Methylene Diphosphonate Bone Scintigraphy Research Articles

99mTc-MDP Bone Scan In the Detection of Bone Metastases in Breast cancer.

Skeletal metastases are clinically significant because of associated symptoms, complications such as pathological fractures and their profound significance for staging treatment and prognosis. Detection of bone metastatic lesions allows radiation therapy or surgical interventions to prevent pathological fractures from disabling the patients. High sensitivity of bone scanning in determining the presence and extent of metastatic disease makes extremely important tool in decision making. Bone scans demonstrate metastatic lesions much earlier than X-ray,C.T.,MRI. 99mTechnetium methylene di-phosphonate (99mTc MDP) bone scintigraphy was performed for the detection of bone metastases in histopathologically proven patients of breast cancer. All spot views were taken as the primary method of acquisition, the regions of the skeleton covered by each spot view. The first spot view of the axial skeleton, usually the posterior projection of the chest, was acquired for approximately 500,000 to 1 million counts depending on the field of view (FOV) of the gamma camera. 53 patients of breast cancer were investigated with gamma camera. On visual analysis there was positive scan findings (bone metastases) in 19 patients (35.84 %) and negative scan findings (normal bone scan) in 34 patients (66.6%). 99mTc-MDP bone scintigraphy elucidates, non-invasively, tumour characteristics and may be indicative for prognosis and response to chemotherapy and hormonal treatment. Purpose of study was to diagnose, staging and see the treatment response in breast cancer patients.

An Incidental Finding of Extraosseous Uptake in Technetium 99m Methylene Diphosphonate Bone Scintigraphy: Uterine Leiomyoma

We present the case of a 58-year-old, postsurgical breast cancer patient who was examined for routine controls at the Oncology Department of Namik Kemal University, Tekirdag, Turkey. She was referred to the nuclear medicine department for possible metastatic spread to the skeleton; 740 MBq of methylene diphosphonate tecnetium 99m ([Tc-99m] MDP) was injected intravenously, and 3 hours later a whole-body bone scan was performed. The whole-body bone scan showed no abnormal uptake associated with bone metastases, but in the anterior projection images, an area of mildly increased technetium 99m methylene diphosphonate uptake was seen in the right pelvic region. This appearance did not seem related to bone structures. When a more detailed history of this region was obtained, we learned of the patient's uterine leiomyoma. As a result of ultrasound and magnetic resonance imaging findings, the mildly increased tracer uptake in the right pelvic area on bone scintigraphy was consistent with a calcified uterine myoma. We concluded that a soft tissue concentration of labeled phosphates should always be kept in mind when interpreting whole-body bone scans.

Utility of bone scintigraphy in diagnosis of post- traumatic osteitis pubis

Minor musculoskeletal injuries usually heal within few weeks with conservative treatment, but in pelvic injuries, symptoms may persist for long duration and patient need medical attention to get relief from disturbing pain symptoms. We present a case of post-trauma osteitis pubis in a 58-year-old female, who reported with lower abdominal and left side hip joint pain since 2 months, after an episode of trivial trauma to her pelvis. Technetium-99m methylene diphosphonate bone scintigraphy was performed, which confirmed the site of injury in symphysis pubis and left hip joint, by increased radiotracer localization at both of these symptomatic sites.

F-18 FDG PET-Positive Cortical Fibrous Defect in a Patient with Peripheral T Cell Lymphoma (PTCL).

