Optimal imaging positions for 3-phase bone scanning of patients with bony pathology of the feet

The aim of the study was to optimize imaging positions of (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) 3-phase bone scanning for the accurate localization of foot pathology in patients with trauma and diabetes-related complications.

(99m)Tc-MDP 3-phase bone scanning was performed for 26 controls and 27 patients with foot pathology. Flow was acquired in 1 of the following projections: anterior-posterior, medial-lateral, or plantar. Blood-pool and delayed images were acquired in a set of 5 projections (anterior, posterior, medial, lateral, and plantar). Images from the control group were checked for the views that best visualized individual bones or regions of the foot. These views were cross-correlated with images from the patient group to see whether they localized the exact site of the foot lesion.

In the controls, the plantar view was the best view for visualization of the forefoot region. The mid foot was best assessed on the anterior view. Medial-lateral views were best suited for imaging the hind foot, and the posterior view was the best for the ankle joint. In the subjects with foot pathology, lesions were accurately assigned to the affected bone using the imaging criteria derived from the controls. In a few cases, however, additional views were needed because of overlap or shine-through of activity, particularly in mid-foot lesions.

Optimal imaging positioning of the foot by bone scanning can be achieved using 5 views, which can yield accurate localization of a particular structure or bone, thereby improving the diagnostic accuracy of the procedure.