MDP Bone Scan Research Articles

A comparative study of zoledronic acid and once weekly Alendronate in the management of acute Charcot arthropathy of foot in patients with diabetes mellitus

Aim:The aim of this study was to assess and compare the response to two forms of treatment-immobilization with zoledronic acid injection and immobilization with oral weekly Alendronate, in patients with diabetes mellitus and acute Charcot arthropathy (CA) of foot in terms of clinical and radiological parameters.Material and Methods:Patients attending the endocrinology and podiatry clinic with history of diabetes mellitus and Acute CA were taken for study. The patients were randomized into two treatment groups. Group Z-zoledronic acid injection along with total contact cast (TCC). Group A-Tab. Alendronate 70 mg. once a week till the complete clinical resolution of acute CA along with TCC. Forty-five patients were randomized and 40 of them completed the study. The primary end point was complete clinical resolution of acute CA-defined as temperature difference between normal and affected foot <1°F.Results:Among the 40 patients, 30 (75%) had complete clinical resolution. The mean number of days taken for complete clinical resolution since the initiation of treatment (either Zoledronic acid or Alendronate) was approximately 122 days. There was no significant difference in a number of days required for complete clinical resolution, between the two forms of therapy. There was more than 50% reduction in the visual score between the baseline and the final scan. The target to non-target ratio in the skeletal phase also showed an average of 40% reduction from the baseline to the final skeletal scintigraphy.Conclusion:Both Intravenous Zoledronic acid and oral alendronate had comparable efficacy with respect to the time taken for attaining complete clinical resolution of acute CA of foot. However, Alendronate therapy was cost effective among the two. 99mTc MDP bone scan can be used as an adjuvant to the clinical parameters in assessing the response to therapy.

Bone metastasis versus bone marrow metastasis? Integration of diagnosis by 18F-fluorodeoxyglucose positron emission/computed tomography in advanced malignancy with super bone scan: Two case reports and literature review

Super scan pattern on technetium-99m methyldiphosphonate (Tc-99m MDP) bone scintigraphy is a special condition of extremely high bone uptake relative to soft tissue with absent or faint renal radioactivity visualization, which is usually seen in diffuse bone metastases or discrete endocrine entities. Here, two cases with super bone scan are presented. One was a young man diagnosed with gastric cancer. The other was a middle-aged woman with a history of breast cancer with recent recurrence. Both cases had 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) diagnosis simultaneously. Based on imaging of 18F-FDG PET/CT, diffusely incremental 18F-FDG avidity in spine/pelvis on PET and subtle erosion of cortical bone on CT were seen. The cytological results of bone marrow biopsy showed evidence of malignant metastasis. However, there were several focal discrepant findings between the 18F-FDG PET/CT and Tc-99m MDP bone scan. According to integration of both imaging findings and the result of bone marrow biopsy, we believe that the disseminated malignant spread in bone marrow is a primitive alternation in the super bone scan and that it is also as a result of neoplasm-related endocrine factors.

Bone Scan and SPECT/CT Findings in Marble Bone Disease.

Marble bone disease or osteopetrosis (OS), is a rare inborn disorder characterized by the failure of osteoclasts to resorb bone [1]. Overall incidence of the disease is estimated to be 1 case in 100,000-500,000 population [2]. Whereas the radiographic features of the disease are well known, information on bone scan imaging is sparse in the literature. We present technetium-99m methylene diphosphonate (99mTc MDP) bone scan features of osteopetrosis,along with single photon emission computed tomography–computed tomography(SPECT/CT) correlation in a young male (Fig. 1). Fig. 1 A 23-year-old man underwent a 99mTc MDP bone scan for the evaluation of sclerotic lesions in the pelvis found on a radiograph obtained for his hip pain. On planar scan (a, b), intense tracer uptake was noted in the entire skeleton, notably in the proximal ... On conventional imaging, generalized sclerosis, more commonly in metaphyseal regions is seen in bones. Various patterns described on bone scan include diffuse increased uptake that may also be a “Superscan” and non-uniform uptake with foci of hyperemia [3–5]. Use of SPECT/CT in OS has not been described in literature previously. In our case, SPECT/CT was performed to rule out fracture of left femur or pelvic bone as a cause of patient’s symptoms. It is known that pelvic X-ray has limited value for detecting pelvic fractures compared with CT scanning and hence we performed SPECT/CT even when the radiographs were available [6]. In such a case, planar imaging alone will miss the uptake secondary to fracture as it will be masked by metaphyseal areas of intense tracer uptake. Additional advantage of SPECT/CT in such cases is that it can confirm that the areas of abnormal tracer uptake are limited to metaphyseal regions and hence can clinch the diagnosis of OS. In general, radiographic findings are considered sufficient for diagnosis of OS and biopsy is reserved only in pre-bone marrow transplant work-up, in cases where diagnosis is unclear or for genetic diagnosis [7]. SPECT or SPECT/CT can be used as a problem solving tool when conventional imaging findings are inconclusive or pathological fracture is suspected. Our case illustrates bone scan and SPECT/CT findings of this rare disorder. Though rare, this diagnosis should be kept in mind when similar uptake pattern and CT characteristics are encountered in practice.