Fibrous cortical defects (FCD) are relatively common skeletal lesions that are often discovered incidentally on radiographs of children and young adults. They are most often located in the metaphysis or diametaphyseal junction of the distal femur or proximal tibia[1–5]. Fibrous cortical defects generally undergo spontaneous regression over time and are rarely seen radiographically after the second decade of life [2, 3]. FCD histological appearance is that of whorled proliferations of spindle cells intermixed with multinucleate giant cells, and foam cells. (Fig 1). In some cases the central abnormality may be also surrounded by leucocyte infiltration[13]. Conventional radiographic, CT, and MRI characteristics of fibrous cortical defects have been well described[1–4]. Several studies have also described the appearance of fibrous cortical defects on Tc-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy [5,6]. On CT a fibrous cortical defect is defined as a radiolucent, cortically based round to ovoid absence of bone measuring less than 2.0 cm in greatest diameter, with sharp sclerotic margins and no associated soft-tissue or bone marrow abnormality. MRI image usually shows cortically based soft tissue replacing bone without involvement of extraosseous soft tissues. On MR, the cortical defect often has a bright centre and a dark peripheral margin on T2- weighted images and shows central enhancement and a dark peripheral margin on contrast-enhanced T1- weighted images[7]. Bone scan shows markedly increased radionuclide accumulation in both early perfusion and delayed bone imaging in typical cortical defects. . However, absence of markedly increased tracer accumulation does not mean this diagnosis should be excluded. The use of F-18 fluorodeoxyglucose positron emission tomography (FDGPET) is established for the staging of malignant disease[8]. However, it is well known that FDG is not a tumor-specific agent and intense FDG uptake can occur in many non-malignant conditions such as infection, active inflammation, healing trauma and benign tumors[9]. As a consequence, increased FDG uptake in a benign lesion can be misinterpreted as a site of metastatic disease in patients with known malignancy. Very few reports have described the appearance of fibrous cortical defects on PET/CT [7].

Tc-99m MDP Uptake in a Giant Pulmonary Chondroma

Abstract: Pulmonary chondromas are very rare benign tumors. We report a case of huge solitary pulmonary chondroma in a 53-year-old woman without specific symptom. The lesion was detected by CT and Tc-99m methylene diphosphonate bone scintigraphy. The primary diagnosis after radiologic examination was pulmonary hamartoma. Then, surgical excision was performed, and the pathology showed pulmonary chondroma.

Single photon emission computed tomography/computed tomography of the skull in malignant otitis externa

Malignant otitis externa is a severe, rare infective condition of the external auditory canal and skull base. The diagnosis is generally made from a range of clinical, laboratory, and imaging findings. Technetium 99m methylene diphosphonate bone scintigraphy is known to detect osteomyelitis earlier than computed tomography. The authors present a patient with bilateral malignant otitis externa where the extent of skull base involvement was determined on 3-phase bone scintigraphy with single photon emission computed tomography/computed tomography.

Methylene Diphosphonate Uptake in a Case of Vertebral Hemangioma

Osseous hemangiomas are usually asymptomatic. Symptomatic hemangiomas are rare and represent approximately 1% of all cases. Hemangiomas usually present as photopenic defects in methylene diphosphonate (MDP) bone scintigraphy. MDP uptake in vertebral hemangiomas is extremely rare. We report a 20-year-old woman who presented with upper back pain. MDP bone scan showed focus of MDP uptake in the seventh dorsal vertebra. SPECT/CT localized the uptake to vertebral body and transverse process with CT findings suggestive of hemangioma. Further, MRI also confirmed hemangioma in the same location.

Prospective Evaluation of 99mTc MDP Scintigraphy, 18F NaF PET/CT, and 18F FDG PET/CT for Detection of Skeletal Metastases

Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. (18)F sodium fluoride ((18)F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are few prospective studies comparing these three methods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial. This is a prospective study (Sep 2007-Dec 2010) of 52 patients with proven malignancy referred for evaluation of skeletal metastases. There were 37 men and 15 women, 19-84 years old (average, 55.6 ± 15.9). Technetium-99m ((99m)Tc) MDP bone scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CT were subsequently performed within 1 month. Skeletal lesions were detected by (99m)Tc MDP bone scintigraphy in 22 of 52 patients, by (18)F NaF PET/CT in 24 of 52 patients, and by (18)F FDG PET/CT in 16 of 52 patients. The image quality and evaluation of extent of disease were superior by (18)F NaF PET/CT over (99m)Tc MDP scintigraphy in all 22 patients with skeletal lesions on both scans and over (18)F FDG PET/CT in 11 of 16 patients with skeletal metastases on (18)F FDG PET/CT. In two patients, (18)F NaF PET/CT showed skeletal metastases not seen on either of the other two scans. Extraskeletal lesions were identified by (18)F FDG PET/CT in 28 of 52 subjects. Our prospective pilot-phase trial demonstrates superior image quality and evaluation of skeletal disease extent with (18)F NaF PET/CT over (99m)Tc MDP scintigraphy and (18)F FDG PET/CT. At the same time, (18)F FDG PET detects extraskeletal disease that can significantly change disease management. As such, a combination of (18)F FDG PET/CT and (18)F NaF PET/CT may be necessary for cancer detection. Additional evaluation with larger cohorts is required to confirm these preliminary findings.

