Bone Scintigram Research Articles

Accessory Breast Cancer: A Case Report of Carcinoma Originating from Aberrant Breast Tissue in the Axillar Region.

A 74 year-old woman with accessory breast cancer in the left axillar region had a painful mass in the left axillar region. Physical examination revealed a mass of about 3 cm in diameter with hemorrhagic ulceration of the skin. The movements of her left arm were severely limited because of the pain. A biopsy specimen showed malignant metastatic tissues, whereas the gallium scintigram and bone scintigram disclosed multiple systemic metastases. Though radical cure could not be achieved surgically, she underwent local resection of the left axillar mass to alleviate the clinical symptoms. The histopathological examinaton revealed a solid tubular adenocarcinoma combined with scirrhous type adnocarcinoma, which was compatible with that of breast cancer. Her clinical symptoms were remarkably improved after operation and then she was followed up at the outpatient clinic. However, she died of respiratory failure due to pleural metastases 10 months after operation.

Sequential changes of urinary pyridinoline and deoxypyridinoline as markers of metastatic bone tumor in patients with prostate cancer: a preliminary study

Urinary concentration of pyridinoline and deoxypyridinoline, novel markers of bone resorption, was measured serially in patients with prostate cancer as markers of metastatic bone tumor. In 11 patients, five without bone metastasis and six with bone metastasis, pyridinoline and deoxypyridinoline were serially monitored for between 6 and 24 months. All patients received some hormonal therapy with or without radical prostatectomy. Pyridinoline and deoxypyridinoline were measured by ion-paired high-performance liquid chromatography and were adjusted according to urinary creatinine concentration. The sequential changes of pyridinoline and deoxypyridinoline were compared with those of prostatic specific antigen and alkaline phosphatase as well as with the findings of bone scintigrams. During the observation periods, no metastatic bone lesion developed and no significant changes in pyridinoline and deoxypyridinoline occurred in the five patients without bone metastasis. In the six patients with bone metastasis, the levels of prostatic-specific antigen showed relatively rapid decreases after starting therapy. In contrast, the levels of pyridinoline, deoxypyridinoline and alkaline phosphatase showed transient increases followed by gradual decreases in most cases. Correlations were observed between the changes of pyridinoline and deoxypyridinoline and the findings of bone scintigrams. The data suggest that serial monitoring of pyridinoline and deoxypyridinoline could be clinically useful as markers of metastatic bone tumors and may allow less frequent bone scintigrams during patient followup.

The application of registration of bone scintigram with plain radiographs in the diagnosis and management of wrist pain

The application of registration of bone scintigram with plain radiographs in the diagnosis and management of wrist pain

A CASE OF BREAST CANCER WITH MULTIPLE BONE METASTASIS IN WHICH BISPHOSNATE WAS VERY EFFECTIVE

The case involved a 53-year-old woman there was a previous history of undergoing a right mastectomy (t1, n0) in 1983. After a disease-free interval of 10 years and 4 months, her back pain becarne worse in October 1993 and she was diagnosed as having multiple bone metastasis (without other metastases) by a bone scintigram at another hospital in May 1994. Thereafter her symptoms were gradually getting worse and eventually she could not leave bed (PS-4) in October of the same yean the patient was admitted to the hospital when C-PTHrP was as high as 66.6.pmol/L and hypercalcemia (Ca level of 15.2mg/dl) was confirmed. After admission a combination chemotherapy with bisphosphonate, duxorubicin, 5 FU, CPA, and MPA was conducted and a change in the bone metastasis picture from osteolytic to sclerotic response was observed with normalization in plasma caicium level. Eventually bone metastaticfoci disappeared. The patient has been strictly followed up on an ambulant basis in PS-O, as of about 17 months after the treatment. This paper descibes this case with a review of the literature.

