Improvement of bone scintigraphy by quantitative evaluation compared with X-ray studies and iliac crest biopsy in malignant disease.

Bone marrow biopsy of the iliac crest was performed on 268 patients (124 males; 144 females). Of these patients 206 had haematological systemic disorders (HSD) or carcinoma and suspected bone involvement, which was confirmed by biopsy on 66 patients. Bone biopsy was performed not longer than 3 weeks after X-ray examination and bone scintigraphy which, combined, had already raised the suspicion of skeletal involvement in 55% of the 66 patients with skeletal involvement diagnosed by biopsy. Additional quantitative evaluation of the bone scans using bone to soft tissue ratios was able to increase the overall accuracy to 67% in that group. Additional quantitative assessment of the scan yielded considerably more effective bone scintigraphy, particularly in cases with visually normal patterns. Available equipment should therefore be used in scintigraphic bone imaging on a routine basis. It was shown that the various methods of examination, i.e. X-ray, biopsy and scintigraphy with both visual and quantitative evaluation provide their own individual values for the final diagnosis. Therefore, if one of the methods shows a negative result, bone involvement is not excluded and the others should be used for confirmation.