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What are the 2 types of bone?
- 1. Amorphous Calcium Phospate (ACP)
- -new bone
- 2. Hydroyapetite
- Older mature bone
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Name 4 Bone Imaging Agents
- 1. Calcium and Phosphorus (no gamma)
- 2. Strontium (slow clearance)
- 3. Flourine (^ bone uptake)
- 4. Tc Complexes
- -POP (O2 easily broken by phosphorylates)
- -PCP (more stable) [EDHP, MDP, HDP]
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What are the critical organs for MDP/HDP? Describe localization
- MDP: Bladder
- HDP: Bone surface
Localization:
- Chemisorption- Negative O2 atoms bind to positive Ca+ in bone.
- ACP has higher binding affinity than hydroxyapetite
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Describe how a 3 phase bone scan looks for osteomyelitis, cellulitis, and non inflammatory (degenerative joint)
- Osteomyelitis: ^ uptake in every phase
- Cellulitis:^ uptake in flow and pool
- Noninflammatory:^ uptake in delay
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Paget's disease has uptake in what regions?
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Describe avascular necrosis
**Occlusion of nutrient artery to bone**
Early: v uptake and blood activity (cold spot)
Late: collateral circulation ^ uptake on bone
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TcO4 impurity will show up where in a bone scan?
thyroid and stomach
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Why is F18 Sodium Fl better than diphosphonates for bone scanning?
- ^ blood clearance
- ^ sensitivity and resolution than SPECT
- ^ diagnostic accuracy in assessment of malignaant and benighn skeletal disease
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What type of lesions do breast and prostate cancers cause and what would you use?
cause Blastic in Bone (Breast Blastic Bone)
Kidney, thyroid, lung, and myeloma cause lytic
- FDG is good for lytic
- NaF is good for blastic
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What are the indications for Radionuclide Tx?
- 1. Pain relief, not curing
- 2. Improve quality of life
- 3. Incurable disease but expected to live several months
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What is special about Radium Chloride when it comes to bone pain Tx?
It's an alpha emitter so it doesn't travel far therefore it spares bone marrow
Alleviates pain and PROLONGS LIFE
used for prostate cancer
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T or F : P32 Does not cause significant hematological depression
F: it DOES b/c it gets incorporated into marrow cells
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Describe the uptake and etc for Strontium Chloride (Metastron)
- uptake: similar to Ca+ (longer duration in mets)
- Pts experience flare response (pain worsens in 2-3 days; taken w/o aspirin b/c aspirin may cause clotting problems)
- Platement>60,000; WBC>2,400 (done every week)
- 50% is retained in bones
- Primary excretion URINARY
- Critical organ: bone surfaces
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Which Bone pain pharmaceutical is supplied as a frozen sol'n and has to have the dose calibrator pre calibrated before measuring?
Sm 153 Lexidronam
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