骨シンチグラムにおける撮像条件と診断情報との関係

Image quality of scintigrams is influenced by several imaging conditions. But, the relationship between image quality and diagnostic information has been not clearly evaluated. Therefore the diagnostic information was evaluated visually by radiologists using bone scintigrams changing the imaging conditions : total counts, image density, and distance from collimator to patient surface. The diagnostic information was considered the point of whether normal or abnormal scintigrams and in the abnormal scintigrams, the information of abnormal position, the abnormal area and the abnormal radioactive distribution on the bone scintigrams. Analysis of variance for the diagnostic information was performed. We concluded that using our methods the relationship between imaging condition and diagnostic informaton is analyzed quantitatively and the base of imaging technique is evaluated objectively.

骨シンチグラフィにおける膝蓋骨へのいわゆる正常集積の検討

In the present study, we examined the influences of gender and ages on accumulation in the patellae on scintigram. The subjects were 828 patients who underwent bone scintigraphy during the past one and half years at the Department of Radiology, Nagoya University Hospital. Patients younger than 20 years old and those with abnormality of the patellae were excluded. The degree of accumulation in the patellae was evaluated using the A-P whole body scintigraphy in comparison with accumulation at the diaphysis of the femur and classified to two categories, “Positive” (higher accumlation than that of the diaphysis of the femur) and“Negative” (equal or lower than that of the diaphysis of the femur) . In general, the degree of accumulation was higher in females than in males. In both males and females, the degree of accumulation increased with age. A difference between the two sides in the degree of accumulation in the patellae was observed in 32% of subjects. The results of this study may serve as basic data for the interpretation of bone scintigrams.

Hypertrophic osteoarthropathy in staging skeletal scintigraphy for lung cancer

To assess the prognostic significance of hypertropic osteoarthropathy (HOA) discovered on routine staging bone scintigraphy in patients with lung cancer. Between 1989 and 1992 all 99mTc-MDP bone scintigrams performed for the staging of bronchogenic carcinoma were reviewed. HOA was diagnosed by the observation of cortical/periosteal increased uptake in the extremities of the long bones. Follow-up and confirmation of the diagnosis was obtained by hospital computer, histology records, operative records, patient notes and radiological data where available. 164 staging scintigrams for lung cancer were identified. Twenty-eight patients (17%) were observed to have HOA. Patients with and without HOA were well matched for age and sex. There was little difference in the distribution of cell type but the HOA groups has a greater incidence of peripheral tumours. There was no significance in survival between the two groups. Two of three long-term survivors had clinically overt HOA and one presented with arthralgia. HOA is often seen on skeletal scintigraphy for staging of lung cancer and has no prognostic significance. The data also support current teaching that a high index of suspicion for HOA, as a cause of arthralgia may lead to early diagnosis of a potentially resectable lung carcinoma.

Survival Rates of Patients With Metastatic Spinal Cancer After Scintigraphic Detection of Abnormal Radioactive Accumulation

This retrospective study analyzes the timing of spinal metastases and the survivability of patients with cancer after the detection of spinal metastases. To evaluate the timing of spinal metastases in primary lesions and the survivability of patients with metastatic spinal tumors. Few studies have analyzed the influence of primary lesions on survival rates of patients with metastatic spinal tumors. This is a review of bone scintigraphy that was performed serially in patients with pulmonary cancer, breast cancer, prostatic cancer, cervical cancer, renal cancer, and gastric cancer from 1980 to 1991. To exclude false positive cases, the spinal areas showing abnormal accumulation on bone scintigrams were further examined by other methods of diagnostic imaging. The timing of scintigraphic detection of spinal metastases and the survivability were studied in 425 patients with spinal metastases. The survivability after spinal accumulation was determined by the Kaplan-Meier survival curve. The mean period, from the diagnosis of the primary lesion to the detection of abnormal accumulation in the spine, was shortest in pulmonary cancer (3.6 +/- 6.1 months), and it was longest in breast cancer (29.4 +/- 33.5 months). The 1-year survival rate was high in breast cancer (78%) and prostatic cancer (83%), and it was low in pulmonary cancer (22%) and gastric cancer (0%), respectively. The 6-month survival rate of gastric cancer was 15%. When managing metastatic spinal tumors, it is essential to select therapeutic methods based on adequate consideration of the features of primary lesions and the expected prognosis.

Urinary bladder herniation into the scrotum. Incidental demonstration on bone scintigraphy.

