NUCLEAR-MEDICINE IN PRIMARY BONE-TUMORS

Introduction: Conventional radiography is the method of choice to diag nose a primary bone tumor but in many cases it is necessary to integra te it with nuclear medicine scintigraphy using several radionuclides, including Ga-67, (201)T1, Tc-99m-MIBI and especially Tc-99m-diphosphon ates. Recently a new technique has been recently introduced, that is p ositron emission tomography with 2(F-18) fluoro-2 deoxy-D-glucose as r adiopharmaceutical. Objective: The specific purpose of this work is to show that nuclear medicine bone scanning is a very important method i n the detection and diagnostic management of primary bone tumors. Diag nosis, staging and follow-up: Three-phase bone scintigraphy, integrate d with SPECT, is clinically useful to confirm the radiologic diagnosis of bone tumor. These techniques conveniently related to each other an d to radiographic findings, can evaluate the tumor's local aggressiven ess, often differentiating benign from malignant lesions, to monitor t reatment efficacy, to permit total body scanning for the detection of recurrences. Nuclear medicine diagnostic techniques are not in competi tion with radiographic tools as CT and MRI which are highly sensitive in detecting even small lesions thanks to their excellent anatomical r esolution. In questionable cases, we can integrate radiologic imaging with dynamic studies, in particular with FDG-PET, increasing the speci ficity of diagnosis and permitting more accurate follow-up. Conclusion s: Patient management optimization needs the integration between dynam ic nuclear medicine findings and the anatomical patterns provided by c onventional radiology to increase imaging sensitivity and specificity. Equipe work is determinant to customize the diagnostic work-up to the individual patient's needs to reduce the cost of patient management a voiding useless examinations. (C) 1998 Elsevier Science Ireland Ltd. A ll rights reserved.