 Dari citra planar (B),tampak penangkapan radioaktivitas yang meningkat
patologis (lesi osteoblastik) pada proyeksi os.costae VII anterior kanan

 Dari SPECT/CT,tampak penangkapan radioaktivitas yang meningkat

patologis (lesi osteoblastik) dengan penebalan kortek pada os.costae
VII ant kanan
Tidak tampak penangkapan radioaktivitas yang meningkat patologis pada
tulang-tulang lainnya

Kesimpulan
Gambaran demikian menunjukkan suatu fraktur lama pada os.costae
VII ant kanan.Tidak tampak gambaran metastase pada tulang
RESTAGING
A 76 YEARS OLD WOMAN WITH HISTORY OF NSCLC WHO WAS TREATED WITH
SURGERY AND ADJUVANT CHEMOTHERAPY.
RESTAGING
A 48 YEARS OLD WOMAN WITH HISTORY BREAST CANCER AND TREATED WITH
SURGERY.THE PATIENT REFUSE NEOADJUVANT THERAPY
 Dari citra planar ,tampak penangkapan radioaktivitas yang meningkat
patologis (lesi osteoblastik) pada proyeksi os.costae IX,X anterior kanan,
os.costae VI,VIII,IX posterior kiri dan VII,X posterior kanan.

 Dari SPECT/CT,tidak tampak penangkapan radioaktivitas (lesi osteolitik)

pada korpus os.vertebra thorakal.

Kesimpulan
Gambaran demikian mendukung suatu metastases pada tulang-tulang diatas.
RESTAGING
initial 3 Month 6 Month
Bone metastasis from breast carcinoma. Scintigram from the initial bone study
(left) demonstrates numerous foci of increased activity.

On a scintigram obtained 3 months later (center), the abnormalities are more

intense,and new abnormalities have become evident.

On a third scintigram obtained yet

3 months later (right), many lesions have resolved, and those that remain have
decreased in intensity.No new abnormalities have appeared.

The changes present on the second study (center) reflect a response to

treatment and the flare phenomenon, not disease progression.
RECURRENT OF CANCER
 THREE PHASE

Osteomyelitis. Dynamic (left), blood pool (center), and bone (right) images
from a three-phase bone scan demonstrate focal hyperperfusion,
focal hyperemia, and foci of increased bone uptake, respectively,
in the right great toe.
Paget disease.
Whole-body scintigram
demonstrates increased
radiotracer accumulation in
the proximal right femur and in the
deformed and enlarged tibias.
 18F NaF PET/CT

• Fluoroapatite crystal by chemoadsorbion to hydroxyapatite

crystal  osteogenic activity

• Show greater number of metastasis lesions compare to

Tc-99m MDP and 18F FDG PET/CT
18F-NaF PET/CT

1. Showed both blastic and lytic lesions

2. Good target to background ratio
3. Showed smaller lesions
4. Good spatial resolution
5. High sensitivity and specifity

 Staging,Restaging,Respon to therapy,prognostic
A. Tc-99m MDP Bone
Scintiraphy
B. 18F-NaF PET

LYMPHOMA NON
HODGKIN
A. AXIAL IMAGE OF CT
B. 18F NaF PET/CT
A. AXIAL IMAGE OF 18F FDG PET/CT
B. AXIAL IMAGE OF 18F NaF PET/CT