Bone scintigraphy was performed for staging in a patient with prostate carcinoma. Physical examination revealed an enlarged scrotum and inguinal hernia. The bone scintigrams demonstrated wide-spread bony metastases, as well as dense accumulation of activity in the scrotum that appeared contiguous with the urinary bladder. A radiocontrast cystogram confirmed herniation of the urinary bladder into the scrotum.

Focal areas of increased renal tracer uptake on bone scans can mimic metastases in the lower ribs

Focal renal concentration of radioactivity can simulate metastatic deposits in the lower ribs on bone scintigrams. 400 consecutive bone scintigrams were reviewed for focal areas of increased tracer activity in the kidneys. 62 patients (15.5%) had at least one renal hot spot. In 42 of these 62 patients (67.7%) there was an increased focal uptake in the left kidney (18 upper pole, 18 middle pole and six lower pole). 50 out of 62 bone scans (80.7%) showed increased activity in the right kidney (14 upper pole, 32 middle pole and four lower pole). With the incidence of focal areas of activity in the upper poles of the kidneys being 8%, the interpretation of a single focal abnormality projected over the lower ribs should be made with particular care, especially in cancer patients.

THE VALUE OF SKELETAL SCINTIGRAPHY IN PREDICTING THE NEED FOR REVISION SURGERY IN TOTAL KNEE REPLACEMENT

We have reviewed the results of 99mtech-netium-methylene diphosphonate (Tc-MDP) bone scintigrams performed on patients following total knee arthroplasty. In addition, 67gallium (Ga) citrate scintigrams were carried out sequentially on 29 patients. Three groups of patients were identified: those with asymptomatic knees (undergoing scans for other reasons); those with aseptic or septic loosening; and those with pain without radiologic evidence of loosening. There was good correlation between the results of the scans and the final outcome. We conclude that sequential 99mTc-MDP and 67Ga citrate scintigrams are useful for demonstrating the presence of aseptic and septic loosening in knee prostheses, and pain with a normal scan appearance is probably not due to loosening or infection.

Quantitative Bone Scintigraphy in Patients with Prostatic Carcinoma Treated with LH-RH Analogues

In 14 men with prostatic carcinoma, quantitative scintigraphy of the vertebrae from Th10 to L5 was performed before and 2 weeks and 2 and 6 months after start of treatment with luteinizing hormone-releasing hormone (LH-RH) analogues. Serum prostate-specific antigen (PSA) was also determined. The patients with normal bone scintigram showed no change in gamma camera count rate during the study, but fall in PSA values. The patients with abnormal bone scintigram responded to treatment with flare phenomenon, with increased count rate at 2 weeks, followed by fall to pretreatment level at 2 months. PSA showed decrease as early as 2 weeks after the start of treatment. Bone scintigraphy was found to be useful before therapy, especially in patients with elevated PSA levels, and after 2 months, when the flare phenomenon had subsided. Serial measurement of PSA provided a guide to disease activity.

Observer variation in the interpretation of bone scintigraphy

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent κ values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, κ values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

A case of non-insulin-dependent diabetes mellitus with vertebral osteomyelitits: usefulness of imaging diagnosis

A 63-year-old woman with NIDDM poorly controlled by insulin therapy was admitted to our hospital because of fever and severe lumbago. Laboratory data revealed diabetic ketosis and a hypercoagulable state with infection. Bone and gallium scintigrams revealed an abnormal accumulation of the isotopes at L4–L5, where magnetic resonance imaging showed inflammatory changes. The patient was then diagnosed as having pyogenic vertebral osteomyelitis. Antibiotic chemotherapy and the administration of gebexate mesilate improved the inflammation and hypercoagulable state. When diabetic patients suffer from severe lumbago with sustained fever, and show segmental knock pain along the spine, pyogenic vertebral osteomyelitis should be considered. Bone and gallium scintigrams, and MRI are of clinical value for the early diagnosis of the disease.

Clinical study on prognosis of metastatic prostate cancer based on extent of disease on pretreatment bone scintigraphy.

