Gholami Amir, Jafaripour Iraj
Department of Nuclear Medicine, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran.
Department of Cardiology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
Caspian J Intern Med. 2022 Spring;13(2):439-441. doi: 10.22088/cjim.13.2.439.
Bone scintigraphy with 99mTc labeled radiopharmaceuticals is a valuable method in nuclear medicine for assessing the bony structure. In clinical setting, bone scintigraphy is accomplished after the injection of 99mTc labeled diphosphonate complexes into a peripheral vein. Inadvertent intra-arterial injection on the antecubital region may cause a special form of artifacts leading to problems inaccurately interpreting these studies as functional images.
We present a 44-year-old man with history of chest wall pain for bone scintigraphy as part of a work-up for determining the pain source. The patient received an injection of 740MBq 99mTc-methylene diphosphonate (MDP) into a blood vessel at the right forearm. Two hours later, an increased uptake of activity was observed on the right forearm and ulnar half of the wrist-hand in the whole body and spot images. The scan findings were consistent with the anatomical and physiological expectations of the ulnar arterial perfusion range. This case displays that an incidental injection with a 99mTc labeled diphosphonate into the ulnar artery results in a hot ulnar half of the palm and ulnar-sided three digits, because these areas are directly exposed to radiopharmaceutical, therefore more radiopharmaceutical is deposited.
It is important for the physician, and especially for the nuclear medicine technician, to know the specific appearance created in the bone scan due to such an event so that they do not make a diagnostic mistake.
使用99mTc标记的放射性药物进行骨闪烁扫描是核医学中评估骨骼结构的一种重要方法。在临床实践中，骨闪烁扫描是在将99mTc标记的二膦酸盐复合物注入外周静脉后完成的。在前臂区域意外动脉内注射可能会导致一种特殊形式的伪影，从而在将这些研究解读为功能图像时产生问题。
我们报告一名44岁男性，有胸壁疼痛病史，进行骨闪烁扫描作为确定疼痛来源检查的一部分。患者在右前臂的一根血管内注射了740MBq的99mTc-亚甲基二膦酸盐（MDP）。两小时后，在全身及局部图像中观察到右前臂和腕-手部尺侧的放射性摄取增加。扫描结果与尺动脉灌注范围的解剖学和生理学预期一致。该病例表明，意外将99mTc标记的二膦酸盐注入尺动脉会导致手掌尺侧及尺侧三个手指出现放射性热点，因为这些区域直接暴露于放射性药物，因此有更多放射性药物沉积。
对于医生，尤其是核医学技术人员来说，了解此类事件在骨扫描中产生的特定表现非常重要，这样他们就不会做出错误诊断。
