LEARN NUCLEAR MEDICINE
Musculoskeletal · Case 05
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IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 67-year-old woman with history of osteoporosis presents with complaint of pelvic and back pain. A whole body scan is ordered.
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Sacral insufficiency fractures and rib fracture
Imaging Findings
The delayed whole body scan shows intense uptake of the radiotracer in the sacrum, in an H-shaped pattern. In addition there are multiple bilateral anterior ribs, left greater than right.
Essential Facts
Foci of activity within sequential ribs is typical pattern for rib fractures.
Rib fractures may require medical attention to evaluate for internal organ damage of the heart, lungs, kidney, spleen, and liver. Simple, uncomplicated fractures are typically managed conservatively, while complicated cases may require surgical stabilization.
Scan Information
A whole body scintigraphy scan using Tc-99m MDP tracer can be used to detect multiple fractures. Nuclear scintigraphy of the bone commonly uses the radionuclides technetium-99m (Tc-99m) or fluoride-18 (F-18). Tc-99m is usually attached to medronic acid (Tc-99m MDP), and F-18 is usually incorporated into sodium fluoride (F-18 NaF). Once these molecules are injected, a nuclear camera that contains a Sodium Iodide crystal captures the decay on photons from the radioisotope. The process of scintillation, when the photon emitted by the radionuclide hits the crystal within the nuclear camera, allows for this to be achieved. The scintillations are converted to images for interpretation..
References
Nuclear Medicine Case Review Series, by Harvey A. Ziessman, Elsevier, 2011, p. 31-32.
https://drive.google.com/drive/folders/1KsSGxRufvR3DHpqh3IzcyCQx_X1-Qs3m
Lee, K.-J., et al. “Bone Scan as a Screening Test for Missed Fractures in Severely Injured Patients.” Orthopaedics & Traumatology: Surgery & Research, Elsevier Masson, 18 Nov. 2014, www.sciencedirect.com/science/article/pii/S1877056814002588.