The pretreatment bone scintigrams of 58 patients with prostate cancer with bone metastasis were reviewed and the prognostic value of the initial extent of bone involvement was compared with that of other pretreatment characteristics. The extent of bone metastasis revealed by the scan was related to survival. The serum level of alkaline phosphatase at pretreatment and pathological grade also had some predictive value. Although the pathological grade of primary tumours was related to prognosis, the survival of patients with the same histological grade differed according to the initial extent of disease; patients with extensive disease along with raised serum alkaline phosphatase (twice or more as high as the cut-off value) had poorer prognosis than did those with lower alkaline phosphatase or smaller extent of disease. The extent of bone involvement in combination with serum alkaline phosphatase level therefore apparently has higher prognostic value than does disease extent alone.

Incidental Demonstration of Hepatic Amebic Abscess by Triple-Phase Bone Scintigraphy

A 21-year-old male presented with a 2-month history of right shoulder pain and intermittent fever. Radiographs of the right shoulder were normal. A triple-phase bone scintigram showed no abnormalities in the shoulder, but the flow and blood pool images demonstrated an avascular area in the high, right upper quadrant which was ultimately found to be a hepatic amebic abscess. Although abdominal pain is the most common presenting symptom of hepatic amebic abscess, shoulder pain associated with an immobile diaphragm may also occur

ＲＡ骨盤部骨折の検討

Twenty-three RA cases with one or more pelvic fractures are reported. All cases were females and were observed to have osteoporosis due to rheumatic disease, disuse and prolonged use of steroids. In many cases they had histories of surgery in the lower limbs. 8 cases were traumatic fractures and 15 cases were stress fractures. The site of fracture was mostly the symphysial surface of the pubis and ischium, and pubic rami. It was often difficult to diagnose pelvic fractures in RA cases at an early stage because in many cases the fracture line was unclear on plain X-P. Bone scintigram and the amount of alkaline phosphatase in plasma were useful for early diagnosis of these fractures. After bed-rest of several weeks duration the clinical result of all patients were judged to be good.

The role of the vertebral veins in the dissemination of prostate carcinoma

A total of 75 prostate cancer and 67 lung cancer patients with positive bone scintigrams were studied. The patterns of spread of tumors to various bones were different between the 2 groups. The differences in the distribution of bony metastases between the prostate and lung are explained by the role of Batson's vertebral venous plexus.

A CASE OF VON RECKLINGHAUSEN'S DISEASE WITH BREAST CANCER

A case of von Recklinghausen's disease with breast cancer is reported. 45-year-old woman was admitted to our hospital 7 months after she noted a tumor in her left breast. The preoperative classification was T2N1bM0, Stage II. Standard radical mastectomy was carried out. Postoperative adjuvant chemotherapy could hardly be performed. The patient complained of lumbago 6 months after the operation, and a bone scintigram showed multiple bone metastasis. The reasons for the advanced stage and poor postoperative course were thought to be the patient's breast tumor resembled a skin tumor and she could not understand the methods of treating her breast cancer because of her mental retardation.

A CASE OF GASTRIC CARCINOMA WITH METASTASIS TO THE TONGUE

A 77-year-old woman was seen at another hospital because of discomfort of the tongue and was admitted to the hospital with a suspecion of carcinoma of the tongue. There was a previous history of undergoing total gastrectomy with splenectomy for a gastric carcinoma of type 2' (P0H0T2N1M0, Stage II, D2, and radicality of A) about one year and 8 months before. Histopathologically, the resected specimen revealed well differentiated tubular adenocarcinoma. Thereafter she had been receiving 5-FU orally at a dose of 150mg/day. Physical examination on admission showed a 3×3cm tumor on the right lateral border of the tongue, right neck lymphadenopathy and two subcutaneous tumors on the right middle abdomen. Abdominal CT examination revealed liver metastasis, and a bone scintigram showed bone metastasis. Biopsy of the tongue tumor indicated adenocarcinoma which was the same result that the primary lesion showed. In addition the both specimens were positive for CA 19-9 staining. The tumor of the tongue was diagnosed as metastasis of the gastric carcinoma. After completion of MTX/5-FU sequential therapy, the patient was discharged from the hospital and is followed on an ambulant basis.