"Mild increased FDG uptake" on PET/CT - what's it mean? 2) Nuclear bone scan "hot spots" indicate areas of increased blood flow so more of the radioactive tracer (chemically similar to bisphosphonates) it taken up. 3 Extraosseous uptake must be carefully assessed and it may occur due to a wide variety of factors such as benign or malignant disease processes, artefactual causes (such as other recent nuclear medicine investigations) or . but there is increased uptake within the bone marrow that is related to increased hematopoietic activity as a response to chemotherapy A B C AB. Your doctor may order a bone scan if you have unexplained skeletal pain, bone infection or a bone injury that can't be seen on a standard X-ray. Metastatic disease: Typically prostate, lung, and breast. To gauge the significance of such nonosseous uptake and, in particular, to determine whether these findings contain useful diagnostic information, the technical and medical staff in nuclear medicine must recognize the various patterns of . Increased uptake is also known as a Hot Spot . Increased uptake of 18 F-FDG can also be noticed in . Increased uptake is seen in the region of the ethmoids, right frontal and right maxillary sinuses Offprint requests to: B.L. Sometimes instead of uniformly increased uptake of tracer by sternum, only horizontal stripes were seen "Striped- tie" sign [13]. technical causes, reduced tracer uptake etc., the uptake on the bone scan, the FDG uptake and the synovial enhancement seen on the CT suggests a substantial degree of synovitis. cardiac uptake was demonstrated on the bone scan and a differ-ential diagnosis including ischaemia/infarction and myocarditis was reported (Figure 6a). Clinical implications of increased uptake in bone marrow ... Osteopenia - UW Radiology Furthermore, they may have im- Radionuclide Bone Imaging: An Illustrative Review ... The radionuclide bone scan showed diffuse increased uptake at the hip joint, more intense at the periphery, affecting both the femoral head and acetabulum (Fig 1B), Hip aspiration yielded a small amount of turbid, viscous fluid. - in areas of inflammation, capillaries dilate, causing increased blood flow and blood pooling. What Causes Increased Uptake On Bone Scan? Bone scan. Some tumors, fractures and infections show up as areas of increased uptake. Technetium 99m-methylene diphosphonate (Tc99m-MDP) was developed in 1975 and is the predominant radiotracer used in skeletal scintigraphy. However, for most bone metastases the bone scan is a highly sensitive but not specific technique. Degenerative Changes. Bone scan (Fig 2A) showed diffusely increased uptake by the skull compatible with Paget's disease. In 14 of these, moderately severe to severe arthritis appeared to cause the uptake; metastatic disease was the cause in 8 cases; and in 1 . Mild focal increased uptake is also noted bilaterally along proximal humeral cortices. What does increased tracer uptake mean? Radionuclide cisternography (Fig 2B) revealed communicating normal pressure hydrocephalus. uptake on bone scintigraphy reported [5]. Cancer. Physiologic uptake is normally seen in the brain, heart, liver, spleen, gastrointestinal tract, urinary collecting system (including the bladder), and bone marrow. Increased uptake seen in a Bone scan can mean many things: To name a few of the most popular causes: Infection. Except in myeloma, it is generally a much more sensitive technique than the skeletal survey for bone metastases. Increased tracer uptake corresponds to revascularization phase. New radiopharmaceuticals with greater infection avidity are being . [] Though the reported sensitivity of bone scan is high, its specificity is low due to . It is a measurement of thyroid function, but does not involve imaging. When these findings occur on the bone scan, the first step is to confirm or exclude qual-ity control-related technical causes, arti-facts, and pitfalls because they are often found to be the cause of unexpected distri-butions of radiotracer activity on bone scin-tigraphy. 11 years ago. Cardiac scintigraphy in case 1. The scan demonstrated mildly increased octreopeptide uptake at a rectal mass and focal uptake at multiple regions throughout the bone marrow of the axial skeleton, consistent with metastases. Furthermore, they may have im- § micromotion and attempts to stabilise cause increase secretion of calcified bone matrix and increased uptake on bone scan and SPECT § Look for osteolysis /lucencyon CT § Patellofemoral problems § Progression of OA § Patellofemoral maltracking § Overstressing due to patella baja § Femoral component malpositioning Unexpected extraosseous radiotracer accumulation has been reported since bone scans were first introduced in the 1970s. Malignant bone tumors. "The pattern of FDG uptake is easily identifiable as benign or malignant, especially if this is confirmed by CT or MRI findings. Figures 1-7 show artifacts, e.g. The expanding use of PSMA PET worldwide has also revealed PSMA ligand uptake in diverse nonprostatic diseases, which raised questions about the specificity of this imaging modality. Red bone marrow island PET/CT shows a focus of increased radiotracer accumulation at the distal right femur (left figure, crosshair, SUV: 3.7) corresponding to subtle focal bone marrow increased attenuation on co- registered CT. MR shows a well-demarcated focus of mildly