99mTc-MDP Bone Scintigraphy Research Articles

Lincoln’s Sign

Classical appearance of "Lincoln's sign" on 99mTc-MDP bone scintigraphy has been described in literature in case of monostotic Paget disease of mandible showing increased radiotracer uptake in the body of mandible. This pattern has also been described as "black beard" sign. The monostotic presentation of Paget disease is rare, and involving the mandible, however, is very unusual. We present a case of carcinoma of the tongue with contiguous spread to the mandible presented in the similar fashion as the earlier reported Lincoln's sign or black beard sign on 99mTc-MDP bone scintigraphy. This appearance was confirmed with SPECT/CT, and the lytic sclerotic lesion of the mandible was confirmed.

Comparison of 18F Fluoride PET/CT and 99mTc-MDP Bone Scan in the Detection of Skeletal Metastases in Urinary Bladder Carcinoma

The aim of this study was to compare (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma. In this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35-80 years) underwent (99m)Tc-MDP planar and SPECT/CT bone scan (BS) followed by (18)F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation. (18)F-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of (99m)Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of (99m)Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of (18)F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between (99m)Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and (18)F-fluoride PET/CT (κ = 0.74) were found. ( 18)F-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional (99m)Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.

Prevalence of Stress Reaction in the Pars Interarticularis in Pediatric Patients With New-Onset Lower Back Pain

Spondylolysis is a defect of the pars interarticularis and is most commonly encountered in the lower lumbar spine of pediatric patients. Stress reaction of the pars interarticularis was regarded as an early stage of this pathological diagnosis in which no obvious anatomical change is detected. Both SPECT with (99m)Tc MDP and CT of the lumbar spine have been used to evaluate the patients with low back pain. The purpose of this study was to determine the prevalence of stress reaction in pars interarticularis in pediatric patients presenting new-onset back pain using both bone SPECT and CT. The records and images of 63 consecutive pediatric patients (mean age, 13.2 years) with new onset of back pain, who received both (99m)Tc MDP bone scintigraphy with SPECT of the lumbar spine and lumbar thin-slice CT were retrospectively analyzed. The results of bone SPECT and CT were retrospectively compared. Among the cohort of 63 patients who had both bone SPECT and thin-slice CT of the lumbar spine, there was a total of 56 positive SPECT results indicating stress injuries in the pars interarticularis. Spondylolysis was shown on both bone SPECT and thin-slice CT in 45 patients. In 11 patients, stress reaction was shown. In 7 patients, no abnormality was detected by either SPECT or thin-slice CT. Our result showed that a significant portion (19.6%, 11 of 56) of the stress injuries in the pars interarticularis will be CT-negative stress reaction in pediatric patients with new-onset back pain.

Osteosarcoma of the Maxilla: Mimicking Dental Pathology on Bone Scan

A 21-year-old male with mild pain and swelling on his right cheek was referred to our department for the Tc-99m MDP bone scintigraphy. A focal, prominent activity uptake in the right maxillar region mimicking dental pathology at first sight was noticed on his bone scan. A mass originating from the right maxillary bone, invading surrounding soft tissue and showing calcifications that were characteristic radiological features of osteosarcoma was detected on his Computed Tomography scan. Osteosarcoma was diagnosed after histopathologic examination of the biopsy specimen. This case was presented to demonstrate unusual localization of a primary bone tumor mimicking dental pathology and causing diagnostic conflict on the bone scan.

Meme kanserli bir hastada 18-Floro-de-oksi-Glukoz pozitron emisyon tomografisinde multiple kemik metastazları: Olgu sunumu ve literatürün gözden geçirilmesi [Multiple bone metastases detected on 2-[18F]-fluoro-2-deoxy-d-glucose PET

Bone scintigraphy has been widely used to assess skeletal metastasis in patients with breast cancer. 18F-FDG-PET/CT is another imaging modality that has gained previously wide use to determine metastasis based on increased glucose metabolism in malignant cells. Generally, these two modalities give similar results in evaluation of bone metastasis of breast cancer. In this breast cancer case, 99mTc-MDP bone scintigraphy showed normal findings in regards to skeletal metastasis while 18F-FDG-PET/CT, contrast-enhanced CT and MRI revealed multiple metastatic focuses.

