Tc-99m MDP Research Articles

Questionnaire survey of hospitals in Saitama Prefecture regarding the shortage of 99mTc-labeled radiopharmaceuticals and 99Mo/99mTc generators

A questionnaire survey was conducted at all 32 hospitals in Saitama Prefecture to investigate the current difficult situation in terms of nuclear medicine management in the face of the (99m)Tc shortage due to insufficient supply, and 29 hospitals (90.6%) replied. Of the 29, 15 (51.7%) reported a reduction in the number of nuclear medicine studies performed due to the shortage of supply, although the reduction was small. The decrease per month was less than 20 studies in 73% of the institutions. Of the nuclear medicine studies that involve the use of (99m)Tc, the studies whose reduction in number most seriously affected patient management were, in decreasing order: (99m)Tc-MAA lung perfusion scans, (99m)Tc-MAG(3), (99m)Tc-DTPA, or (99m)Tc-DMSA renoscans, (99m)Tc-MDP bone scans, (99m)Tc-HMPAO or ECD brain SPECT studies, (99m)Tc-MIBI or tetrofosmin myocardial SPECT studies, (99m)Tc-radiocolloid sentinel lymphoscintigraphy, (99m)Tc-HSA-D or pyrophosphate bleeding scans, (99m)Tc-GSA hepatic function reserve scans, and (99m)Tc-MIBI parathyroid scans. The reduction is probably ascribable to factors such as cancellations of emergency studies, absence of substitute studies, sequential studies using the same radiopharmaceutical, and higher cost of the syringe-type products than the vial-type products. Substitutes for (99m)Tc studies were performed at 52% (15/29) of the institutions. Myocardial perfusion imaging with (201)Tl chloride was the most common substitute study. The results of this survey suggested the several procedures to resolve the issues related to the shortage. The staffs at all institutions except one gave the impression that their nuclear medicine ordering systems had been greatly affected by the shortage of supply. This adverse circumstance, however, may provide a good opportunity to educate the public about nuclear medicine studies that use (99m)Tc and SPECT, with which citizen are now unfamiliar.

Diagnosing SAPHO Syndrome in Suspected Metastatic Bone Tumors

Abstract: A previously healthy 44-year-old woman who had been followed at different health care facilities for symptoms which had begun 3 years earlier was referred to our service for clinical evaluation. Her problems during the initial examination were pain in the sternoclavicular and sacroiliac joints as well as plantar pustulitis. Based on previous x-ray hyperostosis findings, metastatic bone tumors to the spine and first costocondral junctions bilaterally were suspected. A biopsy of the sternoclavicular lesion showed a nonspecific inflammation pattern. On the first physical examination we found a nontender swelling of the sternoclavicular junctions, necrosis of the plantar epidermis and pain at the sacroiliac joints. The patient was referred for bone scintigraphy and positron emission tomography-computed tomography (PET-CT) scan. The whole body bone scintigraphy using Tc-99m MDP showed increased accumulation of the radiotracer in the anterior chest wall and in the right sacroiliac joint. Metastatic bone tumor was not suggested, although exclusion of bone metastases was difficult. The PET-CT with F-18 FDG showed areas with low metabolic activity in the anterior chest wall (SUV Max: 1.96) and in the right sacroiliac joint (SUV Max: 2.18) making the diagnosis of malignancy and acute infection unlikely. The clinical symptoms, the typical skin lesions involving the soles of the feet and low hypermetabolic lesions on PET-CT made the final diagnosis of SAPHO syndrome.

