Skip to main content
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1979 Jun;130(6):503–514.

Skeletal Scintigraphy

I Ross McDougall 1
PMCID: PMC1238705  PMID: 390886

Abstract

Skeletal scintigraphy, using phosphates or diphosphonates labeled with technetium 99m, is a sensitive method of detecting bone abnormalities. The most important and most frequent role of bone scanning is evaluating the skeletal areas in patients who have a primary cancer, especially a malignant condition that has a tendency to spread to bone areas. The bone scan is superior to bone radiographs in diagnosing these abnormalities; 15 percent to 25 percent of patients with breast, prostate or lung cancer, who have normal roentgenograms, also have abnormal scintigrams due to metastases. The majority of bone metastases appear as hot spots on the scan and are easily recognized. The incidence of abnormal bone scans in patients with early stages (I and II) of breast cancer varies from 6 percent to 26 percent, but almost invariably those patients with scan abnormalities have a poor prognosis and should be considered for additional therapies. Progression or regression of bony lesions can be defined through scanning, and abnormal areas can be identified for biopsy. The incidence of metastases in solitary scan lesions in patients with known primary tumors varies from 20 percent to 64 percent. Bone scintigraphy shows positive uptake in 95 percent of cases with acute osteomyelitis. Stress fractures and trauma suspected in battered babies can be diagnosed by scanning before there is radiological evidence. The procedure is free from acute or long-term side effects and, except in cases of very young patients, sedation is seldom necessary.

Although the test is sensitive, it is not specific and therefore it is difficult to overemphasize the importance of clinical, radiographic, biochemical and scanning correlation in each patient.

Full text

PDF
503

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alavi A., McCloskey J. R., Steinberg M. E. Early detction of avascular necrosis of the femoral head by 99m technetium diphosphonate bone scan: a preliminary report. Clin Orthop Relat Res. 1977;(127):137–141. [PubMed] [Google Scholar]
  2. Antoniades J., Croll M. N., Walner R. J., Brady L. W. Bone scanning in carcinomas of the colon and rectum. Dis Colon Rectum. 1976 Mar;19(2):139–143. doi: 10.1007/BF02590867. [DOI] [PubMed] [Google Scholar]
  3. Benz G., Brandeis W. E., Geiger H., Georgi P. "Cold" lesion in bone scan of an osteogenic metastasis of Wilms' tumour. Pediatr Radiol. 1978 Feb 28;6(4):233–234. doi: 10.1007/BF00975543. [DOI] [PubMed] [Google Scholar]
  4. Berg G. R., Kalisher L., Osmond J. D., Pendergrass H. P., Potsaid M. S. 99mTc-diphosphonate concentration in primary breast carcinoma. Radiology. 1973 Nov;109(2):393–394. doi: 10.1148/109.2.393. [DOI] [PubMed] [Google Scholar]
  5. Blair R. J., McAfee J. G. Radiological detection of skeletal metastases: radiographs versus scans. Int J Radiat Oncol Biol Phys. 1976 Nov-Dec;1(11-12):1201–1205. doi: 10.1016/0360-3016(76)90095-x. [DOI] [PubMed] [Google Scholar]
  6. Bonte F. J., Parkey R. W., Graham K. D., Moore J., Stokely E. M. A new method for radionuclide imaging of myocardial infarcts. Radiology. 1974 Feb;110(2):473–474. doi: 10.1148/110.2.473. [DOI] [PubMed] [Google Scholar]
  7. Brower A. C., Teates C. D. Positive 99mTc-polyphosphate scan in case of metastatic osteogenic sarcoma and hypertrophic pulmonary osteoarthropathy. J Nucl Med. 1974 Jan;15(1):53–55. [PubMed] [Google Scholar]