Role of 18F-fluoride PET/CT in the assessment of multiple myeloma: initial experience

The aim of this study was to report our early experience with (18)F-fluoride PET/CT for detecting lesions and evaluate the usefulness of this modality in the assessment of multiple myeloma (MM). (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy (BS) studies from 7 myeloma patients (4 male and 3 female, mean age 55 years) diagnosed according to standard criteria were reviewed retrospectively. Two reviewers visually and quantitatively analyzed the images and recorded their findings after reaching a consensus. Diagnostic certainty regarding the presence or absence of myeloma lesions was evaluated according to the reference standard consisting of whole-body magnetic resonance imaging and whole-body X-ray. A total of 93 affected areas were definite according to the reference standard. Of these, 83 affected areas (89 %) were identified on (18)F-fluoride PET/CT, whereas 54 affected areas (58 %) were found on BS. Mean SUVmax in the affected areas was 9.8 ± 3.2 (standard deviation) ranging from 5.0 to 21.2. A total of s17 lesions with bone fracture were also detected by (18)F-fluoride PET/CT and 2 lesions (12 %) were negative on BS. Our result showed that (18)F-fluoride PET was a possible modality to detect areas of lesions in patients with MM.

Multimodality imaging in biochemical recurrence of prostate cancer: Utility of 18F-NaF PET/CT in early detection of metastasis

A 54-year-old male with biopsy proven Gleason 9 prostate cancer presented with rapidly increasing serum PSA level of 12.4 ng/ml and PSA doubling time <1 month after radical prostatectomy. Conventional imaging scans (chest, abdomen and pelvis CT and 99mTc-MDP bone scintigraphy) were obtained which identified a single equivocal mildly sclerotic and active lesion in T8 vertebral body (Fig. 1). The patient was then enrolled in an ongoing prospective clinical imaging trial designed to assess the diagnostic utility of 18F-FDG PET/CT and 18F-NaF PET/CT in men with biochemical recurrence of prostate cancer and negative or equivocal standard imaging. While 18F-FDG PET/CT was negative, 18F-NaF PET/CT demonstrated numerous randomly distributed fluoride avid lesions in the skeleton (cervical/thoracic/lumbar spine, bilateral acetabuli pelvis, right clavicle) compatible with skeletal metastases (Fig. 2). Follow-up MRI of the spine confirmed the bony lesions (see Fig. 1). Patient was then started on androgen deprivation therapy (bicalutamide/leuprolide acetate) and radiotherapy to a painful area in lower-thoracic spine (3250 cGy to T7–T11) after which his PSA declined to 0.6 ng/ml. Follow-up 18F-NaF PET/CT showed increase in sclerosis on CT and decline in NaF uptake at sites of skeletal metastases. Conventional bone scintigraphy and CT are standard in the imaging evaluation of men with suspected metastatic disease based on rising serum PSA level. However, when available, 18F-NaF PET/CT should be considered since it may be useful in early detection of occult skeletal metastases as clearly demonstrated here in our case.1–3 Fig. 1 Initial imaging evaluation of a man with biochemical relapse of prostate cancer: (A) equivocal 99mTc MDP bone scan, (B) equivocal sagittal view of thoracic spine CT, (C) sagittal view of follow-up thoracic spine MRI (performed after 18F-NaF PET/CT) demonstrating ... Fig. 2 Demonstration of widespread osseous metastatic disease with 18F-NaF PET/CT: maximum intensity projection images of 18F-NaF PET/CT (A) at baseline, (B) at 6 months after start of therapy, (C) transaxial CT and fused 18F-NaF PET/CT appearance of a lesion ...

