99mTc-methylene Diphosphonate Research Articles

Diagnosis and surgical treatment of primary isolated aggressive lumbar myeloid sarcoma: a rare case report and review of the literatures

BackgroundMyeloid sarcoma is a rare, extramedullary, solid tumor derived from immature myeloid cell precursors. It is most frequently accompanied by acute myelogenous leukemia, though infrequently found in non-acute myelogenous leukemia patients. The tumor may involve any part of the body, but the lumbar spine is seldom involved. The present case study aims to understand the diagnosis and surgical treatment of a rare primary isolated myeloid sarcoma of the lumbar spine causing aggressive spinal cord compression in a non-acute myelogenous leukemia patient.Case presentationA 29-year-old man complained of an aggressive radiating pain to the lower extremities and moderate dysuria with a Visual Analogue Scale score that gradually increased from 3 to 8. Lumbar enhanced magnetic resonance imaging and computed tomography revealed a lumbar canal lesion at lumbar spine L2 to L4 with spinal cord compression. A whole body bone scan with fused single photon emission computed tomography/computed tomography demonstrated abnormal 99mTc-methylene diphosphonate accumulation in the L3 lamina and spinous process. No evidence of infection or hematology disease was observed in laboratory tests.Due to rapid progression of the symptoms and lack of a clear diagnosis, decompression surgery was performed immediately. During the operation, an approximately 6.0 × 2.5 × 1.2 cm monolithic, fusiform, soft mass in the epidural space and associated lesion tissues were completely resected. The radiating pain was relieved immediately and the dysuria disappeared within 1 week. Intraoperative pathological frozen section analysis revealed a hematopoietic malignant tumor and postoperative immunohistochemistry examination confirmed the diagnosis of myeloid sarcoma.ConclusionsThe primary isolated aggressive lumbar myeloid sarcoma is rarely seen, the specific symptoms and related medical history are unclear. Surgery and hematological treatment are effective for understanding and recognizing this rare tumor.

Quantitative bone single-photon emission computed tomography imaging for uninfected nonunion: comparison of hypertrophic nonunion and non-hypertrophic nonunion

BackgroundRecently, a standardized uptake value (SUV) has been used to evaluate bone single-photon emission computed tomography (SPECT). The aim of this study was to investigate quantitative SPECT imaging of uninfected nonunion to compare hypertrophic nonunion and non-hypertrophic nonunion using volume-based parameters.MethodsWe evaluated 23 patients with uninfected nonunion who underwent SPECT acquisition 3 h after an injection of 99mTc-hydroxymethylene diphosphonate or 99mTc-methylene diphosphonate from April 2014 to November 2019. We reconstructed the acquired data and performed voxel-based quantitative analysis using the GI-BONE software. Quantitative parameters, maximum SUV (SUVmax), peak SUV (SUVpeak), and mean SUV (SUVmean) in the high and low uptake areas of nonunion were compared between hypertrophic nonunion and non-hypertrophic nonunion. The contralateral limb was used as a control, and the ratios of the quantitative parameters were calculated.ResultsThe values for the quantitative parameters (high uptake area/low uptake area, respectively), SUVmax control ratio (12.13 ± 4.95/6.44 ± 4.71), SUVpeak control ratio (11.65 ± 4.58/6.45 ± 4.64), and SUVmean control ratio (11.94 ± 5.03/6.28 ± 4.95) for hypertrophic nonunion were higher than those for non-hypertrophic nonunion (7.82 ± 4.76/3.41 ± 2.09 (p = 0.065/0.12), 7.56 ± 4.51/3.61 ± 2.23 (p = 0.065/0.22), and 7.59 ± 5.18/3.05 ± 1.91 (p = 0.076/0.23)).ConclusionsSUVmax, SUVpeak, and SUVmean control ratios obtained from bone SPECT images can quantitatively evaluate the biological activity of nonunions and may be an effective evaluation method for treatment decisions, especially the necessity of autologous bone grafting.

Patient-specific Extravasation Dosimetry Using Uptake Probe Measurements.

