Model Validation of Breast Cancer Induced to Bone Using 99mTcMDP

@#Metastasis is a process of tumour cells escaping from the primary site and form a new lesion in other organs. It is a common phenomenon where bone is the frequent metastatic site. Bone scan using 99m-Techetium-Methylenediphosphate (99mTc-MDP) is used to diagnose bone pathologies such as bone metastases. 99mTc-MDP specifically binds to calcium which present in bone. This study aimed to validate 99mTc-MDP in breast cancer-induced to bone rat model and to determine calcium presence in the progression of metastasis. The rats were divided into two groups (normal and cancer-induced groups). For cancer-induced group, the left femur was induced with breast cancer cell line, MDA-MB-231. After 21 days, all rats were subjected to SPECT-CT scan. Our finding suggests that the kidney uptake of 99mTc-MDP is due to the calcium crystal presence caused by hypercalcemia. This is only a preliminary data, and further analysis will be conducted.

Protocolo combinado de 99mTc-Ciprofloxacina y 99mTc-MDP en el diagnóstico de osteomielitis y prótesis articular infectada / 99mTc-ciprofloxacin/99mTc-MDP combined protocol in the diagnosis of osteomyelitis and infected joint prosthesis

Introducción. El centellograma óseo con 99mTc-MDP es una técnica útil en el diagnóstico de osteomielitis, sin embargo, presenta especificidad limitada en presencia de patología ósea previa (osteomielitis complicada). La 99mTc-ciprofloxacina es uno de los radiofármacos más difundidos para la detección de infecciones óseas, aunque persisten controversias sobre su rendimiento diagnóstico. Objetivo. Determinar el valor clínico del protocolo combinado de centellograma con 99mTc-ciprofloxacina y 99mTc-MDP en el diagnóstico de osteomielitis complicada y prótesis articular infectada. Materiales y métodos 37 pacientes con sospecha clínica de osteomielitis complicada o prótesis infectada fueron estudiados mediante centellograma con 99mTc-ciprofloxacina y 99mTc-MDP. 26/37 pacientes presentaban fractura previa, 7 prótesis de rodilla y 4 prótesis de cadera. En todos ellos se realizó seguimiento clínico y bacteriológico. Resultados. El método presentó sensibilidad de 94 por ciento, especificidad de 79 por ciento, valor predictivo positivo de 81 por ciento y valor predictivo negativo de 94 por ciento, con una exactitud de 86 por ciento. Conclusiones. El protocolo combinado de 99mTc-ciprofloxacina y 99mTc-MDP presenta elevado rendimiento para el diagnóstico de osteomielitis complicada y prótesis articular infectada.

Introduction. Bone scintigraphy with 99mTc-MDP is a useful technique in the diagnosis of osteomyelitis, however, has limited specificity in the presence of previous bone pathology (complicated osteomyelitis). 99mTc-ciprofloxacin is one of the most widely used radiotracers for the detection of bone infection, although controversies persist on its diagnostic performance. Objective To determine the clinical value of 99mTc-ciprofloxacin/99mTc-MDP combined protocol in the diagnosis of complicated osteomyelitis and infected joint prosthesis. Materials and methods 37 patients with clinically suspected complicated osteomyelitis or infected prosthesis were studied with 99mTc-ciprofloxacin and 99mTc-MDP scintigraphy. 26/37 patients had previous fractures, 7 had knee replacements and 4 had hip replacements. All of the patients underwent clinical and bacteriological follow-up. Results. The method presented sensitivity of 94 percent, 79 percent specificity, 81 percent positive predictive value and 94 percent negative predictive value, with an accuracy of 86 percent. Conclusions. The combined protocol using 99mTc-ciprofloxacin/99mTc-MDP showed high diagnostic performance in complicated osteomyelitis and infected joint prosthesis.

