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45 Cards in this Set
- Front
- Back
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What causes an area of bone to be hot
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when there is increased bone turnover
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If an x ray shows a lytic area can there still be a hot are on bone scan
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yes, it is just a marker of metabolic activity
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What is the tracer used for bone scans
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99tc labeled diphosphate compound - MDP or HMDP
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What is the dosage used for bone scans
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20mCi
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How long do you wait after giving the contrast and scanning
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3-4 h
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What is the first phase of a 3 phase bone scan
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bolus injection with dynamic 3-5 second images for 1 minute
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What is the second phase of a 3 phase bone scan
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immediate blood pool image for 1000k (really the extracellular space)
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What is the last phase of the 3 phase scan
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the bone scan portion at 3-4 hrs
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Where would you expect to see increased active bone turnover in a normal patient
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periarticular, growth plate in kids
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What is a possible problem in imaging a patient with poor renal functin
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increased soft tissue activity which will limit the quality
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If a patient has slightly poor renal uptake you might expect to see what
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the kidneys will be better seen
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What is seen in metastatic disease on a bone scan
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extensive hot lesions and mostly in the axial skeleton
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What portion of the bone is most commonly involved in metastatic disease
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the red marrow
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What is expected to be seen on a nuclear scan of a patient with pagets disease
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intense tracer uptake with geographic distrubution
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What is seen on x-ray of a patient with pagets disease
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deformity or expansion of bone
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What is a common cause of reflex sympathetic dystrophy
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trauma
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What is the finding on bone scan of a pt with reflex sympathetic dystrophy
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increased uptake in all portions of 3-phase scan involved extremity, including periarticular bone.
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What is the MC cause of hypertrophic osteoathropathy
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lung cancer
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What are the findings on bone scan of a patient with hypertrophic osteoarthropathy
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increased cortical uptake in extremities causes railroad track appearance
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Can hypertrophic osteoarthropathy have a lumpy appearance
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yes
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What is the appearance of rib fx on bone scan
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multiple hot spots in a linear distribution (assuming multiple fx)
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What is seen with all tumors on bone scan
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they are hot
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Can you differentiate between malignant and benign tumors on bone scan
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no
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Where are enchondroma typically seen
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proximal humerus or proximal femur
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What is the intensity of the hot spot of an enchondroma
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mid level
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What part of bones does a osteoid osteoma affect
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the cortial
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What is the brightness on bone scan
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bright because it makes osteoid
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Is an osteosarcoma bright on bone scan
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yes this also produces osteiod
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What is a unique characterist of osteosarcoma on bone scan
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it can invade the soft tissue and make the soft tissue bright also
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What are some mets that are cold bone lesions
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myeloma, thyroid, renal carcinoma
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What are some primary cold bone lesions
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unicameral cyst and less often hemangioma and EG
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What is a particularly common cold lesion
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myeloma
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What is the flare phenomenom
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following sucessful treatment of cancer there will be increased uptake bc the bone is healing
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How long does the flare phenomenom last
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3-6 months
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How long do fractures remain hot
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6 months to 3 years
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What is the finding on bone scan within 24 h of trauma
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abnormalities on all 3 phases of bone scan
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What is the finding of stress fractures on bone scan
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focal cortical uptake that may extend in the the medullary space
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What is the finding on the 3 phase study of a patient with stress fx
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abnormal on all 3 phases
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What is the findings of shin splints on bone scan
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more diffuse tibial uptake in linear pattern
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How is osteomyelitis usually evaluated
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with three phase bone scan
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When is a 3 phase bone scan non-diagnostic for osteomyelitis
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if there is underlying bone disease
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What will be seen in all 3 phases of osteomyelitis
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increased uptake
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What will be seen in cellulitis
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increased uptake in the flow and immediate phase but normal in the delayed bone scan
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What is seen in tumor and fx in a bone scan
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increased uptake in all 3 phases
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How do you determine if a patient has osteomyelitis if there is underlying bone disease
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MR, but if not possible do a comparison study
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