MDP Bone Scan Research Articles

False Negative Result of Ga-67 Scintigraphy in Tuberculous Spondylitis: Report of a Case

Tuberculous spondylitis is a difficult condition to diagnose clinically. However, Ga-67 scintigraphy can playa useful role in its detection. A false negative result of Ga-67 scintigraphy was demonstrated in a case of tuberculous spondylitis in this report. A 79-year-old female had fever of unknown origin (FDO) and severe low back pain for- several months. Abnormally increased radioactivity was noted in the L3/41evels on Tc-99m MDP bone scan; however, normal uptake of radioactivity was noted on Ga-67 scintigraphy. Finally, tuberculous mycobacterial infection involving the vertebral bones of L3/4 levels was diagnosed by histologic evaluation. We emphasize that tuberculous spondylitis has to be considered in the condition of a positive Tc-99m MDP bone scan while negative on Ga-67 scintigraphy.

Diagnosis of infection after total hip arthroplasty

Forty-eight total hip arthroplasties for which revision surgery was performed were reviewed to determine the accuracy of laboratory tests, plain radiographs, hip aspiration, and technetium-99m MDP and gallium-67 scans in demonstrating the presence or absence of infection of the prosthesis. Six of the 48 hips were diagnosed as having an infection at the revision surgery. The erythrocyte sedimentation rate and the C-reactive protein levels were significantly higher in the patients with infected prostheses. The difference in the white blood cell count was not significant. There was no significant relationship between the presence of infection and the severity of loosening and instability of the implants diagnosed by plain radiographs. The accuracy of hip aspiration in diagnosing the infection was 83%, with a sensitivity of 40% and a specificity of 92%. The accuracy of technetium-99m MDP bone scan was 79%, with a sensitivity of 83%, and a specificity of 79%. Gallium-67 scan had an accuracy of 96%, a sensitivity of 67%, and a specificity of 100%. The findings in the present study indicated that diagnostic tests consisting of laboratory tests and plain radiography, followed by hip aspiration and sequential use of technetium-99m MDP and gallium-67 scintigraphies, are suitable for differentiation between mechanical loosening and infection of total hip arthroplasty.

Myocardial Tc-99m MDP Uptake on a Bone Scan in Senile Systemic Amyloidosis with Cardiac Involvement

A Tc-99m MDP bone scan showed diffuse myocardial uptake in a 61-year-old man who reported progressive glove- and stocking-like parasthesias. Results of complete blood counts, thyroid and liver function tests, tumor markers, electrolytes, and electrocardiography were normal. Electromyelographic findi

Bilateral accessory iliac horns: pathognomonic findings in Nail-patella syndrome. Scintigraphic evidence on bone scan.

Nail-patella syndrome is a rare hereditary (autosomal dominant) disorder, also called hereditary osteo-onychodysplasia and Fong's syndrome. Its incidence is 4.5 per million population in the United States. Patients have a characteristic tetrad of pathologic symptoms including fingernail dysplasia, hypoplastic or absent patellas, radial head dislocation, and iliac horns. Soft-tissue changes and renal dysplasia have also been associated with the syndrome. Iliac horns are bilateral accessory outgrowths consisting of cortex and medulla continuous with the iliac bone. They are located at the site of attachment of the gluteus medius muscles and project posterolaterally. These smooth bony outgrowths are asymptomatic, frequently palpable, and, because they have no effect on gait, they need not be treated. Iliac horns are the pathognomonic feature of Nail-patella syndrome; that is, they occur in approximately 80% of cases and are observed only in this condition. Four patients (two female, two male) with Nail-patella syndrome have been examined in the authors' department: three family members, including a 37-year-old woman, her 18-year-old son, and her 15-year-old daughter, and an unrelated 26-year-old man. All patients, regardless of age or sex, had similar pelvic findings on their bone scans. Although whole-body scans were obtained in all patients, significant scintigraphic findings were observed only in the pelvis in all the patients examined. This is most likely the result of the mild nature of the related deformities, which do not yield scintigraphically detectable osteoblastic changes. A representative image showing these independent ossification on a Tc-99m MDP bone scan is presented. A conventional pelvic radiographic image of the same patient's pelvis is presented for comparison.