A pilot study on the clinical value of 18F-sodium fluoride PET/CT in advanced prostate cancer.

10589 Background: We evaluated the clinical utility of 18F-sodium fluoride PET/CT bone scan (18F-NaF) in the detection of bone metastases in patients (pts) with prostate cancer in comparison with Technetium-99m MDP bone scan (TcBS). Methods: In a prospective study, from October 2010-December 2011, 30 prostate cancer pts (ages 51-79), 21 with known bone metastases and 9 without known bone metastases, had18F-NaF and a TcBS performed. Abnormal foci of uptake on both TcBS and 18F-NaFwere classified as benign, malignant or indeterminate. Benign lesions included uptake in the joints and linear uptake at the endplates of the vertebral bodies consistent with degenerative changes. Malignant uptake on 18F-NaF scans was confirmed by characteristic osteoblastic features on CT. All TcBS and 18F-NaF were reviewed by an experienced nuclear medicine physician. For the patient-based analysis, scan results were categorized as positive (POS) = any malignant lesion; indeterminate (IND) = not distinctly malignant or benign; negative (NEG) = benign lesions only. Results: In the lesion-based analysis, 21 of 30 (70%) pts had more malignant lesions identified on 18F-NaF than on TcBS. The mean number of additional malignant lesions per patient on 18F-NaF vs TcBS was 4. Eight of the 30 pts had same number of malignant lesions identified in both studies. One of 30 pts had one less malignant lesion identified on 18F-NaF than on TcBS. CT correlation by 18F-NaF PET/CT of this particular lesion did not confirm osteoblastic feature. Malignant lesion distribution on 18F-NaF included: spine (28%), thorax (26%), pelvis (24%), long bones (13%) and skull (10%). In the patient-based analysis, 24 pts (80%) were POS by 18F-NaF, of whom 14 pts were POS, 8 were IND, and 2 were NEG by corresponding TcBS; in the 4 pts with NEG 18F-NaF, zero were POS, 2 were IND and 2 were NEG by corresponding TcBS. Conclusions: 18F-NaF identified more malignant lesions than TcBS. 18F-NaF may also add useful information in the management of advanced prostate cancer pts with and without known bone metastases.

Multimodality imaging in biochemical recurrence of prostate cancer: Utility of 18F-NaF PET/CT in early detection of metastasis