  8. Campbell D. J., Banks A. J., Oates G. D. The value of preliminary bone scanning in staging and assessing the prognosis of breast cancer. Br J Surg. 1976 Oct;63(10):811–816. doi: 10.1002/bjs.1800631020. [DOI] [PubMed] [Google Scholar]
  9. Castronovo F. P., Jr, Callahan R. J. New bone scanning agent: 99m Tc-labeled 1-hydroxy-ethylidene-1, 1-disodium phosphonate. J Nucl Med. 1972 Nov;13(11):823–827. [PubMed] [Google Scholar]
  10. Chaudhuri T. K., Chaudhuri T. K., Gulesserian H. P., Christie J. H., Tonami N. Extraosseous noncalcified soft-tissue uptake of 99mTc-polyphosphate. J Nucl Med. 1974 Nov;15(11):1054–1056. [PubMed] [Google Scholar]
  11. Chaudhuri T. K., Schapiro R. L., Christie J. H. Positive 87m Sr bone scan in a case of hypertrophic pulmonary osteoarthropathy. J Nucl Med. 1972 Jan;13(1):120–121. [PubMed] [Google Scholar]
  12. Citrin D. L., Bessent R. G., Greig W. R. Clinical evaluation of 99mTc-labeled monofluorophosphate: a comparison with ethane-hydroxy-diphosphonate. J Nucl Med. 1974 Dec;15(12):1110–1112. [PubMed] [Google Scholar]
  13. Citrin D. L., Bessent R. G., McGinley E., Gordon D. Dynamic studies with 99mTc-HEDP in normal subjects and in patients with bone tumors. J Nucl Med. 1975 Oct;16(10):886–890. [PubMed] [Google Scholar]
  14. Citrin D. L., Bessent R. G., Tuohy J. B., Greig W. R., Blumgart L. H. Quantitative bone scanning: a method for assessing response of bone metastases to treatment. Lancet. 1974 Jun 8;1(7867):1132–1133. doi: 10.1016/s0140-6736(74)90618-7. [DOI] [PubMed] [Google Scholar]
  15. Citrin D. L., Bessent R. G., Tuohy J. B., elms S. T., McGinlay E., Greig W. R., Blumgart L. A comparison of phosphate bone-scanning agents in normal subjects and patients with malignant disease. Br J Radiol. 1975 Feb;48(566):118–121. doi: 10.1259/0007-1285-48-566-118. [DOI] [PubMed] [Google Scholar]
  16. Citrin D. L., Furnival C. M., Bessent R. G., Greig W. R., Bell G., Blumgart L. H. Radioactive technetium phosphate bone scanning in preoperative assessment and follow-up study of patients with primary cancer of the breast. Surg Gynecol Obstet. 1976 Sep;143(3):360–364. [PubMed] [Google Scholar]
  17. Corcoran R. J., Thrall J. H., Kyle R. W., Kaminski R. J., Johnson M. C. Solitary abnormalities in bone scans of patients with extraosseous malignancies. Radiology. 1976 Dec;121(3 Pt 1):663–667. doi: 10.1148/121.3.663. [DOI] [PubMed] [Google Scholar]
  18. Croft B. Y., Teates C. D. "Lunch syndrome," a bone-scanning artifact: case report. Clin Nucl Med. 1978 Apr;3(4):137–138. doi: 10.1097/00003072-197804000-00005. [DOI] [PubMed] [Google Scholar]
  19. D'Ambrosia R. D., Shoji H., Riggins R. S., Stadalnik R. C., DeNardo G. L. Scintigraphy in the diagnosis of osteonecrosis. Clin Orthop Relat Res. 1978 Jan-Feb;(130):139–143. [PubMed] [Google Scholar]
  20. Danigelis J. A., Fisher R. L., Ozonoff M. B., Sziklas J. J. 99m-to-polyphosphate bone imaging in Legg-Perthes disease. Radiology. 1975 May;115(2):407–413. doi: 10.1148/115.2.407. [DOI] [PubMed] [Google Scholar]
  21. Davies C. J., Griffiths P. A., Preston B. J., Morris A. H., Elston C. W., Blamey R. W. Staging breast cancer: role of bone scanning. Br Med J. 1977 Sep 3;2(6087):603–605. doi: 10.1136/bmj.2.6087.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Donnelly B., Johnson P. M. Detection of hypertrophic pulmonary osteoarthropathy of skeletal imaging with 99mTc-labeled diphosphonate. Radiology. 1975 Feb;114(2):389–391. doi: 10.1148/114.2.389. [DOI] [PubMed] [Google Scholar]
