Utility of delayed whole-body bone scintigraphy after directed three-phase scintigraphy

AJR Am J Roentgenol. 2009 Aug;193(2):338-42. doi: 10.2214/AJR.08.2142.


Objective: The purpose of this study was to determine the diagnostic yield and clinical importance of delayed whole-body bone scintigraphy in directed three-phase examinations.

Materials and methods: The records of 400 consecutively registered patients who underwent combined three-phase and delayed whole-body (99m)Tc-methylene diphosphonate bone scintigraphy for a variety of indications were reviewed. Clinical indications, findings, recommendations, and outcome were assessed.

Results: Three-phase bone scintigraphy was performed on 156 men and boys and 244 women and girls (61%). Fifty-two patients (13%) were 17 years old or younger, and 236 patients (59%) were older than 40 years. The mean increase in study duration due to whole-body imaging was 25 minutes (range, 21-31 minutes). Excluding the three-phase area of interest, the whole-body examination had a normal tracer distribution in 131 examinations (33%), showed solely degenerative changes in 103 (26%), and showed findings unrelated to the area of interest in 166 patients (41%). In no case did the findings outside the area of interest alter the diagnosis or diagnostic certainty in the three-phase study, but those findings did generate 82 recommendations for additional diagnostic investigation. As a direct result of the recommendations, clinicians requested 18 radiographic, two CT, one MRI, and one ultrasound examinations, one additional bone scan, and two referrals to a consultant. Recommendations based on findings outside the three-phase area of interest affected treatment in one case: Temporomandibular joint uptake resulted in a referral for physical therapy.

Conclusion: For most indications, delayed whole-body imaging after directed three-phase bone scintigraphy does not improve diagnostic yield, does not alter patient care, and may be an unnecessary use of medical resources.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Diseases / diagnostic imaging*
  • Bone Neoplasms / diagnostic imaging
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Incidental Findings
  • Infant
  • Male
  • Middle Aged
  • Radiography
  • Radionuclide Imaging
  • Retrospective Studies
  • Technetium Tc 99m Medronate
  • Whole Body Imaging* / economics
  • Young Adult


  • Technetium Tc 99m Medronate