Methylene Diphosphonate Bone Scintigraphy Research Articles

Tc-99m MDP Scan with Unusual and Isolated Skeletal Metastasis in Skull Bone in a Case of Testicular Seminoma.

Seminomas are common germ cell tumors (GCT) that may arise in the testes as well as in extra testicular locations such as mediastinum with/without testicular tumor. Testicular tumors are usually detected early due to their location and presentation as testicular mass. The overall prognosis of the seminomatous GCTs is good with surgery as the mainstay of treatment in localized disease. Bone metastases, especially when present in isolation are exceedingly rare in seminoma. Here, we present a rare case of skull bone metastasis in a case of testicular seminoma which was detected on technetium-99m labeled methylene diphosphonate bone scintigraphy with single-photon emission computed tomography with computed tomography.

Malignancy incidence and primary tumor investigation in the patients with vertebral compression fractures by means of combined Tc-99m methylene diphosphonate bone scintigraphy and fluorodeoxyglucose positron emission tomography/computed tomography

Purpose: Vertebral compression fractures frequently present with back pain and are determined by magnetic resonance (MR) imaging. However, fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is performed to determine the pathological fractures and primary tumors in a single imaging modality. The aim of this study is to evaluate the incidence of pathological fractures and primary tumors by means of combined bone scintigraphy and FDG PET/CT. Materials and Methods: Twenty-eight patients (15 females, 13 males; mean: 67.8 ± 11.6 years) with compression fractures determined by MR or plain radiographs were the subject of this study. The patients were referred for whole-body bone scintigraphy and due to the suspicion of metastasis additional FDG PET/CT was performed. The results of both studies were compared with the pathological and/or follow-up results. Results: The bone scintigraphy and PET/CT did not reveal concordant results according to the Kappa test. The SUVmax cutoff value was accepted as “7” and with this cutoff value, PET/CT achieved 57.1% sensitivity and 95.2% specificity in the determination of pathologic compression fractures. Conclusion: Although the results of bone scintigraphy and FDG PET/CT were not correlated with each other, FDG PET/CT revealed high specificity in the detection of pathologic fractures.

Thumb Metacarpal-Trapezoid Impingement as an Etiology of Pain After Trapeziectomy and Basal Joint Soft Tissue Arthroplasty: A Case Series

To report a poorly described etiology for pain after trapeziectomy and soft tissue basal joint arthroplasty, diagnosed with the aid of nuclear imaging. Five patients (4 women and 1 man), average age 62 years (range, 59-65 years) presented with pain an average of 7 months (range, 2-11 months) after basal joint arthroplasty. The dominant hand was involved in all cases. Advanced imaging including 25 mCi 99mTc methylene diphosphonate bone scintigraphy and single-photon emission computed tomography (CT) showed intense tracer uptake between the base of the thumb metacarpal and residual trapezoid. Computed tomography scans confirmed abutment between these bones. The symptoms were attributed to this finding, and revision surgery consisting of excision of the trapezoid and arthrodesis of the index and middle finger carpometacarpal joints was performed. Mean follow-up was 40 months (range, 12-60 months). Grip strength improved from a mean of 10.5 to 23 kg, and lateral pinch strength improved from a mean of 3 to 6.75 kg. Radiographic fusion of the index finger metacarpal to capitate was confirmed in 4 of 5 patients; it was indeterminate in one patient who was completely pain-free. Radiographic fusion of long finger carpometacarpal joints was indeterminate in 3 patients. Patient-Rated Wrist Evaluation pain scores improved from 35 to 6, Patient-Rated Wrist Evaluation function scores from 78 to 14, and Quick-Disabilities of the Arm, Shoulder, and Hand scores from 37 to18. Impingement between the base of the thumb metacarpal and remaining trapezoid should be considered a potential source of pain after trapeziectomy and soft tissue arthroplasty. Advanced imaging (bone scintigraphy and single-photon emission CT and standard CT) are helpful to confirm the diagnosis. Therapeutic V.