Evaluation of Response to Therapy in a Patient with Lung Cancer: Correlation of Sclerotic Bone Lesions with F 18 FDG PET/CT and Bone Scintigraphy

A 64-year-old male patient with small cell lung cancer underwent Fluorine-18 fluorodeoxyglucose (F 18 FDG) positron emission tomography (PET)/CT scan which revealed multiple F 18 FDG uptake in the spine, both humeri, ribs, pelvis and proximal long bones. There was no obvious lytic or sclerotic bone destruction accompanying these lesions on CT component of the study. After the patient received six courses of chemotherapy a repeat F 18 FDG-PET/CT was performed for evaluation of therapy response. The PET/CT showed the presence of multiple sclerotic lesions on CT without FDG uptake, corresponding to the bone lesions on the previous PET/CT scan. A concomitant Tc 99m Methylene diphosphonate (Tc 99m MDP) bone scintigraphy (BS) revealed no pathologically increased Tc 99m MDP uptake in the skeletal system. The FDG avid lesions in the skeletal system, which were not sclerotic initially, were transformed into FDG non-avid sclerotic lesions after chemotherapy. This was attributed to the direct effect of previous successful therapy for bone metastases, leading to the transformation of metabolically active disease, into blastic metabolically inactive metastases. In conclusion, a F 18 FDG negative bone lesion, which is sclerotic on CT, may represent post-treatment osteoblastic change rather than active tumor and BS might play a role in the discrimination of these two situations. Conflict of interest:None declared.

C11-Acetate and F-18 FDG PET for Men With Prostate Cancer Bone Metastases

This study tested the feasibility of C11-acetate (acetate) positron emission tomography (PET) imaging to assess response to therapy in men with bone metastatic prostate cancer and compared results for disease detection and response evaluation with F-18 fluorodeoxyglucose (FDG) PET. Men with ≥3 prostate cancer bone metastases identified by Tc-99m methylene diphosphonate (MDP) bone scintigraphy and/or computed tomography were enrolled in a prospective study of serial acetate and FDG PET imaging. Patients were imaged before and 6 to 12 weeks after initial androgen deprivation therapy for new metastatic prostate cancer or first-line chemotherapy with docetaxel for castration-resistant prostate cancer. Qualitative assessment and changes in the tumor:normal uptake ratio were used to assess response by both acetate and FDG PET. In addition, the detection of bone metastases pretherapy was compared for acetate and FDG PET. A total of 8 patients with documented bone metastases were imaged, of which 6 were imaged both pre- and post-therapy. Acetate PET detected bone metastases in all 8 patients, whereas FDG PET detected lesions in 6 of the 7 imaged patients. Acetate PET generally detected more metastases with a higher tumor:normal uptake ratio. Qualitative and quantitative assessments of post-treatment response correlated with composite clinical designations of response, stable disease, or progression in 6 of 6 and 5 of 6 by acetate and 4 of 5 and 3 of 5 by FDG PET, respectively. In this pilot study, results indicate that acetate PET holds promise for response assessment of prostate cancer bone metastases and is complementary to FDG PET in bone metastasis detection.

Significance of increased scrotal Tc-99m MDP uptake in patients with prostate cancer

We observed an unusually increased scrotal uptake as an interesting finding in some patients with prostate cancer who were scanned for any possible metastatic disease. This study was designed to investigate the significance of this incidental finding in the technetium-99m methylene diphosphonate scintigraphies. The study population consisted of 104 patients with biopsy-proven prostate cancer (group I), 55 male patients with other cancers (group II), 30 male patients with nonmalignant diseases (group III) and finally 15 patients with benign prostate hypertrophy (group IV). The square-shaped regions of interest are placed centrally on the scrotum and then on the lateral femoral soft tissue. Then the simple ratios of the scrotal and femoral soft tissue mean counts (S/Bg) were calculated. The statistical significance of differences among the groups in terms of scrotal uptake was determined. Group I showed increased scrotal uptake relative to the other groups. The mean uptake ratios (S/Bg±standard deviation) were 3.49±1.42 in group I, 2.89±0.70 in group II, 2.87±0.75 in group III, and 2.91±0.60 in group IV. This ratio was significantly higher in patients with prostate cancer than the normal group (P=0.024), the group with benign prostate hypertrophy (P=0.004), and the patients with other cancers (P=0.004). Our results showed that technetium-99m methylene diphosphonate bone scintigraphy, as a routine for detecting metastatic disease or performed for other purposes, could give clues for a hidden prostate cancer. Then, in elderly male patients, we strongly recommend that it is wise to keep one's eye on scrotal activity when bone scans are read and where there is any doubt, take appropriate regions of interest to make quantitative evaluations.

