Bone Scintigraphy In Patients Research Articles

An evaluation of the diagnostic performance of the triphasic bone scintigraphy in patients suspected of aseptic total knee arthroplasty loosening

BackgroundTotal Knee Arthroplasty (TKA) is a widely conducted and successful orthopedic procedure. However, aseptic loosening, a common cause of TKA failure, necessitates revision surgery. Diagnostic accuracy of triphasic bone scintigraphy, a common imaging modality for aseptic loosening detection, remains controversial. This study investigated the diagnostic accuracy of bone scintigraphy when separately evaluated by a nuclear physicist and an orthopedic surgeon, and the interrater reliability between the two. MethodsPatients undergoing knee revision surgery due to suspected aseptic loosening at three medical centers from 2006 to 2023 were included. Relevant demographic, clinical, and procedural data were extracted from the records. The bone scintigraphy results as noted by the nuclear physicist and orthopedic surgeon were used as index test and intraoperative findings of loosening were used as reference tests. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and kappa's agreement was assessed. ResultsOut of 611 revision TKAs, 59 cases were analyzed. The nuclear physicist's evaluation of bone scintigraphy had a sensitivity of 73 %, specificity of 0 %, positive predictive value of 93 %, negative predictive value of 0 %, and diagnostic accuracy of 69 %. The orthopedic surgeon's evaluation showed higher sensitivity, specificity, positive and negative predictive values, and an accuracy of 84 %. Agreement levels were moderate (kappa = 0.46) between the nuclear physicist's and orthopedic surgeons evaluation. InterpretationThe diagnostic accuracy of bone scintigraphy for aseptic loosening is 84 % when evaluated by the orthopedic surgeon compared to 69 % for the nuclear physicist's evaluation. Kappa's agreement between the two was moderate.

Comparison Of Three Methods for Calculation of Sacroiliac Joint Index in Different Age Groups in Bone Scintigraphy

Objective: The aim of this study is to evaluate three techniques for calculating the sacroiliac joint (SIJ) index by bone scintigraphy in patients. Materials and Methods: Patients (n:160) who did not exhibit abnormalities on bone scan were analyzed and were divided into 4 groups; 3-20 years, 21-40 years, 41-60 years, 61-86 years, respectively. Irregular and rectangular region of interest (ROI) were used for first and second methods, respectively. Horizontal rectangular ROI was selected for the last technique. The SIJ index was calculated by the following formula: SIJ count/sacrum count. Results: There was no difference between the averages of all three methods according to right and left SIJ index (p>0.05). The averages of all SIJ values differed for three methods (p

Evaluation of two-dimensional total bone uptake (2D-TBU) and bone scan index (BSI) extracted from active bone metastatic burden on the bone scintigraphy in patients with radium-223 treatment.

Radium-223 is a first alpha-emitting radionuclide treatment for metastatic castration-resistant prostate cancer (mCRPC) patients with bone metastases. Although the spread-based bone scan index (BSI) and novel index of the intensity-based two-dimensional total bone uptake (2D-TBU) from bone scintigraphy may provide useful input in radium-223 treatment, they have not been evaluated in detail yet. This study aimed to fill this gap by evaluating BSI and 2D-TBU in patients treated with radium-223. Twenty-seven Japanese patients with mCRPC treated with radium-223 were retrospectively analyzed. The patients were evaluated via blood tests and bone scans at baseline and 3 cycles intervals of treatment. BSI and 2D-TBU were analyzed via VSBONE BSI in terms of correlations, response to radium-223 treatment, association with treatment completion, and the Kaplan-Meier survival analysis was performed. Nineteen patients (70.4%) completed six cycles of radium-223 treatment, whereas eight patients (29.6%) did not complete the treatment regimen. A significant difference in baseline BSI and 2D-TBU was observed between these groups of patients. Both BSI and 2D-TBU were highly correlated (r = 0.96, p < 0.001). Univariate analysis showed an association between radium-223 completion in median BSI and 2D-TBU values (p = 0.015) and completion percentage differences (91.7% vs. 45.5%; p = 0.027). The Kaplan-Meier product limit estimator showed that the median overall survival was 25.2 months (95% CI 14.0-33.6 months) in the completion group and 7.5 months (95% CI 3.3-14.2 months) in the without completion group (p < 0.001). The overall survival based on median cutoff levels showed a significant difference in 2D-TBU (p = 0.007), but not in BSI (p = 0.15). The 2D-TBU may offer advantages over BSI in classifying patients towards radium-223 treatment based on the degree of progression of bone metastases. This study supports the importance of preliminary assessment of bone metastasis status using BSI and 2D-TBU extracted from VSBONE BSI for radium-223 treatment decisions.

