Abstract
Various radiopharmaceuticals and imaging techniques are commonly used in nuclear medicine imaging to diagnose benign and malignant bone lesions. With increasing availability and utility of conventional and advanced nuclear medicine procedures, it has become necessary to know about their limitations during interpretation. Advanced fusion imaging systems, such as SPECT/CT and PET/CT, increase the complexity of inherent artifacts of individual techniques. Comprehensive quality control program and standardized scan techniques are needed to reduce the incidence and intensity of artifacts. Broadly, these artifacts can occur due to radiopharmaceutical, instrumental, and patient-related factors, and proper knowledge about them helps us to avoid misinterpretation and improve the specificity. In this chapter, we elaborate on important artifacts, how they can alter scan findings, approaches to recognize them, and ways to avoid them.
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Abbreviations
- BMD:
-
Bone mineral densitometry
- CT:
-
Computed tomography
- DXA:
-
Dual-energy X-ray absorptiometry
- PET:
-
Positron-emission tomography
- SPECT:
-
Single-photon emission computed tomography
References
Agrawal K, Marafi F, Gnanasegaran G et al (2015) Pitfalls and limitations of radionuclide planar and hybrid bone imaging. Semin Nucl Med 45:347–372
Blake GM, Fogelman I (1997) Technical principles of dual energy X-ray absorptiometry. Semin Nucl Med 27:210–228
Buchpiguel CA, Roizemblatt S, Pastor EH et al (1996) Cardiac and skeletal muscle scintigraphy in dermato- and polymyositis: clinical implications. Eur J Nucl Med 23:199–203
Busemann-Sokole E (1987) Measurement of collimator hole angulation and camera head tilt for slant and parallel hole collimators used in SPECT. J Nucl Med 28:1592–1598
Cerqueira MD, Matsuoka D, Ritchie JL, Harp GD (1988) The influence of collimators on SPECT center of rotation measurements: artifact generation and acceptance testing. J Nucl Med 29:1393–1397
Chew FS, Hudson TM, Enneking WF (1981) Radionuclide imaging of soft tissue neoplasms. Semin Nucl Med 11:266–276
Davis MA (1975) Particulate radiopharmaceuticals for pulmonary studies. In: Subramanian G, Rodes BA, Cooper JF (eds) Radiopharmaceuticals. Society of Nuclear Medicine, New York
Dizendorf E, Hany TF, Buck A et al (2003) Cause and magnitude of the error induced by oral CT contrast agent in CT-based attenuation correction of PET emission studies. J Nucl Med 44:732–738
Gnanasegaran G, Cook G, Adamson K, Fogelman I (2009) Patterns, variants, artifacts, and pitfalls in conventional radionuclide bone imaging and SPECT/CT. Semin Nucl Med 39:380–395
Goerres GW, Ziegler SI, Burger C et al (2003) Artifacts at PET and PET/CT caused by metallic hip prosthetic material. Radiology 226:577–584
Goldberg E, Lieberman C (1977) “Hot spots” in lung scans. J Nucl Med 18:499–500
Gordon L, Schabel SI, Holland RD, Cooper JF (1981) 99m Tc-methylene diphosphonate accumulation in ascitic fluid due to neoplasm. Radiology 139:699–702
Graham LS (1984) Quality assurance of anger cameras. In: Rao DV, Chandra R, Graham MC (eds) Physics of nuclear medicine – recent advances. American Institute of Physics, New York
Hany TF, Steinert HC, Goerres GW et al (2002) PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology 225:575–581
