Received 30 Jul Accepted 17 Oct Published 22 Jan Introduction Bone scans have become a key tool in assessing musculoskeletal pathology [ 1 , 2 ].
Patients and Materials patients were prospectively enrolled in this study. Results Within the scope of this study we prospectively assessed patients. Incorporated in these tables are abbreviations which represent the following. Table 1. Table 1 shows Chi-square probability and values for the physical assessment findings and the Blood Pool phase in both the study and control groups. Table 2. Table 2 shows the Chi-square probability for findings on physical assessment correlated with planar scintigraphy in the lateral compartment of the knee in both study groups.
Table 3. Table 3 shows the Chi-square probability for findings on physical assessment correlated with planar scintigraphy in the medial compartment of the knee in both study groups. Table 4. Table 4 shows the Chi-square probability for findings on physical assessment correlated with planar scintigraphy in the patellofemoral compartment of the knee in both study groups.
Table 5. Table 5 shows the Chi-square probability values for findings on physical assessment correlated with SPECT in the lateral compartment of the knee in both study groups. Table 6. Table 6 shows the Chi-square probability values for findings on physical assessment correlated with SPECT in the medial compartment of the knee in both study groups.
Table 7. Table 7 shows the Chi-square probability values for findings on physical assessment correlated with SPECT in the patellofemoral compartment of the knee in both study groups. Table 8. Table 8 summarizes the statistically significant differences in Chi-square values of the relative knee compartments in each of the patient groups and mapping modalities.
Mapping method Pattern and power of uptake in different knee compartments Excessive tenderness to palpation at medial knee compartment Excessive tenderness to palpation at lateral knee compartment Excessive tenderness to palpation at patellofemoral knee compartment Planar scintigrphy LatFmPs 0. Table 9. Table 9 summarizes the correlations found between excessive tenderness to palpation in the different knee compartments and planar scintigraphy and SPECT in the study symptomatic patient group.
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McCarty and W. Koopman, Eds. View at: Google Scholar T. Radin and R. View at: Google Scholar S. Petersson, T. Svensson, D. Buckland-Wright, D. Macfarlane, and J. Dieppe, J. Cushnaghan, P. Young, and J. View at: Google Scholar E. Etchebehere, M. Etchebehere, R. Gamba, W. Belangero, and E. Yang, R. Ratani, P. Mittal, R. Chua, and S. Collier, R. It is necessary to validate these data with larger series for less common indications, such as lung and renal cancers, which might metastasize to the distal limbs before spreading to the axial skeleton [ 17 , 18 ].
Moreover, this protocol increased detection rate of extra-axial lesions, particularly in the femoral neck, the area associated with the higher risk of pathologic fracture. The study was performed with ethical standards according to the Declaration of Helsinki and was approved by the local ethics committee at the authors' institution.
The authors have declared no conflicts of interest and no financial support for this article. National Center for Biotechnology Information , U. Journal List Biomed Res Int v. Biomed Res Int. Published online Jul Author information Article notes Copyright and License information Disclaimer.
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Methods consecutive patients with a history of cancer were referred for bone scans to detect bone metastases. Introduction Bone scintigraphy remains a widely used imaging modality in the metastatic workup in patients with cancer, especially prostate, breast, and lung cancers.
Material and Methods 2. Patients From October to August , consecutive patients referred for a bone scan for metastatic workup in the Nuclear Medicine Department of the University Hospital of Geneva were included in the study. Open in a separate window. Figure 1.
Figure 2. Figure 3. Figure 4. Ethical Approval The study was performed with ethical standards according to the Declaration of Helsinki and was approved by the local ethics committee at the authors' institution.
Conflicts of Interest The authors have declared no conflicts of interest and no financial support for this article. References 1. Love C. Radionuclide bone imaging: an illustrative review. Schillaci O. Nuclear Medicine Communications. Utsunomiya D. Romer W. Journal of Nuclear Medicine. Zhang Y. Helyar V. International Commission on Radiological Protection. ICRP publication. Suissa S. For PBS, our results in terms of sensitivity and specificity are also significantly better than those published by Jambor et al.
This diagnostic outcome may require additional imaging, along with associated costs, time and impact on the patient. To improve the detection of bone metastases, it would seem appropriate to examine the bone marrow hematopoietic located within the axial skeleton as thoroughly as possible, because it is the main site of bone metastatic dissemination.
However, there is as yet no specific guidelines on the bone scan protocol. On their PBS, 4 of them had no lesion. The other 7 patients had at least one indeterminate lesion. Histological confirmation was requested for only 2 patients. False negative test results could be evoked.
However, the clinical follow-up, longer than 1 year, almost rules out undetected bone metastasis, particularly in case of a negative examination. Indeed, it is ethically impossible to obtain histological proof for every lesion and further imaging confirmation seems illusory when the number of lesions per region becomes large.
All patients received written information and we obtained consent allowing the use of their clinical data for research purposes under a protocol approved by the ethics committee. A non-linear spatial resolution restoration filter, provided by the manufacturers, was systematically applied to obtain a PBS in 5—6 minutes. A low-dose CT was performed with the following parameters on the Symbia T2 Siemens : modulation of mAs according to morphology Care4D , kV, slice thickness 5 mm and pitch 2.
For the analysis of PBS, the skeleton was divided into 7 distinct regions: the skull, the spine segmented into 3 parts cervical, thoracic and lumbar , the pelvis, the ribs associated with the sternum, and the appendicular skeleton.
We formulated a score Sc at 3 levels, taking into account the uptake intensity, their number and their topography:. Typical benign lesions according to CT data were bone cysts, degenerative lesions e. Lesions with tracer uptake which were not typically benign or malignant on CT were considered as equivocal. After Bone scan, a month follow-up was carried out for all patients. It was based on the collection of clinical and biological patient data.
Patients with Sc3 without recurrence or progression during follow-up were considered true negative. Patients with a Sc 1 confirmed by imaging or histological examination were considered to be true positive. Patients with a Sc 1 or 2 not confirmed by further investigations or without progression in follow-up were considered false positive.
If follow-up examinations showed metastatic lesion, patients were considered as false negative. All calculations were performed using SAS 9.
The added value is reflected in the improved detection performance of bone metastases and a better characterization of equivocal lesions allowing a more exhaustive bone staging and thus a more adaptive and personalized treatment. VF: conception and design of the study, acquisition of data, analysis and interpretation of data; drafting of the article and final approval of the version to be published. CR: conception of the study, revising it for important content and final approval.
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