Cardiac [99mTc]Tc-hydroxydiphosphonate uptake on bone scintigraphy in patients with hereditary transthyretin amyloidosis: an early follow-up marker?

PurposeThere is a need for early quantitative markers of potential treatment response in patients with hereditary transthyretin (ATTRv) amyloidosis to guide therapy. This study aims to evaluate changes in cardiac tracer uptake on bone scintigraphy in ATTRv amyloidosis patients on different treatments.MethodsIn this retrospective cohort study, outcomes of 20 patients treated with the transthyretin (TTR) gene silencer patisiran were compared to 12 patients treated with a TTR-stabilizer. Changes in NYHA class, cardiac biomarkers in serum, wall thickness, and diastolic parameters on echocardiography and NYHA class during treatment were evaluated.ResultsMedian heart/whole-body (H/WB) ratio on bone scintigraphy decreased from 4.84 [4.00 to 5.31] to 4.16 [3.66 to 4.81] (p < .001) in patients treated with patisiran for 29 [15–34] months. No changes in the other follow-up parameters were observed. In patients treated with a TTR-stabilizer for 24 [20 to 30] months, H/WB ratio increased from 4.46 [3.24 to 5.13] to 4.96 [ 3.39 to 5.80] (p = .010), and troponin T increased from 19.5 [9.3 to 34.0] ng/L to 20.0 [11.8 to 47.8] ng/L (p = .025). All other parameters did not change during treatment with a TTR-stabilizer.ConclusionA change in cardiac tracer uptake on bone scintigraphy may be an early marker of treatment-specific response or disease progression in ATTRv amyloidosis patients.

Assessment of incidental cardiac uptake in bone scintigraphy across Spain. ECCINGO study

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Pfizer SLU Introduction Myocardial uptake on bone scintigraphy with diphosphonates has become a useful tool for the early detection of transthyretin cardiac amyloidosis (ATTR-CM), the prevalence of which remains unknown. Purpose To assess the prevalence of myocardial uptake in bone scintigraphy in patients without previous clinical suspicion of cardiac amyloidosis (CA). Methods Observational, retrospective, multicentre study in 21 hospitals across Spain, their reference population represented 24.38% of the total national population. All scans performed for non-cardiac reasons during the months of September, October and November 2019 were reviewed. Scans with positive cardiac uptake (Perugini scores 1-3) were evaluated by a central laboratory. Medical histories of the patients with positive uptake were reviewed. Results 9864 scans were reviewed. Cardiac uptake was observed in 71 patients (0.72%) over 18 years of age (85.90% male). According to the central laboratory assessment the distribution in the Perugini grading scale was, grade 1 (23.90%), grade 2 (29.60%) and grade 3 (46.50%). No relationship between sex and Perugini grade was observed. Heart/Contralateral ratio (H/CL) was available for 24 patients with a mean of 2.1 ± 1.1 (95% CI 1.7–2.6). A third of the patients (33.80%) also presented extracardiac uptake, being the most common: bone metastasis (7.04%) abdominal wall (5.60%) and lower limbs muscular mass (4.20%). A previous heart failure (HF) diagnosis was found in the 16.90% of the patients with positive uptake, being most of them 57.10% in NYHA class II. Patients ≤ 80 y.o. were diagnosed with heart failure earlier than patients &amp;gt; 80 y.o. (p = 0.02) and with atrial fibrillation earlier than patients &amp;gt; 80 y.o. (p = 0.05). Ten patients with cardiac uptake were subsequently diagnosed with ATTR amyloidosis (ATTR-Y) with a mean delay of 10.8 months (95% CI: 6.0–16.8). All ATTR-Y patients were &amp;gt; 70 y.o., 90.00% were male, had left ventricular hypertrophy (LVH) compared to 25.49% of patients in whom a diagnosis of ATTR (ATTR-N) was not confirmed (p = 0.00003). Patients in the ATTR-Y group presented some episode of orthostatic hypotension and involuntary weight loss in the clinical history (30.00% in both) compared to 3.77% (p = 0.025) and 5.88% (p = 0.05) of the ATTR-N group respectively. Conclusions This national study found a prevalence of 0.72% of incidental cardiac uptake in bone scintigraphies performed for non-cardiac reasons in adult patients. The results of this study bring light on the profile of the elderly patients with incidental cardiac uptake. The referral of these patients can facilitate the early diagnosis of CA with the consequent impact on the management and prognosis of patients.

