Unlimited access >

Bone Scan vs..? UPDATE /\/\ back to vet 12/2

I’m to the point where I think it’s my last option for diagnostics. What I’d like to know is what it’s limitations are. What can it or can’t it show? When is it worth the money and when is it not?

If I go ahead with this I’m going to do the whole body - there’s a whopping $300 difference between that and a ‘partial’ scan. Given this mare’s issues, just gonna go for the gold!
Anyway, most of my concern is in the pelvic region. Too far back for xray to be of any use. Not sure ultrasound would show anything. ?? Have done back injections, osphos, etc., with limited success.
Don’t really want to start a long saga but I’ve spent enough money on ‘maybe’ that it’s time to do something else.
Thanks!

1 Like

This is where bone scan could be a blessing or a curse. It will “light up” problem areas, but it can’t tell you what’s actually wrong. So if there’s uptake in the pelvic region or another area that’s challenging to visualize, you may end up pinpointing the specific area but still struggling with further diagnostics. Ultrasound can be useful for some of these - rectal US can help image SI, for example, when x-ray isn’t productive.

5 Likes

Bone scan is good for that area if you have acute inflammation. Chronic problems not so much in my experience. You are limited with ultrasound but can potentially see some things on ultrasound that may not be detected on bone scan like LS disc problems or dorsal ligament problems.

Another potential problem with bone scans is that you might get a fair amount of uptake in your secondary pain areas that could be a red herring. For example, you think you have a pelvis area problem. You might get compensatory inflammation elsewhere in the back, caudal neck, hocks, etc. The results can be hard to interpret. You’ll wind up imaging those other areas too with xray or ultrasound.

Bone scans also do not show soft tissue problems except where they cause bone inflammation. So if you have PSD, maybe you’ll see hock area uptake where the PSL attaches. But if you have lower branch issues, bone scan would not show that.

I won’t say bone scans are bad. They have utility. But know you still might not get a clear answer. For axial skeleton, I tend to try to do all the other imaging first or try some treatments as diagnostic. Especially if the issue has been going on for a long time.

2 Likes

I just did a bone scan! I thought it was fairly helpful since as mentioned, it lights up problem areas. From there, you can go in with other diagnostics like x-ray, ultrasound, endoscopy, etc.

1 Like

I am at the ‘chicken or egg’ point… is X causing Y or vice versa? FWIW it’s an OTTB. After 5 years finding myself going backwards, at best stagnant, I’m kind of done. I need to know IF “this” is even fixable, or I should just call it. I’ve done rads on everything I can, more than once. I’ve gotten new saddles. I’ve tried time off. Robaxin. Bute trial. Back injections. Hocks. Osphos. Estrone. Every rehab protocol I can find. Have not done SI injections, yet. Given what it will cost? Is why I’m leaning towards just doing the bone scan.
After 6 weeks off - she put a nail in her hoof - when I put her back to work she literally was falling down behind trying to canter on the lunge. But in pasture, straight line, can go like mad and never miss a beat.
???
At this point I’m up for almost anything.

1 Like

Just got done with a bone scan on my youngster. I had taken him up and they did a bunch of back and neck xrays and tried neck injections (even though it wasn’t really showing significant changes on xray). I wish I had just went right to the bone scan then…would have saved me some time.

I will say that I had one with chronic SI issues not really show any uptake on the scan. However, current horse (who presents like a back/SI issue)…lit up on two of his ribs on the scan. We do have to go back in a week to ultrasound that area…but usually when the ribs light up it suggests a fracture in that area. He doesn’t palpate sore on his back either. So the scan definitely helped us narrow down what we were trying to diagnose…would never have guessed rib issue, although it does make sense with the symptoms/presentation.

I also learned that it is almost never worth doing a partial scan…did that once and had to go back a rescan the rest. More cost and time effective to just do the full scan. It helps if you know there is a pain/inflammation issue but can’t quite pinpoint location. But not at all helpful if that is a soft tissue only issue.

3 Likes

I was in the same place as you. Numerous vet appointments, expensive diagnostics, and I finally just went for the bone scan. Which I’m glad I did, because we’d never have found the problem (altho, to be fair to me, I knew what the problem was and kept saying it, but no one thought that was the problem). As mentioned above, his hocks and splits (I think) lit up, and a teeny tiny little bit on his back. Vet said, aha! it’s his hocks. I said it’s not either. And fortunately so did his regular vet, so we did x-rays on the little spot on his back. Kissing spines, which was super mild to look at, but pretty major for him.

