Bone Scintigram Research Articles

Additional information from Quantitative 24-Hour99MTc-Mdp Bone Scintigraphy in Patients with Prostatic Carcinoma

Quantitative bone scintigraphy was performed at 4 and 24 h after injection of 99mTc-MDP. The lower thoracic and all the lumbar vertebrae were recorded in 37 patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months postoperatively. Fourteen patients had normal bone scintigrams. By means of the measured variation in the count rate between normal vertebrae, the criterion for a vertebra to be considered as abnormal was determined using the 4 h-uptake values. For patients with normal scintigrams the count rate at 24 h was below the 4 h level and the mean 24 h/4 h ratio was determined to be 0.85 +/- 0.09 (1 SD). Normal vertebrae in patients with skeletal metastases had only slightly lower count rate values at 24 h than at 4 h. Abnormal vertebrae showed a higher count rate at 24 h, especially two weeks postoperatively, while a tendency towards lower values than at 4 h was seen after 6 months. If the 24 h/4 h ratio is used as an extra criterion to the count rate at 4 h, the vertebrae will be more accurately defined as normal or abnormal.

Ultrasound appearances of extramedullary haematopoiesis in the liver and spleen

Extramedullary haematopoiesis is an uncommon finding in the adult patient. Many sites have been described, the liver and spleen being more common. The ultrasound appearances have not been well documented. Two cases of extramedullary haematopoiesis in the liver and spleen are presented. A 58-year-old man presented with a history of a cough, haemoptysis, dyspnoea and weight loss. On examination he had finger clubbing, no significant chest signs and hepatomegaly. A bronchial neoplasm was suspected clinically and the initial chest radiograph demonstrated a right lung mass adjacent to the hilum. Full blood count was normal and the erythrocyte sedimentation rate was raised at 52 mm/h. Bronchoscopy revealed extrinsic compression of the right upper lobe bronchus but biopsy was unsuccessful. Ultrasound examination of the abdomen demonstrated multiple echogenic lesions in an enlarged liver (Fig. 1). Some of these lesions contained central echo-poor areas. The spleen was of normal size, and contained one echogenic mass similar to those in the liver. No other abnormality was shown in the remainder of the abdomen and pelvis. The most likely diagnosis for these lesions was metastatic carcinoma. Ultrasound-guided Trucut biopsy was performed. The lesion chosen was peripheral and without any central echopoor area. Histology revealed immature and mature cells of the myeloid and erythroid series with occasional megakaryocytes. Dilated sinusoids and portal tracts contained pleomorphic infiltrate. These are the features of hepatic extramedullary haematopoiesis. An isotope bone scintigram using 99Tcm MDP revealed multiple hot spots in the femora, ribs, skull and spine, interpreted as being metastases.

Distribution of Bony Metastases in Prostatic Carcinoma

Fifty-five prostate cancer and 55 breast cancer patients with positive bone scintigrams were studied. The pattern of spread in the axial skeleton and pelvis showed differences between the 2 groups. This difference was not related primarily to bone volume at the site of metastasis. The difference in distribution of bony metastases between breast and prostate is explained by our knowledge of Batson's vertebral venous plexus.

