NUCLEAR MEDICINE: Musculoskeletal

Case Author: Gary A. Ulaner, MD, PhD, Memorial Sloan-Kettering Cancer Center

History

55-year-old man with lung cancer and chest pain who has undergone bone scanning in an evaluation for bone metastasis; the nuclear technologist says the images look unusual and needs to know the cause.

Imaging Findings

Anterior (A) and posterior (B) planar images from a methylene diphosphonate bone scan show uptake in the bones, heart, kidneys, bladder, and bowel.

Cause

Dual-radiotracer scintigraphy

Teaching Points

Unusual nuclear medicine images can result from problems with the scanner, collimator, or radiotracer or from unusual patient physiology.

Reviewing the patient’s history of nuclear medicine examinations may help uncover the cause of an unusual-appearing study.

Free pertechnetate localizes to the salivary glands, thyroid, and stomach.

Visualization of unexpected organs on a nuclear medicine study can be caused by recent administration of a second radiopharmaceutical.

Suggested Readings

Hung JC, Ponto JA, Hammes RJ. Radiopharmaceutical-related pitfalls and artifacts. Semin Nucl Med 1996; 26:208–255

Vallabhajosula S, Killeen RP, Osborne JR. Altered biodistribution of radiopharmaceuticals: role of radiochemical/ pharmaceutical purity, physiological, and pharmacologic factors. Semin Nucl Med 2010; 40:220–241

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