Demonstration of Spinal Osteomyelitis With Ga-67 Citrate, Tc-99m MDP, and Tc-99m Ciprofloxacin With Provisionally Negative Results on MRI

A 65-year-old woman was hospitalized with pyrexia and lumbar back pain. Radiographs of her lumbar spine and MRI were performed on the day of admission and the results were considered normal. Five days after admission, a Tc-99m MDP bone scan was performed and showed nonspecific increased uptake at L2-L3. Planar and SPECT Ga-67 citrate scintigraphy showed increased tracer uptake at L2-L3. MRI confirmed osteomyelitis at this site. A Tc-99m ciprofloxacin scan was performed and also showed infection at L2-L3. Group B Streptococcus grew in blood cultures from the patient, who improved clinically after a prolonged course of antibiotics.

Comparison of Tc-99m MDP, Tc-99m HSA and Tc-99m HIG uptake in rheumatoid arthritis and its variants

Tc-99m polyclonal immunoglobulin-G has been shown to be a successful agent in the depiction of active inflammation in rheumatoid arthritis (RA). The objective of this study was to compare the uptake behaviors of Tc-99m HIG and Tc-99m MDP in RA and variants of rheumatoid arthritis (VRA). Seventeen patients with RA and 8 patients with VRA presenting with active inflammation were included in this study. Ten subjects with well-diagnosed degenerative joint disease constituted the control group. All joints in patients were also imaged with Tc-99m HSA to evaluate the vascularization status of the joints. Tc-99m HIG and HSA scans were obtained at 2, 4 and 24 hours after the injection of 555 MBq Tc-99m HIG and 296 MBq Tc-99m HSA. Conventional bone scans were performed 4 hours after the injection of 740 MBq Tc-99m MDP. Target-to-background (T/B) ratios were obtained exclusively over the joint regions. Tc-99m HIG T/B ratios of the active joints in RA were significantly higher than those of the non-active joints and the control group (p < 0.05). Tc-99m HIG T/B ratios in active joints showed a progressive increase between 2 and 24 hour images (p < 0.05). In contrast, Tc-99m HSA T/B ratios decreased in all active joints significantly (p < 0.05) except the ankle joint region (p > 0.05). The T/B ratios in Tc-99m MDP bone scans were higher in all active joints than in non-active RA joints and joints of controls but significantly differences were only detected in wrist and elbow joints. All clinically active joints in VRA patients accumulated Tc-99m HIG and HSA, and showed increased Tc-99m MDP uptake. These joints had a very similar Tc-99m HIG retention pattern to the RA joints. The detection rate of active joint inflammation with Tc-99m HIG was much higher than that with Tc-99m MDP. The increasing Tc-99m HIG uptake ratio between 2 and 24 hours in contrast to Tc-99m HSA indicates the presence of other binding mechanisms besides increased vascularity in RA.

Tc-99m-labeled leukocyte and skeletal scintigraphy in a case of pelvic osteomyelitis.

Osteomyelitis in red marrow-containing regions of the axial skeleton may produce photopenic defects on radiolabeled leukocyte scintigraphy. A 47-year-old man underwent elective penile reconstructive surgery. The postoperative course was complicated by wound infection, and the patient reported progressive anterior pelvic pain despite antibiotic therapy. A Tc-99m MDP bone scan revealed focal hyperemia and increased tracer uptake in the body of the pubis and pubic crest bilaterally, suspicious for regional osteomyelitis. A Tc-99m stannous colloid-labeled leukocyte study performed subsequently showed absent white cell accumulation in the corresponding area, with a normal pattern of distribution elsewhere in the skeleton. Bone biopsy from the pubic symphysis demonstrated a neutrophilic cellular infiltrate and granulation tissue consistent with active bony infection.

Hyperthyroidism: an underappreciated cause of diffuse bone disease.