Clinical Use of Quantitative Analysis of Bone Scintigraphy to Assess the Involvement of Arthritis Diseases in Patients with Joint Symptoms.

We aimed to compare the diagnostic ability of quantitative analysis of bone scintigraphy with that of visual analysis for identifying arthritis disease involvement in patients with joint symptoms. We retrospectively included 93 patients with joint symptoms who underwent Tc-99m methylene diphosphonate bone scintigraphy for evaluating arthritis disease involvement. Bone scintigraphy images were visually and quantitatively analyzed using an in-house software by two reviewers. On quantitative analysis, joint uptake ratio was measured for 64 joints in 14 joints areas. The inter-rater agreement of visual and quantitative analyses was assessed, and diagnostic abilities were compared based on the area under the receiver operating characteristic (ROC) curve (AUC) values. Regarding visual analysis, there was a moderate degree of inter-rater agreement (kappa coefficient of 0.597), while there was a substantial inter-rater agreement (concordance correlation coefficient of 0.987) in the measurement of the joint uptake ratio. The comparisons of ROC curves for the total 5941 joints revealed that the joint uptake ratio had a significantly higher AUC value (0.789) to detect the affected joint than that of the visual analysis (p < 0.001). Quantitative analysis using joint uptake ratio showed substantial reproducibility and higher diagnostic ability to detect joints involving arthritis diseases than visual analysis on bone scintigraphy.

Osteoblastic and hyperostotic craniofacial lesion detected by 99mTc-labeled methylene diphosphonate bone scintigraphy and single-photon emission computed tomography/computed tomography: a pictorial essay.

99mTc-bisphophonates bone scan, planar and single-photon emission computed tomography/computed tomography (SPECT/CT) modalities, is a commonly used technique that provides high sensitivity and specificity for detection of osseous metastases. However, besides bone metastases, SPECT/CT provides an accurate evaluation of the localization of the lesions and supplies anatomic information that can be valuable for diagnosis of nonmalignant bone diseases, occasionally disclosed in the skull. Reporting of craniofacial lesions detected by 99mTc-MDP (99mTc-labeled methylene diphosphonate) bone scintigraphy and SPECT/CT in the literature is limited. The aim of this pictorial review is to present the findings detected by 99mTc-MDP bone scintigraphy and SPECT/CT including cases under two broad categories: osteoblastic and hyperostosis craniofacial lesions.

Prostate-Specific Membrane Antigen-Targeted Radiopharmaceuticals in Diagnosis and Therapy of Prostate Cancer: Current Status and Future Perspectives.

Prostate cancer is the most common cancer to affect men in the United States and the second most common cancer in men worldwide. Prostate-specific membrane antigen (PSMA)-based positron emission tomography (PET) imaging has become increasingly popular as a novel molecular imaging technique capable of improving the clinical management of patients with prostate cancer. To date, several 68Ga and 18F-labeled PSMA-targeted molecules have shown promising results in imaging patients with recurrent prostate cancer using PET/computed tomography (PET/CT). Studies of involving PSMA-targeted radiopharmaceuticals also suggest a higher sensitivity and specificity, along with an improved detection rate over conventional imaging (CT scan and methylene diphosphonate bone scintigraphy) and 11C/18F-choline PET/CT. In addition, PSMA-617 and PSMA I&T ligands can be labeled with α- and β-emitters (e.g., 225Ac, 90Y, and 177Lu) and serve as a theranostic tool for patients with metastatic prostate cancer. While the clinical impact of such concept remains to be verified, the preliminary results of PSMA molecular radiotherapy are very encouraging. Herein, we highlighted the current status of development and future perspectives of PSMA-targeted radiopharmaceuticals and their clinical applications.

The utility of radionucleotide imaging in the surgical management of axial neck pain from cervical facet joint arthropathy.