A 54-year-old male with biopsy proven Gleason 9 prostate cancer presented with rapidly increasing serum PSA level of 12.4 ng/ml and PSA doubling time <1 month after radical prostatectomy. Conventional imaging scans (chest, abdomen and pelvis CT and 99mTc-MDP bone scintigraphy) were obtained which identified a single equivocal mildly sclerotic and active lesion in T8 vertebral body (Fig. 1). The patient was then enrolled in an ongoing prospective clinical imaging trial designed to assess the diagnostic utility of 18F-FDG PET/CT and 18F-NaF PET/CT in men with biochemical recurrence of prostate cancer and negative or equivocal standard imaging. While 18F-FDG PET/CT was negative, 18F-NaF PET/CT demonstrated numerous randomly distributed fluoride avid lesions in the skeleton (cervical/thoracic/lumbar spine, bilateral acetabuli pelvis, right clavicle) compatible with skeletal metastases (Fig. 2). Follow-up MRI of the spine confirmed the bony lesions (see Fig. 1). Patient was then started on androgen deprivation therapy (bicalutamide/leuprolide acetate) and radiotherapy to a painful area in lower-thoracic spine (3250 cGy to T7–T11) after which his PSA declined to 0.6 ng/ml. Follow-up 18F-NaF PET/CT showed increase in sclerosis on CT and decline in NaF uptake at sites of skeletal metastases. Conventional bone scintigraphy and CT are standard in the imaging evaluation of men with suspected metastatic disease based on rising serum PSA level. However, when available, 18F-NaF PET/CT should be considered since it may be useful in early detection of occult skeletal metastases as clearly demonstrated here in our case.1–3 Fig. 1 Initial imaging evaluation of a man with biochemical relapse of prostate cancer: (A) equivocal 99mTc MDP bone scan, (B) equivocal sagittal view of thoracic spine CT, (C) sagittal view of follow-up thoracic spine MRI (performed after 18F-NaF PET/CT) demonstrating ... Fig. 2 Demonstration of widespread osseous metastatic disease with 18F-NaF PET/CT: maximum intensity projection images of 18F-NaF PET/CT (A) at baseline, (B) at 6 months after start of therapy, (C) transaxial CT and fused 18F-NaF PET/CT appearance of a lesion ...

Incidental Detection of Gastrointestinal Stromal Tumor by Tc-99m MDP Bone Scan

This case demonstrates extraosseous 99m-technetium methylene diphosphonate (Tc-99m MDP) accumulation from a gastrointestinal stromal tumor. A 75-year-old woman underwent a temporal bone CT for conductive hearing loss that showed sclerosis in the right occipital condyle. Follow-up Tc-99m MDP bone scan for osseous metastases instead showed a mass-like extraosseous accumulation of Tc-99m MDP in the anterior left upper quadrant. Differential diagnoses included gastric cancer, lymphoma, metastatic melanoma, systemic hypercalcemia, or heterotopic mesenteric ossification. Contrast CT showed a well-circumscribed mass arising from the stomach, and subsequent pathology confirmed gastrointestinal stromal tumor. These tumors rarely can contain osteoclast-like giant cells and should be considered for extraosseous Tc-99m MDP accumulation.