Extravasation is a common problem in radiopharmaceutical administration and can result in significant radiation dose to underlying tissue and skin. The resulting radiation effects are rarely studied and should be more fully evaluated to guide patient care and meet regulatory obligations. The purpose of this work was to show that a dedicated radiopharmaceutical injection monitoring system can help clinicians characterize extravasations for calculating tissue and skin doses. We employed a commercially available radiopharmaceutical injection monitoring system to identify suspected extravasation of 18F-fluorodeoxyglucose and 99mTc-methylene diphosphonate in 26 patients and to characterize their rates of biological clearance. We calculated the self-dose to infiltrated tissue using Monte Carlo simulation and standard MIRD dosimetry methods, and we used VARSKIN software to calculate the shallow dose equivalent to the epithelial basal-cell layer of overlying skin. For 26 patients, injection-site count rate data were used to characterize extravasation clearance. For each, the absorbed dose was calculated using representative tissue geometries. Resulting tissue-absorbed doses ranged from 0.6 to 11.2 Gy, and the shallow dose equivalent to a 10 cm2 area of adjacent skin in these patients ranged from about 0.1 to 5.4 Sv. Extravasated injections of radiopharmaceuticals can result in unintentional doses that exceed well-established radiation protection and regulatory limits; they should be identified and characterized. An external injection monitoring system may help to promptly identify and characterize extravasations and improve dosimetry calculations. Patient-specific characterization can help clinicians determine extravasation severity and whether the patient should be followed for adverse tissue reactions that may present later in time.

Emphysematous osteomyelitis diagnosed on Tc99m MDP SPECTCT scintigraphy: a case report

Background: Emphysematous osteomyelitis is a rare but fatal condition, caused by gas-forming bacteria. We reported a rare case of emphysematous osteomyelitis of left femur in a 27-year-old diabetic male, diagnosed on Tc99m methylene diphosphonate (MDP) single photon emission computed tomography-computed tomography (SPECT-CT) scintigraphy. The pattern of uptake in emphysematous osteomyelitis on Tc99m MDP SPECT-CT scintigraphy was not reported previously. Case Presentation: A 27-year-old diabetic male patient presented with history of pain in left thigh and fever for 10 days. He was referred to nuclear medicine department for Tc99m MDP bone scan. He had no history of trauma or surgery, and his radiograph of left femur was unremarkable at presentation. Tc99m MDP SPECT-CT scintigraphy showed abnormal uptake in femur with intraosseous air, pathognomic of emphysematous osteomyelitis. Further imaging by magnetic resonant imaging (MRI) showed edematous changes in the musculature of left thigh with marrow replacement changes in left femur favoring the diagnosis of emphysematous osteomyelitis. However, no bacterial growth was detected on blood culture due to prior administration of intravenous antibiotics. Conclusion: Tc99m MDP SPECT-CT scintigraphy is helpful in diagnosis of such rare conditions like emphysematous osteomyelitis, in addition to common pathologies of bone. Furthermore, this report is helpful for nuclear physicians to know about the pattern of uptake on planner bone scan and SPECT-CT images in such a rare infection of bone, by gas forming bacteria.

Unusual Case of Neuroblastoma with Only Growth Plate Metastasis in Bilateral Lower Limbs on Metaiodobenzylguanidine Scintigraphy.

Neuroblastoma is the most common extracranial solid tumor in childhood developing from primitive neural crest cells. I-131-metaiodobenzylguanidine (MIBG) a norepinephrine analog is highly sensitive and specific to identify primary and distant metastatic sites. We report the case of a 2-year-old female child with progressively increasing abdominal distention. Computed tomography (CT) revealed a large mass lesion involving the right suprarenal region with no hepatic or lymph node metastasis. No obvious skeletal abnormality was detected on the whole-body skeletal survey and Tc-99 m-methylene diphosphonate bone scan to suggest metastasis. I-131-MIBG scintigraphy with single-photon emission computerized tomography-CT showed MIBG-avid primary tumor in a suprarenal location with bilateral lower limbs growth plate as the only site of metastasis.