Axial neck pain is common and often debilitating. Diagnosis of the specific pain source can be a challenge, and this confounds effective treatment. Cervical facet arthropathy is implicated in many of these cases. The diagnosis is readily made on conventional cross-sectional imaging modalities, particularly CT imaging. However, this modality falls short in determining if an osteoarthritic facet joint is truly the source of symptoms. Radionucleotide imaging presents a noninvasive radiological adjunct to conventional cross-sectional imaging in the workup of patients with suspected facetogenic pain. Herein, the authors present the patient-reported outcomes (PROs) following posterior instrumented arthrodesis of the subaxial cervical spine from a consecutive case series of patients with a diagnosis of cervical facet joint arthropathy and a concordant positive radionucleotide tracer uptake. The clinical case series of patients treated by the senior author at a single tertiary care institution between September 2014 and April 2018 was reviewed. Patients were selected for inclusion if their primary symptom at presentation was axial neck pain without neurological deficits and if CT imaging revealed facet arthropathy of the cervical spine. These patients underwent radionucleotide imaging in the form of a planar 99mTc methylene diphosphonate (99mTc MDP) bone scintigraphy study. Those with a finding of radionucleotide tracer uptake at a location concordant with the facet arthropathy were selected to undergo posterior cervical instrumented arthrodesis of the affected levels. PROs were recorded at the time of surgical consultation (i.e., after nonoperative treatment) and at 6 weeks, 3 months, 6 months, and 1 year following surgery. These included neck and arm pain, the Neck Disability Index (NDI) and the 12-Item Short Form Health Survey responses. A total of 11 patients were included in this retrospective case series. The average reported neck pain and NDI scores were high at baseline; 7.6 ± 2.3 and 37.1 ± 13.9 respectively. Twelve months after surgical intervention, a significant decrease in reported neck pain of -4.5 (95% CI -6.9, -2.1; p = 0.015) and a significant decrease in NDI of -20.0 (95% CI -29.4, -10.6; p = 0.014) was observed. This case series represents the largest to date of patients undergoing surgical arthrodesis following a finding of facet arthropathy with a concordant positive radioisotope image study. These observations add support to a growing body of evidence that suggests the utility of radioisotope imaging for identification of a facetogenic pain generator in patients with primary axial neck pain and a finding of cervical facet arthropathy. These preliminary data should serve to promote future prospective, controlled studies on the incorporation of radionucleotide imaging into the workup of patients with suspected facetogenic pain of the cervical spine.

Incidental thyroid uptake during 99mTc-methylene diphosphonate bone scintigraphy in oncologic patients

Introduction: Extraosseous accumulation of 99mTc – methylene diphosphonate (MDP) may be due to neoplastic, dystrophic, hormonal, inflammatory, ischemic, traumatic or excretory disorders. 99mTc-MDP incidental thyroid uptake is not frequent and is possibly caused by the presence of dystrophic or metastatic calcification, biopsy procedure and presence of benign or malignant thyroid nodules. To analyze the etiological factors leading to 99mTc-MDP uptake in the thyroid gland. Methods: Fifty patients (pts), 19 females (38%) and 31 males (62%), 62±12 years, with no pervious history of thyroid disease, were included in the study. In the period January 2016 – January 2018, all pts underwent MDP bone scintigraphy due to oncologic indication and incidental tracer uptake was noted in the region of the thyroid gland. Ultrasonography (US) was performed in all pts. Patients with detected nodules underwent 99mTc-pertechnetate scintigraphy and fine needle aspiration cytology (FNAC). Thyroid hormone and autoantibodies levels were also analyzed. SPECT/CT procedure was performed in all patients to precisely localize the MDP uptake. Results: Thirty-nine patients had calcifications in the thyroid gland (29 with microcalcifications and 10 with macrocalcifications). In 23 patients, thyroid nodules were detected. 99mTc-pertechnetate scintigraphy presented 15 cold nodules and 8 nodules with increased tracer uptake. FNAC in 3 patients presented nuclear anisocariosis, with Hurthle cell metaplasia, and surgery was advised. In 11 patients, thyroid cartilage calcifications were detected. Conclusion: Incidental findings of thyroid 99mTc-MDP accumulation during bone scintigraphy indicate presence of additional, previously unexpected, active disease processes.

