Radiopharmaceutical extravasation in bone scintigraphy: a cross-sectional study

Area of Science:

• Nuclear Medicine
• Radiology
• Medical Imaging

Background:

• Technetium-99m Hydroxymethylene diphosphonate (HMDP) bone scintigraphy is a standard diagnostic tool for bone disorders.
• Radiopharmaceutical extravasation is a known complication that can affect image quality and patient management.

Purpose of the Study:

• To quantify and characterize Tc-99m HMDP extravasation in bone scintigraphy.
• To compare visual classification of extravasation events with image processing software analysis.
• To identify risk factors associated with Tc-99m HMDP extravasation.

Main Methods:

• A cross-sectional study analyzed 400 randomly selected bone scintigraphy exams from 2018.
• Prevalence and 95% confidence intervals (CI) were calculated for extravasation.
• Odds ratios (OR) and 95% CIs were computed to assess associations between patient characteristics and extravasation.

Main Results:

• The prevalence of Tc-99m HMDP extravasation was 26.5% (95% CI: 22.4-31.0).
• Inpatient setting (OR: ~7) and wrist administration (OR: ~3) were associated with significantly higher odds of extravasation compared to outpatient and hand administration, respectively.
• Statistically significant differences were found in extravasation severity scores between visual grades and image processing software analysis (P < 0.001).

Conclusions:

• Tc-99m HMDP extravasation affects approximately one in four patients undergoing bone scintigraphy.
• Patient setting (inpatient vs. outpatient) and injection site (wrist vs. hand) are significant factors influencing extravasation risk.
• Visual assessment of extravasation severity is deemed acceptable and reliable.