title: Characteristic uptake pattern of bone scintigraphy in patients with hepatocellular carcinoma following treatment with high-intensity focused ultrasound.
abstract: OBJECTIVE
  This study retrospectively reviews the characteristic bone scintigraphic findings in 18 patients with hepatocellular carcinoma (HCC) following treatment with high-intensity focused ultrasound (HIFU). A potential complication of HIFU is damage to the tissues along the path of the ultrasound beam and structures superficial to the lesion of interest.
  
  
  METHODS
  Patients with hepatocellular carcinoma who underwent a bone scan between 1st December 2005 and 31st December 2011 were considered for this study. Among these patients, only those who had bone scans after the HIFU treatment were included. The time between HIFU treatment and bone scans, HIFU energy, HCC sites, tumour sizes and related radiological findings were evaluated.
  
  
  RESULTS
  In total, 20 bone scans of 18 patients were reviewed. Of these scans, two patients were normal; three patients showed decreased uptake, four patients showed increased uptake and nine patients showed mixed uptakes of the bony tracer in their rib cages. The defects were located in the anterior, lateral, anterolateral or posterolateral aspects of the rib cage. The majority of those cold defects were in the right anterior rib cages. SPECT/CT was used to localise the decreased uptake in ribs. The magnetic resonance imaging in individual patients invariably showed ill-defined rim enhancement along the right chest wall, signifying chest wall injury.
  
  
  CONCLUSIONS
  The results showed that tissue ablation using HIFU caused tissue injury along the pathway of high-intensity ultrasound beams. The harm to tissues is presented as photopenic area on the rib cages due to necrosis or hot spots due to rib fractures in the bone scan. Since these cold defects are subtle, they are easily overlooked or mistaken as aggressive bony metastasis.
authors.affiliation: Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong.
authors.forename: Wai-Han
authors.initials: WH
authors.lastname: Ma
authors.affiliation: Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong.
authors.forename: Wai-Yin
authors.initials: WY
authors.lastname: Ho
authors.affiliation: Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong.
authors.forename: Andrew S H
authors.initials: AS
authors.lastname: Lai
authors.affiliation: Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong.
authors.forename: Kwong-Kuen
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Department of Radiology, Queen Mary Hospital, 102, Pokfulam Road, Pok Fu Lam, Hong Kong.
authors.forename: Martin
authors.initials: M
authors.lastname: Law
keywords: Bone scan; Hepatocelluar carcinoma; High-intensity focused ultrasound