Nuclear Bone Scintigraphy Research Articles

Pilot Study of F18-Florbetapir in the Early Evaluation of Cardiac Amyloidosis.

Background: Cardiac amyloidosis is an increasingly recognized etiology of heart failure, in part due to the rise of non-invasive nuclear bone scintigraphy. Molecular imaging using positron emission tomography (PET) has promised the direct visualization of cardiac amyloid fibrils. We sought to assess the performance of F18-florbetapir PET in patients with a potential for cardiac amyloidosis in order to identify early disease.Methods: We performed a pilot study of 12 patients: one with asymptomatic transthyretin cardiac amyloidosis, seven with a potential for developing cardiac amyloidosis (two smoldering myeloma and five with extracardiac biopsy demonstrating transthyretin amyloid deposits and negative technetium pyrophosphate scans), and four controls. Patients were imaged with PET/CT in listmode 10–20 min after receiving F18-florbetapir. Static images were created from this acquisition, and mean standardized uptake values (SUVs) of the left ventricular myocardium, blood pool, paraspinal muscles, and liver were calculated.Results: All 12 patients demonstrated radiotracer uptake in the myocardium with mean SUV of 2.3 ± 0.4 and blood pool SUV of 0.8 ± 0.1. The patient with cardiac amyloidosis had SUV of 3.3, while mean SUV for patients at risk was 2.3 ± 0.4 and for controls was 2.2 ± 0.3. After 3 years of follow-up, one patient with SUV below the mean was subsequently diagnosed with ATTR cardiac amyloidosis.Conclusion: In this cohort, PET with F18-florbetapir demonstrated non-specific radiotracer uptake in the myocardium in all patients using a static image protocol; though, the highest values were noted in a patient with ATTR cardiac amyloidosis. There was no difference in the intensity of F18-florbetapir uptake in at-risk patients and controls. Future studies should continue to investigate metabolic PET tracers and protocols in cardiac amyloidosis, including in early disease.

18F-NaF PET/CT.

18F-NaF PET/CT is indicated for diagnostic imaging of bone to define altered osteogenic areas of activity. It provides high-resolution, high-contrast images of the skeletal tissue and has higher sensitivity, specificity, and accuracy than conventional nuclear bone scintigraphy. The low-dose CT

Imaging metastatic prostate cancer with 18F-DCFBC PET/CT (DCFBC) and 18F-NaF PET/CT (NaF).

231 Background: Conventional imaging of advanced prostate cancer (computerized tomography and nuclear bone scintigraphy) is limited and indicates a need for a more specific molecular imaging probe. DCFBC is a radiolabeled PET agent that binds with high affinity to prostate specific membrane antigen (PSMA), which is overexpressed in almost all prostate cancers and through whole-body non-invasive functional imaging, may provide new information on the expression of PSMA. We compare the uptake of DCFBC in bone with respect to NaF PET/CT in metastatic prostate cancer patients. DCFBC has added capability to detect soft tissue metastasis whereas NaF is confined to secondary effects of bone disease. Methods: Subjects with known or suspected prostate cancer metastasis underwent DCFBC PET/CT imaging performed at 1 hour and 2 hours after IV bolus injection of 8 mCi of DCFBC. Patients also underwent a whole body NaF PET/CT scan within 3 weeks of DCFBC PET/CT to assess for bone metastases. Patients received 3 mCi of NaF IV bolus and then were imaged 1hour post injection. PSA levels and antiandrogen therapy status were obtained at the time of DCFBC imaging. Results: Fifteen patients have been preliminarily analyzed. PSA ranged from < .01 to 4379 ng/mL. NaF identified bone lesions in 10 patients but matching focal DCFBC uptake was only seen in 3 patients. DCFBC additionally showed lymph node metastasis in 1of these 3 patient. There were 5 patients without focal abnormal bone uptake on NaF or DCFBC. In this group, 4 of 5 patients had focal DCFBC uptake in lymph nodes or soft tissue lesions. Ten patients were on some form of androgen deprivation therapy (ADT). For those on ADT, 7 of 10 patients had positive findings on NaF, compared to 2 of 10 patients on DCFBC. Conclusions: DCFBC uptake in bone metastasis does not routinely correspond to focal NaF uptake which could be due to distinct mechanisms of tracer uptake and tumor biology. There is an inverse association in focal bone findings when comparing each tracer on antiandrogen therapy. Through whole-body non-invasive functional imaging and further study, DCFBC may prove useful in characterizing prostate cancer based on PSMA expression. Clinical trial information: NCT02190279.

