MDP Bone Scan Research Articles

18 F FDG PET/CT versus 99m Tc MDP Bone scintigraphy in imaging of metastatic osseous disease in breast cancer patients; Solving the discrepancies in light of serum markers.

To assess the performance of 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) versus 99m Tc MDP bone scan in assessment of metastatic osseous disease in breast cancer patients in relation to serum markers. We reviewed PET/CT studies and bone scans for 37 patients (mean age of 55.38 ± 13.08 years) with metastatic breast cancer to bone. To assess metastatic osseous burden, we used semiquantitative scores derived from PET/CT (PMS) and bone scans (BMS). We used McNemar test to compare lesion detection between both modalities and receiver operator characteristic analysis to define the cutoff value of serum CA 15-3 that best predicts additional value for PET/CT over bone scan. In 13 patients (35.1%), more lesions or higher-intensity lesions were detected on PET/CT, while only 4 patients (10.8%) had more prominent lesions on bone scans ( P = 0.049). Additional lesions seen on PET/CT are predominantly osteolytic or medullary (early phase). Most lesions with higher uptake on bone scans appear sclerotic (late phase). CA 15-3 was positively correlated to PMS ( r = 0.386; P = 0.018) but not to BMS ( r = -0.027; P = 0.874). However, serum alkaline phosphatase was positively correlated to both PMS ( r = 0.389; P = 0.017) and BMS ( r = 0.363; P = 0.027). CA 15-3 value of >47 U/ml best predicted additional findings on PET/CT compared to bone scans (area under the curve = 0.708; P = 0.0261). FDG PET/CT detects metastatic osseous lesions during an earlier phase. A higher CA 15-3 predicts a higher metastatic burden on PET/CT but not on bone scan. Bone scans are less specific, likely by missing early lesions and detecting persistent uptake in healing sclerotic lesions.

Skeletal involvement in Erdheim-Chester disease: Multimodality imaging features and association with the BRAFV600E mutation

ObjectiveThe aim of this study was to characterize the distribution of skeletal involvement in Erdheim-Chester disease (ECD) by using radiography, computed tomography (CT), 18F-FDG positron emission tomography/computed tomography (PET/CT), and bone scans, as well as looking for associations with the BRAFV600E mutation. Material and methodsProspective study of 50 consecutive patients with biopsy-confirmed ECD who had radiographs, CT, 18F-FDG PET/CT, and Tc-99m MDP bone scans. At least two experienced radiologists with expertise in the relevant imaging studies analyzed the images. Summary statistics were expressed as the frequency with percentages for categorical data. Fisher's exact test, as well as odds ratios (OR) with 95 % confidence intervals (CI), were used to link imaging findings to BRAFV600E mutation. The probability for co-occurrence of bone involvement at different locations was calculated and graphed as a heat map. ResultsAll 50 cases revealed skeletal involvement at different regions of the skeleton. The BRAFV600E mutation, which was found in 24 patients, was correlated with femoral and tibial involvement on 18F-FDG PET/CT and bone scan. The appearance of changes on the femoral, tibial, fibular, and humeral involvement showed correlation with each other based on heat maps of skeletal involvement on CT. ConclusionThis study reports the distribution of skeletal involvement in a cohort of patients with ECD. CT is able to detect the majority of ECD skeletal involvement. Considering the complementary nature of information from different modalities, imaging of ECD skeletal involvement is optimized by using a multi-modality strategy.