Comparison of irregular flux viewer system with BONENAVI version for identification of Tc-99m MDP whole body bone scan metastasis images.

The Tc-99m methylene diphosphonate (MDP) whole body bone scan (WBBS) has been widely accepted as a method of choice for the initial diagnosis of bone and joint changes in patients with oncologic diseases. The WBBS has shown high sensitivity but relatively low specificity due to bone variation. This study aims to use the self-developing irregular flux viewer (IFV) system to predict possible bone lesions in planar WBBS. The study uses gradient vector flow (GVF) and self-organizing map (SOM) methods to analyze the blood fluid-dynamics and evaluate hot points. The evaluation includes a selection of 368 patients with bone metastasis from prostate cancer, lung cancer and breast cancer. Finally, we compare IFV values with BONENAVI version data. BONENAVI is a computer-assisted diagnosis system that analyzes bone scintigraphy automatically. The analysis shows that the IFV system achieves sensitivities of 93% for prostate cancer, 91% for breast cancer, and 83% for lung cancer, respectively. On the other hand, our proposed approach achieves a higher sensitivity than the results of BONEVAVI version 2.0.5 for prostate cancer (88%), breast cancer (86%) and lung cancer (82%), respectively. The study results demonstrate that the high sensitivity and specificity of the IFV system can provide assistance for image interpretation and generate prediction values for WBBS.

Normal Skeletal Standardized Uptake Values Obtained from Quantitative Single-Photon Emission Computed Tomography/Computed Tomography: Time-Dependent Study on Breast Cancer Patients.

Aim:To estimate the standard uptake values (SUVs) of Tc-99m methylene-diphosphonate (Tc-99m MDP) from normal skeletal sites in breast cancer patients using quantitative single-photon emission computed tomography (SPECT).Materials and Methods:A total of 60 breast cancer patients who underwent Tc-99m MDP SPECT/CT study at different postinjection acquisition times were included in this study. Based on postinjection acquisition time, patients were divided into four study groups (n_15 each), i.e. Ist (2 h), IInd (3 h), IIIrd (4 h), and IVth (5 h). Image quantification (SUVmax and SUVmean) was performed using Q.Metrix software. Delineation of volume of interest was shaped around different bones of the skeletal system.Results:The highest normal SUVmax and SUVmean values were observed in lumber and thoracic vertebra (8.89 ± 2.26 and 2.89 ± 0.58) for Group I and in pelvis and thoracic (9.6 ± 1.32 and 3.04 ± 0.64), (10.93 ± 3.91 and 3.65 ± 0.97), (11.33 ± 2.67 and 3.65 ± 0.22) for Group II, III and IV, respectively. Lowest normal SUVmax and SUVmean values were observed in humerus and ribs (3.22 ± 0.67 and 0.97 ± 0.18), (5.16 ± 1.82 and 1.18 ± 0.16) for Group I, IV, and in humerus (3.17 ± 0.58 and 0.85 ± 0.26), (3.98 ± 1.12 and 1.04 ± 0.28) for Group II and III, respectively. Significant difference (P < 0.05) noted in SUVmax for sternum, cervical, humerus, ribs, and pelvis with respect to time. However, significant difference (P < 0.05) noted in SUVmean for all skeletal sites with respect to time.Conclusions:Our study shows variability in normal SUV values for different skeletal sites in breast cancer patients. Vertebral bodies and pelvis contribute highest SUV values. Time dependency of SUVs emphasizes the usefulness of routinely acquired images at the same time after Tc-99m MDP injection, especially in follow-up studies.

Clinical Use of Quantitative Analysis of Bone Scintigraphy to Assess the Involvement of Arthritis Diseases in Patients with Joint Symptoms.