decreased This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the bones. The radioactive iodine uptake test (RAIU) is also known as a thyroid uptake. Nuclear Medicine Imaging of Shoulder Injuries. Further extensive investigations including muscle biopsy were normal and excluded diagno … Shulkin Fig. This is a posterior view from a 99m Tc-MDP scan of a patient with colorectal cancer. CAUSES OF GENERALLY INCREASED UPTAKE OF 67Ga IN THE SKELETON Common Patient: 1) Skeletal immaturity 2) Increased red cell production with or with- out marrow extension as in chronic anemia from any cause. This finding has been termed "hot kidneys", and is an incidental benign and transient condition . Bone scan. Increased uptake seen in a Bone scan can mean many things:To name a few of the most popular causes:InfectionTraumaDegenerative ChangesCancerIncreased uptake is also known as a Hot Spot - This . His prostate biopsy had revealed adenocarcinoma of the prostate. Symptomatic patients are 32% positive at stage I and II, and 41% positive at stage III. Some tumors, fractures and infections show up as areas of increased uptake. Others can cause decreased uptake of radioactive material. Preoperative bone scan imaging is recommended even though it has a low yield in identifying disease. vey of various causes of non-osseous uptake. X Trustworthy Source Mayo Clinic Educational website from one of the world's leading hospitals Go to source Some activity is normal, but too much or too little bone remodeling is a sign of disease or injury. a general increase of tracer uptake by the manubrium and, in the lateral borders of the body. A negative bone scan at 72 hours excludes a fracture in the appendicular skeleton with a sensitivity of 95% to 100%. - 3rd phase, bone image, is obtained about 3 hr later, when urinary excretion has decreased the amount of the radionuclide in soft tissues. Focal increased uptake is seen at the insertion sites of the supraspinatus and the subscapularis muscle at the head of the humerus. 39.6). The most important factor in causing increased uptake in the bone on the delayed scan is increased bone turnover. Dr. Andrew DeGruccio answered. The significance of increased periprosthetic uptake, however, is less certain. Not Everything that is Hot on a Staging Bone Scan is Malignant: A Pictorial Review of Benign Causes of Increased Isotope Uptake Deirdre E. Moran, MBBCh , Ailbhe C. O'Neill, MBBCh , Eric J. Heffernan, MBBCh , and Stephen J. Skehan, MBBCh This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the bones. The more active the bone turnover, the more radioactive material will be seen. The radioactive substance, called a radionuclide, or tracer, will collect within the bone tissue at spots of abnormal physical and chemical change. There is diffusely increased radiotracer uptake in the thoracolumbar spine and poor . Given patient's history of chemotherapy, findings are favored to be related to chemotherapy. Culture results were posi- tive for Mycobacterium tuberculosis. The classic appearance of osteomyelitis on three-phase bone scans consists of focal hyperperfusion, focal hyperemia, and focally increased bone uptake (, Fig 16). But inflammation from arthritis, cancers, and fractures all increase the blood flow and will cause hot spots. Case reports The following bone scans are intended to give an overview of numerous artifacts, which have been collected over the last few years in a large university-based nuclear medicine de-partment. Researchers have studied the utility of these agents in a . Planar and SPECT/CT images of the SW and AW were performed between July . Relatively Figure 2. A 67-year-old male, a known case of prostate carcinoma, underwent bone scan for skeletal evaluation. young athletes referred for bone scintigraphy by a sports med-icine clinic because of low back pain were evaluated for the presence of asymptomatic bone scan abnormalities in the lower extremities. A bone scan is a type of nuclear radiology procedure. Discussion After cemented total hip replacement bone scans Although bone scan is a sensitive imaging modality, it is nonspecific, and there are multiple potential causes of abnormal isotope uptake that can mimic metastatic disease. stella_luna3604. The reported incidence of high renal uptake of technetium-99m (99 Tc m) hydroxyethylidene diphosphonate (HEDP) on bone scintigraphy ranges from 2% to 15% [1, 2]. Other therapy such as granulocyte colony stimulating factor and . Avascular necrosis or bone infarction. A normal study-ie, one in which periprosthetic uptake is indistinguishable from surrounding nonarticular bone-rules against a prosthetic abnormality (Figure 1). Bone imaging is a study to visually detect bone abnormalities. It is used in the evaluation of benign bone disease like infection/inflammation and also is the standard of care for evaluating metastatic disease in the breast, prostate, and lung cancer. Nuclear medicine uses small amounts of radioactive material called radiotracers. Correlation of the X-rays with the isotope scans showed that increased isotope uptake on the scans corresponded withcortical thickeningor sclerosison the X-rays (Figures 4 and 5). Hypertrophic osteoarthropathy (HOA) is a medical condition characterized by abnormal proliferation of skin and periosteal tissues involving the extremities and characterized by three clinical features: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. 