Nuclear Medicine and the Musculoskeletal System

The current issue of Seminars in Musculoskeletal Radiology is devoted to radionuclide imaging of musculoskeletal disease. Not surprisingly, several of the articles focus on bone scintigraphy, a test ideally suited to the investigation of musculoskeletal disease. It functions at a physiological level, is almost universally available, and has whole-body imaging capability. When performed as a single-photon emission computed tomography/computed tomography (SPECT/CT) study, precise lesion localization is possible.

The importance of bone imaging cannot be overestimated, but it is just one of several radionuclide tests that are useful in musculoskeletal disease. For example, gallium imaging is helpful in select cases of spinal osteomyelitis. Labeled leukocyte imaging has become a mainstay in the diagnostic imaging of infection in general, and, except for the spine, it is the radionuclide imaging procedure of choice for musculoskeletal infection. Positron emission tomography, or PET, has rapidly evolved from a valuable investigational tool to a powerful clinical one. The importance of fluorodeoxyglucose-positron emission tomography (FDG-PET) in oncology cannot be overestimated; its utility in infection is just now being recognized. It is likely that the positron emitter fluorine-18 will assume increasing importance as a bone-imaging agent, potentially replacing the traditional technetium-labeled diphosphonate study.

The impressive advances in tracers have been matched by equally impressive advances in technology with the advent of inline PET/CT and SPECT/CT systems that are revolutionizing diagnostic imaging and undoubtedly will have an impact on musculoskeletal imaging.

With the current issue of Seminars in Musculoskeletal Radiology, I sought to accomplish two objectives. The first was to provide an update of the current role of bone scintigraphy in malignant and benign disease in both children and adults. The second was to present a comprehensive overview of other radionuclide procedures, both established and emerging, that play an important role in musculoskeletal imaging. I hope I have succeeded; you the reader, however, will be the ultimate judge.

I am most grateful to all of the authors who produced the outstanding articles in this issue. I would be remiss if I did not also express my appreciation to the editors, Drs. Mark Schweitzer and David Karasick, who made this endeavor possible.