Transient Diffuse Hepatic Uptake of 99mTc-MDP after Hepatitis B Vaccination / 핵의학분자영상

A 38-year-old female with arthralgia in right elbow joint for 6 months was referred for a bone scan which showed diffuse uptakes of 99mTc-MDP in the liver and spleen without hepatosplenomegaly. She had a history of hepatitis B vaccination 3 days ago. These uptakes were disappeared on the follow-up bone scan after 4 months. We suggest this transient diffuse hepatic uptake after vaccination of hepatitis B might be due to aluminum component within the hepatitis B vaccine as adjuvant.

Comparison with 99mTc MDP Bone Scintigraphy and Whole body 18FDG PET for the Evaluation of Bone metastases in Patients with Lung Cancer / 결핵

BACKGROUND: 99mTechnetium methylene diphosphonates(99mTc MDP) bone scintigraphy is current method of choice for the detection of bone metastases, but whole body 18F-fluoro-deoxy-D-glucose positron emission tomography(18FDG PET) offers superior spatial resolution and improved sensitivity. So we compared whole body 18FDG PET with 99mTc MDP bone scintigraphy in patients with skeletal metastases from lung cancer. PATIENTS AND METHODS: Ninety-two patients with lung cancer taken 18FDG PET together with a 99mTc MDP bone scintigraphy within 1 month between March 2000 and March 2003 were investigated retrospectively. RESULTS: The sensitivity, specificity and accuracy of the 99mTc MDP bone scintigraphy versus 18FDG PET for the detection of bone metastases in lung cancers were 59% vs 82%, 71% vs 94%, and 68% vs 91%, respectively. In the diagnosis of bone metastases from lung cancer, 18FDG PET was statistically superior to 99mTc MDP bone scintigraphy in its specificity and accuracy(P<0.0001). CONCLUSIONS: Whole body 18FDG PET may be useful in detecting bone metastases among patients with lung cancer.

Diagnostic Criteria to Differentiate Medial Meniscal Injury from Degenerative Changes on 99mTc-MDP Knee SPECT in Patients with Chronic Knee Pain / 대한핵의학회잡지

PURPOSE: In patients with chronic knee pain, the diagnostic performance of 99mTc-MDP knee SPECT for internal derangement of knee is deteriorated due to degenerative changes. In this study, we tried to establish diagnostic criteria to differentiate medial meniscal injury (MMI) from degenerative change (DC) when the uptake is increased in medial compartment. MATERIALS AND METHODS: A total of 49 knee SPECT of the patients with chronic (more than 3 months) knee pain, which showed increased 99mTc-MDP uptake in the medial compartment, were included in this study. The diagnosis was confirmed by arthroscopy. On knee SPECT, 3 diagnosic criteria for MMI were investigated. In Criterion I, MMI was diagnosed when crescentic uptake was observed in the medial tibial plateau. In Criterion II, crescentic uptake was further classified into anterior, mid, posterior, and diffuse patterns, according to the location of maximal uptake; and only crescentic mid, posterior, and diffuse patterns were diagnosed as MMI. In Criterion III, MMI was diagnosed when medial tibial plateau showed higher activity then medial femoral condyle. The diagnostic performance of the 3 criteria was compared. RESULTS: The sensitivity and specificity were 93% and 14% in Criterion I, 89% and 38% in Criterion II, and 75% and 67% in Criterion III, respectively. Criterion III had significantly improved diagnostic performance, especially, specificity. CONCLUSION: In this study, we established a practical diagnostic criterion to differentiate MMI from DC on knee SPECT. The result is helpful to improve the diagnostic value of knee SPECT as a screening test for chronic knee pain.

