NM

Question 1

what factor sof bone affect radiotracaer uptake?

Answer 1

vascular supply

osteblastic activity

Question 2

how does diphosphonates get uptaken?

Answer 2

interacts with endogenous calcium to porduce insoluble Tc- calcium

Question 3

How long for diphosphonates to localise to bone

Answer 3

50% within 1 hour

Question 4

MAXIMAL RADIATION FROM BONE SCAN IS RECEIVED BY WHAT ORGAN>

Answer 4

bladder

Question 5

timing of bone scan?

Answer 5

one 2-4 hours after injection to allow soft tissue to disperse

Question 6

indications for bone scintigraphy?

Answer 6

Imaging malignancy (detection and follow-up of osteoblastic skeletal metastases)
Characterisation of bone lesions
Detection of fractures (for example, stress or insufficiency fractures)
Imaging painful prostheses (in cases of infection or loosening)
Osteomyelitis
Complex regional pain syndrome (CRPS)

Question 7

Bone scan - locations to be wary of?

Answer 7

inferior borders of the scapula

ACJ can be variable

SIJ

Question 8

what is hyperostosis frontalis interna?

Answer 8

post menopausal women

Question 9

what is three phase scintigra[hy

Answer 9

images obtained in blood flow, blood pool and delayed

Question 10

What is dynamic and blood pool in bone scintigraphy?

Answer 10

Blood pool - done at 5 minuetes - sees the extracellular fluid witihn the bone

delayed phase - shows osteoblastic activity.

Question 11

In malignancy, what kind of patterns are there for bone scintigraphy?

Answer 11

Solitary focal uptake
Multiple focal areas of uptake
Diffuse increased uptake
Cold lesions (purely lytic)
False negative
Post-treatment flare phenomenon

Question 12

Types of rib uptake for fracture vs malignancy?

Answer 12

Fracture is focal

Malignancy will be elongated along the rib

Question 13

A superscan, diffusely observed tracer uptake, can be a result of what?

Answer 13

Diffuse malignant disease (breast, prostate, lymphoma)
Metabolic bone disease (hyperparathyroidism, renal osteodystrophy)
Mastocytosis
Myelofibrosis

Question 14

Bone scintigraphy - what is a flare phenomenon

Answer 14

increased lesion intensity after chemo

Question 15

Osteoblastic activity within a lesion is more suggestive of an active lesion such as

Answer 15

a skeletal metastasis

Question 16

No uptake in a lesion is more suggestive of what kind of lesion

Answer 16

Benigin

Enostosis

Question 17

What is a stress fracture?

Answer 17

Normal bone with abnormal stress as cumilative rather than an individual load

Question 18

What are the common locations of stress fractures?

Answer 18

Distal third of tibia
Distal fibula
Metatarsal shafts

Question 19

Define insufficiency fracture

Answer 19

Normal stress is applied to a bone that lacks the elastic resilience of normal bone

Question 20

Common locations of insufficiency fractures

Answer 20

pelvic ring
spine
sacrum
rtibia 
femoral neck 
distal radius

Question 21

what makes osteomalacia bone weak?

Answer 21

defective minerlaisation of osteoid. lack of calcium incorporated into the osteoid protein bone matrix

Question 22

Honda sign on scintigraphy?

Answer 22

sacral insufficiency fracture

Question 23

sites where osteonecrosis can occur?

Answer 23

Scaphoid
Navicular
body of talus
humeral head 
distal femur

Question 24

How does osteonecrosis appear on scintigraphy?

Answer 24

Photopaneic in acute phase as vascular compromise.

Afterwards with revascularisation massice osteoblastic repair has big uptake.

Question 25

relationship of complex regional pain syndrome and scintigraphy/ treatment

Answer 25

if CRPS seen on scintigraphy more likely to be successful treatment with steroids

Question 26

scintigraphy in children - main differnece?

Answer 26

major uptake at the growth plates

Question 27

cancers that spread to bone the most

Answer 27

Breast and prostate

Question 28

Three-phase uptake around a prosthesis is suggestive of

Answer 28

infection

Question 29

How do we define metabolic diseases - two types

Answer 29

diffuse and focal

Question 30

What are the main causes of diffuse metabolic bone disease?

Answer 30

osteomalacia Renal osteodystrophy Primary hyperparathyroidism

Question 31

what can you look for on superscans?

Answer 31

Absence of tracer uptake in kidneys and soft tiussues as it will all be in the bone

Question 32

Malignant vs metabolic - involvement of the mandible and the distal skeleton

Answer 32

Metabolic

Question 33

what are looser zones

Answer 33

insufficiency fractures will be seen in early osteomalacia as the bone is most weak here

Question 34

Common locations for pagets disease?

Answer 34

skull vertebra long bones

Question 35

Pagets biochem

Answer 35

Urinary hydroxyproline Raised ALP

Question 36

pattern of uptake in pagets disease?

Answer 36

from the ends inwards

Question 37

pagets mickey mouse sign

Answer 37

whole vertebra involvement

Question 38

what is fibrous dysplaisa?

Answer 38

replacement of bone by fibrous tissue

Question 39

Fibrous dysplasia associated features of the disease - non radiological can be called mcCune Albright syndrome

Answer 39

``` cafe au lait precocious puberty hyperthyroidism excess growth homrone rickets ```

Question 40

Tie sign can be what

Answer 40

Osteomalacia or renal osteodystrophy (typically)