  23. Duszynski D. O., Kuhn J. P., Afshani E., Riddlesberger M. M., Jr Early radionuclide diagnosis of acute osteomyelitis. Radiology. 1975 Nov;117(2):337–340. doi: 10.1148/117.2.337. [DOI] [PubMed] [Google Scholar]
  24. Edelstyn G. A., Gillespie P. J., Grebbell F. S. The radiological demonstration of osseous metastases. Experimental observations. Clin Radiol. 1967 Apr;18(2):158–162. doi: 10.1016/s0009-9260(67)80010-2. [DOI] [PubMed] [Google Scholar]
  25. Feldman J. M., Plonk J. W. 99mTc-pyrophosphate bone scans in patients with metastatic carcinoid tumors. J Med. 1977;8(1):71–80. [PubMed] [Google Scholar]
  26. Flowers W. M., Jr 99MTc-polyphosphate uptake within pulmonary and soft-tissue metastases from osteosarcoma. Radiology. 1974 Aug;112(2):377–378. doi: 10.1148/112.2.377. [DOI] [PubMed] [Google Scholar]
  27. Fogelman I., Bessent R. G., Turner J. G., Citrin D. L., Boyle I. T., Greig W. R. The use of whole-body retention of Tc-99m diphosphonate in the diagnosis of metabolic bone disease. J Nucl Med. 1978 Mar;19(3):270–275. [PubMed] [Google Scholar]
  28. Fogelman I., McKillop J. H., Bessent R. G., Boyle I. T., Turner J. G., Greig W. R. The role of bone scanning in osteomalacia. J Nucl Med. 1978 Mar;19(3):245–248. [PubMed] [Google Scholar]
  29. Fordham E. W., Ramachandran P. C. Radionuclide imaging of osseous trauma. Semin Nucl Med. 1974 Oct;4(4):411–429. doi: 10.1016/s0001-2998(74)80032-2. [DOI] [PubMed] [Google Scholar]
  30. Galasko C. S. The role of skeletal scintigraphy in detection of metastatic breast cancer. World J Surg. 1977 May;1(3):295–298. doi: 10.1007/BF01556841. [DOI] [PubMed] [Google Scholar]
  31. Gelfand M. J., Silberstein E. B. Radionuclide imaging. Use in diagnosis of osteomyelitis in children. JAMA. 1977 Jan 17;237(3):245–247. doi: 10.1001/jama.237.3.245. [DOI] [PubMed] [Google Scholar]
  32. Gerber F. H., Goodreau J. J., Kirchner P. T., Fouty W. J. Efficacy of preoperative and postoperative bone scanning in the management of breast carcinoma. N Engl J Med. 1977 Aug 11;297(6):300–303. doi: 10.1056/NEJM197708112970603. [DOI] [PubMed] [Google Scholar]
  33. Geslien G. E., Thrall J. H., Espinosa J. L., Older R. A. Early detection of stress fractures using 99mTc-polyphosphate. Radiology. 1976 Dec;121(3 Pt 1):683–687. doi: 10.1148/121.3.683. [DOI] [PubMed] [Google Scholar]
  34. Ghaed N., Thrall J. H., Pinsky S. M., Johnson M. C. Detection of extraosseous metastases from osteosarcoma with 99mTc-polyphosphate bone scanning. Radiology. 1974 Aug;112(2):373–375. doi: 10.1148/112.2.373. [DOI] [PubMed] [Google Scholar]
  35. Goergen T. G., Resnick D., Lomonaco A., O'Dell C. W., Jr Radionuclide bone-scan abnormalities in leprosy: case reports. J Nucl Med. 1976 Sep;17(9):788–790. [PubMed] [Google Scholar]
  36. Graffman S., Rangne A. Scintigraphy in diagnosis of osteomyelitis of the jaws. Int J Oral Surg. 1977 Oct;6(5):247–250. doi: 10.1016/s0300-9785(77)80033-1. [DOI] [PubMed] [Google Scholar]
  37. Grames G. M., Jansen C., Carlsen E. N., Davidson T. R. The abnormal bone scan in intracranial lesions. Radiology. 1975 Apr;115(1):129–134. doi: 10.1148/115.1.129. [DOI] [PubMed] [Google Scholar]
  38. Greyson N. D., Walker D. Delayed imaging to distinguish bone lesions from urinary tract activity. Radiology. 1977 Aug;124(2):524–526. doi: 10.1148/124.2.524. [DOI] [PubMed] [Google Scholar]