We aimed to compare the diagnostic ability of quantitative analysis of bone scintigraphy with that of visual analysis for identifying arthritis disease involvement in patients with joint symptoms. We retrospectively included 93 patients with joint symptoms who underwent Tc-99m methylene diphosphonate bone scintigraphy for evaluating arthritis disease involvement. Bone scintigraphy images were visually and quantitatively analyzed using an in-house software by two reviewers. On quantitative analysis, joint uptake ratio was measured for 64 joints in 14 joints areas. The inter-rater agreement of visual and quantitative analyses was assessed, and diagnostic abilities were compared based on the area under the receiver operating characteristic (ROC) curve (AUC) values. Regarding visual analysis, there was a moderate degree of inter-rater agreement (kappa coefficient of 0.597), while there was a substantial inter-rater agreement (concordance correlation coefficient of 0.987) in the measurement of the joint uptake ratio. The comparisons of ROC curves for the total 5941 joints revealed that the joint uptake ratio had a significantly higher AUC value (0.789) to detect the affected joint than that of the visual analysis (p < 0.001). Quantitative analysis using joint uptake ratio showed substantial reproducibility and higher diagnostic ability to detect joints involving arthritis diseases than visual analysis on bone scintigraphy.

Influence of Internal Thoracic Artery Harvesting on Sternal Osteoblastic Activity and Perfusion.

The purpose of this study was to assess the sternal osteoblastic activity and perfusion in the early period after a coronary artery bypass graft (CABG) using single-photon emission computed tomography (SPECT) and three-phasic dynamic scintigraphy (3PDS) with 99mTc methylene diphosphonate (MDP). Methods: The study group consisted of 57 male patients that were 57.3 ± 6.6 years of age. Thirty-six of them were randomized into two groups: in group I (n = 18), the internal thoracic artery (ITA) was skeletonized, and in group II (n = 18), the ITA was pedicled. All the patients in groups I and II underwent an off-pump CABG using 1.7 ± 0.3 grafts, including one anastomosis of the ITA to the left anterior descending coronary artery. The control group III (n = 21) consisted of patients that underwent mitral valve repair surgery, in whom the sternotomy without the ITA harvesting was performed. The 3PDS and SPECT of the thorax with 99mTc MDP were performed 2 weeks after surgery. Results: The sternal phosphates uptake in group I was approximately twice as high as in group II and approximately 1.5 times higher than in group III (p < 0.05). The MDP uptake asymmetry after the ITA skeletonization was the same as in the group with both intact ITAs. In contrast, after the pedicled ITA harvesting, the osteoblastic activity of the ipsilateral side of the sternum was lower than in the contralateral one. There was no statistically significant difference in scintillation count in the xiphoid process between groups I and II (p > 0.05); however, we observed a significant difference in the manubrium and body (p < 0.05). Conclusion: The main factor that improved the sternal perfusion after a CABG was the preservation of branches supplying the sternum using the skeletonization technique of ITA harvesting.

Diagnostic performance of whole-body SPECT/CT in bone metastasis detection using 99mTc-labelled diphosphate: a systematic review and meta-analysis

To evaluate the diagnostic performance of whole-body (WB) integrated single photon emission tomography (SPECT)/computed tomography (CT) in detecting bone metastasis (BM) and to investigate whether WB-SPECT/CT offered any additional benefit value compared to planar bone scintigraphy (PBS) with 99mTc-hydroxy-methylene diphosphonate or 99mTc methylene diphosphonate. Medline, EMBASE, SCOPUS, Web of Science, and CINAHL were searched systematically up to 28 August 2019. All studies using histopathological analysis and/or follow-up imaging and clinical data as the reference standard were eligible for inclusion. Eleven studies (1,611 patients) were analysed. Based on patient analysis, the sensitivity, specificity, and area under the curve (AUC) of WB-SPECT/CT were 92% (92% confidence interval [CI], 89-95%), 95% (95% CI, 94-96%), and 0.9835, respectively, in the case of negative equivocal findings for BM, and 94% (95% CI, 91-96%), 94% (95% CI, 92-95%), and 0.9790, respectively, when regarded positive. On a lesion basis, these parameters were 91% (95% CI, 89-94%), 96% (95% CI, 94-97%), and 0.9906, respectively, in the case negative equivocal findings, and 92% (95% CI, 89-94%), 95% (95% CI, 94-97%), and 0.9898, respectively, when regarded positive. Comparing 1,265 patients from eight studies, higher sensitivity (92% versus 74%, p=0.04) and specificity for WB-SPECT/CT against PBS (93% versus 80%, p=0.01) in the case of positive equivocal findings; however, when regarded negative, WB-SPECT/CT demonstrated higher sensitivity (91% versus 70%, p=0.01), but no significant difference was apparent in specificity (94% versus 89%, p=0.07). Compared to PBS, WB-SPECT/CT had superior diagnostic accuracy in BM detection and exhibited a more reliable performance with less equivocal results.

Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis.

Radionuclide whole-body bone scan is a useful investigation of choice to detect the skeletal metastases in prostate cancer. It is indicated in patients having elevated serum prostate-specific antigen (Sr. PSA) or patients with bone pain. Elevated Sr. PSA levels have high predictive value for skeletal metastases; however, there is no consensus regarding cut-off value of Sr. PSA above which bone scan is indicated. This study was performed to find out the accuracy of Sr. PSA test and to know the optimal cut-off value of Sr. PSA with high sensitivity and specificity in the prediction of skeletal metastases on bone scan in prostate cancer patients. A retrospective analysis of medical records of 307 prostate cancer patients referred to the department of nuclear medicine for bone scan between June 2009 and June 2014 was done. Of 307 patients, 15 cases were excluded due to nonavailability of Sr. PSA. Bone scan was performed 3 h after administration of 20 mCi Tc-99m methylene diphosphonate intravenously. Whole-body sweep imaging was performed and spot views were taken wherever required. Of 292 cases, 174 (59.58%) patients had positive bone scan for metastases and 118 (40.41%) patients had negative bone scan for metastases. Maximum and minimum Sr. PSA levels in positive and negative bone scan patients were 1260 and 0.02 ng/ml and 198.34 ng/ml and 0.01 ng/ml, respectively. On comparison of the mean Sr. PSA levels between positive and negative groups, we found significant Sr. PSA levels (P < 0.05). We used receiver operating characteristic (ROC) curve analyses to find out the accuracy of Sr. PSA test and to know the optimal cut-off value of Sr. PSA with maximum sensitivity and specificity in the prediction of skeletal metastases on bone scan. Area under ROC curve was 0.878 (87%). This indicates that the accuracy of Sr. PSA test in the prediction of skeletal metastases on bone scan was good. The optimal cut-off value of Sr. PSA in the prediction of positive bone scan for skeletal metastases in the management of prostate cancer was 29.16 ng/ml, with sensitivity and specificity of 89.0% and 74.6%, respectively. In this study, we conclude that the accuracy of Sr. PSA test in the prediction of skeletal metastases is good. ROC-derived optimal cut-off value of Sr. PSA for positive skeletal metastases on bone scan is >29.16 ng/ml; thus, the chances of getting positive bone scan for skeletal metastasis are less in prostate cancer patients with Sr. PSA <29.16 ng/ml. ROC-derived sensitivity and specificity of different possible cut-off points of Sr. PSA help reduce the false positive results and increase the diagnostic accuracy of bone scan in the detection of skeletal metastases in prostate cancer patients.

The one-in-all diagnostic value of 99mTc-MDP bone scan combining with single-photon emission tomography (SPECT)/CT imaging in spinal osteoblastoma

