Normal Variants

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5.1.1 Skull

The appearance and intensity of tracer uptake within the skull vary because the count rate is comparatively low and radioactivity distribution is usually uneven. A higher count rate is commonly observed in the peripheries of the skull due to curvature and perpendicular or tangential aligning of the scan detector. Accordingly, calvarial uptake may be diffusely or locally not uniform even in the absence of hyperostosis. Diffuse increased calvarial uptake related to postmenopausal osteoporosis is a rather common finding in elderly women (Senda and Itoh 1987) (Fig. 5.1A, b). Experience dictates that radiographic correlation is a necessity to accurately distinguish increased tracer uptake of simple cranial hyperostosis from pathological uptake of polycythemic cranial hyperostosis, iatrogenic osteoporosis, Paget's disease and renal osteodystrophy with osteomalacia (Fig. 5.1C, D).

Hyperostosis Scintigraphy Superscan BoneCalvarial Bones Lateral

Fig. 5.1A-D Diffuse calvarial uptake in postmenopausal porosis and renal osteodystrophy. A Lateral scintigraph of the skull shows diffuse tracer uptake in the entire cranium (arrows). B Lateral radiograph reveals diffuse osteoporosis (arrows). C Anterior whole-body scan shows the superscan sign with prominent tracer uptake in the skull and facial bones due to severe osteomalacia caused by chronic renal failure (arrows). Note that the kidneys and bladder are not visualized (?). D AP radiograph of the skull and facial bones reveals marked demineralization

Fig. 5.1A-D Diffuse calvarial uptake in postmenopausal porosis and renal osteodystrophy. A Lateral scintigraph of the skull shows diffuse tracer uptake in the entire cranium (arrows). B Lateral radiograph reveals diffuse osteoporosis (arrows). C Anterior whole-body scan shows the superscan sign with prominent tracer uptake in the skull and facial bones due to severe osteomalacia caused by chronic renal failure (arrows). Note that the kidneys and bladder are not visualized (?). D AP radiograph of the skull and facial bones reveals marked demineralization

Demineralization Bone

Fig. 5.2A, B Physiological sutural uptake. A Lateral scin-tigraph of the skull shows localized uptake in the coronal

Navicular Bone Normal Varient

Fig. 5.2A, B Physiological sutural uptake. A Lateral scin-tigraph of the skull shows localized uptake in the coronal suture and the lambda (arrows). B Vertex view reveals cross-like uptake in the coronal and sagittal sutures

Navicular Bone Normal Varient
Fig. 5.3A-D Increased uptake in hyperostosis calvariae diffusa. A Anterior scintigraph of the skull shows symmetrical tracer uptake in both calvaria (arrowheads). B Anterior radiograph reveals diffuse inner table thick

ening (arrows). C, D Lateral scintigraph and radiograph show diffuse uptake and diploic thickening, respectively (arrowheads)

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