  39. Hammond N., Jones S. E., Salmon S. E., Patton D., Woolfenden J. Predictive value of bone scans in an adjuvant breast cancer program. Cancer. 1978 Jan;41(1):138–142. doi: 10.1002/1097-0142(197801)41:1<138::aid-cncr2820410122>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  40. Handmaker H., Leonards R. The bone scan in inflammatory osseous disease. Semin Nucl Med. 1976 Jan;6(1):95–105. doi: 10.1016/s0001-2998(76)80039-6. [DOI] [PubMed] [Google Scholar]
  41. Harcke H. T., Jr Bone imaging in infants and children: a review. J Nucl Med. 1978 Mar;19(3):324–329. [PubMed] [Google Scholar]
  42. Hardoff R., Front D. The value of delayed (24-hour) bone scintigraphy. Clin Nucl Med. 1978 Feb;3(2):39–42. doi: 10.1097/00003072-197802000-00001. [DOI] [PubMed] [Google Scholar]
  43. Hatfield D. R., DeLand F. H., Maruyama Y. Skeletal metastases in pancreatic carcinoma: study by isotopic bone scanning. Oncology. 1976;33(1):44–47. doi: 10.1159/000225100. [DOI] [PubMed] [Google Scholar]
  44. Holmes R. A. Quantification of skeletal Tc-99m labeled phosphates to defect metabolic bone disease. J Nucl Med. 1978 Mar;19(3):330–331. [PubMed] [Google Scholar]
  45. Hopkins G. B., Kristensen K. A. Whole body skeletal scintiphotography in the detection of occult metastatic breast carcinomas. Calif Med. 1973 Oct;119(4):10–13. [PMC free article] [PubMed] [Google Scholar]
  46. Jackman S. J., Maher F. T., Hattery R. R. Detection of renal-cell carcinoma with 99mTc polyphosphate imaging of bone. A case report. Mayo Clin Proc. 1974 May;49(5):297–299. [PubMed] [Google Scholar]
  47. Karelitz J. R., Richards J. B. Pseudophotopenic defect due to barium in the colon. Clin Nucl Med. 1978 Oct;3(10):414–414. doi: 10.1097/00003072-197810000-00015. [DOI] [PubMed] [Google Scholar]
  48. Kempi H. A., van der Linden W. Scintigraphy with 99mTc-tripolyphosphate in the early diagnosis of osteomyelitis. Nuklearmedizin. 1976 Apr;15(2):53–55. [PubMed] [Google Scholar]
  49. Krishnamurthy G. T., Brickman A. S., Blahd W. H. Technetium-99m-Sn-pyrophosphate pharmaco-kinetics and bone image changes in parathyroid disease. J Nucl Med. 1977 Mar;18(3):236–242. [PubMed] [Google Scholar]
  50. Lurye D. R., Castronovo F. P., Jr, Potsaid M. S. Improved method for quantitative bone scanning. J Nucl Med. 1977 Nov;18(11):1069–1073. [PubMed] [Google Scholar]
  51. Lutrin C. L., McDougall I. R., Goris M. L. Intense concentration of technetium-99m pyrophosphate in the kidneys of children treated with chemotherapeutic drugs for malignant disease. Radiology. 1978 Jul;128(1):165–167. doi: 10.1148/128.1.165. [DOI] [PubMed] [Google Scholar]
  52. Maher F. T. Evaluation of renal and urinary tract abnormalities noted on scintiscans: a retrospective study of 1,711 radioisotope skeletal surveys performed in an 18-month period. Mayo Clin Proc. 1975 Jul;50(7):370–378. [PubMed] [Google Scholar]
  53. Mandel P., Saxe B., Spatz M. Urologic serendipity in whole body bone scanning. Urology. 1974 Mar;3(3):283–287. doi: 10.1016/s0090-4295(74)80104-4. [DOI] [PubMed] [Google Scholar]
  54. McDougall I. R., Kriss J. P. Screening for bone metastases. Are only scans necessary? JAMA. 1975 Jan 6;231(1):46–50. doi: 10.1001/jama.231.1.46. [DOI] [PubMed] [Google Scholar]
  55. McDougall I. R., Pistenma D. A. Concentration of 99mTc diphosphonate in breast tissue. Radiology. 1974 Sep;112(3):655–657. doi: 10.1148/112.3.655. [DOI] [PubMed] [Google Scholar]