Діагностична роль остеосцинтиграфії у хворих на ревматоїдний артрит при ендопротезуванні кульшових суглобів

Актуальність. Ревматоїдний артрит є одним з найбільш поширених хронічних запальних захворювань суглобів. Поширеність захворювання серед дорослого населення у різних країнах світу становить від 0,6 до 5 %. Хворіють частіше люди працездатного віку. Пік захворювання припадає на 40–50 років, при цьому жінки хворіють у 2–4 рази частіше, ніж чоловіки. Захворюваність на ревматоїдний артрит у жінок збільшується після 30 років, досягаючи найбільших показників у 45–75 років. Мета: визначити діагностичну роль остеосцинтиграфії у хворих на ревматоїдний артрит при ендопротезуванні кульшових суглобів. Матеріали і методи. Остеосцинтиграфію проводили на томографічній сцинтиляційній однодетектерній гамма-камері «Тамара-301 Т» після внутрішньовенного введення 99m-Tc-пірофосфату активністю 550–770 МБк. Результати. Усіх хворих розподілили на три діагностичні групи. До першої групи було включено 34 (45 %) пацієнтів, у яких відсоток накопичення радіофармпрепарату в проекції ураженого суглоба дорівнював +10–80 %, до другої — 27 (36 %) хворих, у яких відсоток накопичення індикатору в проекції ураженого суглобового комплексу становив +81–150 %, третя група нараховувала 13 (19 %) пацієнтів із накопиченням індикатору в проекції ураженого суглобового комплексу більше ніж +150 %. Через 1 рік після ендопротезування ураженого кульшового суглоба у хворих першої діагностичної групи післяопераційних ускладнень не зафіксовано. У 3 (11 %) пацієнтів другої діагностичної групи та 19 (30 %) пацієнтів третьої діагностичної групи через рік після ендопротезування розвинулось імплант-асоційоване інфекційне ускладнення. ­Висновки. Чим вище відсоток включення радіофармпрепарату в проекції ураженого ревматоїдним артритом суглобового комплексу при остеосцинтиграфії в доопераційний період, тим вище вірогідність виникнення післяопераційних імплант-асоційованих ускладнень після ендопротезування (p &lt; 0,05).

Reliability of Alkaline Phosphatase for Differentiating Flare Phenomenon from Disease Progression with Bone Scintigraphy.

Simple SummaryBone scintigraphy is the most widely used radionuclide technique to investigate bone metastasis, primarily due to its reasonable time and cost factor. However, it is important to recognize that bone scintigraphy to assess treatment response sometimes shows a “flare phenomenon”, which can be misinterpreted as disease progression. Distinction between flare phenomenon and disease progression could help in the decision to continue effective treatments in patients with flare phenomenon and to cease ineffective treatments and consider other salvage treatment plans in patients with disease progression. Despite many methods having been tried to answer this question, there was still no reliable way to differentiate between flare phenomenon and progression of bone metastases. Our results suggest that ALP is a useful serologic marker to differentiate flare phenomenon from disease progression on bone scintigraphy in breast or prostate cancer patients with bone metastasis.The flare phenomenon (FP) on bone scintigraphy after the initiation of systemic treatment seriously complicates evaluations of therapeutic response in patients with bone metastases. The aim of this study was to evaluate whether serum alkaline phosphatase (ALP) can differentiate FP from disease progression on bone scintigraphy in these patients. Breast or prostate cancer patients with bone metastases who newly underwent systemic therapy were reviewed. Pretreatment baseline and follow-up data, including age, pathologic factors, type of systemic therapy, radiologic and bone scintigraphy findings, and ALP levels, were obtained. Univariate and multivariate analyses of these factors were performed to predict FP. An increased extent and/or new lesions were found in 160 patients on follow-up bone scintigraphy after therapy. Among the 160 patients, 80 (50%) had an improvement on subsequent bone scintigraphy (BS), while subsequent scintigraphy also showed an increased uptake in 80 (50%, progression). Multiple regression analysis revealed that stable or decreased ALP was an independent predictor for FP (p < 0.0001). ALP was an independent predictor for FP on subgroup analysis for breast and prostate cancer (p = 0.001 and p = 0.0223, respectively). Results of the study suggest that ALP is a useful serologic marker to differentiate FP from disease progression on bone scintigraphy in patients with bone metastasis. Clinical interpretation for scintigraphic aggravation can be further improved by the ALP data and it may prevent fruitless changes of therapeutic modality by misdiagnosis of disease progression in cases of FP.