Quantitative assessment of nuclear bone scintigraphy using the ‘regions of interest’ technique as applied to the equine cervical spine

Quantitative assessment of nuclear bone scintigraphy using the ‘regions of interest’ technique as applied to the equine cervical spine

Significance of Bone Abnormalities In CML Patients on Imatinib Mesylate Therapy

AbstractAbstract 4759Both Dasatinib and Nilotinib have proven themselves as more effective but costly first line therapy in chronic myeloid leukemia (CML) than imatinib mesylate (IM). Hence, IM would continue to be used as first line therapy in developing countries because of economic reasons. Thus simple diagnostic tools are required which can triage CML patients into different risk categories. Presence of bone abnormalities (osteoblastic, osteolytic and mixed) in CML was generally associated with poor outcome in pre-imatinib era. Nuclear bone scintigraphy is a simple test that has universal availability. The significance of these abnormalities in imatinib-era has not been investigated. We proposed to evaluate the significance of bone abnormalities as seen on nuclear scintigraphy in CML at diagnosis and at follow-up. The bone scintigraphy was performed with 99m Tc methylene di phosphonate 3-hours after an intravenous injection of 740 MBq of the radiotracer. Regions of interest (ROI) were marked using standard software. A second ROI was marked on the diaphyseal region of the involved long bone. The ratio of average counts per pixel between the involved and the normal areas was calculated for each long bone. The average ratios of the right and left half of body were calculated separately. This average scintigraphic quantification ratio were compared before and after IM therapy. The standard investigations including bone marrow examination and cytogenetics studies were done at diagnosis and at follow-up. The bone scintigraphic abnormalities were correlated with cytogenetic remission after 6 months of IM therapy. The starting dose of IM in chronic phase was 400 mg/day and in advanced phase 600 mg/day. The study was approved by institute review board and was carried out according the declaration of Helsinki. Forty-three newly diagnosed CML patients gave consent for the study. The mean age of patients was 40.8+14.6 and male female ratio was 25:18. Thirty-two patients were in chronic phase and 11 were in advanced phase (accelerated or blast crisis). The prevalence of bone scintigraphy abnormalities were found in 76.7% patients (75% in chronic phase and 81% in advanced phase, p =0.06). No bone abnormalities were detected in 10 patients. At a median follow-up of 7 months (range 5–8 months of IM therapy), 16% patients achieved completed cytogenetic remission (CCR) and 80% achieved partial cytogenetic remission (pCR). The average bone quantification decreased from 3.34+1.05 to 2.07+0.44 among patients in CCR and 2.47+0.57 among patients in pCR. One CML patient showed increase in bone quantification from 3.61 at baseline to 4.14 at 6 months and on bone marrow examination, he was diagnosed in blast crisis. No relationship of bone abnormalities was found with Sokal score at baseline. Bone abnormalities as seen on nuclear scintigraphy are thus common among patients with CML. They tend to resolve on IM therapy. However, a longer follow-up of patients is required for further evaluation of this technique in CML patients and whether it can replace sophisticated prognostic molecular techniques which are inaccessible in resource-constraints settings. Disclosures:No relevant conflicts of interest to declare.

Technetium-99m–Methyl Diphosphonate Bone Scintigraphy May Be Helpful in Preoperative Planning for Vertebroplasty in Multiple Myeloma: Two Cases

Favorable vertebroplasty outcomes reflect accurate preoperative identification of vertebral fracture targets, operator proficiency, and assiduous fracture aftercare. Conventional teaching is that nuclear bone scintigraphy is not helpful in the management of osteolytic myeloma bone disease. Nuclear bone scintigraphy in two patients with multiple myeloma and vertebral fracture pain convincingly identified the fracturing vertebral level and provided confidence that synchronous vertebral fractures were not missed, whereas neither had been appreciated by either radiography or magnetic resonance imaging.

SCINTIGRAPHIC AND RADIOGRAPHIC APPEARANCE OF THE SACROILIAC REGION IN HORSES WITH GAIT ABNORMALITIES OR POOR PERFORMANCE

Nuclear bone scintigraphy is commonly used in the diagnosis of sacroiliac disease in horses. The aim of the present retrospective study was to determine if there was an association between radiopharmaceutical uptake pattern and radiographic appearance of the sacroiliac region in horses. Seventy-nine horses undergoing bone scintigraphy with Tc-99 m-HDP and radiography of the pelvis because of lameness or poor performance were studied. Subjective and semiquantitative methods were used to characterize and compare radiopharmaceutical uptake between horses. Ventrodorsal radiographs of the region were obtained and were evaluated. Subjectively, 70 horses (88.6%) had an abnormal uptake pattern. In nine horses, the sacroiliac region was normal (11.4%). There was no association between subjective evaluation of the scintigraphic images and semiquantitative methods. There was a significant association between radiopharmaceutical uptake and conformation (T- or Y-like form) and shape (butterfly-, wing-, leaf-, or horn-like) of the sacrum. The radiopharmaceutical uptake of the tubera sacralia was significantly higher in males (left side P = 0.002, right side P = 0.003). In conclusion, the conformation of the sacrum may play an important role in the scintigraphic appearance and may be the cause of increased radiopharmaceutical uptake.

