Accidente cerebro vascular visualizado en gammagrafía conTc-99m MDP, un hallazgo extraóseo inusual / Stroke in scintigraphy with Tc-99m MDP, an unusual extraosseous finding / Acidente vascular cerebral visualizado na cintilografia com Tc-99m MDP, um achado extra-sensorial incomum

Se presenta el caso de un paciente con antecedente de adenocarcinoma de próstata y diagnóstico de ACV isquémico con transformación hemorrágica. La gammagrafía ósea con Tc-99m MDP complementada con SPECT e imágenes de fusión con TC cerebral simple, realizada a los 15 días, muestra hipercaptación en la región temporal izquierda, correspondiente al ACV en etapa subaguda.

We present the case of a patient with a history of prostate adenocarcinoma with a diagnosis of ischemic stroke with hemorrhagic transformation. Bone scintigraphy with Tc-99m MDP supplemented with SPECT and fusion images with simple cerebral CT, performed at 15 days, shows uptake in the left temporal region, corresponding to stroke in subacute stage

Apresentamos o caso de um paciente com história de adenocarcinoma de próstata com diagnóstico de acidente vascular cerebral isquêmico com transformação hemorrágica. A cintilografia óssea com Tc-99m MDP suplementada com SPECT e imagens de fusão com TC cerebral simple, realizadas aos 15 dias, mostra captação na região temporal esquerda, correspondente ao ACV na fase subaguda

Focal Increased Tc-99m MDP Uptake in the Nutrient Foramen of the Femoral Diaphysis on Bone SPECT/CT / 대한핵의학회잡지

We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the kneewas reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.

SPECT-CT localization of Tc-99m methylene diphosphonate uptake in a subacute brain infarct on bone scintigraphy

Bone scan is a sensitive imaging procedure for cancer patients who are at high risk for bone metastases. Despite the high sensitivity, Tc-99m methylene diphosphonate (MDP) is not a specific tracer and its increased uptake may also be seen in extra-osseous areas. In cases where localization of extra-osseous sites of MDP uptake on planar imaging prove to be difficult, single photon emission computed tomography with computed tomography (SPECT/CT) may be useful. A known lung cancer patient was referred for whole body bone scan to detect bone metastasis. Planar images showed tracer accumulation in the left area of the head, suspicious for skull metastasis. SPECT-CT imaging of the head was done for further evaluation, which showed Tc-99m MDP uptake in the left temporoparietal lobe. Magnetic resonance imaging (MRI) of the brain was subsequently done, which showed a subacute brain infarct corresponding to the Tc-99m MDP-avid focus. Thus, SPECT-CT was helpful in proper anatomical localization of the focal Tc-99m MDP uptake in the head, which otherwise might have been easily mistaken for skull metastasis should only planar imaging was used.

SPECT-CT localization of Tc-99m methylene diphosphonate uptake in a subacute brain infarct on bone scintigraphy

Bone scan is a sensitive imaging procedure for cancer patients who are at high risk for bone metastases. Despite the high sensitivity, Tc-99m methylene diphosphonate (MDP) is not a specific tracer and its increased uptake may also be seen in extra-osseous areas. In cases where localization of extra-osseous sites of MDP uptake on planar imaging prove to be difficult, single photon emission computed tomography with computed tomography (SPECT/CT) may be useful. A known lung cancer patient was referred for whole body bone scan to detect bone metastasis. Planar images showed tracer accumulation in the left area of the head, suspicious for skull metastasis. SPECT-CT imaging of the head was done for further evaluation, which showed Tc-99m MDP uptake in the left temporoparietal lobe. Magnetic resonance imaging (MRI) of the brain was subsequently done, which showed a subacute brain infarct corresponding to the Tc-99m MDP-avid focus. Thus, SPECT-CT was helpful in proper anatomical localization of the focal Tc-99m MDP uptake in the head, which otherwise might have been easily mistaken for skull metastasis should only planar imaging was used.

