ARRS 2022 Abstracts

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E1434. Positive is Not Always Malignant: A Review of Benign Bone Lesions With Increased Uptake on Bone Scintigraphy
Authors
  1. Ryan Baker; SUNY Upstate Medical University
  2. Leen Alkukhun; SUNY Upstate Medical University
  3. Omari Christie; SUNY Upstate Medical University
  4. David Lubin; SUNY Upstate Medical University
Background
Bone scintigraphy, one of the oldest and most utilized nuclear imaging studies, has long been employed for its high level of sensitivity in detecting metastatic osteoblastic disease despite a relatively low specificity. Due to the nature of the scan, detection of bone remodeling processes, numerous different benign lesions such as chondroma, Paget’s disease, infection, arthritis, and fractures all have the potential to imitate malignant lesions. Understanding these malignant mimickers in the context of nuclear medicine is paramount in proper utilization of bone scintigraphy and avoiding confusion in establishing a diagnosis and beginning a treatment plan. This pictorial review illustrates several such cases where a benign process imitates a primary malignant or metastatic process and discusses various imaging findings and imaging modalities that can aid the investigator in differentiating between benign and truly malignant pathologies.

Educational Goals / Teaching Points
This exhibit will review the mechanism of action of bone scintigraphy using Tc99m-MDP, and the factors that increase radiopharmaceutical uptake and review benign pathologies that typically demonstrate uptake on bone scans and their imaging features, including but not limited to enchondromas, aneurysmal bone cysts, fractures, Paget’s disease of bone, osteomyelitis, and hardware loosening.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit will cover variable increased uptake on bone scintigraphy and benign pathologies that demonstrate radiopharmaceutical uptake on bone scintigraphy and may mimic malignant disease.

Conclusion
Bone scintigraphy is an important and sensitive tool for the detection of bone lesions. Unfortunately, it is not specific, and many benign processes can demonstrate increased uptake as well. Correlation with anatomic imaging and clinical presentation is crucial to making the appropriate diagnosis and treatment plan for bone lesions.