Comparison of Bone Metastases between 18F‐NaF PET/CT, 18F‐NaF PET, and Planar 99mTc‐MDP Bone Scintigraphy in Patients with Newly Diagnosed Nasopharyngeal Carcinoma

Purpose Our study aims to compare the diagnostic value of 18F-NaF positron emission tomography-computed tomography (PET/CT), 18F-NaF PET, and planar 99mTc-MDP bone scintigraphy for detection of bone metastases in patients with newly diagnosed nasopharyngeal carcinoma (NPC). Methods Our study retrospectively analyzed 58 patients with pathologically proven NPC. They all underwent both 18F-NaF PET/CT and planar 99mTc-MDP bone scintigraphy within a 7-day interval. Bone metastases were confirmed by follow-up using PET/CT, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). These three examinations were compared using per-patient-based analysis and per-lesion-based analysis. Results 19 patients (32.7%) were classified as having bone metastatic disease in their final diagnosis. The patient-based diagnostic performances (sensitivity, specificity, and overall accuracy) were as follows: 18F-NaF PET/CT (100%, 92.3%, and 94.8%), 18F-NaF PET (100%, 53.8%, and 69.0%), and planar 99mTc-MDP bone scintigraphy (78.9%, 74.4%, and 75.9%). The overall accuracy of 18F-NaF PET/CT was significantly more favorable compared to 18F-NaF PET (p=0.002) and to planar 99mTc-MDP bone scintigraphy (p=0.044). The lesion-based diagnostic performances (sensitivity, specificity, and overall accuracy) were as follows: 18F-NaF PET/CT (98.5%, 93.9%, and 96.6%), 18F-NaF PET (98.5%, 57.1%, and 81.1%), and planar 99mTc-MDP bone scintigraphy (69.9%, 85.7%, and 76.4%). Conclusion 18F-NaF PET/CT outperforms 18F-NaF PET or planar 99mTc-MDP bone scintigraphy in detecting bone metastases with newly diagnosed NPC on a patient-based and lesion-based analysis.

224P Value of bone scintigraphy in breast cancer patients staged with computed tomography

Staging of early breast cancer is a controversial issue. Current guidelines recommend consideration of a computed tomography (CT) scan of the chest, abdominal imaging and a bone scintigraphy (BS) for patients with clinically involved lymph nodes, big primary tumors and aggressive biologic subtypes. In clinical practice patients with early breast cancer are commonly staged with BS and CT scan of chest and abdomen. Nevertheless, additional value of bone scintigraphy in patients staged with CT scan remains not well studied.

The utility of a deep learning-based algorithm for bone scintigraphy in patient with prostate cancer

Bone scintigraphy has often been used to evaluate bone metastases. Its functionality is evident in detecting bone metastasis in patients with malignant tumor including prostate cancer, as appropriate treatment and prognosis are dependent on the presence and degree of bone metastasis. The development of a deep learning-based algorithm in the field of information processing has been remarkable in recent years. We hypothesized that a deep learning-based algorithm is useful in diagnosing osseous metastases in patients with prostate cancer using bone scintigraphy. Thus, this study aims to examine the utility of deep learning-based algorithm in detecting bone metastases in patients with prostate cancer, as compared with nuclear medicine specialists. In total, 139 serial patients with prostate cancer, who underwent whole-body bone scintigraphy, were enrolled in this study. Each scintigraphy examination was evaluated visually and independently by nuclear medicine specialists; this was also analyzed using a deep learning-based algorithm. The number of abnormal uptakes was assessed by the nuclear medicine specialists and with a software which used the deep learning-based algorithm, and the per-patient detection rate and the per-region detection rate were then calculated. The software automatically analyzed bone scintigraphy for the presence or absence of osseous metastasis in individual patients, for the 12 body regions. The detection rates analyzed separately by the nuclear medicine specialists and using the software were then compared. The sensitivity, specificity, and accuracy by the specialist and with the software were calculated. The sensitivity, specificity, and accuracy by the nuclear medicine specialists were 100%, 94.9% and 97.1%. On the other hand, they with the software were 91.7%, 87.3% and 89.2%. No statistically significant difference was determined between the per-patient detection rates assessed by the specialists versus the software. In regional assessment, there was also no statistically significant difference between most of the per-region detection rates (10 of 12 regions) by the specialists versus the results obtained by the software. The software with the deep learning-based algorithm might be used as diagnostic aid in the evaluation of bone metastases for prostate cancer patients.