The diagnostic value of 99mTc-MDP bone scan and computed tomography for bone metastases of breast cancer: a systematic review / 生物医学工程学杂志

According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases. The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0. 87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.

Metastatic Pulmonary Calcification in a Patient with Adult T-Cell Leukemia/Lymphoma / 대한내과학회지

Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive disease that is geographically clustered, mirroring areas endemic for human T-cell lymphotropic virus type 1 infection. Most patients with ATLL present with aggressive manifestations such as severe hypercalcemia, lymphadenopathy, hepatosplenomegaly, and bone marrow involvement with progressive thrombocytopenia. We herein report a case of a patient with ATLL exhibiting increased uptake in both lungs as shown on a bone scan using 99mTc-methylene diphosphonate. This finding is thought to have been caused by metastatic calcification associated with ectopic parathyroid hormone production.

Can Large Dystrophic Calcifications in Breast Guarantee Benignity?: A Case Report

Dystrophic calcifications themselves in the breast are classified as typically benign according to the Breast Imaging Reporting and Data System. However, we experienced a patient with invasive ductal carcinoma surrounding large dystrophic calcifications that could be regarded as long-standing benign conditions such as fat necrosis or hematoma. A 61-year-old woman presented with two large dystrophic calcifications within an irregular mass in the right upper outer breast on mammography. Ultrasonography revealed an irregular mass with dense calcifications showing strong posterior acoustic shadowing. On contrast enhanced magnetic resonance imaging, an irregular mass showed a persistent enhancement pattern and high signal intensity on a diffusion weighted image with non-enhancing areas corresponding to the calcifications. No abnormal uptake was observed on Tc-99m methylene diphosphonate bone scan. Invasive ductal carcinoma was observed on ultrasonography-guided core needle biopsy. In this case, we conclude that typical dystrophic calcifications within a breast mass cannot guarantee a benign diagnosis if the imaging characteristics of the mass are suspicious.

Does fluid restriction affect the image quality of skeletal scintigraphy?

In Islamic countries in the month of Holy Ramadan many Muslims based on their religious Legislation refuse fluid intake during the fasting time though instructed to drink after injection of Tc-99m Methylene-diphosphonates [Tc-99m MDP] used for skeletal scintigraphy. We aimed to establish whether fluid restriction in Tc-99m MDP skeletal scintigraphy has an impact on its quality. One hundred forty-four patients referred for skeletal scintigraphy were studied. Group 1 was well hydrated while group 2 was instructed not to drink till imaging. Image quality was assessed using quantitive measures where by the end of imaging, equal regions of interest [ROI] were drawn over the femoral diaphysis, and the contralateral adductor area. The total number of counts from the bone [B] ROI and soft tissue [ST] ROI was expressed as a ratio [B: ST ratio], and a mean value for each group was established. The image quality was also assessed without knowledge of individual's water intake by a semiquantitative score. No statistically significant difference was found between the B:ST ratio means [P=0.46] and the semiquantitative scores [P=0.42] in both groups. Fluid restriction had no impact on the image quality in Tc-99m MDP skeletal scintigraphy though a higher radiation dose to the urinary bladder wall is anticipated

Sternal nonunion on bone scintigraphy: a case report

Sternal non-union is a severe complication of sternotomy closure following open heart surgeries. Healing problems typically occur in 0.3% to 5% of patients. Technetium-99m methylene diphosphonate [[99m]Tc-MDP] bone scintigraphy has been used to assess bone nonunion to predict the healing response for proper management. In this report, we present the case of a marked sternal nonunion following coronary artery bypass graft [CABG], using radionuclide bone scintigraphy

[99m]Tc-MDP abdominal scintigraphy in a paediatric case of GI protein loss - a viable and simple alternate to HSA imaging