A 37-year-old man and a 40-year-old woman were referred for evaluation of skeletal complaints. Tc-99m MDP bone scans were obtained. Tc-99m MDP bone scanning of the man revealed a metabolic super-scan pattern. Tc-99m MDP images of the woman mimicked autoimmune arthritis. A thyroid workup was performed at a substantial interval after bone scanning. Thyroid laboratory indices in both patients suggested Graves' Disease. I-123 scanning revealed diffuse increased uptake in both patients, confirming the diagnosis of Graves' Disease. Successful treatment was eventually achieved with I-131. We conclude that nuclear medicine physicians should be aware that hyperthyroidism may present either as a pattern of metabolic superscan or may resemble an autoimmune arthritic process; in other words, it should be understood that insofar as bone imaging, Graves' Disease is the Great Imitator. Similarly, referring clinicians need to be aware of these relationships, and appropriately screen patients with skeletal complaints. This is especially important in an era when generalists and ancillary medical personnel are involved in the screening of patients with complex and misleading disease processes.

Incidental detection of calcified dialysis graft on Tc-99m MDP bone scan.

A 48-year-old woman with a renal transplant and a history of immunosuppressive steroid use presented with a history of persistent hip pain. She was referred for radionuclide bone scan to evaluate the presence of avascular necrosis. No evidence of avascular necrosis was seen; however, incidental uptake of Tc-99m MDP was seen in a heavily calcified, nonfunctioning, synthetic dialysis access graft in the left groin.

The role of fluorine-18-deoxyglucose (FDG) positron emission tomography (PET) whole body scan (WBS) in the staging and follow-up of cancer patients: our first experience.

We report the results of FDG PET whole body scan in 75 cancer patients in whom tumor extent was defined by surgical, histological or cytological findings and clinical follow-up. Twenty-five had malignant lymphomas, 24 lung carcinomas, and 26 other types of solid tumors. Twenty-three patients were evaluated at disease onset, before therapy, and 37 at the moment of tumor recurrence; the remaining 15 patients were in complete remission after treatment and were taken as controls. Visual and quantitative PET results were compared with conventional imaging (US, CT scan and/or MRI, and Tc99m MDP bone scan). In the 60 patients with active disease, PET as well as conventional imaging were able to locate the primary tumor in all 23 patients studied at disease onset. However, with regard to lymph node and distant metastases, PET provided the same information as conventional imaging in 31 cases (51.6%), but revealed further neoplastic foci in 29 cases (48.4%), 21 in lymph nodes and 8 at distant sites. The sensitivity of PET, in comparison with conventional imaging, was 100% versus 100% for the detection of the primary tumor, 97.6% versus 55.8% for the localization of node metastases, and 100% versus 55.5% for the visualization of distant metastases. The specificity, calculated in the group of 15 disease-free patients, was 100% for PET and 86.6% for conventional imaging. The therapeutic approach was modified in 12 patients (20%) on the basis of the PET results. Furthermore, in 14 cases (23.3%) with advanced disease, PET provided complete information on tumor spread, otherwise obtainable only by taking together the results of all other diagnostic procedures. Our data indicate a higher accuracy of FDG PET whole body scan compared to conventional imaging techniques in the evaluation of metastatic spread both at initial diagnosis and during follow-up, with an important impact on therapeutic decision-making. Moreover, by providing complete information on tumor spread in some cases, PET can become a profitable tool in terms of cost reduction.

Tc-99m MDP Bone Scintigraphy in Relapsing Polychondritis

A 62-year-old man was wheezing and had chest pain for 2 months. He had a history of bilateral ear swelling, for 3 years. Physical examination showed edematous and red auricles and a saddle nose deformity. Computerized tomography showed tracheal calcifications and tracheobronchial narrowing was observed on bronchoscopy. Tc-99m MDP bone scan performed for chest pain showed diffusely increased uptake in the costochondral junctions. The biopsy showed relapsing polychondritis. He underwent prednisolone therapy for 2 months and his symptoms and scintigraphic findings were improved. This report indicates that MDP bone scintigraphy may be a valuable method in follow-up of relapsing polychondritis.

Sequential Tc-99m MDP bone scans after cementless total hip arthroplasty in asymptomatic patients.