1. PSMA PET imaging was originally used to assess biochemical recurrence of prostate cancer (PCa), but its clinical use was promptly extended to detection, staging and therapy response assessment. A PET scan uses a small amount of a radioactive drug, or tracer, to show differences between healthy tissue and diseased tissue. Causes of liver uptake on bone scan? Diffusely increased skull uptake (a hot skull) is often seen in patients with bone metastases and metabolic diseases. A review of 14,296 unselected bone scans identified 889 scans showing absent or faint renal uptake. An example is phosphonates which were originally studied by Subramanian et al. Often has a diffuse and homogeneous appearance on bone scan. INTRODUCTION. This article reviews the mechanisms of uptake of 99mTc-labeled diphosphonates and 18F-sodium fluoride and discusses and compares the performance . Bone scintigraphy of a patient with enthesopathy of the right supraspinatus and the right subscapularis muscle. Whole-body bone scan and spot views of pelvis demonstrate mild to moderate increased radiotracer activity in right and left sacroiliac joints inferiorly and in sacrococcygeal area, raising possibility of fracture. FDG uptake in synovitis, particularly related to rheumatoid arthritis, has been well-described and the degree of FDG uptake has been used to monitor disease activity (8-12). Key words: knee arthroplasty; . Introduction. Doctors use nuclear medicine to diagnose, evaluate, and treat . Note that healing fractures may display increased uptake long after the initial trauma, with 60 to 80% of fractures returning to normal on bone scan in one year and 95% of fractures returning to normal by 3 years. A subsequent F-FDG PET/CT study was performed for further evaluation and demonstrated markedly increased metabolism at the previously identified rectal . These include whether the uptake is localized or along the rib outline, single or multiple, and associated with other abnormal uptake in the rest of the skeleton . A cold defect in the region of increased uptake on a bone scan indicates the bone scan abnormality is due to infarct How is the bone marrow scan used in AVN? The follow-up bone scan performed 6 patient, it strongly suggested the impression of radiation- induced 99mTc-MDP uptake is due to the reasons of (1) none of signs or symptoms relative to the soft tissue of that area, (2) the relationship of timing between the radiotherapy and the bone scan, and (3) delineation of the area of increased tracer . My question is how to interpret this comment, since I was under the impression that a PET/CT scan definitively disclosed whether there was active myeloma in the bones. This causes a higher increase in FDG uptake in the liver than in the bone marrow and spleen and therefore lower bone marrow-to-liver and spleen-to-liver ratios. Dear Liz S: According to the package insert for fosamax, there is no evidence that it causes increased uptake on bone scan. Anterior (upper Causes of increased uptake of the radiophar . # 'Double density' sign: Increased uptake with central focus of very intense uptake (nidus) # Increased activity on Phase 1, 2 and 3. . The three-phase bone scan shows focal hyperemia, increased soft tissue uptake, and a sharply delineated focal area of increased uptake in the involved bone in an early stage of accelerated remodeling (Fig. Not Everything That Is Hot on a Staging Bone Scan Is Malignant: A Pictorial Review of Benign Causes of Increased Isotope Uptake Deirdre E. Moran, MBBCh*, Ailbhe C. O'Neill, MBBCh, Eric J. Heffernan, MBBCh, Stephen J. Skehan, MBBCh Department of Diagnostic Radiology, St Vincent's University Hospital, Dublin, Ireland When bone metastases are extensive and diffuse, a bone scan on first inspection may appear normal due to the con-fluent nature of the lesions1,4-6 and is often called a "super-scan" (so-called because of the apparent good quality of the scan due to diffusely increased skeletal uptake) and has a number of distinguishing features. Bone scans are also helpful in looking for determining whether cancer has metastasized or spread to the bones. A number of conditions are well known to be associated with this phenomenon. Bone scintigraphy was performed in a healthy 30-year-old man because of post-traumatic heel pain. This is due to a high operative mortality. Bone scan is one of the most common and oldest examinations among all nuclear medicine procedures. Dynamic bone scanning with 99mTc-labeled diphosphonates and 18F-labeled sodium fluoride provides functional information sensitive for subtle changes in bone turnover and perfusion, which assists the clinical management of numerous osseous pathologies. Forty-four patients (18 women, 26 men, median age 42.5 years, range 18-62 years) referred for bone SPECT/CT for painful symptomatic wrist (SW) were additionally imaged on their asymptomatic contralateral wrist (AW). Results can show abnormal bone cells and advanced arthritis as well as help determine the cause of bone pain. Increased uptake was identified in the lower neck anteriorly in 46 patients (38%). The report said that the FDG uptake could be from increased osteoblastic activity in the fracture areas, or also may indicate continued myeloma activity. The common causes of bone infarct are prolonged corticosteroid