Diagnostic performance of a computer-assisted diagnostic system: sensitivity of BONENAVI for bone scintigraphy in patients with disseminated skeletal metastasis is not so high

PurposeBone scintigraphy (BS) of disseminated skeletal metastasis is sometimes misinterpreted as normal. The use of computer-assisted diagnosis (CAD) may resolve this problem. We investigated the performance of a CAD system, BONENAVI, in the diagnosis of disseminated skeletal metastasis.MethodsCases of disseminated skeletal metastasis were selected from a BS log. These patients’ BSs were analyzed by BONENAVI to obtain an artificial neural network (ANN) and bone scan index (BSI). Clinical features (type of primary cancer, CT type, and BS type) were compared with the BONENAVI (ANN and BSI) results. The BS findings (diffuse increased axial skeleton uptake, inhomogeneity of uptake, proximal extremity contrast, and degree of renal uptake) and ANN or BSI were evaluated. Then, negative ANN patients were presented.ResultsFifty-four patients were diagnosed as having disseminated skeletal metastasis. Regarding the primary cancers, 12 had prostate cancer, 16 gastric cancers, 16 breast cancers, and 10 miscellaneous cancers. Total sensitivity of ANN (≥ 0.5) was 76% (41/54). ANN values correlated with the BS type among clinical features. Diffuse increased axial skeleton uptake was mostly correlated with ANN of the BS findings.ConclusionThe BONENAVI CAD system was partially helpful in diagnosing disseminated skeletal metastasis, but the sensitivity of BONENAVI was not sufficient and underestimated the disseminated skeletal metastasis. Further improvement of this CAD system is necessary to improve the detectability of disseminated skeletal metastasis.

Use of Oral Prednisolone and a 3-Phase Bone Scintigraphy in Patients with Complex Regional Pain Syndrome Type I.

To compare the treatment effects of a high-dose and low-dose oral steroid regimen based on changes in the radioisotope uptake ratio (RUR) observed from three-phase bone scintigraphy (TPBS) in patients with complex regional pain syndrome type I (CRPS I), we retrospectively analyzed data of 34 patients with CRPS I from traumatic brain injury and stroke. Depending on the dose of steroid administered, patients were divided into high-dose (n = 14) and low-dose steroid groups (n = 20). We compared the severity scores, Kozin’s classification scores, and RUR observed from TPBS between the two groups. There were significant changes in the severity scores and Kozin’s classification between the baseline and 2 weeks from baseline (p < 0.05), however, there were no significant differences in terms of changes in the scores, classification, or the RUR observed from TPBS at 2 weeks from baseline (p > 0.05). There were no treatment-emergent adverse events (TEAEs) such as blood pressure elevation, impaired glycemic control, or gastrointestinal disturbances. Our results indicate that the efficacy profile of a low-dose oral steroid regimen is comparable to that of a high-dose regimen in alleviating symptoms in CRPS I patients. However, additional prospective, large-scale, multi-center studies are warranted to confirm our results.

Prevalence and Risk Factors of Atypical Femoral Fracture Bone Scintigraphic Feature in Patients Experiencing Bisphosphonate-Related Osteonecrosis of the Jaw.

