Radionuclide imaging may be used to assess and monitor bony metastases particularly from prostatic carcinoma but also from other sites such as renal and bladder tumours.
The radioisotope most widely used is 99m technetium labelled methylene diphosphonate. Areas of increased uptake denote areas of increased osteoblastic activity.
Multiple, well-circumscribed areas of increased activity suggest metastases. Isolated areas may arise for other reasons, for example a recent fracture. Further information from the patient's history or from other investigations such as plain radiographs or magnetic resonance imaging is then necessary to reach a conclusion.
It should be noted that though bone scintigraphy is normally a very sensitive test and often reassuring when negative, false negatives do occur. This is particularly in the case of myeloma, when lytic bone lesions, may not show up, unless there is also a pathological fracture.
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