I debated the partial vs. the full, and for the price difference, went with the full as well.

2 Likes

I’ve found it helpful. It’s a way to get an idea of where to focus additional diagnostics. You definitely want to scan the whole horse. It’s limited by being 2D like radiographs. Although pricey, it may well be cheaper than several months board while you and/or your home vet try to figure out what’s going on.

The radioisotope goes to areas that are being actively remodeled and these “light up” when scanned after a period of time. An old injury may not show up if there’s no current remodeling. Soft tissue being remodeled will light up for a relatively brief period of time which isn’t enough time to scan all of the soft tissue in the horse. Hence, you have to make a decision.

In general I’ve found that any radiographs done at the vet hospital are less expensive than done by a home vet. YMMV.

1 Like

We have had 2 full body scans on 2 different horses. The first scan took us right to the problem area(neck).
The second scan on second horse did not point us to problem. 2 years later, after more vet work, we ultrasounded the pelvis and found an old fracture of third trochanter of femur, that likely had not been dealt with in a way to heal correctly at time of occurrence. Happened prior to us owning horse. This diagnosis definitely explained odd symptoms we had been trying to deal with for 4 years. It likely did not light up on bone scan as was not actively inflamed at that point.

1 Like

I had a horse whose chronic SI problems did not show up on the bone scan, and the scan sent us chasing even more body parts that were not really the problem. I did the scan because my vet was throwing up his hands. Even though we’d talked about injecting the SI for something like 2 years at that point. I have necropsy dissection to prove the SI was indeed a problem. And horse did respond to SI injections once I fired that vet and started over and imaged everything possible including rectal ultrasound which were all normal, so we just tried injecting at that point, having gone back to square one (with another Robaxin trial and in-hand work and saddle fitting etc. etc. in between). So all I really got out of the scan was an extra pissed off insurance company and more bills for injections the horse didn’t really need after all.

I will say it might have been helpful if the horse had cooperated for the front feet part of the scan but he kept pawing at the machine. Definitely do the whole horse if you’re going to go that route. Would I do one in the future? Maybe, but it would depend on the circumstances.

2 Likes

Mare just had hers on Thursday, helped us eliminate and then pinpoint areas to radiograph and ultrasound the next day. Did a whole body scan. We were 8 months into rehabbing a front suspensory when the diagonal hind started having issues. An old injury there complicated matters so a scan helped us see what was fresh and what was old.

4 Likes

At big university hospitals, just about everything is cheaper! The cost of farm calls and services from smaller clinics has gone through the stratosphere lately.

2 Likes

What does a bone scan cost? My vet mentioned $4k. I’m not sure if she checked the actual price or was just guessing, as her office doesn’t offer it.

Also I would want to rule out any of the muscle diseases (pssm2) as I don’t believe those show up on bone scans.

My scan was $2400. That doesn’t include overnight stabling or sedation. I use a lameness practice (Northwest Equine Performance) in Portland and find them to be very reasonably priced on all aspects of care. They have all the tools, including MRI, but are conservative and mindful of the bottom line of clients.

3 Likes

I have done two bone scans and neither one was helpful at all in finding the actual problem.

The Old Man, the points of his hocks lit up. Wtf? Xrays and ultrasounds found nothing wrong. It was not the cause of his lameness.

My late mare - what looked like windpuffs on her hocks lit up. Soft tissue is not supposed to light up on the bone phase. A biopsy revealed those masses to be cancerous, which took us down a totally different road. It was not the cause of her lameness, though.

Just a different perspective. It would take some serious convincing for me to drop that much money on a bone scan again.

1 Like

This is a really great description, especially the limitations and potential red herrings.

1 Like

Have you tried ultrasound at SI and stifles?

Last time I did a bone scan, my vet complained that referral centers often don’t use enough isotope to adequately image the pelvis, especially in larger horses. No clue if that’s still an issue (it’s been awhile!) but it’s not like regulations on dangerous stuff has gotten less onerous over the years…

Might be something to discuss if you do decide to go this route. Best of luck, hope you’re able to get to the bottom of things!

1 Like

This is very interesting and extremely helpful. Thank you for sharing it.

It was a bit over $3k for me including 2 nights board at the hospital and redoing back X-rays after some lower thoracic stuff lit up (which looked the same as the original X-rays from a couple years prior, btw).

That was some years ago so could be up to $4k all in at a university now.

For muscle issues, that won’t show up on bone scan, even soft tissue phase. You’d need to do specific staining of biopsy samples to identify one of the myopathies.

1 Like