  56. McDougall I. R., Pistenma D. A. Letter: Rib abnormality hidden by breast prosthesis. J Nucl Med. 1974 May;15(5):379–380. [PubMed] [Google Scholar]
  57. Miller J. H., Gates G. F. Scintigraphy of sacroiliac pyarthrosis in children. JAMA. 1977 Dec 19;238(25):2701–2704. [PubMed] [Google Scholar]
  58. Miller S. W., Castronovo F. P., Jr, Pendergrass H. P., Potsaid M. S. Technetium 99m labeled diphosphonate bone scanning in Paget's disease. Am J Roentgenol Radium Ther Nucl Med. 1974 May;121(1):177–183. doi: 10.2214/ajr.121.1.177. [DOI] [PubMed] [Google Scholar]
  59. Nordman E., Marjamäki H., Tannila O. The reliability of 99mmTc-pyrophosphate scintigraphy in the diagnosis of bony metastases. Ann Clin Res. 1977 Feb;9(1):31–34. [PubMed] [Google Scholar]
  60. Oren V. O., Uszler J. M. Liver metastases of oat cell carcinoma of lung detected on 99mTc-diphosphonate bone scan. Clin Nucl Med. 1978 Sep;3(9):355–358. doi: 10.1097/00003072-197809000-00006. [DOI] [PubMed] [Google Scholar]
  61. Pabst H. W., Langhammer H. Detection and differential diagnosis of bone lesions by scintigraphy. Eur J Nucl Med. 1977 Dec 30;2(4):261–268. doi: 10.1007/BF00252575. [DOI] [PubMed] [Google Scholar]
  62. Park C. H., Glassman L. M., Thompson N. L., Mata J. S. Reliability of renal imaging obtained incidentally in 99m Tc-polyphosphate bone scanning. J Nucl Med. 1973 Jul;14(7):534–536. [PubMed] [Google Scholar]
  63. Parthasarathy K. L., Landsberg R., Bakshi S. P., Donoghue G., Merrin C. Detection of bone metastases in urogenital malignancies utilizing 99mTc-labeled phosphate compounds. Urology. 1978 Jan;11(1):99–102. doi: 10.1016/0090-4295(78)90217-0. [DOI] [PubMed] [Google Scholar]
  64. Potsaid M. S., Guiberteau M. J., McKusick K. A. Quality of bone scans compared with time between dose and scan. J Nucl Med. 1977 Aug;18(8):787–789. [PubMed] [Google Scholar]
  65. Rappaport A. H., Hoffer P. B., Genant H. K. Unifocal bone findings by scintigraphy. Clinical significance in patients with known primary cancer. West J Med. 1978 Sep;129(3):188–192. [PMC free article] [PubMed] [Google Scholar]
  66. Risky L., Goris M. L., Schurman D. J., Nagel D. A. 99Technetium bone scanning in experimental osteomyelitis. Clin Orthop Relat Res. 1977 Oct;(128):361–366. [PubMed] [Google Scholar]
  67. Russin L. D., Staab E. V. Unusual bone-scan findings in acute osteomyelitis: case report. J Nucl Med. 1976 Jul;17(7):617–619. [PubMed] [Google Scholar]
  68. Schaffer D. L., Pendergrass H. P. Comparison of enzyme, clinical, radiographic, and radionuclide methods of detecting bone metastases from carcinoma of the prostate. Radiology. 1976 Nov;121(2):431–434. doi: 10.1148/121.2.431. [DOI] [PubMed] [Google Scholar]
  69. Serafini A. N. Paget's disease of bone. Semin Nucl Med. 1976 Jan;6(1):47–58. doi: 10.1016/s0001-2998(76)80035-9. [DOI] [PubMed] [Google Scholar]
  70. Sham R., Sain A., Silver L., Seery W. H., Cole A. T. Localization of 99mTc-phosphate compounds in renal tumors. J Nucl Med. 1977 Mar;18(3):311–312. [PubMed] [Google Scholar]
  71. Silberstein E. B., Maxon H. R., 3rd, Alexander G. W., Jr, Rauf C., Bahr G. K. Clinical comparison of technetium-99m diphosphonate and pyrophosphate in bone scintigraphy: concise communication. J Nucl Med. 1978 Feb;19(2):161–163. [PubMed] [Google Scholar]
  72. Singh B. N., Spies S. M., Mehta S. P., Kesala B. A., Quinn J. L. Unusual bone scan presentation in osteomalacia: symmetrical uptake--a suggestive sign. Clin Nucl Med. 1978 Jul;3(7):292–295. doi: 10.1097/00003072-197807000-00008. [DOI] [PubMed] [Google Scholar]