To evaluate the distribution and degree of radioactivity on sequential Tc-99m methylene diphosphonate (Tc-99m MDP) scans in the diagnosis of postoperative loosening in asymptomatic patients who underwent cementless total hip replacement. Tc-99m MDP scans were obtained every three months where possible, for one year in those patients who underwent total hip replacement using a Harris Galante cementless prosthesis. Eighty-three scans from 45 patients were obtained. Uptake was assessed within the five periprosthetic zones (zone 1: greater trochanter; 2: lateral stem of the prosthesis; 3: tip of the prosthesis; 4: medial stem of the prosthesis; and 5: lesser trochanter) using an arbitrary 5-point grading system. Grade 1 indicated normal uptake and Grade 5 indicated highest uptake. The grade of uptake within each zone was then analyzed against their postoperative ages. The radioactivity regressed to Grade 1 or 2 from Grade 4 or 5 within 12 months after cementless total hip replacement in 87.5% and 93.8% of patients in zones 2 and 4, respectively. Even though the radioactivity within zones 1, 3, and 5 tended to decrease, persistent elevation of activity (over grade 2) lasted up to 12 months after surgery in 31% or 37% of the patients. The radioactivity after cementless total hip replacement tended to regress in proportion to the postimplant age. The regression rate varied depending on the periprosthetic zones.

Prostate Specific Antigen and Bone Scan

Prostate specific antigen (PSA) is known to be the most sensitive marker available for monitoring the progression of prostate cancer and the response to therapy. PSA concentrations tend to increase with the advancing clinical stage of prostate cancer. To assess the role of PSA in detecting skeletal metastases, PSA levels were correlated retrospectively with ^99mTc MDP bone scan findings in 35 known prostate cancer patients. The cutoff level was set at 10 ng/ml. Of the 35 bone scans, 24 demonstrated metastatic bone disease. Twenty of the 24 had serum PSA values of& < 10 ng/ml (13-800 ng/ml). Of the 11 patients with negative bone scans, 2 had PSA values& <10 ng/ml. The PSA level had a direct correlation with the incidence of positive bone scan (p& %lt; 0.001). The sensitivity of the marker was 83.3% and its specificity was 81.8%. Thus, serum PSA level is a useful biochemical tumor marker that can help in the assessment of skeletal metastases of prostate cancer patients during their follow-up. When used in combination with scintigraphic bone findings, a more accurate clinical picture of the patient is obtained.

Comparison of Nuclear Bone and Gallium Scans in the Therapeutic Evaluation of Bone Lymphoma

The objective of this study was to compare Tc-99m MDP bone and Ga-67 scans for the therapeutic response to bone lymphoma in 40 patients. The authors retrospectively compared 40 Tc-99m MDP bone scans and 20 Ga-67 scans before therapy, 29 bone scans and 13 Ga-67 scans during the therapy, and 33 bone scans and 15 Ga-67 scans after therapy. Tc-99m MDP and Ga-67 whole body scans were obtained within 2 weeks of each study and were graded visually (grades 1-4) in which grade 3 means similar count density to that of normal iliac alar activity on bone scans and normal liver activity on Ga-67 scans, respectively. The findings of lesion improvement during and after therapy were found in 66.0% (19 of 29) and 72.7% (24 of 33) with Tc-99m MDP bone scans, 84.6% (11 of 13) and 86.7% (13 of 15) with Ga-67 scans, respectively. The mean grades of Tc-99m MDP uptake were 3.06 before, 2.34 during, and 1.75 after therapy. The mean grades of Ga-67 uptake were 3.22 before, 1.42 during, and 1.30 after therapy. Ga-67 scans appear to be more reliable than Tc-99m MDP bone scans in evaluating the therapeutic response of bone lymphoma.

