Nuclear Medicine Imaging Modalities: Bone Scintigraphy, PET-CT, SPECT-CT

Nuclear medicine allows imaging of (patho) physiological processes within the body and contributes in the diagnosis and treatment of specific diseases. In patients with bone metastases, nuclear medicine not only plays an important role in the diagnosis, but may also be used for therapeutic purposes. For several decades, bone scintigraphy has been used and nowadays is still the nuclear medicine imaging method of choice for diagnosing bone metastases in many malignant diseases. Its sensitivity (>90 %) is still superior to any other available imaging method. However, the specificity is rather low and interpretation of scans needs to be carefully evaluated by expert nuclear medicine physicians together with other biological, anatomical and clinical information. In the last two decades, nuclear medicine rapidly evolved. New radiopharmaceuticals (SPECT and PET) were produced, specific for a certain cancer type. Recent development in soft- and hard-ware led to the introduction of hybrid camera systems (SPECT-CT and PET-CT), combining (patho)physiology and anatomy together, leading to better diagnostic results and many advantages, also for the patient. In this chapter the basic principles of nuclear medicine, the different camera systems, and the technique and procedure of the bone scintigraphy will be explained. An overview is given of the available radiopharmaceuticals (SPECT and PET) to detect bone metastases in different cancer types. The role of nuclear medicine in patients with prostate cancer, breast cancer, lung cancer, and some other cancer types will be discussed more extensively.