Myositis Ossificans Mimics an Osteoid Osteoma

Abstract:Myositis ossificans is a form of heterotopic bone formation that is caused most commonly by a traumatic injury. In the active phase, it shows intense uptake on a Tc-99m MDP bone scan, and its extraosseous location is usually evident from planar images alone. However, if it is small and very

An efficient and aseptic preparation of “sodium fluoride (18F) injection” in a GMP compliant facility

"Sodium fluoride ((18)F) injection" is an isotonic NaCl solution containing [(18)F]NaF to be used as bone imaging agent. Although its NDA was approved by the US FDA in 1972, it has not been commercially available since 1975 due to mostly the popularity of (99m)Tc-MDP. Recently, advances in PET/CT technology and the often interrupted (99m)Tc supply have led to the renewed interest in the use of [(18)F]NaF to detect bone metastases in cancer patients. This report introduces an efficient, low-cost and aseptic preparation of "Sodium fluoride ((18)F) injection" for PET scan. (18)F-Fluoride in target water from cyclotron was adsorbed onto four different forms of anion-exchange resins then desorbed by isotonic NaCl solution into the product vial. One of the resins that yielded the product at the suitable pH was used for the aseptic preparation. The components for this setup, including stopcocks, extension tubes, etc., were all single-use, individually packed and sterile. The process was done in a lead-line isolator maintained in grade A (PIC/S) aseptic condition. The quality of the obtained "Sodium fluoride ((18)F) injection" was analyzed according to its monograph in the European Pharmacopoeia (EP). The resin in the chloride form yielded the product of pH 6.7 and was chosen for the subsequent preparation. The radiochemical yield was quantitative. The product met all criteria specified in EP, including biological, physical and chemical specifications. This method is an efficient, space-saving and extremely low-cost operation that easily performed in an aseptic environment meeting GMP standard. The quality of the "Sodium fluoride ((18)F) injection" so yielded meets EP specifications. This setup provides hospital with facility meeting GMP standard a cost effective and efficient method for "Sodium fluoride ((18)F) injection" production without the need for the expensive automatic module and extra QC instrument.

Intravenous Bisphosphonate Therapy Does Not Acutely Alter Nuclear Bone Scan Results

Introduction Theoretically, the bisphosphonates used to treat metastatic bone disease could influence the results of nuclear bone scans which use the structurally similar technetium 99m methylene diphosphonate (99mTc MDP). A prospective clinical study was designed to explore this hypothesis. Patients and Methods Patients with metastatic breast cancer receiving intravenous bisphosphonate (IVBP) therapy who had ≥3 osseous lesions on nuclear bone scan were eligible. A baseline bone scan (number 1) was performed as clinically indicated and IVBP with zoledronic acid was administered within 72 hours. A second bone scan (number 2) was performed within 72 hours of zoledronic acid dosing. Both bone scans were reviewed in a blinded fashion and assessed for changes in the number and intensity of osseous lesions. Ten patients were planned to yield at least 30 lesions. Results Ten patients were enrolled. One patient withdrew consent and 1 was excluded due to protocol deviation. Among the 8 patients were 163 assessable osseous lesions. The median time from bone scan number 1 to IVBP was 1 day (range, 1-2 days). The median time from IVBP to bone scan number 2 was 2 days (range, 1-3 days). The paired imaging showed no changes in the total number of bone metastases. One hundred sixty-one lesions were identical in both scans; in 1 patient there were 2 lesions that were discordant, one more intense, the other less intense. Conclusion These data do not support the hypothesis that IVBP therapy interferes with bone scan results.

Tc-99m MDP Uptake on Bone Scintigraphy by a Giant Rhabdomyosarcoma Involving the Lower Extremity in an Elderly Woman

Tc-99m MDP Uptake on Bone Scintigraphy by a Giant Rhabdomyosarcoma Involving the Lower Extremity in an Elderly Woman

Spindle Cell Sarcoma Degeneration of Giant Cell Tumor of the Knee, Imaged With F-18 FDG PET-CT and Tc-99m MDP Bone Scan

Abstract:Giant cell tumor is a benign but aggressive bone tumor that occurs in young adults ages 20 to 40, accounts for 20% of benign bone tumors, occurs mostly in the metaphyso-epiphyseal region of long bones, and is characterized by the presence of multinucleated giant cells. The risk of malignant