A nine-month old male child presented with low-grade fever, loose stools and facial puffiness. Clinically patient was otherwise normal except for a firm liver on palpation. The laboratory tests revealed hypoproteinemia [both albumin and globulin] and iron deficiency anemia. Differential diagnosis considered were: 1. Nephrotic syndrome, 2. Cystic fibrosis [in view of recurrent diarrhea and respiratory complaints] 3. Chronic liver disease, in view of firm palpable liver 4. Lastly protein losing enteropathy [PLE]. As biochemically patient revealed no positive results, PLE was suspected. For confirmation 99mTc-Methylene diphosponate [MDP] scintigraphy was found to be useful in the setting of non availability of 99mTc-HSA. MDP scan revealed abnormal minimal extravasation of tracer from bowel loops in right lower abdominal quadrant suggesting a diagnosis of PLE. According to the American Gastroenterological Association [AGA] in patients with iron-deficiency anemia who do have GI symptoms, the prevalence of celiac disease is higher and ranges from 10% to 15% which may be a plausible explanation in our patient. The diagnosis of PLE is most commonly based on the determination of fecal alpha-1 antitrypsin clearance. However the localization of gastrointestinal protein [GI] protein loss is possible by scintgraphic techniques alone, as was done in our case using [99m]Tc-MDP instead of conventionally used [99m]Tc-HSA

18F-FDG PET/CT for Diagnosis of Osteosclerotic and Osteolytic Vertebral Metastatic Lesions: Comparison with Bone Scintigraphy

STUDY DESIGN: A retrospective study. PURPOSE: The aims of this study were to investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in PET/computed tomography (CT) in the evaluation of spinal metastatic lesions. OVERVIEW OF LITERATURE: Recent studies described limitations regarding how many lesions with abnormal 18F-FDG PET findings in the bone show corresponding morphologic abnormalities. METHODS: The subjects for this retrospective study were 227 patients with primary malignant tumors, who were suspected of having spinal metastases. They underwent combined whole-body 18F-FDG PET/CT scanning for evaluation of known neoplasms in the whole spine. 99mTc-methylene diphosphonate bone scan was performed within 2 weeks following PET/CT examinations. The final diagnosis of spinal metastasis was established by histopathological examination regarding bone biopsy or magnetic resonance imaging (MRI) findings, and follow-up MRI, CT and 18F-FDG PET for extensively wide lesions with subsequent progression. RESULTS: From a total of 504 spinal lesions in 227 patients, 224 lesions showed discordant image findings. For 122 metastatic lesions with confirmed diagnosis, the sensitivity/specificity of bone scan and FDG PET were 84%/21% and 89%/76%, respectively. In 102 true-positive metastatic lesions, the bone scan depicted predominantly osteosclerotic changes in 36% and osteolytic changes in 19%. In 109 true-positive lesions of FDG PET, osteolytic changes were depicted predominantly in 38% while osteosclerotic changes were portrayed in 15%. CONCLUSIONS: 18F-FDG PET in PET/CT could be used as a substitute for bone scan in the evaluation of spinal metastasis, especially for patients with spinal osteolytic lesions on CT.

Polyostotic Paget's disease

Paget's disease of bone is a common metabolic bone disease in most of the European countries. The disease has distinct geographical distribution being rare in Asia. We report Paget's disease in a 70 years old Pakistani male who presented with history of pain in right leg with difficulty in walking for the last 5 months. Plain X-ray raised suspicion of Paget's disease of bone. Technetium-99m MDP bone scan showed involvement of multiple bones. Bone biopsy confirmed the diagnosis. This case illustrates that Paget's disease of bone does exist in Pakistan

Spontaneous Non-Traumatic Stress Fractures in Bilateral Femoral Shafts in a Patient Treated with Bisphosphonates

Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.