Cherubism: A rare fibro-osseous disorder characterized and diagnosed by one stop imaging with Technetium-99m methylene diphosphonate bone scintigraphy integrated with single-photon emission computed tomography-computed tomography

Cherubism, a rare hereditary fibro-osseous lesion characterized by painless expansion of jaws, starts early in life manifesting itself fully in the second decade of life and is almost regressed in the third decade. Here, we report a sporadic case of Cherubism with clinico-radiological and scintigraphic presentation of its classical features for its disease rarity and single-photon emission computed tomography/computed tomography findings with review the literature.

Role of Baseline Bone Scintigraphy in the Evaluation of Skeletal Metastases of Newly Diagnosed Lung Carcinoma Patients

&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Lung carcinoma is the most common cancer worldwide with high potentiality of being metastasized to bone. Technetium-99m methylene diphosphonate (99mTc MDP) bone scintigraphy is a sensitive nuclear medicine imaging study to detect the skeletal metastases. The utilization of bone scan upon diagnosis of lung cancer appears to help in accurate staging of patients and planning treatment. The aim of the present study was to see the role of baseline bone scintigraphy in the newly diagnosed lung carcinoma patients and also to see the number, pattern and sites of involvement of bone as well as to evaluate the skeletal metastases according to the different histological types of lung carcinoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and Methods:&lt;/strong&gt; This observational study was carried out at the Institute of Nuclear Medicine &amp;amp; Allied Sciences (INMAS), Sylhet during the period of July 2014 to June 2015. A total number of 59 lung carcinoma patients who attended at the scintigraphy division of INMAS, Sylhet within three months of their histopathological diagnosis were included in this study. Clinical staging was done from clinical evaluation (history and physical examination) and also form available investigation reports. Skeletal scintigraphy was performed by dual-head gamma camera using low-energy all purpose collimator, 2-3 hours after IV administration of 20-30 mCi of 99mTc MDP. Interpretation was done by recording the distribution of radiotracer within the skeleton along with correlation of history, physical examination, FNAC or biopsy reports and other relevant investigation findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 59 patients, 43 (72.9%) were male and 16 (27.1%) were female. The age range of the patients was from 37 to 85 years with a mean (± SD) of 59.10 ± 10.43 years. The rate of lung carcinoma was highest in the age group of 55-64 years (45.7%), followed by 45-54 years (27.1%) and 65-74 years (11.9%). Incidence was lowest in patients below 45 years (6.8%) and above 75 years (8.5%). Skeletal metastases were detected in 52.54% of lung carcinoma patients where multiple lesions were seen in 87.1% of cases and solitary lesion in 12.9%. Among the metastatic lesions, 82.9% lesions were distributed in axial skeleton and 17.1% lesions were distributed in appendicular skeleton. Spine was the most frequent site of metastatic involvement in the present study which was 37.8% followed by ribs 28.0%, sternum 9.7% and pelvic bones 7.3%. Thoracic spine was found to be involved more (58.1%). Regarding patterns of metastatic lesions, 23 patients (74.1%) showed hot lesions, two patients (6.5%) showed cold lesions, four patients (12.9%) showed superscan and two patients (6.5%) showed pattern of hypertrophic osteoarthropathy. Bone metastasis was found in 75% cases of small cell lung carcinoma (SCLC) and 49.2% cases of non-small cell lung carcinoma (NSCLC). Among NSCLC, adenocarcinoma showed 62.9% metastases followed by 36.8% squamous cell carcinomas and 20.0% large cell carcinomas. In this series, clinical staging was done and 11 patients ( 18.6% ) were found in stage I, 21 patients ( 35.6% ) in stage II, 23 patients ( 39.0% ) in stage III and 04 patients ( 6.8 % ) in stage IV. Skeletal scintigraphy detected metastatic lesions in six of 11 cases (54.5 %) in clinical stage I, five of 21 cases (23.8 %) in clinical stage II, 16 of 23 cases (69.6 %) in clinical stage III and in all patients (100%) with clinical stages IV showing higher rate of bone metastases with advanced clinical stages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: In this study, skeletal scintigraphy changed clinical staging of 27 patients. Early diagnosis of lung carcinoma, followed by bone scanning without delay helps to diagnose skeletal metastases, the presence of which is a major determinant in subsequent pathological staging and treatment planning.&lt;/p&gt;&lt;p&gt;Bangladesh J. Nuclear Med. 19(2): 111-115, July 2016&lt;/p&gt;