The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease

Introduction: Behcet's disease (BD) is a chronic relapsing inflammatory disease. 40-70% of BD patients display rheumatic features with a 9% incidence as an initial presentation. However, there are no pathognomonic laboratory tests in BD and the diagnosis depends on the occurrence and grouping of sufficient clinical manifestations to allow the physician to either suspect, or definitely diagnose the condition. Our aim was to assess the utility of Tc-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy for the detection of articular involvement in BD patients and its impact on disease activity & severity scoring. Methods: 25 BD patients diagnosed according to the international study group criteria for BD diagnosis (ISG) (18 �, 7 �, mean age 32.44±7.78, disease duration 6.98±4.61year) were included and subjected to selected joint x-ray and bone scintigraphy. Results: 25/25 was scintigraphically positive for arthritis (100%, 64%, 44%, 40%, 36%& 20% in wrist, Metacarpophalangeal, proximal interphalangeal (PIPs), distal interphalangeal (DIPs), Knees & ankles respectively). 13/25 were clinically negative while scintigraphically positive for arthritis. 11/25 (44%) and 8/25 (32%) turned from inactive to active BD and from mild to moderate disease severity, based on their positive hand scintigraphy with treatment modification. 4/25 (16%) had recurrent oral ulcers with normal laboratory data and only positive hand scintigraphy; with follow-up they met ISG criteria. Conclusion: skeletal scintigraphy is a simple diagnostic modality with a low radiation burden, when compared to conventional radiology. Hence, when used appropriately in the diagnostic algorithm of BD, bone scintigraphy can be used for detection of early joint involvement, assessment of the extent and activity status with guidance for the selected therapy.

Femoral-head vascularity after hip surface arthroplasty

BackgroundIatrogenic devascularization of the femoral head is as an area of concern following hip resurfacing arthroplasty, with probable implications on short-term failure and long-term survival of the implant.Materials and methodsWe assessed the vascularity of 25 resurfaced femoral heads in 20 patients by comparison with preoperative and postoperative Tc-99m methylene diphosphonate (MDP) bone scintigraphy images, the postoperative scans being done 9 months after the surgery.ResultsEight out of 25 hips (32%) showed <55% of their preoperative uptake at a mean of 9 months after surgery and were categorized as showing reduced vascularity.ConclusionOur study reveals reduction in vascularity of the femoral-head remnant as a frequent occurrence after hip resurfacing. Our study also highlights the role of bone scintigraphy as tool in assessing the vascularity of resurfaced femoral heads.

Case report. Elbow monoarthritis revealing B cell non-Hodgkin’s lymphoma

Skeletal involvement is described in 25% of patients with non-Hodgkin's lymphoma, typically as secondary, rarely as primary lymphoma of bone. Joint infiltration is very rare and monoarthritis can be a secondary synovial reaction to adjacent bone disease or direct synovial involvement. We describe an unusual case of monoarthritis of the elbow in a middle-aged man without signs and/or symptoms associated with malignancy and with no previous rheumatic disease. Synovial biopsy revealed a diffuse infiltrate of large atypical lymphocytic B cells diagnosed by morphological and immunohistochemical findings as a malignant lymphoma. Staging procedures including total body CT scan, bone marrow biopsy, technetium-99m methylene diphosphonate bone scintigraphy were normal. We discuss the case and the review of literature and suggest that in the evaluation of patients with an unclassified arthritis, synovial or bone biopsy should be strongly considered.

Tc-99m Methylene Diphosphonate Uptake by Numerous Phleboliths in the Lower Extremity Detected Incidentally During Bone Scintigraphy

Phleboliths are calcified thrombi within veins and very common in the veins of the lower part of the pelvis. Most adults have a small number of phleboliths. However, despite the high prevalence, phleboliths with increased uptake on bone scintigraphy have very rarely been reported in the literature. Tc-99m methylene diphosphonate bone scintigraphy was performed on a 46-year-old man with an abscess on the plantar surface of the left foot, which demonstrated incidental, irregular, mottled, increased uptake in the soft tissues of the left thigh and leg, which corresponded to numerous phleboliths on plain radiographs and CT.