183 DETECTION OF BONE METASTASES FROM PROSTATE CANCER: A PROSPECTIVE STUDY OF 99MTC-MDP BONE SCINTIGRAPHY, 18F-FLUOROCHOLINE PET/CT, 18F-FLUORIDE PET/CT COMPARED WITH MRI

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2012183 DETECTION OF BONE METASTASES FROM PROSTATE CANCER: A PROSPECTIVE STUDY OF 99MTC-MDP BONE SCINTIGRAPHY, 18F-FLUOROCHOLINE PET/CT, 18F-FLUORIDE PET/CT COMPARED WITH MRI Mads Poulsen, Henrik Petersen, Poul Flemming Høilund-Carlsen, Jørn S. Jakobsen, Oke Gerke, Jens Karstoft, and Steen Walter Mads PoulsenMads Poulsen Odense, Denmark More articles by this author , Henrik PetersenHenrik Petersen Odense, Denmark More articles by this author , Poul Flemming Høilund-CarlsenPoul Flemming Høilund-Carlsen Odense, Denmark More articles by this author , Jørn S. JakobsenJørn S. Jakobsen Odense, Denmark More articles by this author , Oke GerkeOke Gerke Odense, Denmark More articles by this author , Jens KarstoftJens Karstoft Odense, Denmark More articles by this author , and Steen WalterSteen Walter Odense, Denmark More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.235AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 99mTc-MDP bone scintigraphy is the method of choice to detect bone metastasis in prostate cancer patients. However, the sensitivity and specificity of this image modality is suboptimal, and, therefore, new diagnostic tools are searched for. We examined two promising candidates, i.e., PET/CT with 18F-Fluorocholine and PET/CT with 18F-Fluoride. We compared the diagnostic value of 99mTc-MDP Bone Scintigraphy, 18F-Fluorocholine PET/CT, 18F-Fluoride PET/CT with MRI for the detection of bone metastasis in prostate cancer patients. METHODS Forty-two patients with histological confirmed prostate cancer and bone metastasis detected by 99mTc-MDP Bone scintigraphy, and no prior or active androgen deprivation were prospectively included in our study. The patients were included from April of 2009 until July 2011. The four scans were performed within a maximum of 4 weeks, in random order. The results of the scans were obtained by blinded review. In our analyses we regarded the individual bone lesions as the primary variable. MRI was our gold standard. The patients gave written and oral consent and the study was approved by our local ethics committee. RESULTS The mean age of the patients was 73.2 years (range 53-92). The median PSA level was 77.0 (range 4-5740). The average Gleason score was 7.6 (range 2-10). A total of 431 bone lesions were found in 42 patients, 283 lesions were rated as malignant according to MRI. Results by the three other methods are seen in the table: 99mTc-MDP WB Bone Scintigraphy 18F-Fluoride PET/CT 18F-Choline PET/CT Sensitivity (95% CI) 36.4%(22.4%,50.4%) 92.9%(88.3%,97.6%) 87.5%(76.8%,98.3%) Specificity (95% CI) 81.8%(72.5%,91.0%) 50.0%(32.3%,67.7%) 89.9%(81.2%,98.5%) Positive predictive value (95% CI) 79.2%(63.7%,94.8%) 78.5%(65.7%,91.4%) 94.5%(89.6%,99.3%) Negative predictive value (95% CI) 40.2%(25.3%,55.1%) 78.3%(65.7%,90.9%) 78.5%(61.9%,95.1%) CONCLUSIONS Our results suggest that 18F-Choline PET/CT is superior to both 18F-Fluoride PET/CT and 99mTc-MDP bone scintigraphy with regard to detection of bone metastasis in patients with prostate cancer. In addition, 99mTc-MDP bone scintigraphy, although less expensive, is not optimal for the primary detection of metastatic bone decease in hormone native patients with prostate cancer. It raises the question on whether the conventional 99mTc-MDP whole-body bone scintigraphy is the image modality of choice if 18F-Choline PET/CT is available. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e77 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mads Poulsen Odense, Denmark More articles by this author Henrik Petersen Odense, Denmark More articles by this author Poul Flemming Høilund-Carlsen Odense, Denmark More articles by this author Jørn S. Jakobsen Odense, Denmark More articles by this author Oke Gerke Odense, Denmark More articles by this author Jens Karstoft Odense, Denmark More articles by this author Steen Walter Odense, Denmark More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The role of dual-phase Tc-99m MIBI in the evaluation of potentially operable lesions detected by bone scanning in fibrous dysplasia