Bisphosphonate (BP) is the first-line therapy for the management of osteoporosis. BP-related osteonecrosis of the jaw (BRONJ) and atypical femoral fracture (AFF) are increasingly common comorbidities in patients with osteoporosis under long-term BP treatment. The aim of this study was to evaluate the incidence and risk factors for AFF features on bone scintigraphy in patients with BRONJ. Among total of 373 BRONJ patients treated between September 2005 and July 2014, 237 (220 women, 17 men; median age 73years) who underwent three-phase bone scintigraphy were enrolled for this retrospective study. AFF features on bone scintigraphy and the related clinical factors were assessed. Among 237 patients with BRONJ, 11 (4.6%) showed AFF features on bone scintigraphy. BP medication duration (p = 0.049) correlated significantly with AFF features on bone scintigraphy in patients with BRONJ. BP intake duration of 34months was the cutoff value for predicting the presence of AFF features on bone scintigraphy. Among the patients with BRONJ, all those with AFF features on bone scintigraphy were female patients with osteoporosis who were on oral BP medication; however, these factors were not significantly different along with AFF features on bone scintigraphy. The incidence of AFF features on bone scintigraphy was relatively high in patients with BRONJ. A careful observation of patients presenting with the AFF features on bone scintigraphy may be needed, particularly for female BRONJ patients with osteoporosis who have been on BP medication for over 34months.

Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis.

Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR. A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) "amyloid" OR "amyloidosis" AND (b) "TTR" OR "ATTR" OR "transthyretin" AND (c) "scintigraphy" OR "scan" OR "SPECT" OR "SPET" OR "bone" OR "skeletal" OR "skeleton" OR "PYP" OR "DPD" OR "HMDP" OR "MDP" OR "HDP". Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated. The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89-95%), specificity 95.4% (95% CI 77-99%), LR+ 7.02 (95% CI 3.42-14.4), LR- 0.09 (95% CI 0.06-0.14), and DOR 81.6 (95% CI 44-153). Mild heterogeneity was found among the selected studies. Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.

The Findings on Bone Scintigraphy in Patients With Suspected Tumor-Induced Osteomalacia Should Not Be Overlooked.

The images of bone scan and clinical charts of total 91 patients with confirmed TIO were retrospectively reviewed. The image findings were compared with the results of other imaging studies, surgical notes, histopathologic examinations and clinical follow-ups. In 76.9% (70 of 91) of the patients, the findings of bone scintigraphy did not correspond to the sites of the causative tumors, which were subsequently located. However, in 23.1% of the patients (21 of 91), the sites of the causative tumors corresponded to one of the abnormal technetium 99m-methyl diphosphonate activity on bone scintigraphy. More importantly, 6 tumors corresponded to the dominant activity on bone scintigraphy. Although findings of whole-body scintigraphy are nonspecific in patients with TIO, careful evaluation of bone scintigraphy results can be helpful in guiding further evaluation in some patients.

Factors associated with diffusely increased renal uptake of Tc-99m diphosphono-propanedicarboxylic acid on bone scintigraphy in patients with end-stage renal disease.

We aimed to determine the factors contributing toward diffusely increased renal uptake on bone scintigraphy using technetium-99m (Tc-99m) diphosphono-propanedicarboxylic acid (DPD) in patients with end-stage renal disease. One-hundred and forty-three bone scintigraphies, performed between June 2007 and July 2013, in 135 patients with chronic kidney disease were analyzed retrospectively, including 22 bone scintigraphies (15 patients; eight women; seven men) with glomerular filtration rates less than 15 ml/min/1.73 m. Patients with nephrocalcinosis were excluded. The clinical records of medication and underlying disease were reviewed retrospectively. The presence of renal artery calcification was visually estimated and the Hounsfield unit (HU) of renal parenchyma was measured by abdominal and pelvic nonenhanced computed tomography. Two patients underwent peritoneal dialysis and 13 underwent hemodynamic dialysis. Diffusely increased renal Tc-99m DPD uptake was observed on 15 of 22 (68%) bone scintigraphy images. Laboratory test results were not significantly different between the patients with or without increased renal uptake. A history of inflammatory conditions or antibiotic administration did not correlate with kidney visualization. The significant factor for diffuse renal tracer uptake on multivariate analysis was renal artery calcification (odds ratio: 18.42; 95% confidence interval: 2.01-79.43; P<0.001). The mean HU values were significantly higher in patients with diffuse renal tracer uptake (P=0.04) and renal artery calcification (P=0.02). Small renal arteriolar calcification and a higher HU value of renal parenchyma could be associated with diffusely increased renal Tc-99m DPD uptake in patients with end-stage renal disease.

The clinical significance of technetium-99m methylene diphosphonate bone scintigraphy findings in patients with rhabdomyolysis.

