Has anybody had a bone scan done? What was the reason, what did you see, was it helpful? What was the cost?
My vet recommended it-we are going to try a few other things first but I want to keep this in mind in case it becomes a possibility, given how expensive it is.
I haven’t, but here are the reasons why:
Bone scans do not show soft tissue issues, only active bone inflammation (as far as I understand it).
You use a bone scan to narrow down where to do further imaging, so you will pay for the bone scan and THEN X-rays/ultrasounds. You can do a lot of imaging of suspensories/stifles/feet/neck/etc before you get to the price of the bone scan alone.
Bone scans can show changes that may not actually be bothering the horse - for example, a friend’s horse had DSLD but popped some SI and ankle changes on the scan. She spent a lot of time and money chasing those instead of looking at the more externally obvious dropping pasterns. Meaning, they can sometimes give you/your vets tunnel vision while not actually pointing to the issue.
All of this to say: bone scans are extremely useful in certain cases, but are by no means a comprehensive diagnosis. They are most useful in combination with a lot of other testing, as long as the team is also careful not to throw all other possibilities out “because nothing showed up on the scan”.
YMMV. I’ve heard some success stories and failures locally, but the general consensus is that bone scans are useful when you’ve ruled out soft tissue and are pretty sure it’s bony issues, or you are using insurance to go full send on the all diagnostics before they drop the horse.
Bone scans are a useful first step when you don’t know where to start. For example, horse with a new onset performance issue - but no associated lameness. If he has no obvious injuries, isn’t lame so you can’t block him, and is non-reactive on palpation, a bone scan will likely give you several areas to investigate.
Maybe you get lucky and something that lights up is clearly correlated with the muscles/bones used to perform the activity the horse is struggling with, and you end up short circuiting the rest of the diagnostics. Maybe you end up investigating 3 or 4 things that lit up before you think you find the issue. Maybe you have bad luck and end up finding 6 things that all could be the issue, but you can’t actually figure out which (if any) so you treat a bunch of them and hope for the best. Maybe you get really unlucky - the thing causing your issue doesn’t light up (like negative palmar angles in the hind feet) but a number of things hurt the horse as a result of compensating for the thing that didn’t light up and you end up on a wild goose chase.
And bone scans can be done in phases so you get soft tissue as well.
I live local to a major University vet hospital and know several folks who have done bone scans. Of the 6 or 7 I can think of off the top of my head, only 1 felt that it was worth their time and money in that it led to a diagnosis. Every other one came up with a bunch of “well, maybe…”'s and none of them wound up leading to an actual diagnosis from areas that were picked up on the bone scan.
I’ve done one, which sent me down a rabbit hole of worthless treatments for things that were not the real issue. What wound up helping was injecting the SI which we were considering doing anyway. Bone scan appeared “normal” for the SI region. I’d already done all of the ultrasound imaging I could do. Necropsy showed chronic SI problems.
When faced with similar not quite right but not blockable type issues since, I’ve done a whole lot of other imaging and tests and NOT done another bone scan. Did more listening to my gut and looking at the whole picture as to what made sense, like we should have done in the first case. I did get a little bit luckier I suppose in that we could find some things with regular imaging…but the best you can hope for with a bone scan anyway is that some area lights up that you can further investigate with more precise imaging or treatment anyway. And there’s definitely an art in interpreting the results. And of course if you have a serious issue where you are thinking you need a bone scan anyway, there’s likely some compensatory things going on that could look to be more of a hot issue than the underlying problem.
If it were inexpensive that would be one thing, but in my experience, I can do a lot of other diagnostics with that money that may be less ambiguous in the results.
OP, this is the left rein issues horse that struggles to canter and has worsened with targeted fitness, yes? Did you do a lameness exam with flexions and blocking yet? Have you imaged the stifles (X-ray and ultrasound)? How about those hind feet balance films? I can’t recall what all you have done.