A rare clinical presentation of lung cancer: two cases of solitary digital metastasis on Tc-99m MDP bone scan

BackgroundAcrometastases are accounted for a very small proportion of bone metastases. Lung cancer is the most common acrometastasis origin, and it often has a poor prognosis. The aim of the present cases is to describe the probability of an acrometastasis in the differential diagnosis of finger lesions and to emphasize the importance of taking local views of extremity of complaint for proper interpretation in such patients.Case presentationHere we reported two patients with metastases to the fingers with occult primary lung carcinoma and a history of prior lung malignancy, respectively. First case was a 58-year-old man with history of pain and swelling in the fourth finger of his left hand. He underwent an amputation from the metacarpophalangeal level and the pathological diagnosis was metastatic NSCLC. The second case was a 65-year-old ex-smoker man with a history of prior lung cancer (adenocarcinoma) suffered from a swollen, erythematous, painful tip of the right third finger. Phalangectomy was performed and the histological examination of the amputated part revealed the presence of a metastatic differentiated carcinoma of pulmonary origin.ConclusionsWhen assessing the masses located at fingers, possibility of a solitary metastatic lung lesion should be considered.

Evaluation of the role of vertebral augmentation in chronic vertebral compression fractures: A retrospective study

ObjectivesVertebral augmentation is recommended for acute or subacute vertebral compression fractures (VCFs); few studies claim its usefulness in chronic VCFs also. Use of radionuclide imaging may improvise identification of chronic VCFs that may benefit from vertebral augmentation; hence we have evaluated efficacy of vertebral augmentation procedures in chronic VCFs with incomplete fracture healing suggested either by MRI or Tc99m- MDP bone scan. Materials and MethodsPatients with chronic osteoporotic VCFs (>12 weeks) during the period of June 2013 to June 2019 were included in this retrospective study; patients with evidence of incomplete fracture healing either by MRI or bone scan imaging with Tc 99m-MDP underwent vertebroplasty or kyphoplasty. Primary outcome measure was patient’s pain score measured by numerical rating scale (NRS); secondary outcome measures were patient’s disability assessed by Roland Morris Disability questionnaire (RDQ); quality of life assessed by Quality of life questionnaire of European Foundation of Osteoporosis (QUALLEFO) and analgesic usage. P ​< ​0.050 was considered as significant. Results34 patients were enrolled for the study with median fracture age of 36 months. The median NRS pain scores, RDQ scores, QUALEFFO scores and analgesic usage were significantly reduced at all-time points as compared to the baseline value over the follow up period of 1 year after vertebral augmentation procedure (P ​< ​0.050). Cement leakage was seen in 5 patients (15%). ConclusionVertebral augmentation procedures provided significant improvements in pain scores, disability and quality of life in patients of chronic osteoporotic VCFs with median fracture age of 36 months.

Osteopoikilosis mimicking osteoblastic bone mets: A Case report

Background: Osteopoikilosis is a benign, uncommon disorder that is inherited by the autosomal dominant gene. Multiple benign enostoses are present in this specific kind of sclerosing skeletal dysplasia, which can be mistaken for osteoblastic skeletal metastases. Case Presentation: We present here a case of 50-year-old male patient with pain in lower back for 3 months. His pelvic X-ray showed few sclerotic rounded lesions in ilium, acetabulum and proximal femur. His MRI pelvis showed T1WI and T2WI hypo intense focal lesions in ilium and acetabulum. His 99mTc MDP bone scan was done showing no focal abnormal uptake in lesion reported on pelvic X-ray and MRI. These features are suggestive of Osteopoikilosis, ruling out osteoblastic skeletal metastasis. Conclusion: Osteopoikilosis is usually an incidental finding on radiograph. Both x-ray and MRI findings can mimic skeletal metastasis, but a normal bone scan can rule out metastasis and is useful if metastatic disease is thought to be a possibility.

99m-Tc MDP Bone Scan Image Enhancement using Pipeline Application of Dynamic Stochastic Resonance Algorithm and Block-Matching 3D Filter.

