SCINTIGRAFIA OSOASA TIFAZICA

Triphasic Bone Scan

- See: Technetium 99m
- Discussion:
- initial dynamic images are aquired over the area of concern and then followed immediately afterwards by static
images obtained over
longer periods of time;
- First Phase:
- demonstrates perfusion to a lesion;
- first phase, the nuclear angiogram or flow phase, consists of serial 2- to 5-sec images of the area of suspected
osteomyelitis that are
obtained during injection of the radiopharmaceutical.
- classically, with cellulitis, diffuse increased uptake occurs in first two phases, but uptake is normal or diffusely
increased in third phase;
- osteomyelitis causes focally increased uptake in all three phases;
- Second Phase:
- relative vascularity;
- second phase, the blood-pool image, is obtained within 5 min after injection;
- in areas of inflammation, capillaries dilate, causing increased blood flow and blood pooling.
- classically, with cellulitis, diffuse increased uptake occurs in first two phases, but uptake is nl or diffusely increased in
third phase;
- osteomyelitis causes focally increased uptake in all three phases;
- first phase characterizes the blood flow to the area, while the 2nd visualizes the blood pool;
- these 2 early phases act to characterize degree of inflammation and hyperemia that may be present;
- diseases such as degenerative disease, healing fractures, non- infected prosthesis with loosening, well treated
osteomyelitis, may have
little abnormal activity on the early phases in spite of increase uptake on delayed images;
- it may be difficult to distinguish osteomyelitis from diabetic osteoarthropathy, which are often abnormal on all 3
phases;
- in contrast, a soft tissue infection classically appears only in early phases, with little abnormal focal bone activity
seen on delayed images;
- Third Phase:
- demonstrates relative bone turnover associated w/ a lesion;
- 3rd phase, bone image, is obtained about 3 hr later, when urinary excretion has decreased the amount of the
radionuclide in soft tissues.
- if present, diffuse incr uptake in third phase is probably due to regional hyperemia caused by cellulitis;
- osteomyelitis causes focally increased uptake in all three phases;
- Peds:
- In neonates, the sensitivity of the three-phase bone scan decreases;
- neonates with osteomyelitis have falsely normal or cold defects on three-phase bone scans 22-68% of the time;
- cold lesion on 3rd phase may be caused by subperiosteal abscess;
- in children, large portion of blood supply to the bone comes from periosteal vessels, and these are apparently
disrupted by the
subperiosteal abscess;
- when clinical findings strongly suggest osteomyelitis, but findings on three-phase bone scan are normal, then
consider gallium scan