The flare phenomenon: still learning after 35 years

Excerpt

These are interesting and challenging times for the isotope bone scan with regard to the identification of metastatic disease, with mounting evidence that the addition of SPECT improves sensitivity and specificity, SPECT/CT is even better, ¹⁸F-fluoride PET/CT better still. In addition there is FDG PET/CT with improved sensitivity for skeletal metastases in certain diseases such as lung cancer [1] and with its ability to identify early marrow involvement, with the lurking threat from whole-body MRI never far away. Nevertheless our conventional, beloved bone scan which has served us so well over the years continues to be widely used due to its well-known advantages of simplicity, relatively low cost, high sensitivity and the ease of evaluating the whole skeleton, and in truth because many clinicians are as yet less knowledgeable about the newer methodologies. However, even with this familiar friend it would appear that we are still learning. …