Diagnosis of Acute Osteomyelitis in Previously Irradiated Bone

Abstract: We are reporting a case of acute osteomyelitis in previously irradiated bone. In nonirradiated bone the diagnosis of acute osteomyelitis is established by the mismatch between focal indium-111 whole body scintigraphy (WBC) bone uptake and bone marrow replacement as seen on the Tc-99m sulfur colloid scans in areas of acute osteomyelitis. In previously irradiated bone, the bone marrow is absent due to radiation effects. Accordingly, the combination of indium-111 WBC and Tc-99m sulfur colloid mismatch cannot be implemented. In this case, we found that in spite of previous irradiation of the bone there is uptake in the bone matrix due to cortical and osteoblastic activity as seen on the Tc-99m MDP bone scan. For this reason we are recommending that for the diagnosis of acute osteomyelitis in previously irradiated bone, dual isotope imaging using indium-111 WBCs and Tc-99m MDP is more accurate than indium-111 WBCs and Tc-99m sulfur colloid.

Tc99m MDP bone SPECT in a case of osteomyelitis of the skull

A seven-year-old male child presented with swelling at the left temporal region. His skull X-ray was normal. A three-phase bone scan showed increased blood flow, soft tissue activity, and increased tracer concentration in the left temporal region. Single photon emission computed tomography (SPECT) imaging of the skull revealed full thickness involvement of the left temporal bone. Our case report shows that, in osteomyelitis of the skull, SPECT imaging provides significantly more information for identifying the extent and thickness of bone involvement.

Use of 99mTc-MDP SPECT for assessment of mandibular growth: development of normal values

Planar scintigraphy using (99m)Tc-labeled methylene diphosphonate ((99m)Tc-MDP) has been established as a method for evaluating mandibular growth and asymmetry. However, (99m)Tc-MDP single photon emission computed tomography (SPECT) provides improved image contrast and quantitative capability potentially allowing the clinician to make a more accurate assessment of the stage of activity of normal and asymmetric mandibular growth. The purpose of this study was to utilize (99m)Tc-MDP SPECT in normal subjects to develop a standardized approach to imaging the mandible that could subsequently be used to evaluate patients with potential for mandibular growth abnormalities. Thirty-two patients (22 females, 10 males, 8-25 years of age, mean of 14 years) having (99m)Tc-MDP bone scans (7.4 MBq/kg, maximum of 518 MBq) for indications not involving the head were asked to have an additional SPECT that included the mandibular condyles. Internal (clivus) and external (source of known activity included within the field of view) standards were both investigated. Two- and three-dimensional (2-D and 3-D) regions of interest (ROI) were drawn over each condyle and the clivus in a single slice containing the maximum pixel value within the structure. A 3-D ROI was also drawn about the external standard. Maximum and average pixel values within the 2-D and 3-D ROIs were recorded. Correlation analysis indicated that essentially the same information was obtained whether the maximum or average pixel value within a 2-D or 3-D ROI was used. The right to left ratio provided a parameter that can be used to assess the magnitude of mandibular metabolic asymmetry. Use of an external standard provides the potential for quantifying condylar uptake for assessment of the activity of mandibular growth. Normal ranges for different age groups were determined for condylar uptake using both internal and external standards. (99m)Tc-MDP SPECT provides a quantitative method for assessing mandibular condylar uptake as a reflection of the activity of mandibular growth. The maximum pixel value of a 2-D ROI using external standardization and the right to left ratio of the condylar uptake provide the potential for quantitative evaluation of patients with mandibular asymmetry. These parameters will be further evaluated in an upcoming clinical investigation.

