One of the earliest application of the nucleer bone scan was for the diagnosis of malignant metastasis and fracture of bone by Fleming et al in 1961. Since then, the scope of bone scan has become enormously expanded with continuous technical renovations, re
finement finement of radiopharmaceuticals, greatly raised effi
cacy. and ever more increasing clinical demands. Thus, bone scan is now universally accepted as an indispensable means of the clinical diagnosis of a varie
y of acute and critical skeletal disorders. In recent
by using nuclear angiography, SPECT, and pint,`,le magnification technic, both the sensitivity and
ificity of bone scan have become remarkably en
ced.
Of particular interest the bone scanning augmentwith pinhole technic has been shown to provide
~~ portant information, regarding the anatomy and tabolism of bone, leading to suggest or indicate specific diagnosis of many bone and joint diseases
k et al, 1987; Kim at al, 1993;Bahk et al, 1994;
ang and Bahk, 1994 ; Bahk, 1994). Indeed a number pathohonomonic signs could be sorted out by pin
´le scan and it is becoming ever clearer that bhole bone scan will play an important role not y in the diagnosis but in the clinical research of
u ny skeletal disorders.. Pinhole bone scan appears be a potent differential diagnostic tool for the dis
in complex anatomical units such as the spine, -ad and neck, knee, and hip(Bahk et al, 1987;Bahk
t al, 1994;Yang et al, 1994). Thus, it is fully justi
´ ied to systematically explore the usefulness of this
? ciily accessible yet immensely rewarding scan hnique in the study of bone and joint diseases at
;=rge, with the eventual goal set at establishing a
´.ecemeal analysis system of bone scan, which may called image-phase transition study.
As a practical matter of fact pinhole collimator
can easily be equipped anew by economical arrangement or in many institutions it is already in possesion but just laid aside unused. It is tho be emphasized that the time needed for pinhole scan is no more as long as it used to be. What is still more important is to realize the fact that only the pinhole scan can produce truly magnified image with substantially enhanced spatial resolution, significantly improving both the specificity and sensitivity of examination. Neither the apparent magnification obtained by blowup or geometric magnification technique nor SPECT can achieve this goal. Clearly SPECT is useful in eliminating the superimposed structures, rendering the object to be seen unobstucted. However as is well known the SPECT image is the product of electronically reconstucted and smoothened signals which are acquired by rotary scanning about an object that is stored in a minatured format on a predetermined matrix, which artificially determines the final, seeming resolution. SPECT is not a technique that primarily deals with the spatial resolution but with the elimination of superimposed structures. With the latest modification of the pinhole technique using Tc-99m-oxidronate (HDP)and optimized acquisition, the vast majority of imaging can now be completed within 15 min.
One short list of the diseases that can beneficially be imaged by pinhole scan includes bone infections [acute osteomyelitis, sclerosing osteomyelitis of Garr 6, infective osteitis, periostitis, cortical abscess]; noninfective osteitides [osteitis, condensans ilii, osteitis pubis, condensing osteitis of clavicle, Paget´s disease, costosternoclavicular hyperostosis];inflammation or infection of the synovium [transient or sympathetic synovitis, infective synovitis];pyarthrosis; osteoarthritis;rheumatoid arthritis, seronegative spondylothropathies[ankylosing spondylitis, Reiter´s
syndrome, psoriatic arthritis, enteropathic arthritis]; the arthropathies associated with specific conditions [systemic lupus erythematosus, Sjogren´s syndrome, tophaceous gouty arthritis, Charcot ]*oint] ;soft tissue rheumatism syndromes [tendinitis, bursitis, plantar fasciitis, myositis ossificans];osteochondrosis[LeggCalve-Perthes disease, Kohler´s disease, Friedrich´s disease, Freiberg´s infraction] ; osteochondritis dissecans;vascular bone disorders[avascular nocrosis, bone infarction, reflex sympathetisc dystrophy syndrome, transient osteoporosis] ; metabolic bone diseases[ osteoporosis, renal osteodystrophy, hyperparathyrodism, rickets] ; traumatic and sports injuries [bone contusion, stress fracture, enthesopathies, covert fracture, nonunion of fracture, pseudoarthrosis];metastatic bone tumors; malignant and be
nign primary bone tunics [osteosarcoma, chondrosar coma, fibrosarcoma, Ewing´s sarcoma, multiple my_´´~ eloma and osteoid osteoma, enostosis, exostosis, fibrous cortical defect, bone cysts]; bone dysplasias4~. [fiboros dysplasia, multiple familial exostosis, oste--, ochondromatosis, osteopetrosis, osteopoikilia] ; and´. many other skeletal diseases.
In summary, it is to be emphasized that the pinhole: technique is indeed useful both in the clinical diagno-~´ sis nd basic research of bone and joint diseases and´ with further technical refinement such as dual-pinhole scan system or pinhole-SPECT and more`´ systematic appetcation it can be developed into an i deed potent diagnostic tool to open a new horizon i r! skeletal imaging diagnosis.
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