Evaluation of arthritis in Reiter's disease by bone scintigraphy and radiography

Tc-99m MDP bone scans were used to evaluate the articular inflammation in 38 patients with Reiter's disease and compared with clinical examination and radiologic findings. Our data showed that Reiter's disease predominantly involves the lower limbs, especially the heels, which may be a characteristic feature of Reiter's disease. Bone scans revealed a high diagnostic sensitivity in the detection of clinical arthritis in all peripheral joints, especially in the small joints of the four limbs. The diagnostic sensitivity of radiography was generally lower than bone scintigraphy. In the presence of positive radionuclide findings, clinical arthritis was found in most joints. The scintigram, however, detects a greater number of abnormalities than does clinical assessment in the sternoclavicular joints, shoulders, metacarpophalangeal joints, and tarsals. Because of its high sensitivity, bone scintigraphy is capable of detecting subclinical arthritis, and might provide more objective evidence of early inflammatory joint disease and additional information regarding the pattern of joint involvement. In view of the advantages of low patient radiation exposure, high sensitivity, and the ability to survey the whole body, we consider bone scintigraphy as useful and better than radiography in the detection of early articular inflammation and in establishing the extent and pattern of arthritis in Reiter's disease.

Poor Renal Uptake of Tc-99m DMSA and Tc-99m MDP in a Patient With Fanconi Syndrome and Near Normal Glomerular Filtration Rate

The authors present a patient with Fanconi syndrome who demonstrated poor renal uptake of Tc-99m DMSA and high urinary concentration of the tracer. Tc-99m DTPA imaging was normal and the creatinine clearance was only minimally decreased. These findings suggest that Tc-99m DMSA may be accumulated in the kidney by glomerular filtration and subsequent tubular reabsorption. A Tc-99m MDP bone scan showed faint renal uptake, as well as diffuse high skeletal uptake, particularly in the spine, demonstrating that the metabolic bone disease associated with Fanconi syndrome can be one of the causes of poor renal visualization on a bone scan.

False-Positive Splenic Activity on Bone Scan

A Tc-99m MDP bone scan in a woman revealed splenic uptake of radiolabel. However, the previous (and the following) bone scan did not demonstrate this extraosseous accumulation. The finding was related to a cardiac blood pool scan the previous day, with probable splenic pooling of labeled and denatured red blood cells

Bone Scintigraphy in Evaluation of Heel Pain in Reiter's Disease: Compared with Radiography and Clinical Examination

Tc-99m MDP bone scans were used to evaluate the heel pain (talalgia) in 38 patients with Reiter's disease, and compared with clinical examination and radiologic findings. In our work, 58% (22/38) patients presented talalgia with a total of 35 lesions. Only two lesions of clinical talalgia were missed by the bone scan. The diagnostic sensitivity was as high as 94% (33/35). However, the diagnostic sensitivity of radiography was only 69% (11/16) when the disease duration was more than one year; furthermore, it declined to 33% (4/12) when the disease duration was less than one year. Based on the bone scans, the correlation between positive scintigraphic findings and clinical talalgia was extremely good. Clinical talalgia occurred in all the 33 lesions demonstrated by bone scan. However, three lesions demonstrated by radiography were not consistent with clinical talalgia and not visualized by radioscintigraphy. Our data show that the radionuclide scan is a more sensitive indicator and has better correlation with clinical talalgia than radiography. We consider that bone scintigraphy is superior to radiography in the evaluation of heel pain in Reiter's disease.

Technetium-99m MDP Bone Scan and MRI Correlation in the Detection of Occult Bone Infarction

A 37-year-old female on prednisone therapy for inflammatory bowel disease had chronic focal knee pain bilaterally for several months. Plain film imaging results were normal. However, Tc-99m MDP bone scintigraphy obtained the same day revealed diffuse increased uptake of radionuclide within the distal femoral metaphases and knees bilaterally. Additional diffuse increased activity was seen in the left tibial plateau, with a second small focal area of activity within the proximal tibial diaphysis

Tampon Artifact In Bone Scintigraphy

A 24-year-old female underwent a bone scan to evaluate a sclerotic lesion seen on plain radiography. A Tc-99m MDP bone scan revealed normal osseous distribution of tracer. Abnormal soft tissue uptake was seen in the pelvis in the region of the vagina. After discovering that her menses had just begun, she was asked to replace her tampon. Subsequent pelvic imaging results were normal. When alterations in pelvic images occur in menstruating patients, a tampon artifact should be considered