The aim of this study was to determine the role of whole-body Tc-99m MDP bone scintigraphy (BSc) with dual-phase Tc-99m MIBI scintigraphy (DPMSc) in the assessment of fibrous dysplasia (FD) and the value of DPMSc in the detection of potentially operable lesions for guiding surgical treatment. Twelve patients with histopathologically confirmed FD were evaluated with BSc and DPMSc. The patients were clinically followed up for a mean duration of 75 months. BSc images have been used as a guide to identify the site and the extent of the skeletal involvement. The symptomatic lesions were evaluated with DPMSc. Forty-three lesions were evaluated in 12 patients. BSc showed increased uptake in all of the lesions, whereas DPMSc findings correlated more accurately with the symptoms. Fifteen symptomatic lesions showed increased Tc-99m MIBI uptake on DPMSc, especially in the early phase of DPMSc. The sensitivity, specificity and accuracy values for the early phase in detecting the symptomatic lesions were 100 and 93%, and for delayed phase were 100 and 98%, respectively. BSc is useful in determining the site and extent of the skeletal involvement, especially in polyostotic FD. It seems that the potentially operable symptomatic lesions may be evaluated more accurately with DPMSc as compared with BSc. In addition, it seems that DPMSc findings correlate with the symptoms of FD, and this relationship may have a role in improving the preoperative assessment for guiding surgical treatment. DPMSc could be useful in the work-up of symptomatic patients if our results are validated in a larger patient series.

High false negative rate of Tc-99m MDP whole-body bone scintigraphy in detecting skeletal metastases for patients with hepatoma

Technetium-99m methylene diphosphonate (Tc-99m MDP) whole-body bone scintigraphy (BS) has been widely used for detecting bone metastases. The aim of this study is to investigate the diagnostic accuracy of BS in detecting skeletal metastases for hepatocellular carcinoma (HCC) patients. In addition, the anatomic distribution of the metastatic bone lesions and the prognoses of the HCC patients are also analyzed. We retrospectively reviewed BS results of 179 consecutive HCC patients from January 2005 to December 2006 in our institution. The false negative (FN) rate, sensitivity, and specificity of BS were evaluated by patient-based and region-based analyses. A total of 59 patients (33.0%) were confirmed of bone metastases. A total of 25 of these 59 patients (46.3%) had at least one lesion categorized as BS FN, and the bone metastatic status for 10 patients (17.0%) was underestimated by BS. The most observed metastatic site was spine while the most observed sites with FN of BS were the lower extremity. In total, there were 122 metastatic regions and 33 regions (27.0%) were FN of BS. Patients without any metastases survived significantly longer than any of other groups with metastases. High FN rate of Tc-99m MDP BS in detecting metastatic bone lesions for HCC patients was observed. In our opinion, careful history taking, meticulous examination, and a high index of suspicion are important for HCC patients with unexplained progressive pain in the musculoskeletal system. Even with negative results from Tc-99m MDP BS, the possibility of skeletal metastases cannot be indiscriminately excluded.

892 Detection of bone metastases from prostate cancer: A prospective study of 99mTc-MDP bone scintigraphy, 18F-Fluorocholine PET/CT, 18F-Fluoride PET/CT compared with MRI

892 Detection of bone metastases from prostate cancer: A prospective study of 99mTc-MDP bone scintigraphy, 18F-Fluorocholine PET/CT, 18F-Fluoride PET/CT compared with MRI

Asymmetrically increased uptake in upper extremities on 99mTc-MDP bone scintigraphy caused by intra-arterial injection: Different uptake patterns in three cases

Unexpected findings on bone scintigraphy such as asymmetrical uptake in extremities may cause confusion for the diagnosis. The authors describe three cases of accidental intraarterial injection of Tc- 99m methylene diphosphonate( 99mTc-MDP) on the antecubital region and discuss the findings and differential diagnosis.