Value of bone scanning in the follow-up of breast cancer patients

The aim of the study was to assess the value of routine bone scintigrams, independent of the primary tumor stage or the presence of symptoms, in the postsurgical follow-up of breast cancer patients for the early detection of bone metastases. For this purpose 1,000 patients with postsurgical breast cancer without previous documentation of metastatic disease, who were admitted to the special oncology hospital, Onkologische Klinik Bad Trissl, entered a prospective study in 1987-1988. The parameters followed were the TNM stage of the primary tumor, the presence of pain, bone pain as revealed by a thorough physical examination, and the patient's history for the assessment of risk factors. In addition, a whole-body skeletal scintigram, supplementary X-rays, and additional diagnostic measures were performed, if necessary, to detect bone metastases. It was shown that in 856 of 894 patients (groups 1-6) without clinical symptoms, the clinical examination and radiological and scintigraphic diagnostic measurements, demonstrating the absence of bone metastases, gave matching results, but in 12 of the 894 patients the results of all examinations remained questionable. In another 12 of the 894 patients (groups 1-3) radiological and/or scintigraphical evidence for the presence of bone metastases was found. In 14 of 79 cases (groups 7-10) with clinically suspicious symptoms these were proven to be signs of metastases by subsequent scintigrams, supplementary X-rays, and additional diagnostic measures. In 65 of the 79 patients with clinically suspicious symptoms, bone metastases could not be confirmed by obtaining bone scintigrams or X-rays while in the other 14 patients (groups 9 and 10) evidence for the presence of bone metastases was found in the scintigrams and/or X-rays. However, 10 of these 14 patients were high-risk patients for developing bone metastases as they had axillary lymph node infiltration. The other 4 patients were of the low-risk group as they had positive receptor status or no axillary lymph node infiltration at the time of primary diagnosis. In 13 of 27 patients (groups 11-14) with clinical symptoms indicating the presence of bone metastases this diagnosis was confirmed by scintigrams and/or X-rays (groups 11 and 12), while it was possible to exclude the presence of bone metastases in spite of the symptoms in 11 of the 27 patients. In the other 3 patients the results of the additional examinations remained questionable.(ABSTRACT TRUNCATED AT 400 WORDS)

Prostatic Specific Antigen and the Prediction of Prognosis in Metastatic Prostatic Cancer

Serum prostate-specific antigen (PSA) levels were studied in the EORTC trial of zoladex plus flutamide versus orchidectomy in metastatic prostatic cancer. Forty-four of 60 patients had a decrease of PSA to less than or equal to 10 ng/ml at 3 to 6 months after treatment. The combination of a PSA less than 10 ng/ml after 3 to 6 months treatment and less than 15 spots on the bone scintigram at entry gave the highest probability of not having progressed by 24 months. A rising PSA anticipated bone progression by 6 to 12 months in 13 of 28 patients (46%). The PSA at entry to the trial was related to survival; a discriminant of 300 ng/ml distinguished a poor and better risk group. The lowest level of PSA reached during the first 6 months of treatment was also a univariate survival factor.

Nonosseous accumulation of bone-seeking radiopharmaceuticals.

Bone scintigrams are usually obtained for evaluation of skeletal abnormalities; soft-tissue abnormalities are often an unexpected finding. However, the recognition of specific conditions with extraskeletal accumulation of bone-seeking radiopharmaceuticals greatly enhances the diagnostic value of the study. Several examples of abnormal nonosseous uptake in both neoplastic and nonneoplastic processes involving the brain, lung, heart, breast, bowel, liver, spleen, skeletal muscle, kidney, and bladder are presented. Examples of artifactual uptake in the soft tissues are also described. Causes for nonosseous accumulation are discussed.

Primary Non‐Hodgkin's Lymphoma of the Terminal Ileum with Enterovesical Fistula : A Case Report

A case of primary non-Hodgkin's lymphoma of the terminal ileum with enterovesical fistula is reported. A 50-year-old Malay man presented with haematuria, dysuria and per-rectal bleeding. Intravenous urogram, double contrast enema and an MDP bone scintigram showed a fistulous communication between the bladder and distal ileum. At laparotomy, a large tumour attaching the terminal ileum to the dome of the bladder was found. Histopathological examination of resected small bowel revealed a diffuse histiocytic non-Hodgkin's lymphoma of the small bowel. The bladder mucosa was shown to be normal.