Super Scan Caused by Parathyroid Carcinoma Observed Both in 18F-FDG PET/CT Scan and Tc-99m MDP Bone Scintigraphy

Super scan is a well-known finding described in skeletal scintigraphy characterized by uniform symmetrically increased radiopharmaceutical uptake by bones and consequently diminished renal parenchymal activity. Sy et al. hypothesized that the faint visualization of renal cortex in bone scintigraphy might be the result of increased uptake of radiopharmaceutical by pathologic bones and reduced phosphate excretion. The super scan on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been observed in various conditions such as prostate cancer, lung cancer, renal adenocarcinoma, gastric cancer and primitive neuroectodermal tumor of the kidney. Herein we report the first case of super scan in a 68-year-old-woman with parathyroid carcinoma observed both in 18F-FDG PET/CT and Tc-99m methylene diphosphonate bone scintigraphy. There were extensive hypermetabolic lesions throughout the skeleton in 18F-FDG PET/CT. In contrast to the intense hypermetabolism of the skeleton; the liver, skeletal muscles of the limbs, mediastinum, bowel and especially the brain showed very low FDG uptake. Additionally, there was increased skeletal radiotracer uptake relative to soft tissue, and faint genitourinary tract activity in bone scintigraphy.

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.

Role of Whole-Body Tc 99m MDP Bone Scintigraphy for Evaluating Skeletal Metastasis in Patients with Lung Cancer

Lung cancer is the third most common site of origin of metastatic cancer deposits in bone, after breast and prostate. It’s metastasis to bone is one of the most aggressive tumors and has a very unfavorable prognosis. This retrospective descriptive study was designed to detect the skeletal metastasis of carcinoma (Ca) lung patient by Tc 99m MDP bone scan. The medical records of all patients attended between January 2015 and July 2015 with a diagnosis of lung cancer were reviewed. Lung cancer in all patients was confirmed pathologically, and patients underwent whole-body bone scan for evaluating skeletal metastasis. Patient with clinical and laboratory evidence of infection, trauma, metabolic disease or arthropathy were not included in the study. Bone scan was done after three hours of intravenous administration of 20mci Tc 99m MDP (methylene diphosphonate) and images were obtained on a gamma camera. The mean age of the patients was Mean ± SD was 55.5 ± 12.5 with range from 31 to 90 years. Out of 47 cases, 36 (76.59%) were diagnosed as positive for skeletal metastasis by bone scan and 11 (23.41%) were negative for bony metastasis. Among 36 positive patients, 28 patients (77.86%) were histopathologically diagnosed as adenocarcinoma, 7 patients (19.44%) had squamous cell carcinoma and only one patient (2,7%) had small cell carcinoma. Bone scan findings were compared by either conventional X-ray/CT scan/MRI /pathologically. In present study, the distribution of lesions in bone scan had recorded. Maximum 47.22 % lesions were found in ribs, 27.77% lesions were in lumbar vertebrae, 19.44% in thoracic vertebrae, 19.44% in joints, 16.66% in long bones (femur and humerus), 11.11% in skull bones, 22.22% in pelvic bones, 5.55% in clavicle and 2.77% in scapula. Tc 99m MDP bone scan plays a pivotal role for detection of skeletal metastasis which is very essential to manage Ca lung patient. As bone scintigraphy is very cost effective in govt. nuclear medicine centre in comparison to other imaging modalities, so it can play a major role in detecting skeletal metastasis in ca lung patients in a developing country like Bangladesh.