Holese C, Kristensen K, Sampson CB (1994) Factors which affect the integrity of radiopharmaceuticals. In: Sampson CB (ed) Textbook of radiopharmacy, theory and practice, 2nd edn. Gordon and Breach Science Publishers, Amsterdam
Howarth DM, Forstrom LA, O’Connor K et al (1996) Patient-related pitfalls and artifacts in nuclear medicine imaging. Semin Nucl Med 26:295–307
Hung JC, Ponto JA, Hammes RJ (1996) Radiopharmaceutical-related pitfalls and artifacts. Semin Nucl Med 26:208–255
Jacobson JA, Jamadar DA, Hayes CW (2000) Dual X-ray absorptiometry: recognizing image artifacts and pathology. AJR Am J Roentgenol 174:1699–1705
Kamel EM, Burger C, Buck A et al (2003) Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner. Eur Radiol 13:724–728
Kannivelu A, Padhy AK, Srinivasan S, Ali SZ (2013) Extraosseous uptake of technetium-99m methylene diphosphonate by an acute territorial cerebral infarct in a classical biodistribution pattern. Indian J Nucl Med 28:240–242
Kelly BJ, O’Connor MK (1990) Multiple window spatial registration: failure of the NEMA standard to adequately quantitate image misregistration with gallium-67. J Nucl Med Technol 19:92–95
Koizumi K, Tonami N, Hisada K (1981) Diffusely increased Tc-99m-MDP uptake in both kidneys. Clin Nucl Med 6:362–365
Lentle BC, Scott JR, Noujaim AA, Jackson FI (1979) Iatrogenic alterations in radionuclide biodistributions. Semin Nucl Med 9:131–143
Loutfi I, Collier BD, Mohammed AM (2003) Nonosseous abnormalities on bone scans. J Nucl Med Technol 31:149–153
Malmin RE, Stanley PC, Guth WR (1990) Collimator angulation error and its effect on SPECT. J Nucl Med 31:655–659
Maloof J, Hurst J, Gupta N (1996) Diffuse pulmonary uptake of Tc-99m MDP in sarcoidosis. Clin Nucl Med 21:77–79
Martineau P, Bazarjani S, Zuckier LS (2015) Artifacts and incidental findings encountered on dual-energy X-ray absorptiometry: atlas and analysis. Semin Nucl Med 45:458–469
Masud T, Langley S, Wiltshire P et al (1993) Effect of spinal osteophytosis on bone mineral density measurements in vertebral osteoporosis. BMJ 307:172–173
Morgan SL, Lopez-Ben R, Nunnally N et al (2008) Black hole artifacts-a new potential pitfall for DXA accuracy? J Clin Densitom 11:266–275
Morrison RT, Steuart RD (1995) Delayed massive soft tissue uptake of Tc-99m MDP after radiation therapy for cancer of the breast. Clin Nucl Med 20:770–771
Ng DCE, Lam WWC, Goh ASW (2015) Nuclear medicine imaging. In: Peh WCG (ed) Pitfalls in diagnostic radiology. Springer, Berlin/Heidelberg
O’Connor MK, Kelly BJ (1990) Evaluation of techniques for the elimination of “hot” bladder artifacts in SPECT of the pelvis. J Nucl Med 31:1872–1875
O’Connor MK, Brown ML, Hung JC, Hayostek RJ (1991) The art of bone scintigraphy--technical aspects. J Nucl Med 32:2332–2341
O’Connor MK (1996) Instrument- and computer-related problems and artifacts in nuclear medicine. Semin Nucl Med 26:256–277
Ongseng F, Goldfarb CR, Finestone H (1995) Axillary lymph node uptake of technetium-99m-MDP. J Nucl Med 36:1797–1799
Osman MM, Cohade C, Nakamoto Y, Wahl RL (2003) Respiratory motion artifacts on PET emission images obtained using CT attenuation correction on PET-CT. Eur J Nucl Med Mol Imaging 30:603–606
Oswald WM, O’Connor MK (1987) A noisy photomultiplier tube: its unusual effect on gamma camera image uniformity. J Nucl Med 15:157
Padhy AK, Gopinath PG, Amini AC (1990) Myocardial, pulmonary, diaphragmatic, gastric, splenic, and renal uptake of Tc-99m MDP in a patient with persistent, severe hypercalcemia. Clin Nucl Med 15:648–649