In this pilot study, we have proposed and evaluated pipelined application of the dynamic stochastic resonance (DSR) algorithm and block-matching 3D (BM3D) filter for the enhancement of nuclear medicine images. The enhanced images out of the pipeline were compared with the corresponding enhanced images obtained using individual applications of DSR and BM3D algorithm. Twenty 99m-Tc MDP bone scan images acquired on SymbiaT6 SPECT/CT gamma camera system fitted with low-energy high-resolution collimators were exported in DICOM format to a personal computer and converted into PNG format. These PNG images were processed using the proposed algorithm in MATLAB. Two nuclear medicine physicians visually compared each input and its corresponding three enhanced images to select the best-enhanced image. The image quality metrics (Brightness, Global Contrast Factor (GCF), Contrast per pixel (CPP), and Blur) were used to assess the image quality objectively. The Wilcoxon signed test was applied to find a statistically significant difference in Brightness, GCF, CPP, and Blur of enhanced and its input images at a level of significance. Images enhanced using the pipelined application of SR and BM3D were selected as the best images by both nuclear medicine physicians. Based on Brightness, Global Contrast Factor (GCF), CPP, and Blur, the image quality of our proposed pipeline was significantly better than enhanced images obtained using individual applications of DSR and BM3D algorithm. The proposed method was found to be very successful in enhancing details in the low count region of input images. The enhanced images were bright, smooth, and had better target-to-background ratio compared to input images. The pipelined application of DSR and BM3D algorithm produced enhancement in nuclear medicine images having following characteristics: bright, smooth, better target-to-background ratio, and improved visibility of details in the low count regions of the input image, as compared to individual enhancements by application of DSR or BM3D algorithm.

Avascular Necrosis of Femoral Head Diagnosed by 99mTc MDP Bone Scan Incorporated with SPECT- A Case Report

Avascular necrosis (AVN) may be defined as cellular death of bone components due to the lack of blood supply resulting in joint damage and loss of joint function. This condition may arise from a number of causes i.e. both traumatic and non-traumatic. Diagnosis of the disease at an early stage and deliberate management can prevent the unwanted complications like femoral head collapse and severe arthritis and may save the bone. Although diagnosis of AVN is primarily dependent on radiological investigations, the incremental value and vital role of 99mTc-methylene diphosphonate (99mTc-MDP) single-photon emission computed tomography (SPECT) over planar bone scintigraphy permits more accurate localization of lesions and provide pertinent information to recognize the disease at initial stage for better management. We present a case of unexplained low back pain in a young woman who was diagnosed as having avascular necrosis of both femoral heads by 99mTc-MDP bone scan incorporated with SPECT Bangladesh J. Nuclear Med. 23(1&amp;2): 55-58, 2020

Abstract 149: Hyperphosphatemic familial tumoral calcinosis due to homozygous mutation at Leu366Arg: First case report

Background: Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare disabling autosomal recessive metabolic disorder characterized by hyperphosphatemia and manifestations ranging from progressive deposition of calcium phosphate crystals in the skin, soft tissues and bone, and hyperostosis. The most common cause of HFTC is related to loss-of-function mutations in GALNT3 (Polypeptide N-Acetylgalactosaminyl transferase 3) gene causing defective glycosylation of FGF23.Material and Methods: A 16 year boy presented with lump in the left gluteal area and hyperphosphatemia. Serum ionized calcium, alkaline phosphate, intact PTH, 25-OH vitamin D, serum creatinine and C terminal FGF 23, magnetic resonance imaging of hip, dental CBCT , bone mineral density at lumbar spine and hip by dual x-ray absorptiometry (DEXA) BMD, and 99Tc MDP bone scan, followed by next generation sequencing (NGS) and Sanger's sequencing.Results: A 16 year otherwise healthy boy presented with hard painless lump in the left gluteal area and hyperphosphatemia for last one year. His parents had third degree consanguinity with ancestral roots in Middle East. Father has small calcinosis in the right hand and mother was asymptomatic. Child had no associated bone pain, proximal muscle weakness, fracture or constitutional symptoms. S. phosphorus was 6.98mg/dl (normal: 3.5–5.5) with inappropriately increased TRP (95%) and TMP-GFR (7.2). Serum ionized calcium, alkaline phosphate, intact PTH, 25-OH vitamin D and serum creatinine were normal. MRI showed 5.7x3.7x3 cm lobulated heterogenous hypointensity near left greater trochanter. This mass was excised and showed tissue calcification. 99Tc-MDP bone scan and bone density parameters were normal. CBCT scan maxilla and mandible showed generalized hypercementosis with irregular root morphology. Serum C-terminal FGF 23 was 2401 RU/ml (normal: <150). NGS revealed normal FGF23 and Alpha Klotho genes. Exon 5 of GALNT3 gene showed homozygous mutation at Leu 366 Arg. GALNT3 Leu 366 Arg mutation causing HFTC has been described as compound heterozygous.Conclusion: This is the first case report of homozygous mutation at Leu366Arg causing HFTC.