Discordant findings in patients with non-small-cell lung cancer: absolutely normal bone scans versus disseminated bone metastases on positron-emission tomography/computed tomography

At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. The objective of our study was to compare the sensibility of the 2-deoxy-2-[18F] fluoro-d-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for the detection of bone metastasis in patients with non-small-cell lung cancer (NSCLC) whose technetium 99m methylenediphosphonate (Tc-99m MDP) bone scans were absolutely normal. This study based on the retrospective analysis of 95 consecutive patients with histologically proven NSCLC who underwent F-18 FDG PET/CT and Tc-99m MDP bone scan at the Eskişehir Osmangazi University School of Medicine, Department of Nuclear Medicine between November 2006 and October 2008. Nineteen patients (19 of 95, 20%) with absolutely normal Tc-99m bone scan versus multiple high-grade F-18 FDG avid bony metastases on F-18 FDG PET/CT were selected for the review. Their ages ranged from 46 to 73 years (15 males and four females; mean: 57.2 years). Nine patients had squamous cell carcinoma, six had adenocarcinoma, three had large cell carcinoma and one had adenosquamous cell carcinoma. Tc-99m MDP bone scan that did not reveal bony abnormalities or radiotracer uptake was characteristic of benign disease (defined as absolutely normal) in these patients. Whereas, F-18 FDG PET/CT not only showed extremely disseminated heterogeneous nest-like high-grade FDG avid metastatic foci within the marrow cavity of the upper and lower thoracic spine, lumbar spine, pelvis, rib cages and bilateral proximal long bones, but also showed disseminated osteolytic bony metastases in these areas. Discordant findings of skeletal metastasis between Tc-99m MDP bone scans and F-18 FDG PET/CT imaging may be seen in 20% of the patients with NSCLC. F-18 FDG PET/CT could detect metastatic bone involvement more accurately than bone scintigraphy. Bone scans are insensitive to early bone marrow neoplastic infiltration. Assessment of glucose metabolism with FDG PET/CT can represent a more powerful tool to detect early bone metastases in lung cancer than with traditional bone scans.

Metastasis of humeral osteosarcoma to the contralateral breast detected by 99mTc-MDP skeletal scintigraphy

A rare case of osteogenic sarcoma (OGS) of the left humerus metastasizing to the right breast is presented. This lesion was detected by serendipitous observation on (99m)Tc-MDP skeletal scintigraphy that demonstrated a rounded focus just outside the skeletal outline of the right chest. The focus remained at a similar location on repeat postwash view. Clinical examination revealed a breast mass corresponding to the site of uptake, and a biopsy of this mass revealed it to be a metastasis of osteogenic sarcoma. The present case demonstrates a rare site of metastasis from OGS of the left humerus to the contralateral breast and hence is reported here as an unusual case vignette.

Tc-99m MDP Bone Scintigraphy in Septic Shock

An 8-year-old girl presented with a history of diarrhea, vomiting, and drowsiness. Clinical examination confirmed septic shock with marked metabolic acidosis. As a complication of septicemia, severe ischemia of all 4 limbs was noted from day 1 and she subsequently developed peripheral gangrene. Tc-99m MDP bone scan showed extensive bone infarction in all 4 limbs. Early diagnosis of osteonecrosis and amputation may prevent worsening of sepsis. However, it is not possible to clinically demarcate the level of amputation. Bone scan is a useful diagnostic tool in determining the appropriate level of amputation.

Lung Cancer With Solitary Bone Metastasis in the Radius

We present a 73-year-old man with a new diagnosis of right upper lung adenocarcinoma. Right elbow x-ray and Tc-99m MDP whole body bone scan were performed due to a reddish, swollen, and painful right forearm for 1 week. X-ray, performed on March 25, 2008, showed an osteolytic lesion in the proximal right radius with surrounding soft tissue swelling. Tc-99m whole body bone scan, performed on March 19, 2008, had shown a single area of intense tracer uptake in the proximal right radius and no other bony lesion was identified. Infectious processes were considered initially, but the clinical symptoms and signs didn't improve after antibiotic treatment for 10 days. Incisional biopsy of the proximal right forearm was performed for diagnosis. Histopathologic examination confirmed a bone metastasis in the proximal right radius.

