Comments on “A Pitfall We Should Be Aware of on Bone Scintigraphy” by Lakhdar et al.

Dear Editor,

We read with great interest the article by Lakhdar et al., titled “A pitfall we should be aware of on bone scintigraphy.”^[1] The authors have effectively highlighted a subtle yet significant challenge encountered in nuclear medicine imaging – inadvertent intra-arterial radiotracer injection and its potential to mimic serious pathology and previous reports also have highlighted this phenomenon with various other nuclear imaging as well.^[2-4]

This described case of increased uptake in the distal right upper limb of the patient following injection into the antecubital fossa, which was later attributed to intra-arterial administration, underscores the importance of recognising artifact patterns such as the “glove sign.” This not only prevents misdiagnosis (e.g., metastasis, complex regional pain syndrome (CRPS), or infection) but also protects these patients from unnecessary anxiety, invasive procedures, and healthcare costs.

Importantly, the article reaffirms the value of a thorough clinical correlation and, when appropriate, repeat imaging with corrected technique, such as three-phase bone scintigraphy, to resolve diagnostic ambiguity which may arise in these settings. It also reminds practitioners of the need for vigilance during various injection techniques, particularly in patients undergoing frequent venous access for chemotherapy or biologics.

We commend the authors for sharing this instructive case and believe it serves as an excellent reminder to both nuclear medicine specialists and referring clinicians to consider technical factors when interpreting unexpected scan findings. Thank you for the opportunity to comment on this informative article.