Pitfalls in Tc99m polyphosphate skeletal imaging.

The quality of Tc-PP scans is best in younger patients. In all age groups quality is adversely affected by free TcO4-. This should be suspected if excessive background is present or marked accumulation is noted in the thyroid gland. Direct physician supervision of all studies is recommended. Symptomatic and roentgenographically positive areas may then be determined for special interpretative attention. Objects which attenuate activity should be removed or noted. Potential sources of superficial contamination (product spill, urine, saliva) must be known and considered when extraneous activity does not correlate with skeletal structures or clinical findings. Normal variations in skeletal uptake of Tc-PP include asymmetries between periarticular areas on the right and left, local increases due to physiologic calvarial thickening and uptake in persistently visualized sternal ossification centers. Apparent variations in the vertebral activity may be due to focal plane effects of rectilinear scanners. Hyperemia can cause diffusely increased Tc-PP localization in an entire extremity. This effect may completely obscure a lesion or obscure the extent of a lesion. Tc-PP excretion through the kidneys occasionally provides useful morphologic or functional information concerning the urinary tract which should be inspected on all scans. Abnormal soft tissue uptake occurs in a variety of conditions including healing wounds and some malignant tumors. A large percentage of patients over 40 years of age demonstrate localization of Tc-PP in the walls of the femoral vessels.