Role of Bone Scan and MRI in Designing of Customized Prosthesis for Limb Salvage Surgery of Long Bone Tumors: 4 Years of Single Institution Analysis.

The purpose of this study is to evaluate the role of bone scan (BS) and MRI measurement data in designing Custom Made Prosthesis (CMP) in Limb Salvage Surgery (LSS) in orthopedic oncology patients. The study was done on 126 patients, which include 88 males and 38 females. Pre-operative planning including determination of the osteotomy plane and dimension of the prosthesis was performed based on Tc99m MDP bone scan and MR images comparing with the histopathology examination (HPE) values. Descriptive statistics using appropriate measures of central tendency and dispersion were employed to describe the data. Karl-Pearson correlation coefficient was used to establish the association between continuous covariates. Paired t-test was utilized to test the differences in paired values for statistical significance. Bone scan and HPE values are positively correlated; p value is 0.913 (p < 0.001). However, mean difference between the HPE and bone scan is statistically significant (p < 0.001). MRI scan and HPE values are positively correlated 0.920 (p < 0.001) and mean difference is also statistically not significant (0.920; p < 0.001). If we apply ± 20% window, 94/126 patients (75%) bone scan measurements and 94/112 patients (84%) MRI measurements are matching with the HPE measurements. We conclude that bone scan measurements were found to be more or less equal to MR imaging for determining the tumor extent for the fit of the prosthesis and excellent functional results.

99mTc MDP Bone Scan Findings in CKD-MBD: Could the “Superscan” Image be Useful in Excluding Adynamic Bone Disease?

99mTc MDP Bone Scan Findings in CKD-MBD: Could the “Superscan” Image be Useful in Excluding Adynamic Bone Disease?

Influence of Age, Estrogen receptor (ER),Progesterone receptor (PR) and Epidermal growth factor -2 (HER-2) in Breast Carcinoma Patient in correlation with Radionuclide Bone Scan – Single Institute Based Experience