Peller PJ, Ho VB, Kransdorf MJ (1993) Extraosseous Tc-99m MDP uptake: a pathophysiologic approach. Radiographics 13:715–734
Piccolo S, Lastoria S, Mainolfi C et al (1995) Technetium-99m-methylene diphosphonate scintimammography to image primary breast cancer. J Nucl Med 36:718–724
Popilock R, Sandrasagaren K, Harris L, Kaser KA (2008) CT artifact recognition for the nuclear technologist. J Nucl Med Technol 36:79–81
Pryma DA (2014) Nuclear medicine: practical physics, artifacts, and pitfalls. Oxford University Press, New York
Rogers WL, Clinthorne NH, Harkness BA et al (1982) Field-flood requirements for emission computed tomography with an Anger camera. J Nucl Med 23:162–168
Rosenthall L (1992) Estimation of the effect of a preinjection of Tc-99m MDP on lumbar spine bone mineral density determinations. Clin Nucl Med 17:195–197
Ryan PJ, Evans P, Blake GM, Fogeman I (1992) The effect of vertebral collapse on spinal bone mineral density measurements in osteoporosis. Bone Miner 18:267–272
Sampson CB, Cox PH (1994) Effect of patient medication and other factors on the biodistribution of radiopharmaceuticals. In: Sampson CB (ed) Textbook of radiopharmacy, theory and practice, 2nd edn. Gordon and Breach Science Publishers, Amsterdam
Schneider DL (1998) Pitfalls in interpretation: calcium that’s not bone. J Clin Densitom 1:405–406
Sherkow L, Ryo UY, Fabich D et al (1984) Visualization of the liver, gallbladder, and intestine on bone scintigraphy. Clin Nucl Med 9:440–443
Shih WJ, Wienrzbinski B, Ryo UY (2000) Abnormally increased uptake in the palm and the thumb as the result of a bone imaging agent injection into the radial artery. Clin Nucl Med 25:539–540
Silberstein EB, DeLong S, Cline J (1984) Tc-99m diphosphonate and sulfur colloid uptake by the spleen in sickle disease: interrelationship and clinical correlates: concise communication. J Nucl Med 25:1300–1303
Siminoski K, O’Keeffe M, Brown JP et al (2013) Canadian Association of Radiologists technical standards for bone mineral densitometry reporting. Can Assoc Radiol J 64:281–294
Standards Publication No.NU 1-1994 (1994) NEMA: performance measurements of scintillation cameras. National Electrical Manufactures Association, Washington, DC
Storey G, Murray IPC (2004) Bone scintigraphy: the procedure and interpretation. In: Ell PJ, Gambhir SS (eds) Nuclear medicine in clinical diagnosis and treatment, 3rd edn. Churchill-Livingstone, Philadelphia
Sureshbabu W, Mawlawi O (2005) PET/CT imaging artifacts. J Nucl Med Technol 33:156–161
Tu D-G, Yao W-J, Chang T-W et al (2009) Flare phenomenon in positron emission tomography in a case of breast cancer--a pitfall of positron emission tomography imaging interpretation. Clin Imaging 33:468–470
Vallabhajosula S, Killeen RP, Osborne JR (2010) Altered biodistribution of radiopharmaceuticals: role of radiochemical/pharmaceutical purity, physiological, and pharmacologic factors. Semin Nucl Med 40:220–241
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Kannivelu, A., Loke, K.S.H., Yan, S.X.X., Loi, H.Y., Ng, D.C.E. (2017). Nuclear Medicine Imaging Artifacts. In: Peh, W. (eds) Pitfalls in Musculoskeletal Radiology. Springer, Cham. https://doi.org/10.1007/978-3-319-53496-1_5
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DOI: https://doi.org/10.1007/978-3-319-53496-1_5
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