This study evaluated the relationship between bone scintigraphy finding and clinical factors and assessed the prognostic value of bone scintigraphy finding in patients with rhabdomyolysis. We retrospectively enrolled 143 patients with rhabdomyolysis who had undergone bone scintigraphy. Bone scintigraphy was classified into three groups: no or equivocal soft tissue uptake, a localized uptake, and a diffuse uptake. The relationship of bone scintigraphy findings with clinical factors was evaluated. Multiple logistic regression analysis was performed to identify the risk factors for acute renal failure (ARF) and renal replacement therapy (RRT). Of 143 patients, 52 (36.4%) experienced ARF and 12 (8.4%) required RRT. Among cases caused by exercise, 83.7% showed localized soft tissue uptake. Diffuse soft tissue uptake was only shown among the patients with rhabdomyolysis caused by drug and toxin. Patients with localized or diffuse soft tissue uptake had higher levels of serum creatine kinase, myoglobin, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase compared with patients with no or equivocal uptake (P<0.05). Multiple logistic regression analysis showed that age, female sex, and serum phosphate level were associated with a risk for ARF and only serum creatinine level was associated with a risk for RRT (P<0.05). Bone scintigraphy findings failed to show significance for predicting ARF and RRT (P>0.05). Soft tissue uptake on bone scintigraphy in patients with rhabdomyolysis was related to etiologies and showed limited value for predicting ARF and RRT.

Yield of bone scintigraphy for the detection of metastatic disease in treatment-naive prostate cancer: a systematic review and meta-analysis

To evaluate the yield of staging bone scintigraphy in patients with treatment-naive prostate cancer. A computerised search of the MEDLINE and EMBASE databases was performed to find relevant original literature. Studies that investigated the positivity of a staging bone scintigraphy according to prostate-specific antigen (PSA) levels and/or Gleason score in patients with treatment-naive prostate cancer were eligible for inclusion. Meta-analytic pooling was performed using the inverse variance method for calculating weights. Fifty-four eligible studies, which included a total sample size of 20,421 patients, were included. The pooled proportions of the positive bone scintigraphy in patients with PSA ≤10, 10 <PSA ≤20, and PSA >20 were 3.5% (95% confidence interval [CI]: 2.4-5%), 6.9% (95% CI: 4.5-10.3%), and 41.8% (95% CI: 36.3-47.6%). The pooled proportions of the positive bone scintigraphy examinations in patients with Gleason score ≤6, 7, and ≥8 were 4.1% (95% CI: 2-8%), 10% (95% CI: 6.1-15.8%), and 28.7% (95% CI: 21.8-36.8%). Meta-regression analysis revealed that the Gleason score was a significant factor affecting study heterogeneity in patients with PSA ≤10 (p=0.04). Pooled proportions of positive bone scintigraphy examinations showed 3.4% in patients with a PSA of ≤10 and 3.3% in patients with 10 <PSA ≤20 regarding a Gleason score of ≤7. The present results demonstrate a low proportion of positive bone scintigraphy examinations in treatment-naïve prostate cancer patients with PSA≤20 and Gleason score ≤7. The present study may help guide decision support in daily clinical practice regarding the need for bone scintigraphy in this group of patients and might be considered in the design of future clinical guidelines.

Bone scintigraphy in patients with pain.

Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

When to perform bone scintigraphy in patients with newly diagnosed prostate cancer? a retrospective study

BackgroundTo determine when a bone scintigraphy investigation is appropriate in patients with newly diagnosed prostate cancer (PCa).MethodsWe retrospectively reviewed 703 newly diagnosed PCa patients who were referred for bone scintigraphy. The association between age, prostate specific antigen (PSA), Gleason score (GS) and bone scintigraphy result were investigated by series of crude or stratified analysis.ResultsOverall, 15.08% (106/703) patients had bone metastases. PSA and GS between positive bone scan group and negative bone scan group were significantly different, while age was not. The incidence of bone metastasis in patient with PSA < 20 ng/ml or GS < 8 was less than 10%, but increased dramatically with rising PSA and upgrading GS. In multivariate analysis, PSA ≥ 20 ng/ml (OR = 5.10, 95%CI (2.12-12.27)) and GS ≥ 8 (OR = 3.61, 95%CI (1.55-8.41)) were independently predictive of positive bone scan.ConclusionsPatients with PSA ≥ 20 ng/ml or GS ≥ 8 were in higher risk of bone metastasis, bone scintigraphy was recommended. But a bone scintigraphy is of limited value in PCa patients with PSA ≤ 20 ng/ml and GS ≤ 7.