Background: Breast carcinoma is a common type of malignancy in women worldwide. Radionuclide bone scintigraphy is recognized choice of investigation for the detection of bone metastases both in asymptomatic and symptomatic patients. Biomarkers like Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor -2 (HER-2) also play important role in the management and prognosis of breast cancer. The study was aimed to find out the relationship between the MDP bone scan findingsand hormone receptor and HER-2 status of breast carcinoma patients referred to the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford, Dhaka.&#x0D; Patients and Methods: This cross sectional study was conducted among 301 breast carcinoma patients between January 2018 and December 2019. Planar bone scan and SPECT (if needed) was done to all the patients after intravenous injection of 99mTc-MDP. Receptor status (ER, PR and HER-2) were documented from the patient’s medical records. Breast tumors were classified as (a) Triple positive- HER2-, ER-, and PR-positive) (b) Triple negative- HER2-, ER-, and PR-negative (c) Hormonereceptor (HR) positive (ER+/PR+) with HER-2 negative and d) HR negative (ER-/PR-) with HER-2 positive.Patients were broadly grouped according to age as A. less than 50 years (n = 59) and B. more than 50 (n = 260 ) years.&#x0D; Results: The mean age of the patients enrolled for this study was 59.02±9.3 with range of 32 to 81 years. Out of the 301 patients, positive bone scans were found in 105 (34.8%) and negative bone scan were found 196 (66.2%). Patients of group A (&lt;50years) with triple negative and HR+/HER-status had no bone or bone with visceral metastases. Triple positive subtype had 2 bone metastases, and HR-/HER-2+ subtype had 2 bone metastases and 1 had bone with visceral metastases. Group B (&gt; 50years) patients having HR+/HER2- receptor status showed 16% solitary metastases, 53.2% multiple metastases, 33.3% extensive bony metastases, 13.6% bone with visceral metastases. Triple negative subtype showed 36.0 % solitary metastases, 19.1% bone with visceral metastases. Triple positive subtype group had 40.0% solitary metastases, 34.0 % multiple metastases, 66.7% extensive bony metastases, and 13.6% bone with visceral metastases. HR-/HER-2+ subtype group had 8% solitary metastases, 12.8% multiple metastases, and 18.2 % bone metastases with visceral involvement Overall relationship between bone scan and hormone receptor subtype, showed that most of the patients had HR+/ HER-2-(35.2%) subtype and 25.6% patient had triple positive, 23.3% patient had triple negative and 15.9% patient had HR-/HER-2 – receptor subtype. This study showed the visceral involvement with bone metastases (13 % in HR+/HER-2- 52.2 % in triple negative, 13 % in triple positive, 21.7 % in HR-/HER-2+subtype). Highest bone only metastases (35) in triple positive and HR+/HER-2-(31) subtype. Most of the patiens who had bone metastases with visceral involvement belong to triple negative (52.2%) and HER-2 subtypes -HR-/HER-2+ (21.7%). The result was significant (P&lt;0.001).&#x0D; Conclusion: It is observed from this study that triple positive and HR+/HER-2- were more likely to develop bone metastases than triple negative and HR-/HER-2-. Patients with bone scan negative and HR-/HER-2- or triple negative receptor status most likely develop visceral metastases&#x0D; Bangladesh J. Nuclear Med. 22(2): 114-118, Jul 2019

Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study.

ABSTRACTIntroduction:Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018.Materials and Method:Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared.Results:A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p <0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; −0.77, −0.55 and −0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p <0.05). Pain scores significantly decreased in patients after 12-months of ZA use (−2.92±2.16, p <0.01).Conclusion:Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.

Utility of MDP Bone Scan in Following Up Patients with Sapho Syndrome.

Utility of MDP Bone Scan in Following Up Patients with Sapho Syndrome.

A Comparison of Bone Scan Using between F-18 NaF PET/CT and Tc-99m MDP

Objective: To study bone scintigraphy using between F-18 NaF PET/CT and Tc-99m MDP scan for detecting bone metastases.&#x0D; Material and Methods: Thirteen patients (5 males, mean age 55.4 years, range 34-74 years) who were suspected bone metastases with single or two equivocal lesions on Tc-99m MDP bone scan were recruited between October 2010 and October 2012. All these patients underwent F-18 NaF PET/CT scan within one week after Tc-99m MDP bone scan. The sensitivity, specificity and accuracy of Tc-99m MDP bone scan and F-18 NaF PET/CT in differentiating metastatic bone lesion from benign lesion by patientbased and lesion-based analyses were studied.&#x0D; Results: F-18 NaF PET/CT could identify all seven patients with malignant bone metastases that Tc-99m MDP bone scan was interpreted as malignancy in only three patients (42.9%) and equivocal in the rest of these patients. For lesion-based analysis of the overall 75 lesions, the sensitivity, specificity and accuracy of Tc-99m MDP bone scan were 48%, 83.3% and 70.7% and F-18 NaF PET/CT were 100% for all parameters. Besides the ability of F-18 NaF PET/CT to accurately identify malignancy from benign lesion, unenhanced CT portion of PET/CT can show extra-osseous findings that may change patient management.&#x0D; Conclusion: F-18 NaF PET/CT provides an excellent bone image quality and higher accuracy than Tc-99m MDP bone scan. Then F-18 NaF PET/CT is a good choice for evaluating bone metastases.

