Jaime L. Montilla-Soler, MD, and Rikesh Makanji, MD


Cancer Control. 2017;24(2):137-146. 

In This Article

Abstract and Introduction


Background. Skeletal scintigraphy remains a valuable tool in the initial and subsequent evaluation of the skeletal system in patients with a diagnosis of primary or metastatic neoplasms.

Methods. We discuss radiopharmaceuticals, nuclear medicine imaging techniques, and current as well as future oncological applications in the adult population. Pertinent literature was reviewed to describe the advantages and limitations of available technologies for the evaluation of skeletal metastatic disease. Evaluation of primary and metastatic skeletal disease using nuclear medicine and positron emission tomography techniques is discussed.

Results. Skeletal scintigraphy provides valuable information in the initial evaluation for the presence of osteoblastic skeletal metastases. Incremental advances on available radiopharmaceuticals (fludeoxyglucose F 18, sodium fluoride F 18), coupled with advances in imaging techniques and imaging devices (single photon emission computed tomography/computed tomography, positron emission tomography/computed tomography, positron emission tomography/magnetic resonance imaging), have had a significant impact on sensitivity, specificity, and accuracy rates for the detection of skeletal metastases.

Conclusions. Skeletal scintigraphy has a significant role in the initial diagnosis, staging, restaging, and treatment monitoring of patients with cancer and primary skeletal or metastatic disease. The coupling of diagnostic and therapeutic nuclear medicine agents in the setting of osteoblastic skeletal metastases is a valuable tool for the treatment for certain cancer types, including prostate cancer, and may become more widely used to treat other histologies as more data on other tumor types (eg, breast cancer, osteosarcoma) become available.


Techniques in nuclear medicine remain a mainstay of the initial evaluation and staging of cancer as well as during restaging and treatment monitoring. Advanced imaging techniques such as single photon emission computed tomography (SPECT) and SPECT with computed tomography (CT) offer improved rates of sensitivity, specificity, and accuracy. Use of radiopharmaceuticals for positron emission tomography (PET) integrated with CT or magnetic resonance imaging (MRI) further increase the rate of diagnostic accuracy in this rapidly evolving technology. Thus, the coupling of diagnostic and therapeutic radiopharmaceuticals is important for the treatment of osteoblastic skeletal metastases.