Prostate cancer and markers of bone metabolism: diagnostic, prognostic, and therapeutic implications

Knowledge of bone metastases complicating advanced prostate cancer (CaP) is increasingly relevant in patient selection for novel therapies. Current nuclear bone scintigraphy imaging has limited specificity for prostate metastases. As serum bone markers do correlate with bony lesions, they may play multiple roles in patients with advanced CaP. Currently, these markers play a role in prognostic nomograms for CaP. Recent studies suggest an expanding role for bone markers in the diagnosis and selection of patients for novel therapies. In the future, therapeutic roles for some of these marker pathways will emerge, eventually allowing greater individualization of patient care.

Nuclear Bone Scintigraphy (NBS): A Valuable Tool Depicting Osseointegration at the Sites of Dental Grafts

Hydroxyapatite (HA) implants were used as grafting materials to fill some of the root resections in three patients. Two of the patients had previous root resections without implant insertion. Being implanted to the resection sites, the porous structure of HA serves as a framework for vascular and soft tissue ingrowth. Previous reports on the utilization of three phase nuclear bone scintigraphy (NBS) to evaluate the degree of fibrovascular ingrowth into HA dental implants after surgery are scarce. Three cases are described in which bone scintigraphy was performed at 6 months after implant insertion. The images revealed technetium-99m methylenediphosphonate (99mTc-MDP) uptake at dental implant sites consistent with vascularization and osteoconduction. The current results strongly indicate that osseointegration is complete. This study demonstrates that NBS is a valuable test in the follow up of osseointegration rate at implantation sites and HA is found to be a good biomaterial for grafting purposes showing high osseointegration rates.

Clinical significance of ossification of the cartilages of the front feet based on nuclear bone scintigraphy, radiography and lameness examinations in 21 Finnhorses.

Research on the clinical significance of ossification of the cartilages of the foot has been limited, despite the common nature of the condition and conflicting reports in previous literature. Some radiographic features in the ossification of the cartilages, such as incomplete fusion lines between separate centres of ossification and the ossified base, are of clinical significance. The relationships between radiopharmaceutical uptake in bone phase nuclear scintigraphy at the heels (palmar processes of the distal phalanx, including ossification of the cartilages of the foot), radiographic extent and type of ossification of the cartilages and clinical lameness were evaluated retrospectively in 21 Finnhorses (age > or = 4 years) in a total of 36 front feet. No significant relationship between height of the ossifications and radiopharmaceutical uptake at the ipsilateral heels existed. Clearly separate centres of ossification were not associated with increased uptake. Moderately increased uptake was suspected to be associated with ossification of the adjacent cartilage in only one foot. Intense uptake was present unilaterally in 4 horses, at one medial and 3 lateral heels. In 2 of these horses, a unilateral palmar digital nerve block relieved the mild lameness; 2 horses had no obvious lameness but had a history of being stiff or having locomotion problems during high speed trot. At 2 of the lateral heels, an incomplete fusion line was present between a large separate centre of ossification and the base, and the third horse had a high sidebone with bony protrusions, suggestive of chronic entheseopathy in a narrow foot. At the medial heel, an oblique radiograph revealed a faint radiolucent line at the base of the ossification. In all cartilages with intense radiopharmaceutical uptake at the heel and/or lameness, the ossified part of the cartilage was wider and more irregular compared to other ossifications of the front feet of the individual. Increased radiopharmaceutical uptake, associated with a different radiographic appearance from that of other ossifications of the front feet, was a conclusive sign of clinical significance. Obscure locomotion problems were more commonly associated with ossification of the cartilages than true lameness. This information is useful in lameness and prepurchase examinations and is likely also to be applicable to other coldblooded breeds used for athletic purposes.

Bone scintigraphy in the diagnosis of sacroiliac injury in twelve horses.

Nuclear bone scintigraphy was used to diagnose sacroiliac injury in 12 horses presented for nonspecific rear limb lameness. The most common history was decreased performance and/or a mild chronic rear limb lameness which could not be localised by routine lameness examination. The scintigraphic patterns of the 12 affected horses were compared to 5 normal horses and 10 horses with lameness not related to the pelvic region. Subjective and quantitative evaluation of the bone scans clearly separated the 12 affected horses from the 5 normal horses and the 10 horses with lameness from causes other than the sacroiliac joint disease. The 12 affected horses had a scintigraphic pattern of moderate to marked increased uptake of the radiopharmaceutical within the sacroiliac joint region on the side of lameness. In contrast, the 5 normal horses and 10 horses scanned for other causes of lameness, had a symmetric, or only slightly asymmetric pattern of radioisotope uptake. Although nonspecific for the type of injury, nuclear bone scintigraphy is considered sensitive for the detection of sacroiliac injuries in horses.