Bone Imaging: Radionuclide Scan vs MRI-Reply

In Reply.— Unfortunately, the bone scan figures used in our article for the metastatic lesion of the sacrum in Fig 1 and the stress fracture of the hip in Fig 6 were transposed. The stress fracture was an anterior view on the bone scan and the sacral metastasis was a posterior view. We agree that the bone scan views as shown in the figures would have been the wrong views for the pathologic findings displayed by MRI. In fact, the correct views were obtained but were printed with the wrong corresponding MRI views. Both bone scintigrams were normal as shown in the figures. We apologize for this mishap. We stand behind our statements regarding the use of radionuclide bone scans compared with MRI. Radionuclide bone scanning is a useful and sensitive study for the global view of the skeleton. There is now well-documented evidence that radionuclide bone scans are

Technetium-99m bone scintigraphy and mandibular condylar hyperplasia

Radionuclide skeletal scintigraphy has been successfully used in the assessment of mandibular condylar hyperplasia (condylar hyperplasia) causing mandibular asymmetry to identify the presence of continued active growth in the condylar region. This study reviews 14 cases of mandibular asymmetry and concludes that symmetrical radionuclide uptake in the condylar regions on the bone scintigram excludes a continuing asymmetrical growth focus. Unilateral increased radionuclide uptake may often indicate an abnormally active condylar growth focus but false positive results may be encountered in patients with associated temporo-mandibular joint disease.

Evaluation of Intense Renal Parenchymal Activity ("Hot Kidneys") on Bone Scintigraphy

The bone scintigrams of 600 patients performed over a 12-month period were reviewed. Thirty-six demonstrated abnormalities of the urinary tract of which six cases of intense renal parenchymal activity ("hot kidneys") were found. Two cases were related to treatment with the new antineoplastic agent mitoxantrone. In one patient it was related to treatment with calcitonin. Neither of these associations has been previously reported. Recognized causes of hypercalcemia and recent radiotherapy were present in two patients. No cause could be found in the final patient.

Journal of Bone and Mineral Research

We previously described new bone formation in fluoride-treated osteoporotic patients. Since then, several investigators have contended that fluoride-induced "hot spots," as seen on bone scintigrams, represent stress fractures. To further evaluate this issue we analyzed scintigrams, radiographs, and quantitative computer tomography (CT) scans of the spine and femoral condyles from 129 patients, obtained before and during therapy. Hot spots, new or of increased intensity, were more than twice as common in the weight-bearing peripheral skeleton than in nonweight-bearing sites (p less than 0.001). The hot spots were usually diffuse, multiple, bilateral, and mostly seen early in therapy, a pattern quite different from that expected of stress fractures. Previously, we postulated that mechanical stress and fluoride act synergistically to stimulate new bone formation. If this hypothesis were correct, we would expect to see a greater increase in femoral condyle bone density in patients with hot spots. Consistent with this hypothesis, patients who developed hot spots in the knees had a greater increase in condylar density (22 +/- 2.5 vs. 9 +/- 3.3 mg/cc) than those without hot spots and stress fractures were not seen in either group. Additionally, patients with more than 5 hot spots in the peripheral skeleton had greater increases in spinal and condylar density than those with fewer than 5 hot spots. Finally, stress fractures were found in less than 2% of our patients. While we do not exclude the possibility that some additional patients may have had stress fractures, our data support the hypothesis that the great majority of hot spots seen on the scintigrams are the sites of new bone formation.

Spontaneous osteonecrosis of the knee: value of MR imaging in determining prognosis.

Sixteen patients with early and late stages of spontaneous osteonecrosis of the knee were studied to evaluate if MR imaging can be used to determine the prognosis of the disease. All patients had sequential conventional radiographs and clinical examinations, one or more 99mTc-methylene diphosphonate bone scintigrams, and an MR examination. The duration of the disease at the time of the MR examination ranged from 1 to 58 months (mean, 18 months). A relationship was identified between the pattern of bone marrow alteration noted on long TR/TE MR sequences and the scintigraphic stage and clinical course of the disease. The dimensions of the osteonecrotic region could be identified as well or better on the short TR/TE MR images than on the radiographs in all patients. MR imaging also afforded evaluation of the hyaline cartilage overlying the osteonecrotic lesion, revealing secondary osteoarthrosis in seven patients. We conclude that MR imaging in patients with spontaneous osteonecrosis of the knee may provide information of value for determining the prognosis of the disease.

Kernspintomographie des Knochenmarks bei Karzinompatienten mit einer solitären Mehranreieherung im Skelettszintigramm

Solitary abnormalities in bone scintigrams of cancer patients are a finding causing special diagnostic problems. In a prospective study the value of MRI imaging of the bone marrow was to be ascertained when compared to recognized X-ray studies, as a method of clarifying suspect bone scintigraphy findings. 25 cancer patients presenting with a solitary suspect abnormality in bone scintigrams were examined by X-rays and MRI. In 15 patients, MRI showed that metatases were the probable cause of the hot spot. In 7 patients, radiography, the routinely used method to confirm or exclude the presence of metastases, failed to detect these metastases. In the remaining 10 patients other causes of increased activity in the bone scintigrams could be demonstrated, e.g. fracture, degenerative disease, benign tumour. The results were confirmed by biopsy, operation, autopsy or follow-up. Considering the clinical consequences of the diagnosis of bone metastases, we suggest that a bone marrow MRI of the affected region should be performed to clarify the cause of a solitary hot spot in bone scintigrams of cancer patients, especially if X-ray studies are inconclusive.

同側大腿骨頭下及び転子部骨折の１症例

We report a rare case of ipsilateral fractures of the subcapital and trochanteric regions of the femur with a follow-up period of four years.The patient, a thirty-year-old woman, was injured in an automobile accident. The fractures were supposed to be produced by a so-called “dash board injury”. The subcapital and trochanteric fractures of left femur were identified radiographically. Open reduction and internal fixation with a compression hip screw and two additional screws was performed. The patient was allowed partial weight bearing at three months after the operation and full weight bearing at seven months.The hip was free of pain at last exam, and had a full range of motion. Roentgenogram and bone scintigram showed no evidence of non-union or late segmental collapse, but did shaw bone resorption of the trochanter. It is likely that the excellent result in this case was due to accurate reduction and rigid fixation at the time of operation and to careful after-treatment.

Dynamic quantitative bone scintigraphy in patients with prostatic carcinoma treated by orchiectomy

Dynamic quantitative bone scintigraphy was performed on 31 men with prostatic carcinoma before orchiectomy as well as 2 weeks, 2 and 6 months postoperatively. After injection of technetium methylene diphosphonate Tc 99m (99mTc-MDP) the count rate was recorded as serial images over the lower thoracic and all the lumbar vertebrae from 1 to 240 min post-injection. Thirteen men had normal bone scintigrams with no changes in 99mTc-MDP content at the four different investigation times. Eighteen men had skeletal metastases. Throughout the study half of the abnormal vertebrae in these patients showed an abnormal count rate after only 6 min post-injection. After 1 h it was possible in almost all abnormal vertebrae to predict abnormal bone uptake. In response to therapy a "flare phenomenon" with an increase in count rate was seen 2 weeks after orchiectomy followed by a decrease 2 months postoperatively in most of the abnormal vertebrae. The count rate decreased even below the pre-operative level after 6 months. Also, the normal vertebrae in the patients with skeletal metastases showed a tendency towards the flare phenomenon, which was not seen in patients with normal bone scintigrams.

Diagnostic value of routine bone scintigraphy renal imaging in renal cell carcinoma

Technetium-99m-phosphate compounds used in bone scanning are excreted by the kidney, and excellent renal images can be obtained on routine bone scintigrams. The preoperative bone scans of 49 patients who underwent radical nephrectomy for renal cell carcinoma between 1981 and 1985 were reviewed for renal imaging. Ninety-four percent of the patients had abnormal bone scan renal images (82 % had focal decreased uptake, and 12 % had focal increased uptake). Six percent of the renal images were symmetrical bilaterally. When bone scans are employed in the postoperative follow-up of patients with renal cancer, they can be used to assess the status of the remaining kidney.