Bone Infarcts in a Case of Chronic Myeloid Leukemia: Chronic Phase

Dear Editor, Infarcts are commonly seen in spleen, and rarely in myocardium and brain, in patients of chronic myeloid leukemia (CML). Bone infarcts, manifesting as severe debilitating pain as an initial presentation of CML have not been reported. We present a case of CML in chronic phase whose initial presentation was severe bone pains with inability to walk. Tc-99m MDP bone scan revealed heterogenous areas of bone infarct involving long bones of both upper and lower limbs. She was treated with Imatinib and Ecosprin. She became complete pain-free in 4 months. This case highlights the unusual presentation of CML-CP and complete recovery with standard therapy. A 32-years old woman presented with diffuse bony-pains involving bilateral upper and lower limbs for 3 weeks duration. She was not able to perform her daily routine activities because of severe pain (ECOG performance status 3). Clinical examination revealed mild pallor and splenomegaly (spleen size 8 cm below costal margin). Hemogram revealed hemoglobin 9.4 g/dl, total leukocyte count 136 × 109/l, platelet count 588 × 109/l and differential count-neutrophils 16%, lymphocytes 22%, myelocytes 24%, metamyelocytes 34%, basophils 3% and blasts 1% (Sokal, Intermediate risk 0.83). Her biochemical profile revealed blood urea 36 mg/dl, creatinine 1.1 mg/dl, uric acid 4.2 mg/dl, calcium 8.6 mg/dl and bilirubin 0.8 mg/dl. Her leukocyte alkaline phosphatase (LAP) score was low and RT-PCR for BCR-ABL was positive for p210. She was diagnosed as a case of chronic myeloid leukemia- Chronic phase (CML-CP). Radiographs of limb bones were normal. Tc-99m MDP bone scan revealed heterogenous increased radiotracer uptake in limb bones (involving bilateral humeri, forearm bones, femurs), suggestive of multiple bone infarcts. Rest of the skeleton was normal. She was started on hydroxyurea 500 mg thrice daily, allopurinol 100 mg thrice daily, imatinib mesylate 400 mg once daily and ecosprin 75 mg once daily. She was given analgesics (paracetamol and tramadol) for bone pains. Hydroxyurea and allopurinol were stopped after 2 weeks and imatinib and ecosprin continued. Patient achieved complete hematological response after 2 months of imatinib therapy but continued to have limb pains for 4 months though with decreased intensity. Pain completely subsided 5 months later (ECOG performance status 0). Repeat bone scan performed at 5 months revealed completely normal bone scan. Quantitative PCR for BCR-ABL at 15 months revealed major molecular response. CML accounts for approximately 15 to 20% of leukemias in adults. The clinical findings at diagnosis of CML-CP vary among reported series. Twenty to 50% of patients are asymptomatic, with the disease first being suspected from routine blood tests [1, 2]. Among symptomatic patients, systemic symptoms such as fatigue (34%), weight loss (20%), abdominal fullness (15%) and bleeding episodes due to platelet dysfunction (21%) are common [2]. Abdominal pain and discomfort may include left upper quadrant pain and early satiety due to the enlarged spleen with or without perisplenitis and/or splenic infarction. Tenderness over the lower sternum, due to an expanding bone marrow, is sometimes seen. Acute gouty arthritis may also present due to overproduction of uric acid [3]. Other frequent findings include splenomegaly (present in 48–76%), anemia (45–62%), white blood cell count above 100 × 109/l (52–72%) and platelet count above 600 × 109 (15–34%) [1, 2]. Involvement of extramedullary tissues such as the lymph nodes, skin, and soft tissues is generally limited to patients with blast crisis. Although thrombocytosis is common, thrombosis is not seen [2]. Other rare manifestations include splenic rupture [4] and priapism [5]. The radiological changes studied in CML include diffuse osteoporosis, focal osteolytic and osteoblastic lesions, chloromas and arthritis [6]. Bone pains are one of the common presentations of hematological malignancies [7] and are usually due to marrow infiltration by leukemic cells causing expansion of bone marrow. Bone infarction with severe pain as initial presentation has never been reported in CML-CP, though a case of CML developing bone infarction and progressing to myelofiberosis has been documented [8]. Our patient presented with diffuse debilitating bone pains due to multiple bone infarcts which is an unusual presentation of CML-CP. The patient responded to the usual treatment with complete disappearance of bone lesions and complete clinical recovery.

Bone mineral density change: Comparison between prostate cancer patients with or without metastases and healthy men (a North African ethnic group)

AimTo evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. Patients and methods135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n=55), abnormal but not typical for metastases (score 1: n=45), and typical pattern of metastases (score 2: n=35). ResultsThe patients with bone metastases prostate cancer had significantly higher total bone mineral density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r=0.328; P<0.05; r=0.60; P<0.001; r=0.480; P<0.001, respectively). ConclusionBone metastasis is a major cause of morbidity in prostatic cancer; bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by 99mTc MDP bone scan.

SPECT/CT in the Diagnosis of Skull Base Osteomyelitis.

Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A (99m)Tc MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast-enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

Cambios en la densidad mineral ósea: comparación entre pacientes de cáncer de próstata con o sin metástasis y varones sanos (grupo étnico norteafricano)

Aim To evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings. Patients and Methods 135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n = 55), abnormal but not typical for metastases (score 1: n = 45), and typical pattern of metastases (score 2: n = 35). Results : The patients with bone metastases prostate cancer had significantly higher total bone minera1 density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r = 0.328; P < 0.05; r = 0.60; P < 0.001; r = 0.480; P < 0.001, respectively). Conclusion Bone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by 99mTc MDP bone scan.

Cavernous Angioma Mimicking a Differentiated Thyroid Carcinoma Brain Metastasis

A 30-year-old man diagnosed with follicular thyroid carcinoma treated previously with total thyroidectomy was referred to radioiodine treatment. Post-therapy scan performed 10 days after a 150 mCi 131NaI revealed radioiodine uptake in left temporal region. To elucidate the abnormal head uptake, Tc-99m MDP bone scan and head magnetic resonance image was performed. No anomalous uptake was observed in the bone scan. Head magnetic resonance image found a well-circumscribed lesion in temporal was compatible with a vascular malformation. Angioresonance confirmed the diagnosis of cavernous angioma, a benign vascular tumor.