Natural Progress of Bone Scan after Cementless Hydroxyapatite-Coated Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To observe the progress pattern of quantitative bone uptake in asymptomatic patients with uncomplicated cementless total hip arthroplasties. MATERIAL AND METHODS: A periprosthetic quantitative 99mTc-MDP scintiscan was performed in 62 asymptomatic patients (80 hips) and 10 unoperated normal control group (20 hips) . The patients were studied in eight groups (10 hips each time) at scheduled time intervals (1, 3, 6, 9, 12, 24, 36, and 48 months) . We calculated the comparative ratio of uptake in each of the periprosthetic zones to both sacroiliac joints and compared these results with the control group. RESULTS: The uptake ratio of all the periprosthetic areas (cup and stem areas) peaked at one month after the operations (p<0.05) , and a statistically significant decrease was shown between one and three months (p<0.05) . After three months, the activity was relatively uniform and stable. Bone uptake on the proximal femur in the normal unoperated control group indicated that bone uptake in the metaphyseal area was physiologically high (p<0.01) . Comparing this result with that of the patient group, bone uptake decreased much faster in the HA-coated metaphyseal area than in the non-coated diaphyseal area. DISCUSSION AND CONCLUSION: Previous studies of bone scan after cementless hip arthroplasties reported that bone uptake in the HA-coated metaphyseal area was higher and had longer stabilizing time than that in the non-coated diaphyseal area. And they claimed that evaluation of bone uptake was meaningless in the acetabular cup area. However, our measurement of bone uptake on the proximal femur in the normal unoperated control group indicated that bone uptake in the metaphyseal area was physiologically high. Comparing this result with that of the patient group, bone uptake decreased much faster in the HA-coated metaphyseal area than in the non-coated diaphyseal area. And when a quantitative bone scan of the acetabular cup area was performed and compared to normal acetabulum in the control group, we found that, unlike the claims of several previous studies, the bone scan does produce meaningful results.

A Case of Reflex Sympathetic Dystrophy Syndrome developed after Protein Losing Enteropathy / 대한내과학회지

A 16-year old girl was admitted for chronic diarrhea, generalized edema, severe pain of lower extremities, and general weakness. She could not walk because of burning pain of knee and ankle. 99mTc-MDP bone scan demonstrated increased periarticular uptake in both lower extremity with focal increased activity in proximal portion of both tibias.. Abnormal abdominal activity in ascending, transverse, and descending colon is also seen. Bone densitometry showed severe osteoporosis in lower extremity. 99mTc-HSA scan showed abnormal radioactivity in small bowel, and descending colon indicating protein losing enteropathy. Endoscopic biopsy of terminal ileum showed a few dilated lymphatics in the submucosa. After steroid and supplemental therapy, the symptoms and signs of both protein losing enteropathy and RSDS much improved simultaneously. Reflex sympathetic dystrophy syndrome is a complex of symptoms characterized by severe pain, swelling, autonomic vasomotor dysfunction, and impaired mobility of affected extremities. The important causes are trauma, fracture, and inflammation. We assumed that the reflex sympathetic dystrophy syndrome of this girl was due to protein losing enteropathy. And as far as we know there has not been reported case that protein losing enteropathy assumed as a cause of reflex sympathetic dystrophy syndrome.

Is 99mTc-MDP Mammoscintigraphy Useful in Patients with Breast Mass Lesions ? / 대한핵의학회잡지

PURPOSE: Piccolo et al. advocated the usefulness of Tc-99m-MDP breast scan in differential diagnosis of breast mass with high accuracy. But there are little or no follow-up studies about it as we know. We studied Tc-99m-MDP uptake pattern and lesions/background ratio in patients complaining palpable breast lesions to evaluate the clinical usefulness of Tc-99m-MDP scan. MATERIALS AND METHODS: Total 34 patients were studied with physical examination, mammogram and Tc-99m-MDP scan prospectively. Anteroposterior and both lateral view of breast were obtained 5 minutes after iv injection of 740 MBq Tc-99m-MDP. Breast uptake pattern of Tc-99m-MDP was analyzed by a grade system: 0=no uptake, grade 1=bilateral diffuse uptake, grade 2=asymmetric faint uptake, grade 3=focal hot uptake. 20 cases were pathologically confirmed by excision biopsy or aspiration biopsy. 14 cases were normal in physical examination and mammo-grain. RESULTS: Pathologic results showed 7 carcinomas, 6 benign solid tumors, and 7 fibrocystic changes. Grade 3 pattern of Tc-99m-MDP uptake was noted in 4/7 carcinomas, 3/6 benign solid tumors, and 1/7 fibrocystic changes. Grade 2 pattern was 2/7, 0/7, 3/7 respectively. The average L/B ratio was 1.66 in carcinomas, 1.68 in benign solid masses, 1.20 in fibrocystic diseases, 1.05 in normal patients. L/B ratio was higher in carcinoma and benign mass groups than in fibrocystic change and normal control groups(p=0.005). But there was no statistical difference between L/B ratio of malignant mass group and benign mass group. CONCLUSION: Tc-99m-MDP scan is not suitable to routine clinical use for breast mass diagnosis. It might be used in limited conditions when whole body bone scan is planned.