Evaluation of Skeletal Metastases in Different Clinical Stages of Breast Cancer Patients

Background: Breast cancer is a common form of cancer among women globally. Bone is the most common site to which breast cancer metastasizes. Between 30% and 85% of patients with metastatic breast cancer will develop bone metastases during the course of the disease.Objective: To evaluate the pattern and distribution of skeletal metastases in different clinical stages of breast cancer patients by using Tc-99m MDP bone scan.Materials and methods: A retrospective study was conducted on 305 consecutive female breast carcinoma patients referred for bone scan to Institute of Nuclear Medicine and Allied Sciences, Rajshahi from January 2015 to June 2017. All patients were categorized in one of the three groups; early breast cancer (EBC, comprises clinical stage I and II), locally advanced breast cancer (LABC, clinical stage III) and metastatic breast cancer (MBC, clinical stage IV). Bone scan was performed by an intravenous bolus injection of 20 mCi Tc99m-MDP and bone phase images were taken at three hours after injection of the radiotracer.Results: Out of 305 studied patients, 16 patients (5.25%) were in EBC group, LABC patients were 173 (56.72%) and MBC were 116 (38.03%). 98 patients (32.13%) were positive for skeletal metastases. In 16 EBC patients only 01 patient (6.25%) had skeletal metastasis in thoracic spine. Skeletal metastases were 20.81% in LABC and 52.59% in MBC group. Thoraco-lumbar spine was the commonest site in both groups followed by ribs, pelvic bones, upper and lower extremities, cervical spine, sternum, scapula and skull bone.Conclusion: Bone scan should be done in all LABC and MBC patients and in symptomatic EBC at disease presentation. Parts of bone to focus are thoracic and lumbar spine in all stages, followed by ribs, pelvis and extremities. Tc-99m MDP bone scan play a major role in early detection of skeletal metastasis in breast cancer patients.TAJ 2017; 30(2): 47-53

Evaluation of asymptomatic skeletal metastasis by 99mTc MDP bone scans in NSCLC patients attending INMAS, Rajshahi

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;Lung cancer is the leading cause of cancer deaths worldwide. Lung cancer is often insidious, producing no symptoms until the disease is well advanced. In approximately 7-10% of cases, lung cancer is diagnosed in asymptomatic patients. Some patients are asymptomatic for skeletal metastasis and a recent prospective study showed that in staging of non-small cell lung cancer (NSCLC), failure to perform a bone scan could miss asymptomatic bone metastasis in 14–22% of patients. Radionuclide bone scintigraphy with &lt;sup&gt;99m&lt;/sup&gt; Tc MDP (Technetium-99mmethylene diphosphonate) is very useful nuclear imaging tool to detect skeletal metastasis with a sensitivity of 98.2% and a specificity of 95.2%. The aim of this study was to detect the asymptomatic skeletal metastasis of non-small cell lung cancer patients by &lt;sup&gt;99m&lt;/sup&gt;Tc MDP bone scan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Patients and methods:&lt;/em&gt;&lt;/strong&gt; It is a retrospective study, carried out from January 2015 to December 2016 in Institute of Nuclear Medicine and Allied Sciences, Rajshahi. Bone scan was performed by an intravenous bolus injection of 20 m Ci &lt;sup&gt;99m&lt;/sup&gt;Tc MDP. Bone phase images were taken at three hours after injection of the radiotracer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt; A total of 52 patients were enrolled in the study. The mean age of the patients was 57.6 ± 14.5 years (mean ± SD) with range from 36 to 75 years and 42 (80.77%) were male and 10 (19.23%) were female. Out of 52 patients, only 06 (11.54%) patients were diagnosed as positive and 46 (88.46%) were negative for bone metastasis. Out of 06 patients with positive skeletal metastasis 04 (66.67%) patients had multiple sites (two or more) and 02 (33.33%) patients had solitary site of bone involvement. Common sites of metastasis were in thoracic (83.33%) and lumbar spine (83.33%), ribs (50%), pelvic bones (33.33%), long bones (16.66%), skull (16.66%) and other bony sites including clavicle, sternum, scapula, sacrum (16.66%). Regarding staging prior to bone scan, out of 06 bone scan positive patients 03 (50%) patients were in stage III, 02 (33.33%) patients were in stage IV and 01(16.67%) patient was in stage II. On the basis of histopathology, out of 06 skeletal metastatic patients 04 (66.67%) patients had adenocarcinoma, 01 (16.67%) patient had squamous cell carcinoma and 01 (16.67%) had large cell carcinoma. The exclusion of bone metastasis is important in the initial staging of non-small cell lung cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion:&lt;/em&gt;&lt;/strong&gt; There is debate about whether bone scans should be performed routinely or restricted to patients who present with clinical or laboratory indicators suggesting skeletal metastasis. The present study indicates that if bone scans were done only in patients reporting skeletal symptoms an important number of patients (11.54%) would have been miss-staged due to asymptomatic bone metastasis. As bone scan is very cost effective in comparison to other imaging modalities (MRI / PET-CT), it can play a vital role in detecting asymptomatic skeletal metastasis in NSCLC patients.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 20(2): 110-114, July 2017&lt;/p&gt;

