ABSTRACT
OBJECTIVE: End-stage chronic liver disease (CLD) adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS) findings in liver transplant (LT) candidates with end-stage CLD. METHODS: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe. RESULTS: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and one had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%); bilateral decrease in lower extremity uptake (n=26, 56.5%); symmetrically increased periarticular uptake (n=26, 56.5%); bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA) (n=8, 17.4%); bilateral increased sacroiliac activity (n=16, 34.8%); sacral activity (n=10, 21.7%), coccygeal activity (n=2, 4.3%), focally increased uptake suggestive of metastases (n=5, 10.9%). Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7%) and bilateral diffuse mild or severe degree of renal cortical uptake (n=20, 43.5%). There was a statistically significant difference in serum creatinine values between mild and severe renal uptake groups (p<0.05). There was also statistically significant difference in serum BUN and creatinine values between patients with severe degree of renal uptake and without renal uptake (p<0.05). CONCLUSION: The results of the current study has shown that adolescent LT candidates with end-stage CLD had no osseous abnormality on BS. However, all of adult patients exhibited one or one more osseous abnormalities. Typical scintigraphic findings denoting to abnormalities in bone metabolism were generalized decreased osseous uptake, decreased lower extremity osseous uptake, increased periarticular uptake, increased cortical/periosteal uptake indicating hepatic HOA, and other unusual uptake patterns. Hepatocellular carcinoma metastases may present itself as rib metastases linear in pattern. Soft-tissue uptake in the form of diffuse bilateral mild or severe degree of renal uptake and less commonly mild diffuse liver uptake can be observed. Increased renal uptake may be an early marker of renal dysfuntion or a predictor of hepatorenal syndrome. CONFLICT OF INTEREST: None declared.
ABSTRACT
OBJECTIVES: Owing to ineffective iodine removal, radioiodine dose reduction was recommended in thyroid cancer patients with chronic renal failure. In this study, the radioiodine biodistribution pattern on posttherapy scans in patients with normal renal function and those with chronic renal failure is outlined. METHODS: This study included 10 thyroid cancer patients with chronic renal failure (five females, five males; mean age: 43+/-12.9) and 20 control participants (16 females, four males; mean age: 43.5+/-8.2) with normal renal function. Radioiodine doses used for ablation ranged between 1110 and 3700 MBq in the patient group and between 3700 and 5550 MBq in the control group. Whole-body imaging was performed on day 7 after radioiodine administration. Scans were inspected with regard to oral, nasal, salivary gland, hepatic, mammary, and gastrointestinal uptake patterns. RESULTS: Mild-to-significant liver uptake was present in all patients in the control group, whereas none exhibited gastric uptake. Mild salivary gland, oral or nasal activity was present in a small percentage of patients in the control group. Out of 10 patients with renal failure, eight had salivary gland, nine had gastric, eight had oral uptake linear in pattern that was unresponsive to mouth wash and all had nasal uptake. Six patients reported persistent xerostomia after treatment. Mammary uptake was present in three female patients. Hepatic uptake was faintly visible only in one patient. CONCLUSION: Patients with chronic renal failure exhibited significant salivary gland, oral, nasal, and gastric activity 1 week after radioiodine administration. The linear pattern of oral activity unresponsive to rinsing and persistence of gastric activity for 1 week might suggest adsorption of radioiodine to mucosal cells. Salivary gland dysfunction and the risk of second primary malignancy in iodine-concentrating organs appear as important indications for radioiodine dose reduction in this patient group.
