The isotope bone scan: we can do better

Excerpt

The conventional isotope bone scan using ^99mTc-labelled diphosphonate is perceived as being highly sensitive but non-specific in the detection of skeletal pathology. The poor specificity is a significant clinical issue, as additional investigations are frequently required (X-ray, CT, MRI) to clarify equivocal lesions, such as the presence of degenerative changes, where metastatic involvement is suspected. This inevitably leads to extra cost, heightened concern and frequent delays in management. Where available, specificity (and to a lesser extent sensitivity) has been greatly improved with the use of single photon emission computed tomography (SPECT)/CT [1‐3], but can be further significantly improved with the use of ¹⁸F-fluoride positron emission tomography (PET)/CT [4‐6]. Further, ¹⁸F-fluoride can on occasion identify early metastatic lesions at a time when the bone scan is normal [7‐10]. Nevertheless, ¹⁸F-fluoride is rarely used routinely for bone imaging due to the limited availability of PET, cost and competition for time on the PET scanner. …