BackgroundOsteoblastoma (OB) is an intermediate lesion, which makes the accurate preoperative diagnosis very important. 99mTc-methylene diphosphonate (99mTc-MDP) bone scan and SPECT/CT imaging were evaluated for their diagnostic value in spinal OB.MethodsThis study was a retrospective analysis of patients with spinal OB lesions confirmed by pathology and diagnosed with bone scan and SPECT/CT for preoperative diagnosis from January 2008 to December 2018. The uptake levels of OB on planar bone scan were divided into low, medium, and high groups by visual assessment referring to the uptake of the normal rib, spine, and bladder. X-ray, CT, MRI, bone scan, and SPECT/CT imaging of the patients were analyzed for characteristics summary.ResultsTwenty-five patients were diagnosed for spinal OB (17 males and 8 females with a proportion of 2.1:1), and the average age was 26.8 ± 10.8 years (range 5~59). There were 8 lesions located in the cervical, 6 in the thoracic, and 11 in the lumbar vertebrae. Twenty-four lesions involved posterior elements, especially the pedicles (14/25). Symptoms were predominantly painful with a duration of 18.3 ± 13.9 months (range 0.5~60 months). The lesion size ranged from 9 to 35 mm. All the lesions were low to high uptake in the planar bone scan, and the percentages of low to high levels were 1 (4%), 8 (32%), and 16 (64%) cases.ConclusionsSpinal OB mainly involved the posterior area, and elderly patients should be considered as well. SPECT/CT combined the characteristics of bone uptake and anatomical features of bone tumors, proving its one-in-all diagnostic value for spinal OB and other osteogenic tumors.

Imaging with radiolabelled bisphosphonates.

Radiolabeled bisphosphonates were developed in the 1970s for scintigraphic functional imaging of the skeleton in benign and malignant disease. Tracers such as 99mTc-methylene diphosphonate, that map focal or global changes in mineralization in the skeleton qualitatively and quantitatively, have been the backbone of nuclear medicine imaging for decades. While competing technologies are evolving, new indications and improvements in scanner hardware, in particular hybrid imaging (e.g. single photon emission computed tomography combined with computed tomography), have allowed improved diagnostic accuracy and a continued role for radiolabeled bisphosphonate imaging in current practice.

99mTc-Methylene Diphosphonate Uptake in Soft Tissue Tumors on Bone Scintigraphy Differs Between Pediatric and Adult Patients and Is Correlated with Tumor Differentiation.

ObjectiveTo analyze the difference in 99mTc-methylene diphosphonate (MDP) uptake on bone scintigraphy in extraosseous soft tissue tumors between children and adults and the correlation between tracer uptake and tumor differentiation and histopathology.MethodsPatients with neoplasms with MDP uptake were retrospectively identified. Based on histopathology, tumors were categorized as epithelial malignant tumors, mesenchymal tumors, blastomas and germ cell tumors. The degree of radioactivity accumulation in lesions relative to the uptake in ribs and sternum or spine was classified as “+”, “++” and “+++”. The results were compared between children and adults. The correlations between MDP uptake in soft tumors and tumor differentiation and pathology were investigated.ResultsExtraosseous soft tissue tumors that accumulated MDP were found in 33 children and 31 adults. In children, neuroblastoma was the most common extraosseous soft tissue tumor that accumulated MDP; in adults, MDP uptake was mostly found in lung cancer. MDP uptake in pediatric soft tissue tumors was higher than that in adults. MDP uptake in extraosseous soft tissue tumors with different histopathologic classifications was significantly different among 64 patients. In 41 patients with available tumor differentiation data from histopathology, MDP uptake in low or poorly differentiated soft tumors was higher than that in the moderately or well-differentiated lesions. Necrosis and/or calcifications were showed in most of pediatric and adult neoplasms.ConclusionSignificant elevations in MDP uptake in extraosseous soft tissue tumors are associated with poorly differentiated tumors in both children and adults. The mechanism of bone tracer uptake in pediatric and adult neoplasms was mostly related to necrosis and/or necrosis and calcification. The extraosseous soft tissue tumors with MDP uptake in pediatric patients were different from those in adults. In addition, consistent with the inherent degree of tumor malignancy, MDP uptake in children was higher than that in adults.

Standardized Uptake Value from Semiquantitative Bone Single-Photon Emission Computed Tomography/Computed Tomography in Normal Thoracic and Lumbar Vertebrae of Breast Cancer Patients.

