Medical Imaging Report: Diagnostic Accuracy of Bone Scans

This report provides an overview of medical imaging techniques, focusing on bone scans and their application in detecting bone abnormalities and metastasis. It details the use of Tc-99m MDP bone scans, explaining the process, sensitivity, and limitations. The report also compares Tc-99m MDP bone scans with FDG PET scans, discussing their respective diagnostic accuracies, particularly in detecting skeletal metastases. The document includes a review of relevant literature, highlighting studies that compare the effectiveness of different imaging modalities. It emphasizes the importance of early detection of bone metastasis and the role of imaging in guiding treatment strategies. The report also touches upon the use of SPECT techniques and the impact of patient selection on the accuracy of the scans.

Medical Imaging 1
Medical imaging
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City
Date

Medical Imaging 2
Question one
Bone scan refers to a technique in medicine that utilizes nuclear energy to check for the
areas that are damaged or abnormal in the bones of individual patients. It is also called
scintigraphy. This utilization is usually enhanced by osteoblast cells which immensely participate
in bone rebuilding. Therefore, Tc-99m MDP bone scan as one of the renown imaging technique
is very sensitive to bone reactions and tumor fractures including metastasis. Before the bone is
scanned, it is always recommended that the patient must be introduced to a small amount of
radioactive substance via an injection especially the medronic acid thereafter the gamma camera
takes effect. In other words, a small amount of the radioactive substance is introduced into the
blood stream of the patient through an injection so that it collects in the bones’ abnormal cells
Medronic acid has its origin in phosphate, it undergoes exchange with the phosphate of the bone
to certain parts that have an active growth of bone, in the process causing attachment of the
radioisotope to that part of exchange. Nevertheless, there are usually some cases where the need
to view the small lesions is required particularly that are less than one centimeter, SPECT
technique may be required only after authorization. Such lesions are most likely to be found in
the spine.
Question Two
Objective 1
Metastasis of the bone in neuroblastoma is known as a category of cancer metastases that
normally results from primary invasion of tumor to the bone. However, it is rare to have primary
tumors that originate from the bone such as osteosarcoma and chondrosarcoma.
Objective 2

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According to Chang (2016), the following were the values obtained from detection of the
skeletal metastatic: specificity, sensitivity and accuracy for of FDG PET Scan were 97 percent,
98 percent and 98 percent respectively while those of Tc-99m MDP Bone Scan were 83 percent,
98 percent and 93 percent respectively. The researchers also found out that one of the commonly
missed lesion that could not be identified by the bone scan were in sacrum, spine and pelvis.
Nevertheless, in all the cases, patients were found to have additional sites for diseases of skeletal
metastases. They further state that at one instance the bone scan accidentally identified
metastasis lesions while the FDG PET Scan wrongly identified three lesions. The researches
wrap up their research by their concluding remarks insists that FDG PET Scan is an accurate or
precise technique that could effectively detect the skeletal metastases, and it is more superior
than bone scan especially when detecting sensitive body parts like spine and pelvis.
Langsteger et al. (2016) established that F-NaF PET Correlation with references
standards reflected a 0.96 sensitivity, a 0.91 specificity and a 0.89 predictive value; also, 0.97
negative predictive value and an accuracy value of 0.93. They also established that in a group of
patients that had the scan performed upon, an average of 25% of them had their results leading to
alterations in management of the patient.
Domain Patient selection Index Test Reference
Test
Flow and Timing
Description The selection of the
patients was systematic
Index test is the
quantitative
expression of
the burden of
Index test was
calculated at
baseline and
at 3,6 and 9
A patient who,
upon being
scanned and a
tumor was

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the tumor and
reproduction
observed on
bone
scintigraphy
months on
treatment
observed they
were required to
undergo index
testing
Signaling
questions
Consecutive sampling
Yes
Yes
No Yes
No
No
Yes
Yes
No
Risk of bias Yes, Yes, at some
stage
no Yes, at some
stage
Concerns
applicabilit
y
Yes, there such concerns No, except in
serious cases
No,
Question Three
Bone metastasis happens whenever cells carrying cancer from the primary tumor relocate
to the bone. It is therefore, most likely that breast, lung and prostate cancers would spread to the
bone. Whenever this occurs then it results to a condition called bone metastasis in an individual.
Therefore, this is one of the area that should be identified early enough in a potential victim so
that it is not discovered at the late stage. Early attention is required (Saunders.Macedo et al.,
2019).

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Arvola et al. (2019) states that there is need to determine the imaging modality that has
the top most level of accuracy in detection of metastases in gastric components, in effect, clinical
use of these modalities may vastly assist reduce and enhance distant bone metastases detection in
gastric.
According to Lutz et al. (2017), bone metastases show high metabolic activities with the
low immune responses and that there is usually the likelihood of high immune response in cases
where there are bone metastases and thus the need for scanning and carrying out the appropriate,
commendable therapy.
In Waning et al. (2015) wrapping it all, they define bone metastases by relating it with the
prognostic value of scan of the bone among individual patients having metastatic associated
prostate cancer having been previously gotten medication with ‘andro-gen deprivation’.
Waning et al category of cancer metastases
Lutz et al Cancer that has spread to the bone from the
initial tumor
Arvola et al. category of cancer metastases
Saunders.Macedo et al Cancer that has spread to the bone from the
initial tumor
Bibliography

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Arvola, S., Jambor, I., Kuisma, A., Kemppainen, J., Kajander, S., Seppänen, M. and Noponen,
T., 2019. Comparison of standardized uptake values between 99m Tc-HDP
SPECT/CT and 18 F-NaF PET/CT in bone metastases of breast and prostate
cancer. EJNMMI research, 9(1), p.6.
Chang, C.Y., Gill, C.M., Joseph Simeone, F., Taneja, A.K., Huang, A.J., Torriani, M. and
Bredella, M.A., 2016. Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone
scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases. Acta
Radiologica, 57(1), pp.58-65.
Langsteger, W., Rezaee, A., Pirich, C. and Beheshti, M., 2016, November. 18F-NaF-PET/CT
and 99mTc-MDP bone scintigraphy in the detection of bone metastases in prostate
cancer. In Seminars in nuclear medicine (Vol. 46, No. 6, pp. 491-501). WB
Lutz, S., Balboni, T., Jones, J., Lo, S., Petit, J., Rich, S.E., Wong, R. and Hahn, C., 2017.
Palliative radiation therapy for bone metastases: Update of an ASTRO Evidence-
Based Guideline. Practical radiation oncology, 7(1), pp.4-12.
Saunders.Macedo, F., Ladeira, K., Pinho, F., Saraiva, N., Bonito, N., Pinto, L. and Gonçalves,
F., 2017. Bone metastases: an overview. Oncology reviews, 11(1).
Waning, D.L., Mohammad, K.S., Reiken, S., Xie, W., Andersson, D.C., John, S., Chiechi, A.,
Wright, L.E., Umanskaya, A., Niewolna, M. and Trivedi, T., 2015. Excess TGF-β
mediates muscle weakness associated with bone metastases in mice. Nature
medicine, 21(11), p.1262.