Dual ectopic thyroid: a case report with review of literature

The ectopic thyroid gland is a rare entity which is mostly found along the line of descent of the thyroid gland. Most of the patients present with midline swelling and usually seek medical attention. Dual ectopic thyroid gland is even rarer. The clinical examination and different imaging modalities establish its diagnosis. Radionuclide studies are highly sensitive and specific in demonstrating the functional tissues in patients with ectopic thyroid, thereby guiding further management. The authors reported a case of ectopic thyroid gland in a girl with midline neck management. The authors reported a case of ectopic thyroid gland in a girl with midline neck swelling initially, subsequently lost to follow-up. She again presented with enlarged swelling after a period of three years with dual ectopic thyroid in the neck region on thyroid scan. Thyroid scintigraphy demonstrated that progression in the size of ectopic glands was due to neglect in treatment

Local recurrence of a parosteal osteosarcoma 21 years after incomplete resection / 癌症

Parosteal osteosarcoma (POS) is the most common form of surface osteosarcoma. Its symptoms are insidious and its duration prior to diagnosis is considerably longer than that of other types of osteosarcoma. We report a case of POS with a growing mass but no evidence of metastasis. This tumor, which was diagnosed as calcified hematoma with benign characteristics, was incompletely resected in our hospital 21 years before the diagnosis of recurrence. The patient underwent a wide en bloc resection in our hospital and was free of symptoms, with no signs of tumor recurrence or metastasis during a 53-month follow-up.

(99m)Tc-MDP wholebody bone imaging in evaluation of the characteristics of bone metastasis of primary lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the image characteristics of bone metastasis of primary lung carcinoma.</p><p><b>METHODS</b>Whole-body bone imaging ((99)Tc(m)-MDP) was performed in 258 patients with pathologically proven lung carcinoma. The rate of bone metastasis, distribution of the metastatic lesions and their characteristics were analyzed.</p><p><b>RESULTS</b>Among the 258 cases, 142 patients developed bone metastasis. The overall rate of bone metastasis was 55.0%. The metastases located in axial skeleton were 49.6%, appendicular skeleton 36.0%, trunk bones of the axial skeleton 48.4%, and appendicular girdle skeleton 31.4%. Ribs, thoracic vertebrae, ilium and lumbar vertebrae had a higher rate of bone metastasis, higher than 20%, respectively. 1252 lesions were detected including 406 at the left side of the body, 387 in the axial skeleton and 459 at the right side of the body. There was no significant difference in terms of number of lesions between left side and right side (chi(2) = 3.3, P = 0.072). 1224 bone metastatic foci (97.8%) were presented as strong radioactive, 26 (2.1%) mixed lesion, and 2 (0.2%) low radioactive. According to the shape of the lesions, there were 810 punctate lesions (71.5%), 159 (14.0%) lump form, 108 (9.5%) strip form and 56 (4.9%) lamellar form. The accumulative bone metastasis rate was 28.7% for the patients with one to three lesions. The metastasis rate decreased gradually with the increasing number of metastatic lesions.</p><p><b>CONCLUSION</b>Bone metastasis is very common in patients with lung cancer. Most bone metastases are characterized by strong radioactive and earlier punctate form, often occurs in the trunk bones of axial skeleton or appendicular girdles. The distribution of earlier metastases has not obvious regularity, and advanced bone metastases are often concurrent, multiple and multiform, widely and randomly distributed in the body.</p>

A new radiopharmaceutical for bone imaging: experimental study of 99mTc-HEDTMP / 生物医学工程学杂志

