The most frequently requested investigation in any nuclear medicine
department remains the technetium-99m (99mTc)-labelled
diphosphonate bone scan. Despite rapid advances in all imaging
modalities. there has been no serious challenge to the role of bone
scanning in the evaluation of the skeleton. The main reason for
this is the exquisite sensitivity of the bone scan for lesion
detection. combined with clear visualisation of the whole skeleton.
In recent years several new diphosphonate agents have become
available with claims for superior imaging of the skeleton.
Essentially. they all have higher affinity for bone. thus allowing
the normal skeleton to be visualised all the more clearly. However.
as will be dis cussed. this may occur at some cost to the principal
role of bone scanning. lesion detection. The major strength of
nuclear medicine is its ability to provide functional and
physiological information. With bone scanning this leads to high
sensitivity for focal disease if there has been any disturbance of
skeletal metabolism. However. in many other clinical situations.
and particularly in metabolic bone disease. more generalised
alteration in skeletal turnover may occur. and quantitation of
diphosphonate uptake by the skeleton can provide valuable clinical
information."
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