Osteoscintigraphy or skeletal scintigraphy. Diagnosis of bone cancer and other diseases.

1.What is osteoscintigraphy and why is it performed?

Skeletal scintigraphy is a type of examination that allows you to diagnose bone cancer, bone damage and infections. Bone scintigraphy often detects problems weeks or even months earlier than conventional x-rays.

Why is osteoscintigraphy done?

Skeletal scintigraphy is done to:

• Diagnose bone cancer;
• Find the cause or source of unclear bone pain;
• Examine fractures that are difficult to see on x-ray;
• Look for bone damage caused by infections or diseases such as osteosis deformans.

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Indications for bone scintigraphy

Often, a bone scan is used after other tests, such as a CT scan or MRI, have been done. It helps to evaluate detected anomalies and clarify the diagnosis. Scintigraphy is also used in primary diagnosis. It can be used to diagnose the following diseases:

• Primary malignant tumors and metastatic foci in bones.
• Benign neoplasms in bone tissue.
• Bone fractures: for example, hip fracture, stress fractures, which are difficult to visualize on x-rays.
• Other pathologies affecting the skeletal system: spondyloarthropathy, rheumatoid arthritis, enthesopathies, Paget's disease, avascular osteonecrosis, etc.

In oncology, bone scanning is most informative for diagnosing the following diseases:

• Solid (dense) tumors that are highly likely to metastasize to the bones. In particular, such neoplasms include breast, lung, prostate, and kidney cancer.
• Malignant diseases of the blood and lymphoid tissue that metastasize to the bones, including non-Hodgkin's lymphoma and Hodgkin's lymphoma.
• Osteosarcoma and other primary bone tumors.

A bone scan may be done before a biopsy to examine the area from which material will be taken for testing.

3.How is the examination carried out?

Skeletal scintigraphy is performed and interpreted by a nuclear medicine specialist or a radiologist.

Before osteoscintigraphy, you must remove all jewelry and undress.

A special substance is injected into a vein in the arm to allow the bones to appear in photographs. The substance takes 2 to 5 hours to reach the bones. During this time, you will be asked to drink several glasses of water to flush out the substance. You will need to empty your bladder immediately before taking pictures.

To take pictures, you will be asked to lie down on a table. A special camera scans your bones. The camera does not emit radiation.

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Skeletal bone scintigraphy (osteoscintigraphy)

Scintigraphy of skeletal bones (osteoscintigraphy) is a study of metabolism (metabolism) of bone tissue using radiopharmaceuticals (RPs), which accumulate in the bones of the skeleton.

Advantages of the method : the ability to detect bone tissue pathology before the development of clinical and radiological signs of bone damage.

Indications for osteoscintigraphy:

• oncological pathologies with bone metastasis;
• diagnosis of fractures and tumor processes in bones;
• control of treatment dynamics;
• identification of areas with altered bone tissue during degenerative-dystrophic processes.
• osteomyelitis, myeloma

Preparation for skeletal bone scintigraphy: not required.

Within an hour after administration of the radiopharmaceutical, it is necessary to drink 1 liter of drinking water to improve the accumulation of the drug in the skeletal bones and reduce radiation exposure. Immediately before the test, be sure to empty your bladder.

Contraindications: Pregnancy.

Breastfeeding must be interrupted for 48 hours from the moment of administration of the radiopharmaceutical.

Features of scintigraphy of skeletal bones:

The study is carried out 1.5 to 3 hours after administration of the radiopharmaceutical. Takes from 30 minutes. The conclusion is issued on the day of the study.

Metastases of various tumors in the bone:

Many tumors metastasize to the bones. First of all, suspicion of metastatic damage to the skeleton arises in breast and prostate cancer, lung cancer, kidney cancer and some others. Particular caution should be exercised when the level of tumor markers increases, for example: PSA (prostate-specific antigen), CA 15-3 and some others. After conservative treatment or surgical removal of the tumor, dynamic monitoring of the condition of the bone tissue is recommended. Scintigraphy should be performed the first 2 times with an interval of 6-8 months, then, if the study result is normal, after 1-2 years. You should clarify the need for repeat studies with a radiologist or your attending physician.

Inflammatory and traumatic changes in bone tissue:

One of the indications for radionuclide studies of the skeletal system (bone scintigraphy) is inflammatory changes in bone tissue. The method allows you to determine the prevalence of the process by identifying foci of inflammation in the bones and joints throughout the skeleton, even in the early stages of the disease. Radiographs of osteomyelitis usually reveal a less widespread process than it actually is. Scintigraphy shows the true size of the inflammatory focus.

Osteoscintigraphy in orthopedics and vertebrology:

When replacing joints or installing metal structures in the spine, scintigraphy of the skeleton bones allows us to detect mechanical instability of the prosthesis components (looseness) or an inflammatory process around the prosthesis or metal structure. Unlike other research methods (X-ray, CT, MRI), scintigraphy of skeletal bones makes it possible to determine the intensity of the inflammatory process in various parts of the bone.

Cost of radioisotope research:

4.What are the risks and what can interfere with the examination?

What are the risks of bone scintigraphy?

Allergic reactions to the radioactive substance are very rare. Your body will get rid of it throughout the day through urine and feces. The dose of radioactive radiation received during skeletal scintigraphy is extremely small and therefore has no risk.

What can interfere with osteoscintigraphy?

Skeletal scintigraphy may be interfered with by:

• Pregnancy;
• Barium is in your body;
• Inability to maintain a calm position;
• Full bladder.

Preparing for the study

Most often, special preparation for the study is not required. You can eat as usual and take any medications. If you plan to examine the pelvic bones or hip joint, you will need to empty your bladder and rectum before the procedure to ensure clear images.

When going for research, you need to wear comfortable, loose clothing. It is also very advisable to take with you the results of all studies completed previously, a medical record, certificates, extracts - this will help the doctor evaluate the results in a comprehensive manner and establish an accurate diagnosis.

Contraindications

Bone scintigraphy is contraindicated in pregnant women because radiation from the radioactive tracer may harm the developing fetus. If a woman is breastfeeding a child, she should do so before the procedure. After the scan, you need to express milk once, and only after that you are allowed to resume breastfeeding. Your doctor will give you more detailed recommendations.

If a patient suffers from a cardiovascular disease and is taking medications to treat it, the doctor should be informed about this. This is not an absolute contraindication to scintigraphy, but during the procedure the condition of such a patient must be monitored more carefully.

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Algorithm for the procedure

In conventional x-rays, an image is made by shining x-rays through the patient's body. Bone scintigraphy uses a radioactive material called a radiopharmaceutical (RP) or radioactive isotope that is injected into the blood, swallowed, or inhaled as a gas.

This radioactive material accumulates in the organ or area of ​​the body being tested, where it releases small amounts of energy in the form of gamma rays. Special cameras detect this energy, then use a computer to create images detailing the pathological changes.

The doctor injects a radiopharmaceutical into the patient’s body and sends him home for at least three hours. During the waiting period, you should try to drink at least one and a half liters of water in order to significantly increase the rate of cleansing the body of radionuclides. Before the procedure itself, it is imperative to empty your bladder.

The patient is placed in a sitting or lying position on the couch. It is important not to move or talk during the diagnostic process. There is no one in the research room except the patient; all medical workers are in the adjacent room, from where the observation and diagnostic process is carried out.

The gamma camera, which records changes in bone tissue, is a large crystal that simultaneously scans the entire body. Data from the camera is transferred to a computer and interpreted into a graphic image. To undergo the procedure, it is recommended to choose the best modern medical centers that actively use scintigraphy for bone diagnostics.

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The results can be collected from the radiologist, usually within 24 hours. The images will completely display the human skeleton, which allows you to assess the general condition of the patient’s skeleton, as well as the number and location of metastases. Diagnostics helps not only to determine the source of the disease, but also to suggest its type: benign or malignant.

Side effects

A radiopharmaceutical is a substance that emits radioactive radiation. The most commonly used is technetium-99m. It is safe because the dose a person receives when using it is even less than during a CT scan, and it is completely eliminated from the body after 1-2 days.

Side effects occur in only 1% of patients, and most often they are not dangerous and go away on their own without medical help:

• soreness, redness in the place where the drug was administered;
• unusual taste in the mouth;
• changes in the perception of smells;
• cardiopalmus;
• feeling of discomfort, chest pain.