Malignant Pleural Mesothelioma Presenting as Low Back Pain

Case report. We report malignant pleural mesothelioma (MPM) discovered in a Tc-99m MDP bone scan as a photopenic lesion in a 64-year-old man presenting with low back pain and diagnosed with F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Malignant pleural mesothelioma, an uncommon neoplasm with a poor prognosis, arises from mesothelial cells of the pleura. Typically, the patient presents with either chest pain or symptoms derived from a pleural effusion such as dyspnea, or both. Most cases of MPM are initially detected on chest radiographs and primarily diagnosed with a CT scan. Case study with bone scan and F-18 FDG PET/CT. The Tc-99m MDP bone scan showed a photopenic defect occupying the left side of the T11 vertebra and implicated the existence of a tumor. Pathologic analysis of the paraspinal tumor indicated metastatic neoplastic cells, which we initially suspected originated from the gastrointestinal tract. The CT and magnetic resonance imaging showed no additional information about the primary malignancy; therefore, we did an F-18 FDG PET/CT study, which suggested malignant pleural mesothelioma. The present case highlights both the value of a Tc-99m MDP bone scan when MPM presents, unusually, as low back pain, and the importance of carefully interpreting bone scan images, especially for photopenic defects. It also indicates the usefulness of F-18 FDG PET/CT study in MPM in a difficult histopathological diagnosis.

Hypertrophic Pulmonary Osteoarthropathy Diagnosed by FDG PET-CT in a Patient With Lung Adenocarcinoma

A 52-year-old man had a positron emission tomography computed tomography (PET-CT) scan for staging of a biopsy proven lung adenocarcinoma. An additional acquisition of the lower extremities was performed as the patient complained of bilateral leg pain. The PET-CT scan showed a 6.5 x 5.0 cm left upper lobe lung mass invading the mediastinum with maximal standardized uptake value of 10.7, compatible with primary lung cancer. The CT portion of the PET-CT of the legs showed extensive irregular bilateral periosteal new bone formation in the long bones. The PET images showed diffuse moderately increased FDG uptake in the periostea of the long bones of the legs, with some focal sites of more intense FDG uptake in the thicker portions of the periosteum. A bone scan showed mild hyperemia surrounding the long bones of the legs and intense Tc-99m MDP uptake in the periostea. The patient was diagnosed with hypertrophic pulmonary osteoarthropathy.

Development of an ultra-high resolution SPECT system with a CdTe semiconductor detector

The aim of this work was to evaluate an ultra-high spatial resolution SPECT system with a semiconductor detector and a high-resolution parallel-hole collimator or a pinhole collimator for small animal imaging. We evaluated an ultra-high spatial resolution SPECT system with a high-resolution parallel-hole collimator attached to a cadmium telluride (CdTe) semiconductor detector for small animal imaging. The sizes of an active area and a pixel in the semiconductor detector were 44 x 44 and 0.5 x 0.5 mm(2), respectively. In the high-resolution parallel-hole collimator the size of a hole was 0.4 x 0.4 mm(2), the thickness of a septum 0.1 mm, and the hole-length 30 mm. We also used a high-resolution pinhole collimator with a hole size of 0.3 or 0.5 mmvarphi. The physical performance of this SPECT system was evaluated with some experiments with phantoms filled with (99m)Tc-pertechnatate solution. In addition ideal performance and limitations of the system were evaluated with Monte Carlo simulations under the same geometrical conditions as in the experiments. In the evaluation for small animal imaging, we used mice that were administered with (99m)Tc-MDP. We also conducted an ultra-high resolution X-ray CT of the mice to verify the accumulated location of (99m)Tc-MDP using the bone CT images of the mice. The results of the phantom experiments showed that we could resolve 1 mmvarphi hot-channels and 1.6 mmvarphi cold-rods with the high-resolution parallel-hole collimator and pinhole collimators. We could image 0.3 mmvarphi hot-channels with the high-resolution pinhole collimators. The results of the simulations showed that the resolution limit in the pinhole imaging was about 0.6 mm FWHM. And the results of experiments with mice showed that we could reconstruct high-resolution images of (99m)Tc-MDP. Furthermore, the distribution of (99m)Tc-MDP in a mouse was found to correspond closely to the location of the bones of the mouse in reconstructions made with the ultra-high resolution X-ray CT system. Our results demonstrated that the ultra-high spatial resolution SPECT system was feasible for small animal imaging allowing a relatively long data acquisition time.