Diffuse Pulmonary Uptake of Tc-99m Methylene Diphosphonate in a Patient with Non-tuberculosis Mycobacterial Infection.

Extra-osseous uptake of bone-seeking radiopharmaceuticals has been reported at various sites and it is known to be induced by various causes. Diffuse pulmonary infection, such as tuberculosis, can be a cause of lung uptake of bone-scan agent. Here we report on a patient with non-tuberculosis mycobacterial infection (NTM) who demonstrated diffuse pulmonary uptake on Tc-99m MDP bone scan. After medical treatment for NTM, the patient's lung lesions improved. Extraskeletal lung Tc-99m MDP uptake on bone scan may suggest lung parenchymal damage associated with disease activity.

Myositis Ossificans Mimics an Osteoid Osteoma

Abstract:Myositis ossificans is a form of heterotopic bone formation that is caused most commonly by a traumatic injury. In the active phase, it shows intense uptake on a Tc-99m MDP bone scan, and its extraosseous location is usually evident from planar images alone. However, if it is small and very

Spindle Cell Sarcoma Degeneration of Giant Cell Tumor of the Knee, Imaged With F-18 FDG PET-CT and Tc-99m MDP Bone Scan

Abstract:Giant cell tumor is a benign but aggressive bone tumor that occurs in young adults ages 20 to 40, accounts for 20% of benign bone tumors, occurs mostly in the metaphyso-epiphyseal region of long bones, and is characterized by the presence of multinucleated giant cells. The risk of malignant

TC 99m MDP bone scan in evaluation of painful scoliosis

A 18-year-old male presented with low back ache. The patient was investigated and was diagnosed to have painful scoliosis. X-ray and other examinations could not reveal any diagnosis. The patient was referred to undergo bone scan on clinical suspicion of osteoid osteoma and to rule out stress fracture if any. Planar bone scan was performed, which showed a lesion in L3 vertebra and was further evaluated with SPECT (Single photon emission computed tomography) study to characterize the lesion. On SPECT examination, the classical features of osteoid osteoma, the double density sign (11), was noted in the pars interarticularis region. These findings were confirmed by a CT scan, which showed a sclerotic lesion in pars interarticularis of L3 vertebra. The patient was posted for operation and was relieved of symptoms in the postoperative follow-up.

Diagnosis of Acute Osteomyelitis in Previously Irradiated Bone

Abstract: We are reporting a case of acute osteomyelitis in previously irradiated bone. In nonirradiated bone the diagnosis of acute osteomyelitis is established by the mismatch between focal indium-111 whole body scintigraphy (WBC) bone uptake and bone marrow replacement as seen on the Tc-99m sulfur colloid scans in areas of acute osteomyelitis. In previously irradiated bone, the bone marrow is absent due to radiation effects. Accordingly, the combination of indium-111 WBC and Tc-99m sulfur colloid mismatch cannot be implemented. In this case, we found that in spite of previous irradiation of the bone there is uptake in the bone matrix due to cortical and osteoblastic activity as seen on the Tc-99m MDP bone scan. For this reason we are recommending that for the diagnosis of acute osteomyelitis in previously irradiated bone, dual isotope imaging using indium-111 WBCs and Tc-99m MDP is more accurate than indium-111 WBCs and Tc-99m sulfur colloid.

Discordant findings in patients with non-small-cell lung cancer: absolutely normal bone scans versus disseminated bone metastases on positron-emission tomography/computed tomography