  73. Snow R. M., Weber D. A. Time-dependent image quality using 99mTc-pyrophosphate. J Nucl Med. 1975 Oct;16(10):879–882. [PubMed] [Google Scholar]
  74. Stevenson J. S., Eckelman W. C., Sobocinski P. Z., Reba R. C., Barron E. L., Levin S. G. The toxicity of Sn-pyrophosphate: clinical manifestations prior to acute LD50. J Nucl Med. 1974 Apr;15(4):252–256. [PubMed] [Google Scholar]
  75. Subramanian G., McAfee J. G., Bell E. G., Blair R. J., O'Mara R. E., Ralston P. H. 99m Tc-labeled polyphosphate as a skeletal imaging agent. Radiology. 1972 Mar;102(3):701–704. doi: 10.1148/102.3.701. [DOI] [PubMed] [Google Scholar]
  76. Sy W. M. Bone scan in primary hyperparathyroidism. J Nucl Med. 1974 Dec;15(12):1089–1091. [PubMed] [Google Scholar]
  77. Sy W. M., Westring D. W., Weinberger G. "Cold" lesions on bone imaging. J Nucl Med. 1975 Nov;16(11):1013–1016. [PubMed] [Google Scholar]
  78. Teates C. D., Williamson B. R. "Hot and cold" bone lesion in acute osteomyelitis. AJR Am J Roentgenol. 1977 Sep;129(3):517–518. doi: 10.2214/ajr.129.3.517. [DOI] [PubMed] [Google Scholar]
  79. Tofe A. J., Francis M. D., Harvey W. J. Letter: Incidence of solitary skull and extremity involvement in whole-body scintigrams. J Nucl Med. 1976 Aug;17(8):755–756. [PubMed] [Google Scholar]
  80. Tow D. E., Garcia D. A., Jansons D., Sullivan T. M., Niederman R. Bone scan in dental diseases. J Nucl Med. 1978 Jul;19(7):845–847. [PubMed] [Google Scholar]
  81. Trackler R. T., Miller K. E., Sutherland D. H., Chadwick D. L. Childhood pelvic osteomyelitis presenting as a "cold" lesion on bone scan: case report. J Nucl Med. 1976 Jul;17(7):620–622. [PubMed] [Google Scholar]
  82. Vanek J. A., Cook S. A., Bukowski R. M. Hepatic uptake of Tc-99m-labeled diphosphonate in amyloidosis: case report. J Nucl Med. 1977 Nov;18(11):1086–1088. [PubMed] [Google Scholar]
  83. Vieras F., Boyd C. M. Diagnostic value of renal imaging incidental to bone scintigraphy with 99mTc-phosphate compounds. J Nucl Med. 1975 Dec;16(12):1109–1114. [PubMed] [Google Scholar]
  84. Vieras F., Herzberg D. L. Focal decreased skeletal uptake secondary to metastatic disease. Radiology. 1976 Jan;118(1):121–122. doi: 10.1148/118.1.121. [DOI] [PubMed] [Google Scholar]
  85. Waxman A. D., Bryan D., Siemsen J. K. Bone scanning in the drug abuse patient: early detection of hematogenous osteomyelitis. J Nucl Med. 1973 Sep;14(9):647–650. [PubMed] [Google Scholar]
  86. Waxman A. D., Ducker S., McKee D., Siemsen J. K., Singer F. R. Evaluation of 99mTc diphosphonate kinetics and bone scans in patients with Paget's disease before and after calcitonin treatment. Radiology. 1977 Dec;125(3):761–764. doi: 10.1148/125.3.761. [DOI] [PubMed] [Google Scholar]
  87. Wiegmann T., Rosenthall L., Kaye M. Technetium-99m-pyrophosphate bone scans in hyperparathyroidism. J Nucl Med. 1977 Mar;18(3):231–235. [PubMed] [Google Scholar]
  88. Williams S. J., Green M., Kerr I. M. Detection of bone metastases in carcinoma of bronchus. Br Med J. 1977 Apr 16;1(6067):1004–1004. doi: 10.1136/bmj.1.6067.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  89. Winter P. F., Perl L. J. Letter: Cold areas in bone scanning. J Nucl Med. 1976 Aug;17(8):755–755. [PubMed] [Google Scholar]
  90. Yano Y., McRae J., Van Dyke D. C., Anger H. O. Technetium-99m-labeled stannous ethane-1-hydroxy-1 1-diphosphonate: a new bone scanning agent. J Nucl Med. 1973 Feb;14(2):73–78. [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES