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Spine Bone ScanAka: Bone Scintigraphy of Spine

Indications (with normal L-Spine XRay)
1. Osteomyelitis
2. Bony neoplasm or metastases
3. Occult vertebral Fracture
Mechanism
1. Radiographic tracer compounds taken up by new bone
  1. Technetium Tc 99m Phosphate
  2. Gallium 67 Citrate
2. Incorporated into hydroxyapatite crystals
3. Increased uptake indicates areas of high bone turnover
Advantages
1. Sensitive for bony neoplasm
  1. Test Sensitivity in spinal metastases: 85%
2. Sensitive for infection
Disadvantages: Non-specific
1. False positives in 33% older patients (Osteoarthritis)
2. False negatives
  1. Diffuse bony metastases
  2. Multiple Myeloma
Protocols
1. Technetium Tc 99m Phosphate
2. Gallium 67 Citrate
  1. Most accurate imaging in infectious spondylitis (95%)
3. Single-Photon Emission Computed Tomography (SPECT)
  1. Three dimensional bone scan imaging
  2. Lesions of vertebral pedicles suggests malignancy
References
1. Humphreys (2002) Am Fam Physician 65(11):2299

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.