The value of thallium and three-phase bone scans in the evaluation of bone and soft tissue sarcomas

Calin I. Caluser, Hussein M. Abdel-Dayem, Homer A. Macapinlac, Andrew Scott, John H. Healey, Andrew Huvos, Hovanes Kalaigian, Samuel D.J. Yeh, Steven M. Larson

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47 Scopus citations


Thirty-seven patients with newly diagnosed or treated sarcomas had 47 sets of sequential thallium scans (TS) followed by three-phase bone scan (TPBS) on the same day. The diagnosis in all patients was verified by biopsy (n=40) or long-term follow-up studies (n=7). The sensitivity, specificity, and accuracy of TS and TPBS in detecting sarcomatous lesions was calculated: TS sensitivity was 88%, specificity 69%, and accuracy 83%; blood flow (BF) and blood pool (BP) sensitivity was 91%, specificity 54%, and accuracy 81 %; delayed bone scan (DB) sensitivity was 88%, specificity 38%, and accuracy 74%. In 17 studies the flow and blood pool parts of the TPBS and TS demonstrated the soft tissue component of sarcomas, which would have been missed if only the delayed bone scan had been performed. The TS lesion to normal tissue ratio alone was not very helpful in differentiating sarcomas from benign conditions because some benign lesions are highly cellular and vascular while some malignant lesions, such as chondrosarcoma, have poor vascularity and a less cellular chondroid matrix. However, when the thallium ratio was correlated with similar ratios calculated from yhe BP image, it was found that if the TS lesion to normal tissue ratio exceeded the BP lesion to normal tissue ratio (12 patients), the specificity for detecting sarcomatous lesions was 100%. Nevertheless, the reverse was not true. The positive predictive value of this observation was 100% and the negative predictive value was 37%.

Original languageEnglish (US)
Pages (from-to)1198-1205
Number of pages8
JournalEuropean Journal of Nuclear Medicine
Issue number11
StatePublished - Nov 1 1994



  • Bone scan
  • Soft tissue sarcoma
  • Thallium-201 chloride

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Caluser, C. I., Abdel-Dayem, H. M., Macapinlac, H. A., Scott, A., Healey, J. H., Huvos, A., Kalaigian, H., Yeh, S. D. J., & Larson, S. M. (1994). The value of thallium and three-phase bone scans in the evaluation of bone and soft tissue sarcomas. European Journal of Nuclear Medicine, 21(11), 1198-1205.