use, sickle cell disease, trauma, Gaucher's disease, and renal transplantation. Attenuation artifact due to prosthesis, pacemaker, jewelry, lead shield, barium contrast, etc. Lower neck uptake, frequently seen on anterior views of bone scans done with 99mTc-phosphate compounds, was studied in 122 patients to determine its incidence and etiology. The patients were then reexamined by the referring sports medicine physician, who had full knowledge of the bone scan results. Increased activity: Strong uptake on bone scan means increased metabolic bone activity. Common Causes of False Positive F18 FDG PET/CT Scans in Oncology Kevin R. Carter* and Eduard Kotlyarov . # Malignant pleural effusion # Non-specific uptake in lung/pleural/breast malignancy. May see some focal areas of increased uptake on bone scan. Two hundred and thirty‐one patients had 270 bone scans. Diffusely increased flow and blood pool on images in the first and second phases; third phase may be normal or positive fourth phase normal A review of 14,296 unselected bone scans identified 889 scans showing absent or faint renal uptake. Orthopedic Surgery 29 years experience. Abnormalities at radionuclide bone imaging reflect increased bone mineral turnover in general, not infection specifically. Treatment with corticosteroids can also increase glucose level and hepatic FDG uptake [ 29 ], but BLR or SLR was not independently associated with receiving immunosuppressive drugs (of . uptake on bone scintigraphy reported [5]. A repeat bone scan was performed in 2016 also for prostate cancer staging (Figure 6b). Further work-up proved that in this patient Paget's disease involving the skull was the cause of communicating normal pressure hydro- cephalus leading to . A thyroid scan is a type of nuclear medicine imaging. Lower neck uptake, frequently seen on anterior views of bone scans done with 99mTc-phosphate compounds, was studied in 122 patients to determine its incidence and etiology. T1-weighted coronal MR of hips of the same patient with TOH shows a diffuse zone of low signal intensity in e femoral head and neck consistent with marrow edema. Major Causes of Cold Defects on Bone Scintigraphy. Bone scintigraphy. A number of conditions are well known to be associated with this phenomenon. . Although bone scanning is a test primarily concerned with skeletal abnormalities, important nonosseous findings are occasionally present on the images. They frequently cause increased bone remodeling, leading to nonspecific uptake of Tc-99m-bone scan agents and gallium-67. The majority of cases were associated with renal insufficiency (816/889; 91.8%), while widespread metastatic bone disease was the most common cause in a group of patients without renal disease (53/889; 6.0%). In 14 of these, moderately severe to severe … Bowel uptake is also commonly encountered on bone scans with causes including prior radionuclide scans, colorectal cancer, colitis, active gastrointestinal bleeding, vesicocolonic fistula, and, rarely, ingestion of radioactive urine in cases of faith healing . The majority of cases were associated with renal insufficiency (816/889; 91.8%), while widespread metastatic bone disease was the most common cause in a group of patients without renal disease (53/889; 6.0%). This finding has been termed "hot kidneys", and is an incidental benign and transient condition . in 1971. A bone scan can often help physicians diagnose bone infections, or osteomyelitis, bone tumors and fractures. To evaluate the prevalence and prognostic value of increased uptake in SPECT/CT in asymptomatic wrists. increased uptakeon theacetabularside, particularly aroundthesuperolateral aspect ofthecup (Figure 3). 2. Increased rib uptake was correlated with radiological findings. Increased uptake was identified in the lower neck anteriorly in 46 patients (38%). Bone scan: A bone scan is a nuclear imaging test that helps diagnose and track several types of bone disease. The radioactive substance, called a radionuclide, or tracer, will collect within the bone tissue at spots of abnormal physical and chemical change. When these findings occur on the bone scan, the first step is to confirm or exclude qual-ity control-related technical causes, arti-facts, and pitfalls because they are often found to be the cause of unexpected distri-butions of radiotracer activity on bone scin-tigraphy. Often, extra-osseous uptake of radiotracer is identified, which may either be an incidental finding or relevant to the underlying bone pathology. obtained during injection of the radiopharmaceutical. This could indicate inflammation, fracture, infection, and/or bone tumor. A hot patella on the bone scan is defined as uptake of tracer in In this way, increased radiotracer uptake occurs in multiple pathologic processes, including fractures, infection, malignant disease, and less common osseous diseases such as Paget disease, fibrous dysplasia, osteoidma, and complex regional pain syndrome. Usually, this uptake will clearly conform to the bowel lumen, making additional . tomy, a bone scan was requested to evaluate the patient's low back pain. . Interpretation of results whether due to benign or to metastatic disease depends on other observations. Results can show abnormal bone cells and advanced arthritis as well as help determine the cause of bone pain. 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