My money is on right stifle, NPA, and associated compensatory soreness. My opinion is worth what you paid for it, but I’ve been down this road with an OTTB before. You can get a LOT of imaging done for what you’d be looking at for the bone scan, and IIRC you have been dealing with crappy farrier work and classic stifle symptoms. Obviously there can be more to it, but that’s where I would start. A lameness locator and an experienced vet can go a long way without ever leaving the farm.
Yes it is! My money is also on right hind-but his stifles X-ray clean, hocks X-ray clean, etc so we’re just trying to peel away the layers. It’s odd because he’ll be very good some days and awful others.
Have you ultrasounded? Hind suspensories can be tricky with the symptoms.
Yes…the most recent bone scan was for a horse who suddenly started balking very badly under saddle. We initially tried the usual…scoped and treated ulcers, did xrays and a host of other diagnostics with nothing helpful coming from it.
Did the bone scan and found two fractured ribs. In that case the bone scan was exceptionally helpful as that was not even on the list of potential causes of the behavior (horse did not palpate sore over the ribs…actually liked to be massaged/curried there).
Trainer here- have sent several for bone scans. All very much worth it.
Mystery stopping? Horse had high uptake in neck but no palpation/tripping/shortness in stride
Weird lameness up front that wouldn’t block? Fractured Ulna (can’t block that high safely in my vets opinion)
Have one at the vet getting a bone scan done today. Started stopping, treated what flexed positive with no improvement and we’ve had the horse for years without it stopping. Hopefully we’ll have results within 24hrs on where to look.
All the horses have gone back to their normal jobs once we treated the issue
Keep me updated on the horse getting one today! I am so curious what the bone scans show for different horses.
Thank you guys for your thoughts! I am getting a second opinion-and skipping the bone scan. Not only is it very expensive, but based on numerous people saying they chased things that weren’t problems (and I always have to stop myself from throwing everything at him and seeing what helps to begin with) I don’t want to go down that road.
Looks like you already made your decision but wanted to post my experience with my girl’s bone scan in case it helps. I’ve posted about it before, but a bone scan actually saved us a bunch of time and money. She was NQR in the hind end but blocking and other things weren’t helping us pin down the problem. The bone scan lit up on her hock bones, not the joint, but the bones themselves, which is why all of her flexions were fine. She was diagnosed with juvenile tarsitus/arthritis which just meant we had to let her grow up a bit more even though she was 6 at the time. We never would have found it without the bone scan.
I did a bone scan on my gelding when we couldn’t figure out what was going on via ultrasounds/radiographs/nerve blocks. Now whether or not the scan was helpful is debatable - we discovered “hot spots” in both hind fetlocks that on follow up CT showed OCD lesions within the joint that would have never shown up on radiographs. We treated with stem cell injections, Tildren and corrective shoeing followed by 6 months of turnout. We redid the CT scan at 6 months which showed no real change in the lesions but clinically he was better so who knows if those lesions were really the issue of if the time off did the trick.
I’ve seen both experiences.
My 6 year old mare went in to a top clinic and they suspected it might be a hind suspensory but it was inconclusive on ultrasound and the lameness would vanish at times. she was also very bad at needles so we couldn’t block her. Decided on a bone scan and it had findings on her neck. We did the CT Myelogram and she had very bad compressions and had to be put down. I think a lot about how long it would have taken to look there without the scan. And the risk I put her and those handling her in.
Another horse I know came up terrifyingly lame all of a sudden. The vet wasn’t sure but worried it was a broken pelvis which you can’t really xray. The bone scan and a rectal ultrasound after confirmed her worries. Not sure how else we would have found it.
I think in specific cases, it can be helpful, but my sports medicine vet agrees, it can lead you in places that aren’t helpful. Not unlike horses who have bad xrays but no clinical signs. You have to marry the data. But when you’re out of options, it can be helpful.
For today we got both front cannon bones, rf knee, poll, and c6.
Clinically horse is sound on both soft and hard, flexed fine after coffin and ankle injections and shows no reaction to palpitate in the c6 area.Vet is coming Friday to start xraying these areas.
I have had several done and overall found them far more helpful than not.
