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MD Consult: Books: Goldman: Cecil Medicine: SCINTIGRAPHY

Goldman: Cecil Medicine, 23rd ed.

Copyright © 2007 Saunders, An Imprint of Elsevier

SCINTIGRAPHY

Scintigraphy employs detectors in the form of a gamma camera that can identify decay of intravenously injected radioactive isotopes. Bone scintigraphy is used to identify sites of activity in the rheumatic diseases. The bone scan employs 99m technetium methylene diphosphate (Tc99m-MDP) as the radioactive tracer. The isotope moves to areas of high bone turnover and vascular flow as well as areas of calcium or bone deposition. Three-phase bone scans are obtained at various intervals after injection. Images are obtained at three time points: the early vascular phase, the intermediate blood pool phase, and the late phase. Each phase allows for further characterization of the disease process. Abnormal tracer uptake is seen in areas of inflammation, infection, neoplasm, osteonecrosis, and fracture (see Fig. 279-3 ). The scan is most useful for identifying the location of lesions within the skeleton, but it is nonspecific. Further imaging of the abnormal areas is often necessary to characterize the pathology.

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