Study DesignRetrospective study.PurposeThis study aims to semiquantitatively evaluate the standardized uptake value (SUV) of 99mTc-methylene diphosphonate (MDP) radionuclide tracer in the normal vertebrae of breast cancer patients using an integrated single-photon emission computed tomography (SPECT)/computed tomography (CT) scanner.Overview of LiteratureMolecular imaging techniques using gamma cameras and stand-alone SPECT have traditionally been utilized to evaluate metastatic bone diseases. However, these methods lack quantitative analysis capabilities, impeding accurate uptake characterization.MethodsA total of 30 randomly selected female breast cancer patients were enrolled in this study. The SUV mean (SUVmean) and SUV maximum (SUVmax) values for 286 normal vertebrae at the thoracic and lumbar levels were calculated based on the patients’ body weight (BW), body surface area (BSA), and lean body mass (LBM). Additionally, 106 degenerative joint disease (DJD) lesions of the spine were also characterized, and both their BW SUVmean and SUVmax values were obtained. A receiver operating characteristic (ROC) curve analysis was then performed to determine the cutoff value of SUV for differentiating DJD from normal vertebrae.ResultsThe mean±standard deviations for the SUVmean and SUVmax in the normal vertebrae displayed a relatively wide variability: 3.92±0.27 and 6.51±0.72 for BW, 1.05±0.07 and 1.75±0.17 for BSA, and 2.70±0.19 and 4.50±0.44 for LBM, respectively. Generally, the SUVmean had a lower coefficient of variation than the SUVmax. For DJD, the mean±standard deviation for the BW SUVmean and SUVmax was 5.26±3.24 and 7.50±4.34, respectively. Based on the ROC curve, no optimal cutoff value was found to differentiate DJD from normal vertebrae.ConclusionsIn this study, the SUV of 99mTc-MDP was successfully determined using SPECT/CT. This research provides an approach that could potentially aid in the clinical quantification of radionuclide uptake in normal vertebrae for the management of breast cancer patients.

Bone metabolism of the jaw in response to bisphosphonate: a quantitative analysis of bone scintigraphy images.

We examined the changes in the bone metabolism of the jaw in response to BP treatment, and we used bone SPECT-CT to analyze the site-specific bone metabolism between the jaw and other sites of bone. We compared the changes in the bone metabolism of each part of bone in response to BP treatment by performing a quantitative analysis of bone scintigraphy images between patients treated with low-dose BP for osteoporosis (LBP group; n = 17), those treated with high-dose BP for metastatic bone tumor (HBP group; n = 11), and patients with other oral disease who required bone scintigraphy, with no history of BP treatment (control group; n = 40). The study endpoint was the mean standardized uptake value (SUV) of the uptake of Tc-99m methylene diphosphonate (MDP) in each group. The mean SUVs of the HBP group were significantly lower at the axial bone of the cervical vertebra, thoracic vertebra, sternum, and rib compared to those of the LBP and control groups. The LBP group's mean SUV was significantly higher at the temporal bone, the anodontia part of the alveolar bone in maxilla, the vital teeth part of alveolar bone in the mandible, and the temporomandibular joint. There was no significant difference among the three groups at the mandibular angle and mandibular ramus. Our analyses revealed that the bone metabolism of the jaw and temporal bone in the BP-treated patients was enhanced, and no suppression of bone remodeling in the jaw by BP was observed.

Physiologic Periostitis: Erroneous presentation on 99mTc MDP bone scintigraphy - a case report

