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**5** 

*Spain* 

**Clinical Approach** 

Noelia Medina-Gálvez1 and Teresa Pedraz2

*Rehabilitation, Miguel Hernández University* 

**Nuclear Medicine in Musculoskeletal Disorders:** 

*1Hospital Universitario de San de Juan de Alicante, Department of Physical Medicine and* 

Nuclear medicine supplies with functional perspective in the diagnosis of different pathologies of the musculoskeletal system. Bone scintigraphy is one of the most used nuclear medicine techniques in our clinical practice for location, evaluation and diagnosis of these pathologies because of its high sensitivity. This technique identifies functional changes before structural lesions have been established. For the study of musculoskeletal disorders, the usage of three-phase bone scintigraphy is applied more often than conventional bone scintigraphy. However, due to its low specificity, it has been replaced by other techniques such as magnetic resonance imaging (MRI) in the evaluation of localized lesions. New techniques in nuclear medicine which provide precision with high sensitivity are currently available, such as single-photon emission computed tomography (SPECT), useful in the evaluation of lumbar and hip pathology, or the presence of inflammation in small joints (hands and feet), and positron emission tomography (PET), which provides a metabolic imaging. Several radionuclides can be used in the scintigraphic evaluation, although the most commonly used for bone scintigraphy are labelled with technetium 99-m (99mTc), standing out diphosphonate compounds such as methylene diphosphonate (MDP). This radiopharmaceutical (Tc-99m-MDP) is used for studying metabolic bone diseases like Paget´s disease, transient osteoporosis and reflex sympathetic dystrophy. And it is also useful in the location of polytopic forms of avascular osteonecrosis, in the study of hidden painful radiologic bone lesions such as osteoid osteoma or others bone tumours, in the evaluation of soft-tissue lesions, and in the assessment of spread pattern of bone metastases. Furthermore, this radionuclide may locate bone fractures, identify the cause of pain in patients with chronic pain after arthroplasty, show the evolution of heterotopic ossification and provide information about musculoskeletal system infections (in combination with other radionuclides) and paediatric diseases. Other radionuclides commonly used in the evaluation of infectious or inflammatory processes in the musculoskeletal system are gallium citrate and indium 111-labelled leukocytes, since the latter increases the specificity of technetium radiotracer. Local treatments can be applied by radio isotopic techniques. One of these is radiosynoviorthesis, used in the treatment of patients with persistent monoarthritis in different stages (from inflammatory poliarthritis to pigmentary

**1. Introduction** 

villonodular sinovitis).

*2Hospital General Universitario de Alicante, Department of Rheumatology* 