Distal appendicular skeletal involvement of diffuse large B-cell lymphoma on technetium-99m methylenediphosphonate bone scintigraphy and 18F-fluorodeoxyglucose positron emission tomography/computed tomography: a case report

BackgroundWe report a case of a patient with appendicular bone involvement of diffuse large B-cell lymphoma visualized by whole-body technetium-99m methylenediphosphonate bone scintigraphy (bone scan) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Case presentationA 73-year-old Asian man who had gingival swelling of the labial area of the left maxillary lateral incisor presented to our institution. Positron emission tomography/computed tomography demonstrated hypermetabolic lesions with maximum standardized uptake values of 12.15 in the left testis, 1.92 in the skin of the right chest, and 2.88 in the left ulna and third metatarsal bone. A bone scan showed multiple uptakes in the left ulna, hand, both tibiae, and the left foot. We diagnosed the tumor as diffuse large B-cell lymphoma by excision. Magnetic resonance imaging showed enhanced signaling of lesions with soft tissue edema in the olecranon of the left ulna, the third metacarpal bone of the left hand, and the third metatarsal bone of the left foot. Magnetic resonance imaging findings prompted a diagnosis of lymphoma. Eight cycles of chemotherapy plus external radiotherapy targeted to the involved bone sites were given for 5 months. Follow-up positron emission tomography/computed tomography and bone scanning revealed the disappearance of hypermetabolism and decreased uptake in lesions compared with the previous images. Laboratory data were also all within the normal limits after chemotherapy.ConclusionsThis report highlights that appendicular bone involvement of diffuse large B-cell lymphoma can be detected on whole-body bone scans and by positron emission tomography/computed tomography.

The role of three-phase 99mTc-MDP bone scintigraphy in the diagnosis of periprosthetic joint infection of the hip and knee

Background/Aim. In the last five decades primary hip and knee arthroplasty is the most common and effective surgical intervention worldwide. Infection, although unfrequented, is the most serious complication. Nuclear medicine imaging, not affected by metallic hardware, is the current imaging modality of choice for the evaluation of suspected joint replacement infection. The aim of this study was to estimate the diagnostic accuracy of three phase 99m technetium methylene diphosphonate (99mTc-MDP) bone scintigraphy in periprosthetic hip and knee joint infection. Methods. Inclusion criteria of patients in the study were suspected knee or hip periprosthetic joint infections. In this study, we examined 45 patients (14 men and 31 women) with 39 hip and 24 knee prosthesis (total 63). In all patients, three-phase bone scintigraphy was performed after intravenous application of 555 MBq of 99mTc-MDP. The final confirmation of infection was microbiological or pathohistology finding. Results. Infection was confirmed in 29 prosthetic joints, in 13 (44.8%) knee and 16 (55.2%) hip joints while there was no infection in 34 prosthetic joints. The connection of different modalities of negative and positive findings 99mTc-MDP three-phase bone scintigraphy with the final confirmation of infection showed a high statistical significance (p &lt; 0.001). Three phase bone scintigraphy showed a high sensitivity of 90% but a modest specificity of 69.7% in the detection of periprosthetic infection with the diagnostic accuracy of 79%. The calculated positive predictive value was 73% but the negative predictive value was high 89%. Our results of three-phase bone scintigraphy with calculated sensitivity, specificity and diagnostic accuracy of 79% are in consent with the majority of published studies, or even slightly better. Conclusion. Bone scintigraphy is sensitive in the diagnosis of periprosthetic infection but insufficiently specific. In the detection of periprosthetic infections three-phase bone scan can be used as a diagnostic method of the first line only aimed at its exclusion. The only reasonable use of bone scintigraphy is in combination with other radionuclide methods with high specificity.

