Orthopedic oncology procedures account for about half of the bone scans conducted at Myers' practice. In certain forms of bone cancer, osteomyeloma, for example, aggressive metastases can lead to necrotic lesions, represented by a cold or dim spot on the scan. In the case of osteosarcoma, a tumor or area of metastases would show-up as an intense hot spot, says Myers.

Infection of the bone, or osteomyelitis, is "an interesting entity," Myers says. At its onset, infections often run cold on a scan, but at some point bone remodeling goes into overdrive and turns red hot. Another radioisotope that can be used with SPECT/CT to scan specifically for infection is indium-111, which homes in on infected bone tissues after being combined with white blood cells, says Green.

The future of SPECT/CT

Perhaps one of the most exciting applications of modern SPECT/CT technology is in the realm of radiotherapy, says Green. Quadramet, another bone-targeting radiopharmaceutical, also known as samarium-153-lexidronam, is the therapeutic version of technetium-99m MDP. Quadramet is a mixed beta-gamma emitter, which means that it has both therapeutic and diagnostic properties and can be used in bone pain palliation procedures, which have been shown to effectively treat painful metastatic bone disease.

In any case, it looks as though any improvements in SPECT/CT will represent a lucky break for an aging population.



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