The purpose of this study is to prepare 99mTc-HEDTMP [N-(2-hydroxyethyl) ethlenediamine-1,1,2-tri (methylene phosphonic acid), a new kind of bone seeking compound; to investigate its biological properties; and to explore the possibility of using it as a potential radiopharmaceutical for skeleton scintigraphy. HEDTMP was labeled with 99mTc by "pretinning" method, the radiochemical purity was 97.00% +/- 0.34%. 99mTc-HEDTMP was found to be stable in 5 hours in vitro with the radiochemical purity over 95% even after being diluted by physiological saline with the factor of dilution 100. The plane bone scanning of rabbits showed that 99mTc-HEDTMP was principally absorbed by skeletal system. Skull, spine and legs could be observed clearly, and were more legible than the images of 99mTc-MDP. Mice trial also indicated the high bone seeking of 99mTc-HEDTMP. The skeletal uptake was 11.92% ID/g, 13.19% ID/g, 10.14% ID/g, 10.04% ID/g, 7.71% ID/g separately at 30 minutes, 1 hour, 3 hours, 6 hours and 24 hours after the injection. Kidney seemed to be the major excretory organ. The clearance of blood was quick and the retaining amount in non-target organs was small. These results indicate that 99mTc-HEDTMP can be prepared easily, and its biological properties can be compared favorably with the commonly used bone imaging agent, and it is well worth further researching as a promising potential radiopharmaceutical in nuclide diagnosis for skeleton diseases.

Multiple myeloma in younger age

A Multiple Myeloma [MM] is rare in younger age group. We report MM in a 30-year-old female, who presented with multiple lytic areas upon skeletal survey, but with negative Bence Jones protein. Bone marrow biopsy confirmed it to be a case of multiple myeloma. Patient was put on chemotherapy and radiography to which she responded and now is ambulatory

Value of additional skull lateral static imaging in whole-body bone imaging for skull bone invasion evaluation in nasopharyngeal carcinoma patients: comparison with CT / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the value of the additional skull lateral static imaging in whole-body bone imaging (WBI) vs CT for evaluation of skull base invasion in patients with nasopharyngeal carcinoma.</p><p><b>METHODS</b>A total of 405 patients with pathologically confirmed NPC underwent WBI with additional static imaging of the left and right skull as well as CT examination of the nasopharynx and skull base within one week before the radiotherapy.</p><p><b>RESULTS</b>The concordance rates between WBI and CT for positive and negative diagnosis were 29.48% and 76.05% in these cases, respectively, with the total concordance rate of 81.23%. The concordance rates between skull lateral static imaging with visual judgment and CT examination for positive and negative diagnosis were 67.95% and 74.07%, respectively, showing a total concordance rate of 87.16%. Skull lateral static imaging with semi-quantitative analysis and CT examination showed concordance rates for positive and negative diagnosis of 75.64% and 74.07%, respectively, with a total rate of 88.64%. In 27 patients with negative diagnosis by CT but a positive one in skull lateral static imaging with semi-quantitative analysis, 9 had a positive diagnosis by magnetic resonance imaging.</p><p><b>CONCLUSIONS</b>Skull lateral static imaging can be of value in the diagnosis of skull base invasion in NPC patients and may serve as an effective means for screening skull base invasion in NPC.</p>

Analysis of radioactive distribution in the sacrum in whole-body bone scanning / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the radiogenic distribution in the sacrum in whole-body bone scanning.</p><p><b>METHODS</b>A total of 212 patients receiving whole-body bone scanning without any explicit bone metastases were divided into different age and gender groups. The radioactive distribution in the sacrum in whole-body bone scanning was analyzed statistically.</p><p><b>RESULTS</b>Of these cases, 31.1% presented with thin radioactive distribution in the sacrum and 11.3% exhibited increased radioactive distribution. Normal radioactive distribution in the sacrum was found in 57.6% of the cases. In both male and female elderly patients (>70 years), the rate of normal radioactive distribution in the sacrum was obviously reduced with increased rate of thin radioactive distribution. The female elderly patients showed higher rate of increased radioactive distribution in the sacrum than male elderly patients.</p><p><b>CONCLUSION</b>The radioactive distribution in the sacrum is similar between female and male patients. Elderly male patients over 70 years have generally thin radioactive distribution in the sacrum due to the presence of osteoporosis, which is also associated with latent fracture of the sacrum to result in increased radioactive distribution in the sacrum in whole-body bone scanning.</p>