OBJECTIVES: the purpose of this study was to determine if visualization of discrete sacral foramina on bone scintigraphy can be used as an adjunct criterion supportive of a superscan diagnosis. METHODS: the Radiology Information System at our institution was queried for all bone scintigraphy reports, during July 1999 to July 2009, containing the words/phrases: normal bone scan, normal bone scintigraphy, superscan, or diffuse osseous metastatic disease. The final study group consisted of 22 normal studies and 8 superscans. All studies were reviewed by 2 nuclear medicine physicians who rated the examinations on a numeric scale of bone-to-soft tissue activity, whether they would classify the study as a superscan (based on previously published criteria), whether sacral foramina were visualized, and, if so, how many? RESULTS: of the 22 normal studies, no distinct sacral foramen was visualized in 17 cases. Of the 8 superscan patients, 1 patient demonstrated 8 foramina, 4 patients demonstrated 4 foramina, 1 patient demonstrated 3 foramina, and 2 patients demonstrated none. There was a statistically significant difference between the normal and superscan groups (P < 0.0017). Based on statistical analysis, it was determined that visualizing at least 3 distinct sacral foramina could be used as an ancillary finding to support the diagnosis of superscan. CONCLUSIONS: the ability to clearly visualize at least 3 sacral foramina is a statistically significant finding that may be useful as an ancillary criterion to differentiate normal bone scintigraphy from a superscan.
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