Diagnosis and semiquantification of osteonecrosis of the jaw by bone scan index on bone scintigraphy.

e639 Background: Bone management is extremely important for maintaining QOL of prostate or renal cancer patients with bone metastasis. Physicians often administrate bone modifying agents (BMA), zoledronic acid or denosumab, to prevent skeletal-related event and bone pain for such patients. However, osteonecrosis of the jaw (ONJ) is one of sever adverse events of BMA (Medication-related ONJ; MRONJ). The early detection and follow-up of ONJ is extremely important issue. In order to achieve this issue, we utilized bone scintigraphy and a computer-aided diagnosis using a bone scan index (BSI). Methods: A total of 22 patients with either prostate cancer or renal cancer (27 lesions) diagnosed with MRONJ after treatment with BMA were investigated. Median age was 72.5 years (range 52-82 years). The primary disease was prostate cancer (81.8%), renal cancer (18.2%). Regarding the treatment, 86.4% of the patients were treated with bisphosphonate drugs, none in denosumab, and both in 13.6%, respectively. The median duration of medication was 33 months (range 7-70 months) by the time of MRONJ diagnosis. All patients underwent Tc-99m methylene diphosphonate bone scintigraphy. Bone uptake in the jaw was analyzed using BSI, which was calculated by BONENAVI (FUJIFILM RI Pharma, Japan; EXINIbone, EXINI Diagnostics, Sweden). Significant hot spots were manually selected according to both serial scintigraphic images and dental records, and the fraction of them to the entire skeleton was referred as BSI of the jaw (BSIJ). The level of BSIJ was evaluated in comparison with stage of ONJ and inflammation marker, C-reactive protein (CRP). Results: The median BSIJ of lesions was 0.14 (range 0.00-0.43) at the time of MRONJ diagnosis. If MRONJ is not treated appropriately, BSIJ tended to increase during treatment with BMA. When patients were classified according to their clinical stages of MRONJ, higher stage MRONJ lesions had significantly higher BSIJ (p &lt; 0.01). In addition, BSIJ was correlated with CRP. Conclusions: Evaluation of BSIJ using BONENAVI on bone scintigraphy was helpful for early detection and follow-up of MRONJ. Furthermore, increased BSIJ on bone scintigraphy were related to CRP and stage of ONJ.

Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design

BackgroundThe detection of occult bone metastases is a key factor in determining the management of patients with renal cell carcinoma (RCC), especially when curative surgery is considered. This prospective study assessed the sensitivity of 18F-labelled sodium fluoride in conjunction with positron emission tomography/computed tomography (18F-NaF PET/CT) for detecting RCC bone metastases, compared with conventional imaging by bone scintigraphy or CT. Patients and methodsAn adaptive two-stage trial design was utilized, which was stopped after the first stage due to statistical efficacy. Ten patients with stage IV RCC and bone metastases were imaged with 18F-NaF PET/CT and 99mTc-labelled methylene diphosphonate (99mTc-MDP) bone scintigraphy including pelvic single photon emission computed tomography (SPECT). Images were reported independently by experienced radiologists and nuclear medicine physicians using a 5-point scoring system. ResultsSeventy-seven lesions were diagnosed as malignant: 100% were identified by 18F-NaF PET/CT, 46% by CT and 29% by bone scintigraphy/SPECT. Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by 18F-NaF PET/CT. On an individual patient basis, 18F-NaF PET/CT detected more RCC metastases than 99mTc-MDP bone scintigraphy/SPECT or CT alone (P = 0.007). The metabolic volumes, mean and maximum standardized uptake values (SUVmean and SUVmax) of the malignant lesions were significantly greater than those of the benign lesions (P < 0.001). Conclusions18F-NaF PET/CT is significantly more sensitive at detecting RCC skeletal metastases than conventional bone scintigraphy or CT. The detection of occult bone metastases could greatly alter patient management, particularly in the context when standard-of-care imaging is negative for skeletal metastases.