Tuberculosis of the Spine on Tc-99m MDP Bone Scan

Dedicated multislice single-photon emission computed tomography-computed tomography (SPECT-CT) is useful for accurate anatomic localization and lesion characterization of abnormal findings on planar scintigraphy. We present a case of a 33-year-old woman with a history of low back pain. Lumbar spine radiographs demonstrated irregularity of the superior end plate of L2 with an associated compression fracture. A Tc-99m MDP bone scan was performed given her young age and the absence of a history of trauma. The whole body planar imaging revealed nonspecific findings of diffuse linear increased tracer uptake involving L2. The SPECT-CT findings were in keeping with spinal tuberculosis. This was confirmed with culture of CT-guided aspiration of a left psoas collection, which revealed heavy growth of Mycobacterium tuberculosis. This case highlights the benefits of multislice SPECT-CT imaging in the anatomic localization of increased metabolic activity and provision of additional diagnostic information. This enabled rapid diagnosis and management.

Establishment of an experimental human lung adenocarcinoma cell line SPC-A-1BM with high bone metastases potency by 99mTc-MDP bone scintigraphy

Bone metastasis is one of the most common clinical phenomena of late stage lung cancer. A major impediment to understanding the pathogenesis of bone metastasis has been the lack of an appropriate animal and cell model. This study aims to establish human lung adenocarcinoma cell line with highly bone metastases potency with (99m)Tc-MDP bone scintigraphy. The human lung adenocarcinoma cancer cells SPC-A-1 were injected into the left cardiac ventricle of NIH-Beige-Nude-XID (NIH-BNX) immunodeficient mice. The metastatic lesions of tumor-bearing mice were imaged with (99m)Tc-MDP bone scintigraphy on a Siemens multi-single photon emission computed tomography. Pinhole images were acquired on a GZ-B conventional gamma camera with a self-designed pinhole collimator. The mice with bone metastasis were sacrificed under deep anesthesia, and the lesions were resected. Bone metastatic cancer cells in the resected lesions were subjected for culture and then reinoculated into the NIH-BNX mice through left cardiac ventricle. The process was repeated for eight cycles to obtain a novel cell subline SPC-A-1BM. Real-time polymerase chain reaction (PCR) was used to compare the gene expression differences in the parental and SPC-A-1BM cells. The bone metastasis sites were successfully revealed by bone scintigraphy. The established bone metastasis cell line SPC-A-1BM had a high potential to metastasize in bone, including mandible, humerus, thoracic vertebra, lumbar, femur, patella, ilium and cartilage rib. The expression level of vascular endothelial growth factor gene family, Bcl-2 and cell adhesion-related genes ECM1, ESM1, AF1Q, SERPINE2 and FN1 were examined. Gene expression difference was found between parental and bone-seeking metastasis cell SPC-A-1BM, which indicates SPC-A-1BM has metastatic capacity vs. its parental cells. SPC-A-1BM is a bone-seeking metastasis human lung adenocarcinoma cell line. Bone scintigraphy may be used as an accurate, sensitive, noninvasive tool to detect experimental bone metastases in intact live NIH-BNX mice.

Tc-99m MDP Uptake in Retroperitoneal Fibrosis

A 60-year-old man with a history of surgical resection of leiomyosarcoma of the right kidney had a bone scan to evaluate possible metastatic osseous disease. The bone scan showed significantly increased Tc-99m MDP activity in the right abdomen, corresponding to a heterogeneous mass in the right retroperitoneal region on the subsequent abdominal CT scan. These findings were initially interpreted as recurrent malignancy. However, the surgical pathology examination demonstrated that the lesion was retroperitoneal fibrosis, which was not previously known to have increased MDP uptake.