Bone Marrow Scintigraphy

Bone marrow scintigraphy is a diagnostic nuclear medicine procedure that allows imaging of the hematopoietically (blood formation-related) active bone marrow and can be used primarily to evaluate bone marrow-associated tumors such as multiple myeloma. For imaging by scintigraphy, a 99mTechnetium marker is injected intravenously as a radiopharmaceutical (also called a “tracer”; chemical compound of a radionuclide with other substances) so that the bone marrow can be accurately assessed.

Indications (areas of application)

  • Plasmocytoma (synonyms: multiple myeloma, Kahler’s disease after Otto Kahler, Huppert’s disease) – this clinical picture represents the main indication for the use of bone marrow scintigraphy. Multiple myeloma is a so-called monoclonal gammopathy, in which a pathological release and production of immunoglobulins (antibodies) occurs due to a bone marrow tumor. Typically, in multiple myeloma, functionally impaired plasma cells (most mature differentiation stage of B lymphocytes; their function is the secretion of antibodies) occur, which are responsible for the formation of immunoglobulins.
  • Leukemias (blood cancers) – the use of bone marrow scintigraphy here allows accurate imaging of the affected bone marrow.
  • Diagnosis of bone marrow displacing processes – this is a nonspecific reduction of bone marrow, for example, by carcinomas, which are accompanied by a reduction in function.
  • Tumors from the lymphatic system such as Hodgkin’s and non-Hodgkin’s lymphomas – if bone marrow involvement is suspected in the presence of a malignant tumor of the lymphatic system, a bone marrow scintigraphy should be performed.
  • Metastases in solid tumors – in an existing breast carcinoma or bronchial carcinoma, metastases are often found in the bone marrow, so the use of bone marrow scintigraphy is indicated.
  • Before performing a bone marrow biopsy – in hemolytic disease, bone marrow scintigraphy is performed before the bone marrow biopsy is performed

Contraindications

Relative contraindications

  • Lactation phase (breastfeeding phase) – breastfeeding must be interrupted for 48 hours to prevent risk to the child.
  • Repeat examination – no repeat scintigraphy should be performed within three months due to radiation exposure.

Absolute contraindications

  • Gravidity (pregnancy)

Before the examination

  • Application of the radiopharmaceutical – the most commonly used radiopharmaceutical for performing bone marrow scintigraphy in an oncological setting is a 99mTechnetium-labeled monoclonal antibody of the IgG (immunoglobulin G) type against the “nonspecific cross-reacting antigen”-95. This antigen is a differentiation antigen of granulopoiesis (differentiation of progenitor cells into granulocytes/white blood cells).

The procedure

The basic principle of bone marrow scintigraphy is based on the detection of γ-radiation released by the radiopharmaceutical using a γ-camera. The radiopharmaceutical is an intravenously injected colloid substance that has a size of several nanometers and thus can be deposited in the reticulohistiocytic system (part of the immune system) of the bone marrow in addition to the liver and spleen. Based on the distribution of the radiopharmaceutical, it is possible to deduce where the hematopoietic bone marrow is located. With the help of bone marrow scintigraphy, more frequent displacement of the bone marrow can be diagnosed, in addition to the rare over-accumulation of the radiopharamone in the tissue. Of critical importance to the use of bone marrow scintigraphy is that the procedure is potentially more sensitive (probability of correctly detecting disease) than the use of skeletal scintigraphy.

After the examination

Actions taken after scintigraphy is performed depend on the results of the examination. If the findings are negative, no post-examination measures are usually required. Because of the rapid elimination of the radiopharmaceutical, no special measures are necessary afterward.

Possible complications

  • Intravenous administration of radiopharmaceutical may result in local vascular and nerve lesions (injuries).
  • Radiation exposure from the radionuclide used tends to be considered low. Nevertheless, the theoretical risk of radiation-induced late malignancy (leukemia or carcinoma) is increased, so that a risk-benefit balance should be made.