Tc-99m MDP Bone Scan Evaluation in Breast Cancer: A Study on 425 Patients

Breast cancer is the most frequent female cancer, especially in 'developed' countries. 30-85% of metastatic breast cancer patients will develop bone metastases during the course of the disease. The objective of this study was to evaluate the skeletal metastases in breast cancer patients by using Tc-99m MDP bone scan. A retrospective study was conducted on 425 consecutive female breast carcinoma patients referred for bone scan to Institute of Nuclear Medicine and Allied Sciences, Rajshahi from January 2015 to November 2017. Bone scan was performed by an intravenous bolus injection of 20 mCi Tc99m-MDP (technetium 99m methylenediphosphonate). Bone phase images were taken at three hours after injection of the radiotracer. Out of 425 patients, 290 patients (68.24%) had either normal bone scan or negative for skeletal secondaries and 135 patients (31.76%) were positive for skeletal metastases.Out of 135 positive bone scans 114 (84.44%) patients had multiple sites (two or more) and 21 (15.56%) patients had solitary site of bony involvement. Highest number of skeletal metastases was noted in thoraco-lumbar spine (81.48%). Other sites of metastases were in cervical spine (22.96%), pelvic bones (54.81%), ribs (40.74%), sternum (16.30%), scapula (19.26%), upper extremities (28.15%), lower extremities (36.30%), skull bone (12.60%) and clavicle (13.33%). Tc-99m MDP bone scan is very cost effective in comparison to other imaging modalities (CT, MRI, and PET) and play a major role in early detection of skeletal metastasis in breast cancer patients.Medicine Today 2018 Vol.30(2): 49-52