Diffuse hepatic and splenic Tc-99m MDP tracer uptake in case of multiple myeloma

Tc-99m methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. There is a need to understand the pathophysiological basis of the non-osseous uptake, which may have a clinical relevance or deteriorating effect on the quality of the bone scan. We describe a case of multiple myeloma, where extraosseous uptake in the form of diffuse hepatic and splenic uptake, with almost normal skeletal tracer distribution, has been seen on the bone scan.

Intense Accumulation of Tc-99m MDP in Pericardial Metastasis From Breast Cancer

Extraosseous uptake often seen on Tc-99m methylene diphosphonate bone scintigraphy has clinical significance. In a routine follow-up study on a 54-year-old female patient with breast cancer, we encountered a rare finding of pericardial metastasis clearly demonstrated by Tc-99m methylene diphosphonate bone scintigraphy. This incidental finding of increased uptake in the periphery of the cardiac contour on a bone scan reflects radionuclide accumulation in pericardium, myocardium, or pericardial effusion itself. In our case, an additional computed tomography examination of the chest was useful for making the definitive diagnosis of dystrophic calcification of the pericardium.

Too old to exercise? Unusual muscular uptake on 99mTc methylene diphosphonate bone scintigraphy

An 81-year-old man was referred for bone scintigraphy. He had recently been diagnosed with prostatic carcinoma. Images obtained 3 hours after injection of technetium-99m methylene diphosphonate showed no evidence of metastatic bone disease, but symmetrical increased soft tissue uptake was seen extending from the inferior margin of the scapula to the neck of the humerus (Figure 1). This was confirmed on single photon emission computed tomography/computed tomography to lie within the teres major muscles. There was also focal radiotracer uptake within the lower cervical and first thoracic vertebral end plate, secondary to osteoarthritis (as confirmed by single photon emission computed tomography/computed tomography).

Langerhans Cell Histiocytosis of the Atlas in the Pediatric Spine: Total Reconstitution of the Bone Lesion After Nonoperative Treatment

Langerhans cell histiocytosis is a non-neoplastic disease of unknown etiology. It is characterized by a clonal proliferation of Langerhans histiocytes, which are cells of the monocyte-macrophage lineage. Clinically, its manifestations range from isolated bone lesions to multisystem disease, with this latter form more likely to be seen in younger patients. The most common manifestation of Langerhans cell histiocytosis is a localized or multifocal benign infiltration of bones by the Langerhans histiocytes, and this was formerly called eosinophilic granuloma. It usually affects the skull, proximal portion of the femur, mandible, ribs, and pelvis1,2. Between 7% and 25% of these patients have spinal involvement3,4, with the most frequent site of involvement being the thoracic vertebrae, followed by the lumbar and cervical regions1,4-6. More than half of the cervical spinal lesions in pediatric patients with Langerhans cell histiocytosis affect the C3-C5 segment1,7,8, and involvement in the upper cervical spine is uncommon. There are very few published cases describing Langerhans cell histiocytosis of the atlas in children7,9-15. We report on two pediatric patients who had Langerhans cell histiocytosis of the atlas that was treated nonoperatively, resulting in complete reconstitution of the bone. Our patients' families were informed that data concerning the cases would be submitted for publication, and they consented. Case 1. A ten-year-old boy was admitted to our institution for evaluation of a two-month history of neck pain associated with slight restriction of head rotation. The neck pain was continuous and progressively increasing, and the use of nonsteroidal anti-inflammatory medication had resulted in no improvement. Radiographs of the cervical spine revealed no abnormality. Technetium-99 methylene diphosphonate bone scintigraphy showed increased uptake on the left side of …

A case of skeletal sarcoidosis imitating skeletal metastases on bone scintigraphy

A 70-year-old woman receiving long-term corticosteroid therapy for sarcoidosis presented with hip pain. She underwent whole-body technetium 99m methylene diphosphonate bone scintigraphy to exclude avascular necrosis of the femoral head. Although there was no suggestion of avascular necrosis,