UPPER EXTREMITY RADIONUCLIDE BONE IMAGING - THE WRIST AND HAND

Bone scintigraphy of the hands and wrists represents an important adju nct imaging technique that complements plain film radiographic examina tion. The use of the three-phase bone scan provides clinical informati on not only regarding osseous uptake but the blood flow and extravascu lar distribution of the radiotracer as well. Scintigraphic evaluation of the hands and wrists is employed in acute and chronic conditions. I n the event of an equivocal or negative plain film, the bone scan can identify occult fractures. Of particular concern is the identification of scaphoid fractures due to the higher incidence of osteonecrosis. W ork related injuries represent a significant health issue. The bone sc an can be a part of the algorithm for evaluating chronic pain syndrome s including reflex sympathetic dystrophy. The complimentary roles of b one scanning and imaging with gallium-67 citrate or radiolabeled leuko cytes has proven useful in the evaluation of acute or chronic osteomye litis. In addition, the diphosphonates are useful in identifying solit ary and multiple primary bone tumors. In the case of primary bone tumo r, thallium-201 can be used to evaluate response to therapy. Although uncommon in the hand and wrist, the bone scan can identify metastatic tumors or tumor related conditions such as hypertrophic osteoarthropat hy, Finally, bone scintigraphy may be useful in identifying location a nd extent in a variety of conditions such as fibrous dysplasia, histio cytosis X, and Paget's disease. Copyright (C) 1998 by W.B. Saunders Co mpany.