Does 99mTc-MDP bone scintigraphy add to the investigation of patients with symptomatic unicompartmental knee replacement?

AimThe purpose of this study was to determine whether nuclear medicine 99mTc-Methyl diphosphonate bone scintigraphy (99mTc-MDP bone scintigraphy) added information over plain radiographs loosening infection in symptomatic unicompartmental knee replacements (UKRs). Methods and materialsA cohort of 39 patients who presented with knee pain following UKR was retrospectively reviewed. All had undergone nuclear medicine bone scans for possible loosening or infection of the prosthesis. The findings of the bone scintigraphy were compared to subsequent operative findings during diagnostic arthroscopic investigation or revision surgery for those patients who had undergone these procedures. ResultsOf the 39 patients with painful knees following UKR, surgical findings confirmed that 11 had either loose (n=9) or infected (n=2) implants. Logistic regression analysis demonstrated no statistically significant combination of features on nuclear medicine or radiographs associated with failure of the prosthesis due to infection or loosening (p>0.05).Classification of a satisfactory position of the UKR on plain radiography exhibited a high negative predictive value (96% for infections, and 80% for loosening). However, plain radiograph was not sensitive for loosening (50%) or infection (37%) of the UKR with very low positive predictive values (9.1% for infection and 27.3% for loosening). ConclusionThis study provides no evidence to support the routine use of 99mTc-MDP bone scintigraphy in the clinical decision-making for patients with a painful UKR.Level of evidence: level 4.

MP-16.17 Detection of Bone Metastases from Prostate Cancer: A Prospective Study of 99mTc-MDP Whole-Body Bone Scintigraphy, 18F-Fluorocholine PET/CT, 18F-Fluoride PET/CT Compared with MRI

MP-16.17 Detection of Bone Metastases from Prostate Cancer: A Prospective Study of 99mTc-MDP Whole-Body Bone Scintigraphy, 18F-Fluorocholine PET/CT, 18F-Fluoride PET/CT Compared with MRI

Single bony lesions on 99mTc-MDP bone scintigrams of children with known malignancy

Introduction: 99mTc-MDP bone scintigraphy is employed to investigate children with known or suspected malignancy. While the presence of multiple lesions on bone scans of children in the context of known malignancy is generally considered to be due to metastases, the exact significance of solitary hot spots remains unknown. An accurate diagnosis is critical in order to determine the optimal management and eventual outcome. This study was undertaken to evaluate the significance of solitary abnormalities on bone scintigrams of children with known or suspected malignancy.

The CT flare response of metastatic bone disease in prostate cancer

New or worsening bone lesions in patients responding to treatment, known as the flare phenomenon is well described on (99m)Tc-MDP bone scintigraphy, but to our knowledge has not previously been described on CT. The appearance of new or worsening bone sclerosis on CT in patients with prostate cancer may therefore be erroneously classified as disease progression. To assess the incidence of osteoblastic healing flare response at 3-month CT assessment in patients with castrate-resistant prostate cancer and to identify associated features that enable differentiation from progressive metastatic bone disease at 3 months. CT scans of 67 patients with castrate-resistant prostate cancer undergoing treatment were reviewed by a radiologist blinded to clinical outcome. Changes in number, size, and density of metastatic bone lesions were documented and Response Evaluation Criteria in Solid Tumours (RECIST) in soft tissue lesions, alkaline phosphatase, prostate specific antigen, and (99m)Tc-MDP bone scans were used for correlation. Of the 39 patients who had 3- and 6-month follow-up, eight patients (21%) demonstrated an increase in number, size, or density of sclerotic lesions on the 3-month CT scan despite improvement in PSA and soft tissue lesions. Three out of eight patients (8%) maintained partial response/remained stable at follow-up and were defined as showing a flare response: in this group bone metastases evident on CT showed a qualitative and quantitative increase in density and no lesions faded at 3 months. In contrast, in all patients who progressed at 3 months by PSA/RECIST criteria (n = 8) bone lesions showed a mixed pattern with some lesions increasing and others decreasing in density. The incidence of flare response of metastatic bone disease evident at 3-month post-treatment CT in patients with prostate cancer undergoing systemic treatment is 8%. In patients with falling PSA and stable/responding soft tissue disease at 3 months an increase in bone sclerosis in the absence of fading bone metastases can be interpreted as flare and is likely to represent a response.