HYBRID BONE SCINTIGRAPHY IN GASTROINTESTINAL MALIGNANCIES – INSTITUTIONAL EXPERIENCE

Objective: Bone metastases in gastrointestinal (GI) malignancies are uncommon and known to be predominantly lytic thus rendering a limited role for conventional bone scintigraphy. The aim of the study is to review Tc99m MDP bone scans performed in patients with known GI malignancy and the utility of Single-photon emission computed tomography (SPECT)/CT in characterization of bone lesions.Methods: Retrospective review of bone scans was done from June 2014 to December 2016 in patients with known GI malignancy, using electronic Hospital Information System.Results: A total of 110 patients (60 males, 50 females; Age range: 22–84 years, Mean Age 51.4 years with SD of 14.8) had bone scan over a period of 30 months. The commonest indications for referral were suspected bone metastasis on other imaging modalities including [CT (n = 56), Magnetic resonance imaging (n = 10), Positron emission tomography/CT (n = 6)], musculoskeletal pain (n = 37), pathological fracture (n = 1), neurological symptoms (n = 1), hypercalcemia (n = 1) and others (n =14) including restaging workup etc. Metastatic lesions were identified in 32 (29%) patients whereas 78 (71%) patients had benign non-aggressive lesions leading to normal bone scans. Among 32 patients with osseous metastasis, 8 (25%) patients had unifocal lesion; axial skeleton (n = 2) appendicular skeleton (n = 6), 24 (75%) patients had multifocal lesions; axial skeleton (n = 6), appendicular skeleton (n = 6) and both axial + appendicular (n = 12). Four (12%) patients had concurrent visceral metastases. In our cohort, based on the location of primary tumour, the frequencies of osseous metastasis were; esophagus = 15 out of 43 (35%), gastric = 7 out of 18 (39 %), gastro-esophageal junction = 1 out of 8 (1.5%) and colorectal = 9 out of 40 (22.5). SPECT/CT was acquired in 29 out of 110 patients, which characterized metastatic lesions (n = 12) and benign looking non-aggressive entities (n =17). Overall, bone scan upstaged disease in 31% and down staged 15% patients.Conclusion: Bone metastases in GI malignancies, though uncommon, show an aggressive pattern, with axial and appendicular involvement, and can be readily identified with hybrid bone scintigraphy in symptomatic patients. Key words: Hybrid imaging, Tc99m MDP, bone metastases, gastrointestinal malignancies

Spectrum of MDP Bone Scan in Paediatric Patients - Experience at NINMAS

Objective: To assess the clinical indications and spectrum of MDP bone scan findings in paediatric patients referred to the National Institute of Nuclear Medicine and Allied Sciences (NINMAS).Materials and Methods: Paediatric patients, age ranged from 2-18 years referred to NINMAS from January 2014 to November 2015 for bone scintigraphy were included in this study. All patients had 99mTc MDP bone scan for various clinical indications. The spectrum of clinical indications and bone scan findings were recorded and analyzed.Results: Total 2323 bone scans with 99mTc MDP were done in NINMAS in the above mentioned period. Among them 91 (3.917%) cases were in paediatric age group. Of which 82 (90.11%) patients with known malignancy were referred for radionuclide skeletal survey. The most common clinical indications were osteosarcoma 30 (32.96%) cases and Ewing’s sarcoma 25 (27.47%) cases followed by five neuroblastoma (5.49%), four (4.39%) rhabdomyosarcoma, three (3.29%) Langerhans cell histocytosis and rest others. Bone scan was positive in 58 (63.7%) cases and normal in 33 (36.3%) cases. Out of 58 cases 38 had features of primary bony lesion, 10 cases had multiple metastases, four cases had primary bone tumour of Ewing’s sarcoma as well as metastases.Conclusion: Bone scan is a popular imaging modality for skeletal survey of paediatric patients in malignancy, both primary and metastatic bone diseases. Bone scanning in paediatric patients contributes a major role in detecting the cause and localizing the pathology of bone. High quality imaging, interpreted by physicians familiar with paediatric diseases, correlation with clinical records and other imaging are mandatory to maximize the benefit.Bangladesh J. Nuclear Med. 19(1): 28-31, January 2016

Is 99m Tc-methylene diphosphonate bone scintigraphy a sensitive method for detecting bone lesions in multiple myeloma?

Background:Bone lesion in multiple myeloma (MM) is most commonly presented as a lytic lesion in this disease. Determination of extent of bone lesions in MM is necessary to follow-up the patients. Whole body bone scan with 99m, Tc-methylene diphosphonate (MDP) has a lower sensitivity than other modalities.Methods:From the patients with MM admitted to Ayatollah Rouhani Hospital of Babol-Iran from 2009 to 2015, who had undergone whole body bone scan during diagnostic process, were entered into the study. Findings of bone scan were compared with MRI.Results:Of the 19 patients, sixteen (84.2%) of them had positive finding in bone scan, fifteen (78.9%) had MRI of the spine. While of the thirteen patients who had positive finding in MRI, seven (53.8%) had more positive finding in thorcolumbosacral MRI than in bone scan.Conclusions:99m-Tc MDP bone scan is a sensitive but insufficient method for detecting bone lesions in MM.