They can do something with soft tissue. The radioisotope is taken up by any actively remodeling soft tissue before it’s taken up by remodeling bone, but it’s fairly transient. So, the process is to inject the horse with the radioisotope, wait a bit, scan the most important soft tissue areas (because there isn’t time to do all), wait some more, scan bones.
Horse #1. Insured. Bone scan #1 done to aid in where to look with MRI. Stupidly did not scan entire horse. (note - always scan the entire horse). Helped in determining where to look with MRI; also had stifle scanned bc there had been an issue there–nothing active found in stifle. Found damage in collateral ligaments in hoof. Rehabbed horse; got two good years after a year total of rehab. Issues resurfaced making us think he’d reinjured soft tissue in foot. Bone scan #2 done to aid in MRI but this time I was smarter and had the whole horse scanned. Found issues in neck in addition to soft tissue in foot. Vet felt that neck was the driving force for other injuries (there is a longer story here if anyone is actually interested). Treated neck and feet; horse was sound but never really returned to jumping much of anything and was ultimately retired at age 14. So, would this have played out differently had we scanned the whole horse and presumably found the neck problems the first time. Who knows. This saga started in 2008 and people weren’t nearly as aware of neck issues as they are now. While the second scintigraphy helped to find the neck issue, by that time we were effectively kind of done as it turned out. But at least I had data. I feel like I could have spent months fishing around with diagnostics all while paying board, etc.
Horse #2 . Not insured. Did scintigraphy when mysterious lameness (hind) appeared age 4. Found major neck issues. Treated. Attempted to bring back into work. No dice. Turned out for a year. Brought back into work. All good until it wasn’t not even a year later. Ended up euthanizing him shortly after his seventh birthday bc the neck was that bad and the vet felt that he’d just keep re-injuring himself the same way a third and fourth and so on time.
Horse #3. Insured. Did scintigraphy to help locate lameness in hoof capsule. Follow-up MRI. Clearly focussed injured area based on both dx that corresponded to a divot area on foot; concluded that he’d stepped on a rock. Nothing all that bad in foot though Found some other minor areas. Treated foot pretty aggressively; also treated other areas. Lameness returned roughly a year later. Followup MRI again showed some damage in foot but nothing awful that corresponded to degree of lameness. Attempted to rehab but he kept going lame part way in; then couldn’t even get sound. Relocated to facility where he could be turned out without shoes for six months. Horse sound. Shod with four flat shoes and doing meter jumpers for last 2.5 years. Lives out 24/7, ring has great footing, but I drive a lot more. In retrospect, yes, he stepped on a rock but I think there was irritation in the foot from odd angles (he wants to grow a LOT of toe), less-than-ideal footing, possibly EMS, and living in a box stall. I don’t know how helpful the scintigraphy was here, other than aiding the MRI because what we found wasn’t all that much of a surprise.
Very different situation for someone paying board and paying some sort of layup “training” fee and trying to manage a horse in a box stall or even a small paddock versus someone who has land and can just let the horse be for a bit. Because, ultimately, that was what fixed horse #3.
Will second that if you do go that route, definitely scan the whole horse. I know one that got hind end done, which found some problems, but the horse also had spine and neck problems which were found on a second scan after horse became worse not better following first round of treatments.
I wish the horse I had scanned would have let us scan his front feet, but he was not compliant for that part and I didn’t want to purchase a broken gamma camera, so that part never got done but I wonder if we would have gone with MRI of the feet years earlier if he’d complied (maybe not, maybe the feet weren’t that bad at the time, and he was hardly ever lame even after pretty terrible looking MRIs).
“Bone scans do not show soft tissue issues, only active bone inflammation (as far as I understand it).”
This is not true. There are two phases of a bone scan, and one will absolutely show soft tissue inflammation. It’s how my horse’s torn SI was diagnosed.
You can do a soft tissue phase off a bone scan shortly after injecting the Technetium.
It is a brief window, so you need to make the decision on where to look for soft tissue uptake before the scan.
The general idea is that blood flow is increased in an area of active inflammation, and this will be visible before the Tc goes into the bone.
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