RADIONUCLIDE BONE SCAN, 3 PHASE STUDY

DATE: 10/4/2005

PROCEDURE:  Following IV administration of technetium 99m methylenediphosphonate (MDP), dynamic (phase 1), blood pool (phase 2), and delayed images (phase 3) were obtained of the following views.

VIEWS: [...]

RADIOPHARMACEUTICAL DOSE: [25] mCi

CORRELATIVE STUDIES: None

COMPARISON: None

CLINICAL HISTORY: The patient is a [...]-year-old [fe]male with a history of [...].

FINDINGS:

On the blood flow and blood pool views, normal tracer activity is noted throughout both [...] extremities. At 15 minutes, there is a focus of moderately increased tracer activity in the [...]; however, there is significant tracer activity within the soft tissue and therefore a delayed scan at 24 hours was obtained. At 24 hours, there is a moderately increased tracer activity in the same region involving the [...].

On the blood flow and blood pool views, tracer activity is noted in the main aortic vasculature as well as in the blood pool of the heart, liver and spleen. While the spine is unremarkable on the blood flow phase, the blood pool phase shows a suggestion of mild activity in the L5 region. On the delayed images, significant tracer activity is seen in the region of the lower lumbar spine, at the L5 region. There is a photopenic area at L3-4 probably related to hardware that was also seen in the recent lumbar spine radiographic series. Additional small area of increased activity at approximately T11 and L2 vertebral levels is likely degenerative. Also on the delayed views, there are two focal areas of moderately increased uptake in the left lower posterior ribs, likely T8 and T9 levels. These are of uncertain etiologies and may be due to prior fractures. Normal tracer activity is noted in the kidneys and in the urinary bladder. 

CONCLUSIONS:

Abnormally increased tracer activity is noted in the [...] consistent with osteomyelitis.

1. There is increased tracer activity in the L5 vertebral region on the delayed view with a mildly increased activity of the same area in the blood pool phase. The blood flow phase is unremarkable. An underlying infectious/inflammatory process at this level cannot be excluded. An WBC scan may be helpful for further assessment. 2. Post-operative lower lumbar changes with presence of hardware noted, as correlated to recent x-ray and clinical history. 3. Likely degenerative changes in the thoracolumbar spine. 4. Focal uptakes involving two areas in the left posterior lower ribs, possibly related to traumatic injury. Recommend clinical correlation and radiographic assessment, if indicated.

Thank you for referring this patient to the UCLA Nuclear Medicine Clinic.

I, [...], M.D., Ph.D., have reviewed this Nuclear Medicine study personally, and am in full agreement with the findings of the report presented here.