At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. The objective of our study was to compare the sensibility of the 2-deoxy-2-[18F] fluoro-d-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for the detection of bone metastasis in patients with non-small-cell lung cancer (NSCLC) whose technetium 99m methylenediphosphonate (Tc-99m MDP) bone scans were absolutely normal. This study based on the retrospective analysis of 95 consecutive patients with histologically proven NSCLC who underwent F-18 FDG PET/CT and Tc-99m MDP bone scan at the Eskişehir Osmangazi University School of Medicine, Department of Nuclear Medicine between November 2006 and October 2008. Nineteen patients (19 of 95, 20%) with absolutely normal Tc-99m bone scan versus multiple high-grade F-18 FDG avid bony metastases on F-18 FDG PET/CT were selected for the review. Their ages ranged from 46 to 73 years (15 males and four females; mean: 57.2 years). Nine patients had squamous cell carcinoma, six had adenocarcinoma, three had large cell carcinoma and one had adenosquamous cell carcinoma. Tc-99m MDP bone scan that did not reveal bony abnormalities or radiotracer uptake was characteristic of benign disease (defined as absolutely normal) in these patients. Whereas, F-18 FDG PET/CT not only showed extremely disseminated heterogeneous nest-like high-grade FDG avid metastatic foci within the marrow cavity of the upper and lower thoracic spine, lumbar spine, pelvis, rib cages and bilateral proximal long bones, but also showed disseminated osteolytic bony metastases in these areas. Discordant findings of skeletal metastasis between Tc-99m MDP bone scans and F-18 FDG PET/CT imaging may be seen in 20% of the patients with NSCLC. F-18 FDG PET/CT could detect metastatic bone involvement more accurately than bone scintigraphy. Bone scans are insensitive to early bone marrow neoplastic infiltration. Assessment of glucose metabolism with FDG PET/CT can represent a more powerful tool to detect early bone metastases in lung cancer than with traditional bone scans.

Tc-99m MDP Bone Scintigraphy in Septic Shock

An 8-year-old girl presented with a history of diarrhea, vomiting, and drowsiness. Clinical examination confirmed septic shock with marked metabolic acidosis. As a complication of septicemia, severe ischemia of all 4 limbs was noted from day 1 and she subsequently developed peripheral gangrene. Tc-99m MDP bone scan showed extensive bone infarction in all 4 limbs. Early diagnosis of osteonecrosis and amputation may prevent worsening of sepsis. However, it is not possible to clinically demarcate the level of amputation. Bone scan is a useful diagnostic tool in determining the appropriate level of amputation.

Malignant Pleural Mesothelioma Presenting as Low Back Pain

Case report. We report malignant pleural mesothelioma (MPM) discovered in a Tc-99m MDP bone scan as a photopenic lesion in a 64-year-old man presenting with low back pain and diagnosed with F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Malignant pleural mesothelioma, an uncommon neoplasm with a poor prognosis, arises from mesothelial cells of the pleura. Typically, the patient presents with either chest pain or symptoms derived from a pleural effusion such as dyspnea, or both. Most cases of MPM are initially detected on chest radiographs and primarily diagnosed with a CT scan. Case study with bone scan and F-18 FDG PET/CT. The Tc-99m MDP bone scan showed a photopenic defect occupying the left side of the T11 vertebra and implicated the existence of a tumor. Pathologic analysis of the paraspinal tumor indicated metastatic neoplastic cells, which we initially suspected originated from the gastrointestinal tract. The CT and magnetic resonance imaging showed no additional information about the primary malignancy; therefore, we did an F-18 FDG PET/CT study, which suggested malignant pleural mesothelioma. The present case highlights both the value of a Tc-99m MDP bone scan when MPM presents, unusually, as low back pain, and the importance of carefully interpreting bone scan images, especially for photopenic defects. It also indicates the usefulness of F-18 FDG PET/CT study in MPM in a difficult histopathological diagnosis.

Tuberculosis of the Spine on Tc-99m MDP Bone Scan

Dedicated multislice single-photon emission computed tomography-computed tomography (SPECT-CT) is useful for accurate anatomic localization and lesion characterization of abnormal findings on planar scintigraphy. We present a case of a 33-year-old woman with a history of low back pain. Lumbar spine radiographs demonstrated irregularity of the superior end plate of L2 with an associated compression fracture. A Tc-99m MDP bone scan was performed given her young age and the absence of a history of trauma. The whole body planar imaging revealed nonspecific findings of diffuse linear increased tracer uptake involving L2. The SPECT-CT findings were in keeping with spinal tuberculosis. This was confirmed with culture of CT-guided aspiration of a left psoas collection, which revealed heavy growth of Mycobacterium tuberculosis. This case highlights the benefits of multislice SPECT-CT imaging in the anatomic localization of increased metabolic activity and provision of additional diagnostic information. This enabled rapid diagnosis and management.