Background: Physiologic periostitis (PP) is characterized by periosteal reaction without any inflammatory condition, and with a more common presentation in pediatric age group involving long bones. It can easily be misinterpreted for a pathological process due to asymmetrical presentation in some cases. 99mTc-methylene diphosphonate (MDP) bone scintigraphy is one of the effective tools for its diagnosis as it helps to localize multiple lesions in the whole skeleton. Case Presentation: A male child, 1 month of age, was referred to the nuclear medicine department of our hospital with swelling involving the right hip for 2 weeks with no history of fever and trauma. There was a mild skin discoloration at the site of swelling along with restricted leg movements. The 99mTc-MDP bone scan (BS) showed abnormal increased uptake in the proximal and distal ends of the right femur along with increased uptake in proximal right humerus. X-ray images showed periosteal reaction involving diaphyseal ends of respective long bones, and these findings together with the patient’s history and normal biochemical profile suggested the presence of PP in this case. The patient’s condition was improved later after treatment with non-steroidal antiinflammatory drugs (NSAIDs), thus confirming our diagnosis. Conclusion: PP is one of the differential diagnoses in children presenting with pain or swelling in upper or lower limbs. As the condition is self-limiting, it is important to accurately diagnose this condition before subjecting the child to vigorous testing and treatments. Exceptional behavior of this condition on BS should also be kept in mind.

Avascular necrosis of head of femur mimicking skeletal metastasis on 99mTc MDP bone scintigraphy - a rare case report

Background: 99mTc-Methylene diphosphonate (MDP) bone scan of a patient with known breast carcinoma showed a solitary osteoblastic lesion in the femoral head. Solitary bone metastatic lesion and a benign cause-like remodeling phase of avascular necrosis (AVN) were the top most differential diagnoses and therefore can easily be misinterpreted for each other. Magnetic resonance imaging (MRI) is considered as the gold standard for diagnosis of AVN and can help in differentiation between AVN and skeletal metastasis. Case Presentation: A 40-year-old female patient of right breast carcinoma, treated with mastectomy, chemotherapy, and radiotherapy underwent 99mTc-MDP bone scintigraphy for pain in left hip with restricted movements. The bone scan showed focal uptake in the head of left femur with suspicion of AVN, which turned out to be a metastatic lesion on MRI. Later on, longitudinal follow-up of bone scan after 1 year showed a lesion in the left femoral head extending up to the trochanteric region with additional new lesions confirming skeletal metastasis. Conclusion: Solitary skeletal metastatic lesion in the head of femur is a rare finding, although in the presence of local symptoms AVN always remains at the top of the list for differential diagnosis of solitary osteoblastic focus in the femoral head. Bone scan is a primary tool for skeletal metastatic survey due to high sensitivity but due to low pathognomonic specificity, additional imaging with MRI must be considered as a safe, non-invasive, and easily available option for further characterization of solitary lesions.

Skeletal Changes in Hypoparathyroidism: X-ray to Bone Scintigraphy.

Parathyroid hormone (PTH) is a key in maintaining calcium homeostasis. Decreased PTH will result in decreased bone remodeling and increased bone density. The major cause is iatrogenic injury to parathyroid gland. X-ray and dual-energy X-ray absorptiometry are used to identify the skeletal changes. Typical skeletal changes are metaphyseal sclerosis in long bones and sclerosis of vertebrae and pelvic bones. 99mTc methylene diphosphonate scintigraphy is used to identify metabolic bone diseases. There are no typical scan findings in case of hypoparathyroidism. We like to report an interesting image of skeletal scintigraphy in case of hypoparathyroidism.

18F-Sodium Fluoride PET: History, Technical Feasibility, Mechanism of Action, Normal Biodistribution, and Diagnostic Performance in Bone Metastasis Detection Compared with Other Imaging Modalities.

The skeleton is the third most common site for metastasis overall, after the lungs and liver. Accurate diagnosis of osseous metastasis is critical for initial staging, treatment planning, restaging, treatment monitoring, and survival prediction. Currently, 99mTc-methylene diphosphonate whole-body scanning is the cornerstone of imaging to detect osseous metastasis. Although 18F-sodium fluoride (18F-NaF) was one of the oldest medical tracers for this purpose, it was replaced by other tracers because of their better physical properties, until recently. Continued development of PET scanners has opened a new era for 18F-NaF, and given its higher sensitivity, there have been increasing applications in imaging. In this review, we will discuss the history, technical aspects, radiobiology, and biodistribution of this tracer. Finally, we compare the accuracy of 18F-NaF PET with other conventional imaging methods for detection of osseous metastasis.