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      The EANM practice guidelines for bone scintigraphy

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          Abstract

          Purpose

          The radionuclide bone scan is the cornerstone of skeletal nuclear medicine imaging. Bone scintigraphy is a highly sensitive diagnostic nuclear medicine imaging technique that uses a radiotracer to evaluate the distribution of active bone formation in the skeleton related to malignant and benign disease, as well as physiological processes.

          Methods

          The European Association of Nuclear Medicine (EANM) has written and approved these guidelines to promote the use of nuclear medicine procedures of high quality.

          Conclusion

          The present guidelines offer assistance to nuclear medicine practitioners in optimizing the diagnostic procedure and interpreting bone scintigraphy. These guidelines describe the protocols that are currently accepted and used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary.

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          Most cited references48

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          SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0.

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            Phase II study of abiraterone acetate in chemotherapy-naive metastatic castration-resistant prostate cancer displaying bone flare discordant with serologic response.

            Abiraterone is an oral inhibitor of CYP17, which is essential for androgen biosynthesis. This multicenter study assessed its efficacy in patients with castration-resistant prostate cancer (CRPC), without prior chemotherapy or CYP17-targeted therapy, and frequency of bone scans discordant with prostate-specific antigen (PSA) and clinical response. Thirty-three patients received abiraterone acetate 1,000 mg daily with prednisone 5 mg twice daily in continuous 28-day cycles. Patients were evaluated monthly for efficacy and safety. Bone scan flare was defined as the combination, after 3 months of therapy, of an interpreting radiologist's report indicating "disease progression" in context of a 50% or more decline in PSA level, with scan improvement or stability 3 months later. A 50% or more decline in PSA level at week 12 was confirmed in 22 of 33 (67%) patients. Declines in PSA level of 50% or more were seen in 26 of 33 (79%) patients. Undetectable PSA levels (≤0.1 ng/mL) occurred in 2 patients. Median time on therapy and time to PSA progression were 63 weeks and 16.3 months, respectively. Twenty-three patients were evaluable for bone scan flare. Progression was indicated in radiologist's report in 12 of 23 (52%), and 11 of 12 subsequently showed improvement or stability. As prospectively defined, bone scan flare was observed in 11 of 23 (48%) evaluable patients or 11 of 33 (33%) enrolled patients. Adverse events were typically grade 1/2 and consistent with prior published abiraterone reports. Clinical responses to abiraterone plus prednisone were frequent and durable in men with metastatic CRPC. Further investigation is needed to clarify the confounding effect of bone scan flare on patient management and interpretation of results. Clin Cancer Res; 17(14); 4854-61. ©2011 AACR.
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              Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions.

              99mTechnetium methylene diphosphonate (99mTc MDP) bone scintigraphy is currently the method of choice for the detection of bone metastases, but 18F-fluoro-deoxy-D-glucose positron emission tomography (18FDG PET) offers superior spatial resolution and improved sensitivity. We have compared 18FDG PET with 99mTc MDP bone scintigraphy in patients with skeletal metastases from breast cancer and have analyzed the data in subgroups based on radiographic characteristics of lesions. Twenty-three women with breast cancer and confirmed bone metastases were studied with both 99mTC MDP bone scintigraphy and 18FDG PET, and the number of lesions detected and the quantitation of uptake (standardized uptake values [SUVs]) of 18FDG in osteolytic and osteoblastic metastases were compared. Survival was compared for both lytic and blastic bone metastases and for patients with high and low accumulation of 18FDG. 18FDG PET detected more lesions than 99mTc MDP scintigraphy (mean, 14.1 and 7.8 lesions, respectively; P 3.6; P=.4). 18FDG PET is superior to bone scintigraphy in the detection of osteolytic breast cancer metastases, which led to a poorer prognosis. In contrast, osteoblastic metastases show lower metabolic activity and are frequently undetectable by PET. The biologic explanation for this observation remains to be elucidated.
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                Author and article information

                Contributors
                +33-(0)1-49-95-82-83 , +33-(0)1-49-95-91-08 , frederic.paycha@aphp.fr
                Journal
                Eur J Nucl Med Mol Imaging
                Eur. J. Nucl. Med. Mol. Imaging
                European Journal of Nuclear Medicine and Molecular Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1619-7070
                1619-7089
                4 June 2016
                4 June 2016
                2016
                : 43
                : 1723-1738
                Affiliations
                [ ]Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
                [ ]Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
                [ ]Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
                [ ]Nuclear Medicine Spitalerhof, Spitalerstraße 8, 20095 Hamburg, Germany
                [ ]Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
                [ ]Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands
                [ ]Department of Nuclear Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
                [ ]Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
                [ ]Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR), University of La Rioja, Logroño, La Rioja Spain
                [ ]Department of Radiology, Memorial Sloan Kettering Center, New York, NY USA
                [ ]PET-CT Center Linz, Department of Nuclear Medicine and Endocrinology, St Vincent’s Hospital, Seilerstaette 4, 4020 Linz, Austria
                [ ]Department of Nuclear Medicine, Centre Hospitalier Universitaire de Lyon, Lyon, France
                [ ]Department of Nuclear Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
                [ ]Department of Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
                [ ]Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France
                Article
                3415
                10.1007/s00259-016-3415-4
                4932135
                27262701
                a8eee3ea-6ae6-4725-879b-e9399f7b4279
                © The Author(s) 2016

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 2 May 2016
                : 3 May 2016
                Categories
                Guidelines
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2016

                Radiology & Imaging
                bone scintigraphy,bone scan,bone spect/ct,bone disease
                Radiology & Imaging
                bone scintigraphy, bone scan, bone spect/ct, bone disease

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