Asymmetrically increased uptake in upper extremities on 99mTc-MDP bone scintigraphy caused by intra-arterial injection: Different uptake patterns in three cases

Unexpected findings on bone scintigraphy such as asymmetrical uptake in extremities may cause confusion for the diagnosis. The authors describe three cases of accidental intraarterial injection of Tc- 99m methylene diphosphonate ( 99mTc-MDP) on the antecubital region and discuss the findings and differential diagnosis.

Incidental Multiple Focal Uptakes of Tc-99m MDP in Both Lungs Without Lung Parenchymal Abnormality

We report a case of incidental multiple focal uptakes of Tc-99m MDP in both the lungs without lung parenchymal abnormality. A 15-year-old girl who had no symptoms or history of pulmonary disorder was referred for Tc-99m MDP bone scintigraphy to evaluate temporomandibular joint disorders. Bone scintigraphy showed multiple focal uptakes in the chest. Single photon emission computed tomography/computed tomography scan performed on the same day showed that abnormal uptakes were located in both the lungs and no abnormalities in the corresponding pulmonary parenchymal sites. Abnormal uptakes resolved on bone scintigraphy after 7 days.

Urinary bladder carcinoma associated with Paget′s disease of skull: Imaging findings on Tc99m-MDP bone scintigraphy, F18-Fluoride PET/CT and F18-FDG PET/CT

We report the imaging findings of a patient with Paget's disease in metastatic carcinoma bladder evaluated by Tc99m-Methylene diphosphonate (MDP) bone scintigraphy, F18-Fluoride positron emission tomography/computed tomography (PET/CT) and F18-fluorodeoxy glucose (FDG) PET/CT. Tc99m-MDP bone scan showed intense uptake in the skull bones without any other abnormal tracer distribution. F18-Fluoride PET/CT revealed intense uptake in the pelvic bones along with skull bones, but F18-FDG PET/CT showed intense multifocal FDG uptake in the bladder and bilateral inguinal lymph nodes, with no abnormal uptake in the skull bones. CT images showed thickening of skull bones.

The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease

Introduction: Behcet's disease (BD) is a chronic relapsing inflammatory disease. 40-70% of BD patients display rheumatic features with a 9% incidence as an initial presentation. However, there are no pathognomonic laboratory tests in BD and the diagnosis depends on the occurrence and grouping of sufficient clinical manifestations to allow the physician to either suspect, or definitely diagnose the condition. Our aim was to assess the utility of Tc-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy for the detection of articular involvement in BD patients and its impact on disease activity & severity scoring. Methods: 25 BD patients diagnosed according to the international study group criteria for BD diagnosis (ISG) (18 �, 7 �, mean age 32.44±7.78, disease duration 6.98±4.61year) were included and subjected to selected joint x-ray and bone scintigraphy. Results: 25/25 was scintigraphically positive for arthritis (100%, 64%, 44%, 40%, 36%& 20% in wrist, Metacarpophalangeal, proximal interphalangeal (PIPs), distal interphalangeal (DIPs), Knees & ankles respectively). 13/25 were clinically negative while scintigraphically positive for arthritis. 11/25 (44%) and 8/25 (32%) turned from inactive to active BD and from mild to moderate disease severity, based on their positive hand scintigraphy with treatment modification. 4/25 (16%) had recurrent oral ulcers with normal laboratory data and only positive hand scintigraphy; with follow-up they met ISG criteria. Conclusion: skeletal scintigraphy is a simple diagnostic modality with a low radiation burden, when compared to conventional radiology. Hence, when used appropriately in the diagnostic algorithm of BD, bone scintigraphy can be used for detection of early joint involvement, assessment of the extent and activity status with guidance for the selected therapy.