In this presentation, application of bone scan in the management of primary bone tumors has been explained with multiple examples.

1. Application of bone scan
in primary bone tumors
Ramin Sadeghi, MD
Associate Professor of Nuclear Medicine
Nuclear Medicine Research Center, Mashhad University of Medical Sciences

2. Clinical condition
Screening first study
 X-Ray is absolutely required in a patient with suspected bone lesion.
 Bone scan is not appropriate in screening first study.

3. Positive localized or regional symptoms.
Radiographs negative or findings do not
explain symptoms.
 MRI with or without IV contrast is the most appropriate test.
 Bone scan may be appropriate for better localization and characterization of
the possible tumor.

4. A 30 y/o female with knee pain

6. Lesion on radiographs definitively
benign. Not osteoid osteoma.
 CT or MRI can be helpful in symptomatic patients.
 Bone scan is not indicated.

7. 8 y/o patient with fracture
superimposed on bone cyst

9. Lesion on radiographs. Radiographic and/or
clinical pattern suspicious for osteoid
osteoma.
 CT without contrast is the most appropriate test.
 MRI may be useful
 Bone scan may be appropriate as an adjunct to CT

10. A 25 y/o patient with history of
nocturnal pain in the hip

14. Lesion on radiographs. Indeterminate for
malignancy with mineralized matrix.
 MRI and CT are the most appropriate tests.
 Bone scan can be appropriate when evaluating for disease distribution or
other areas of involvement.
 Specially for differentiation of enchondroma from chondrosarcoma in the
medullary chondroid lesions

15. A 45 y/o patient with hip pain

18. Lesion on radiographs. Indeterminate for
malignancy. Lytic or sclerotic lesions.
 MRI and Ct scan are the most appropriate tests.
 Skeletal bone survey is appropriate in case of suspicion for multiple myeloma
 Bone scan is appropriate for evaluating for disease distribution or other areas
of involvement.

19. A pediatric patient with lytic lesions in
the skull

22. Lesion on radiographs. Aggressive,
suspicious for malignancy.
 MRI and CT are the most appropriate tests.
 Bone scan is appropriate for diagnosis of multifocal disease.

23. A 50 y/o patient with arm pain

25. Lesion with pathological fracture on
radiographs. Not definitively benign
 MRI and CT are the most appropriate tests.
 Bone scan is appropriate to look for multifocal disease.

26. A 50 y/o patient with pathological
fracture of the clavicula

29. No radiographs. “Incidental” finding on
MRI. Not clearly benign.
 X-ray of the area is the most appropriate test.
 CT may be appropriate.
 Bone scan is not indicated.

30. A 20 y/o patient with incidental lesion
found on MRI

34. No radiographs. “Incidental” finding on
CT. Not clearly benign.
 MRI is the most appropriate as well as X-ray
 Bone scan may be useful depending on the MRI and X-ray results. Usually not
appropriate.

35. A 45 y/o with incidental finding on CT

38. What is the role of bone scan is
confirmed primary bone tumors

39. Ewing sarcoma

41. A 18 y/o female patient with hip pain

45. Follow up with bone scan in a Ewing
sarcoma patient

48. Giant Cell Tumor

49. A 30 y/o patient with a giant cell tumor
lesion in the knee region. Suspicious for
multiple brown tumors

51. Osteosarcoma

52. Osteosarcoma

53. Osteosarcoma

54. Osteosarcoma with relapse

57. Chordoma