Abnormal Gastrointestinal Accumulation of Radiotracer by Gastric Bleeding During 99mTc-MDP Bone Scintigraphy / 대한핵의학회잡지

We present a case in which a patient with acute hemorrhagic gastritis demonstrated abnormal gastrointestinal accumulation of radiotracer during Tc-99m-methylene diphosphonate (MDP) skeletal scintigraphy. A hemorrhage gastritis was subsequsently demonstrated by endoscopy. The menchanism for the intestinal localization of Tc-99m-MDP in this patient is not clear, but we guess that the extravasated blood containing the radiopharmaceutical cannot recirculate and stays at the bleedings site, so we can see the intestinal activity.

Diagnosis of Osteomyelitis by the Sequential Use of ⁹⁹mTc / 대한정형외과학회잡지

The sequential use of ⁹⁹mTc-methylene diphosphonate(⁹⁹mTc-MDP) and ⁶⁷Ga imaging is thought to be useful to diagnose acute hematogenous osteomyelitis, and to determine whether it is active or inactive in chronic osteomyelitis. We compared the results obtained by the sequential use of ⁹⁹mTc-MDP and ⁶⁷Ga imaging with those obtained by the surgical culture and biopsy in 31 patients who were supposed to have the osteomyelitis and admitted to Pusan National University Hospital from July 1987 to July 1989. The results were as follows:l. According to the diagnosis at discharge, 4 cases were normal, 20 cases active osteomyelitis, and 7 cases inactive osteomyelitis. 2. Four normal cases were negative both with ⁹⁹mTc-MDP and with ⁶⁷Ga. Twenty cases of active osteomyelitis showed positive results both with 99mTc-MDP and with ⁶⁷Ga. And of 7 cases of inactive osteomyelitis, 6 cases showed positive ⁹⁹mTc-MDP and negative ⁶⁷Ga, 1 cases was negative both with ⁹⁹mTc-MDP and with ⁶⁷Ga. 3. It is suggested that in active osteomyelitis both ⁹⁹mTc-MDP and ⁶⁷Ga were positive, in inactive osteomyelitis ⁹⁹mTc-MDP positive and ⁶⁷Ga negative and in normal or wastive ostemyelitis both ⁹⁹mTc-MDP and ⁶⁷Ga negative. 4. The sequential use of ⁹⁹mTc-MDP and ⁶⁷Ga imaging was particularly useful to diagnose acute hematogenous osteomyelitis in the case of the obscure diagnosis and supposedly normal radiological finding and to determine whether chronic osteomyelitis is active or complicated by an acute flare-up.

Assesment of the Prognosis of Femoral Neck Fractures: Preoperative and Postoperative Tc / 대한정형외과학회잡지

In 38 patients with femorsl neck fracture trested at Cstholic Hospital from Aug. 1980 to Jun. 1985, 24 patients were followed for more thsn 2 years. Preoperative bone scanning with 99m Tc MDP was performed in those 24 patients and postoperative follow-up bone scan assesment of the femorsl vascularity was done in 9 patients of them. Following results were obtained. 1 . Tc 99m methylenediphosphonate bone scanning was effective in assesing the femoral head vascularity in the femoral neck fracture patients. 2. The femoral head activity could be changed in the postoperative scanning : there could be further injury to the blood supply during operation or femoral head revascularization after operation 3. Some information about the possibility of future avascular necrosis could be obtained by comparing preoperative and postoperative bone scan in order that early preventive measures might be applied against the late head collapse. 4. It was conculuded that internal fixation should be considered first in the treatment of fresh femoral neck fracture : the indication of head replaement surgery could not be rnade by preoperative bone scan only.