Radiolocalization of atypical lesions for intraoperative identification: technical factors, localization quality, success rates, patient safety, and spectrum of applications

A 60-year-old male, with history of treated Gleason 7 prostate carcinoma presenting with a rising prostate-specific antigen (PSA). The only active site of disease was a posterior right 10th rib lesion (black circle) identified on a Tc-99m methyl diphosphonate bone scan (a). This lesion underwent CT-guided radiolocalization (b) where a 9-mm sclerotic rib lesion (white circle) is being injected with Tc-99m MAA using a percutaneous needle (white arrow). A right lateral scintigram (c) depicts focal radiotracer in the region of targeted rib lesion. This portion of the right 10th rib was surgically excised and pathology confirmed metastatic prostatic adenocarcinoma. Patient’s serum PSA subsequently dropped from 29.3 to 3.7？ng/m