Optimisation of density and contrast yielded by multiformat photographic imagers used for scintigraphy

The maximum optical density (MOD) and contrast (characterised by an effective gamma, gamma eff) yielded by multiformat photographic imagers used for scintigraphy, was determined by densitometry of a computer image, which consisted of a pattern of uniform squares containing known counts. A series of clinical scintigrams were photographed using various MOD and gamma eff values, and were graded by three experienced clinicians. It was found that a MOD of 1.6 and a gamma eff of 2.9 yielded optimal images for general use if bone scintigrams are also to be photographed. Lesion detectability in phantom images using extreme MOD and gamma eff values that were still clinically acceptable was determined. At very low false-positive rates (<or=1%) the higher gamma eff yielded a significantly greater lesion detectability (p=0.02) at an information density of 2200 counts cm-2 in accordance with Whitehead's theory. It is concluded that quantification and optimisation of density and contrast factors are important and that the technique described enables quality control of multiformat imagers with respect to these factors.

血管柄付同種骨移植の実験的研究 放射線学的検討 Ｉ

Among major histocompatibility complex (MHC) mismatched dogs, bone allografts of the vascularized tibia with short-term immunosuppression drugs were done.This preliminary study was divided into three groups using twelve dogs as follows:1. Allograft with Cyclosporin (CyA) in three pairs.2. Allograft with FK506 (FK) in three.3. Autograft without immunosuppression in one dog served as a control.Radiological evaluations after operation were analyzed by plane X-ray, angiogram and bone scintigram.Allograft with CyA had union at about three months as early as autograft, but allograft with FK did not have nonunion yet. Because two of three dogs given high dose of FK506 (1.0mg/kg/day) died approximately three weeks after transplantation and another dog under low dose of FK506 (0.32mg/kg/day) showed rejection by Tc-P bone scintigram. The graft rejected showed no callus formation in the plane radiogram. Bone scintigram indirected the definit process of rejection, differentiating between vascular thrombosis of the anastomosed vessel and rejection.

Incidence of Osteonecrosis in Asthmatic Children on Long-Term Steroids

Twenty-four asthmatic children ranging in age from 4 to 18 years (average 12.6 years) who had been treated with daily prednisone therapy of 10 to 60 mg/day for an average duration of 26.3 months were studied for possible early detection of bone and other steroid effects. Musculoskeletal symptoms were absent and orthopedic examinations as well as roentgenogram of the hips and shoulders were normal. Fourteen of 24 children had been on 10 mg/day for at least 1 year; and of these 14, 10 were cushingnoid and 7 children showed significant growth suppression, falling below the third percentile level when height measurements were plotted using the National Center for Health Statistics Growth Chart. For detection of early changes of osteonecrosis, bone scintigram using Technetium-99m pyrophosphate was utilized. Twenty-three patients had normal scans. One cushingoid boy with posterior subcapsular cataracts had asymmetry of uptake involving only the right humeral head on two occasions. These findings suggest that an...

血管柄付同種骨移植の実験的研究 免疫抑制剤投与中止後の早期結果 ＩＩ

We had already reported the result of the vasucularized bone allografts in dogs with immunosuppression. This paper shows the early result after withdrawal of Cyclosporin (CyA) or FK506 (FK).Dogs with CyA have got partial bone union of the end of the graft and complete bone union of the other end of the graft. After wirhdrawal of CyA, the partial bone union of the end showed bone resorption and complete bone union of the other end kept bone union in the plane radiogram. Two weeks after the graft had little uptake and fourteen weeks after it had re-uptake by bone scintigram.Dogs with FK have got non-union of the both ends of the graft, after withdrawal of FK it have still had non-union in the plane radiogram and got no uptake by bone scintigram twenty-three weeks after.