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Scintigraphy
1.
2. What Is Nuclear Scintigraphy?
n Musculoskeletal system
imaging modality
n Aids in diagnosing
subtle to severe and
complex lameness
n Can be used to monitor
the healing of fractures
n Pre-purchase exams
n Referred to as nuclear
medicine, bone scan,
and scintigraphy
3. n Horse is injected with a radioactive isotope (Tc99m) that has an
affinity to localize in bone.
n Areas of osteoblastic activity or accelerated metabolism of the bone
will result in a “hot spot”.
n Gamma radiation is emitted by the horse and detected by the
camera creating an image.
How It Works
4. Phases of a Bone Scan…
n Vascular Phase
¨ Not used readily in horses unless
a lack of blood supply is
suspected. Ie. iliac thrombosis
n Soft Tissue or Pooling Phase
¨ Allows us to examine the soft
tissue structures of the lower limbs
(ie. tendons/suspensory)
n Bone Phase
¨ Performed 2-3 hours after
injection to ensure the isotope has
been well distributed into the
bone.
5. n Hospitalized for a
minimum of 48 hours
after injection.
n Patients are confined to
a stall to allow for the
radioactive isotope to
decay.
n Ensures both patient
and handler safety.
Horse Handling and Management
6. Why Scintigraphy?
n Scintigraphy is an excellent
way to identify lameness
issues that are difficult to
diagnose.
¨ Pelvic, shoulder and back imaging
are all possible. These areas may
be inaccessible to other modalities
(x-ray or ultrasound).
n Aids to rule out suspected
fractures or isolate the main
cause of a lameness if a “multi
focal” lameness is present.
7. n Highly sensitive but non-specific
¨ It is extremely good at isolating an area of increased metabolic
activity (fractures, inflammation etc) but may not characterize the
nature of the injury specfically. (bone bruising vs. a chip vs.
fracture).
n Radiography / ultrasound or regional anesthesia can
then be used to characterize the highlighted areas of
interest.
n Many “hot spots” are completely diagnostic in that there
are breed and occupational characteristics that make
them definitive
8. When would you consider
Scintigraphy?
n A sudden onset lameness.
n Failure to localize the
lameness by blocking.
n Lameness involving one or
multiple limbs.
n Persistent / intermittent
lameness.
n History of poor performance.
n Monitor the healing of an injury
or fracture.
TIBIAL STRESS FRACTURE
AFTER 4 MONTHS STRICT STALL REST
9. n Front end, hind end,
or full body
n With or without soft
tissue phase
n It is important to
always compare left
and right sides of the
horse. Some “hot
spots” are normal for
certain breeds
BONE SCAN OF A FOAL –
NORMAL INCREASE UPTAKE
IN GROWTH PLATES
BONE SCAN OF A
WARMBLOOD – WITH
INCREASED UPTAKE
OF THE DORSAL P1
16. EXERTIONAL
RHABDOMYOLYSIS – TYING UP
n Muscle
damage
due to a
breakdown
of striated
muscle
fibers. Note
the “brush
stroke”
uptake of
isotope.
17. Case 6: “Mood”
n 2 Year Old Thoroughbred Racing Filly
n Presented with acute right hind lameness
n Suspected to have an injury to the
proximal right hind limb / pelvis
n Scintigraphy elected