Hybrid Single-Photon Emission Computed Tomography/Computed Tomography Imaging Features of Tumoral Calcinosis in Technetium-99m Methylene Diphosphonate Bone Scintigraphy

Tumoral calcinosis (TC) is an uncommon ectopic calcification syndrome. TC is a benign condition characterized by the presence of large calcific soft tissue deposits occurring predominantly in a periarticular location. It generally occurs as a complication of renal dialysis or trauma, and is rarely seen in familial and sporadic cases. Bone scintigraphy is a sensitive method for diagnosing TC. We report a case of year old female with. She underwent bone scintigraphy to see the sites of involvement, which showed intense foci of tracer activity in soft tissue in bilateral thigh and gluteal region. Hybrid single-photon emission computed tomography/computed tomography of the pelvis and thigh localized tracer uptake to the calcification in the gluteal and thigh region.

Evaluation of Distribution Features of Bone Metastases by Bone Scintigraphy in Prostate Cancer

Prostate cancer (PCa) represents the most common non-cutaneous malignancy for men, where an estimated 241,740 new cases will be diagnosed in 2013 in the United States [1]. Whereas most of those new diagnoses will be clinically localized, up to 17% of patients may experience metastatic disease, in which the risk of cancer- specific mortality is increased [2]. In this context, it is well established that, beyond regional lymph nodes, the skeleton represents the most common metastatic site [3].The study aims to evaluate the pattern of distribution of bone metastases in prostate cancer patients by 99mTc- methylene diphosphonate (99mTc-MDP) bone scintigraphy. It was formed in 150 patients with pathologically proven prostate cancer and presented for bone scans with 99mTc-methylene diphosphonate (99mTc-MDP) for detection and evaluation of bone metastases. It was noted that patients with bone metastases had significantly higher frequency of bone pain when compared with patients without and noted that spine was the most commonly affected site (60.0 %) followed by ribs (52.0 %) and femur (30.0 %). Spread of bony metastases among the bony skeleton has distribution manner not only to the right or to the left. Metastatic bony lesions of prostate cancer are located mainly in spine (58.0%) followed by ribs (52.0 %) and femur (30.0 %). Patients with extensive bone metastasis had significantly higher frequency of skull, spine, scapula, humerous, sternum, ribs, iliac bone, ischium, and femur metastases

Tc-99m MDP bone scintigraphy in the evaluation of the joint damage in asymptomatic alpine ski racers

To evaluate the role of 99m-technetium methylene diphosphonate (Tc-99m MDP) bone scintigraphy on the detection of joint damage in asymptomatic alpine ski racers. This study included 20 male asymptomatic alpine ski racers (age range: 18-21 years). None of the skiers had a history of ski crashes. Bone scan findings of the racers were examined with Tc-99m MDP bone scintigraphy during the active racing season and the inactive training season. Planar anterior and posterior images of hip, knee, and ankle joints were obtained 4 h after intravenous injection of 20 mCi Tc-99m MDP. All images were interpreted visually by 2 experienced nuclear medicine physicians. Free regions of interest were drawn on hip, knee, and ankle joints, as well as background regions. Joint-to-background ratios were calculated for each joint, and the uptake ratios of both right and left joints during active ski season were compared to those during the inactive training period. Uptake ratios of the right and left hip, knee, and ankle joints were significantly higher during the active racing period than those calculated during the inactive period (P < 0.005). Bone scintigraphy may have an important role in detecting joint injuries of hip, knee, and ankle joints in asymptomatic alpine ski racers and can be used successfully when MRI is unavailable.