Tc-99m MDP Bone Scan Research Articles

Multifocal Bone and Visceral Melioidosis in a Cirrhotic Patient Identified by 99mTc MDP Bone Scan

A 58-year-old diabetic male with hepatic cirrhosis presented with fever and vague bone pains. Technetium methylene diphosphonate (99mTc MDP) three phase bone scan (Figures 1 and ​and22) identified not only multiple sites of bone involvement but also extraskeletal renal involvement that was later proven by culture. Burkholderia pseudomallei was isolated from a blood culture, confirming a diagnosis of systemic melioidosis. Although lung abscess is the most common presentation disseminated disease often occurs, particularly in the presence of impaired host immunity, which was apparent in this patient. Pleural effusion, skin and soft tissue swellings, and liver and splenic abscesses may be encountered. Neurological involvement (brain stem encephalitis, cerebral abscess, cranial nerve palsies, and paraparesis), although less common, can be seen in 4% of cases. Figure 1. 99mTc MDP regional three-phase bone scan showed multifocal bone involvement. Vascular and soft tissue phase images showed symmetrically increased vascularity and soft tissue tracer uptake in both knee joints. Increased soft tissue tracer uptake was noted ... Figure 2. 99mTc MDP whole-body bone scan. Skeletal phase images depict diffusely intense tracer uptake in the left femoral shaft with interspersed small cold defects. A hot spot is seen in left eighth rib posteriorly with associated increased tracer uptake in the ... Melioidosis1 is a great masquerader, and it is often confused with staphylococcal abscesses in acute form, tuberculosis in chronic presentations, or a generalized sepsis. Aspirated pus may show caseating material similar to the material in tuberculosis, and tissue biopsy may show granuloma.

Clinical Utility of Radiation Medicine 99mTc-Methylene Diphosphanate Bone Scintigraphy in the Early Diagnosis of Rheumatoid Arthritis.

The value of 99mTc-Methylene diphosphanate (99mTc-MDP) bone scan in predicting development of bony destruction, swelling, new bone erosions and skeletal deformities in small joints and bones was studied by visual evaluation of bone scans. 99m Tc-MDP was injected intravenously. 3 hours after the 99mTc-MDP injection, they have been underwent spot views of entire skeletons with planar scintigraphy in the anterior and posterior positions. All patients were examined under the Electronics Corporation of India Limited (ECIL) single head gamma camera imaging machine, equipped with a low-energy high-resolution parallel-hole collimator. In 9 patients with newly diagnosed rheumatoid arthritis a total of 60 patients of 99mTc-MDP bone scan were examined clinically, scintigraphically, and radiographically. The follow up period was 2 years. Seven patients found increased radiopharmaceutical increased in small joints. Onset of the rheumatoid disease was found in three out of seven patients. 2/9 patients, the joints which were eroded scintigraphically, was active at all the checkups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by radionuclide scanning never eroded. Scintigraphic and clinical activity and radiographic erosion correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of bony erosions in patients of rheumatoid arthritis.

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.

Utility of 99mTc-MDP Bone Scan in Comparison to Mri and Plain Radiographs for the Diagnosis of Early Spondyloarthropathy

Introduction: Spondyloarthropathy as a cause of inflammatory lower back ache often goes undiagnosed for long. Though various clinical criteria have been developed, evidence of sacroiliitis is considered the basis for diagnosis. As sacroiliitis may become apparent on plain radiographs after a long duration, it is important to evaluate the efficacy of other imaging techniques to make an early diagnosis. Magnetic resonance imaging (MRI) and development of various specific sequences have helped in picking up structural changes as well as inflammation in sacroiliitis. The present study is to assess the role of MRI and radionuclide bone scan in patients with early SpA of less than 3 years. Materials and methods: Patients with inflammatory LBA, defined according to the Calin criteria and satisfying the European Spondyloarthropathy Study Group (ESSG) criteria for SpA of less than 3 years duration, were included. Controls had mechanical LBA. A detailed clinical assessment and assessment of disease activity and functional impairment was done with validated measures. Radiological assessment included conventional radiograph of the pelvis, radionuclide scan and MRI of sacroiliac joints (SI joints). The sensitivity, specificity and predictive value of each modality in contributing to the diagnosis of SpA were assessed. Results: Assessment of 136 SI joints in 42 patients [(Age 29 (± 5.6) and 26 controls (Age 32.1 (± 8.91)] was done. The mean disease duration of cases was 12.5 (± 10.2) months. Conventional radiograph failed to pick up sacroiliitis in any of the cases. Positive bone scan was present in 34 cases (28 bilateral sacroiliitis, 6 unilateral sacroiliitis). Bone scan had a sensitivity of 81.8% and a specificity of 87%. Magnetic resonance imaging abnormality was present in 37/42 (88%) (bilateral in 27 and unilateral in 10) and in none of the controls. This accounted for a sensitivity of 87% and a specificity of 100%. The MRI changes included bone marrow edema (82%), synovial enhancement (60%), subchondral edema (42%), erosions (46%) and sclerosis (38%). JOSS

Application of left femoral neck radioactive uptake ratio in (99)Tcm-MDP bone scan for evaluation of osteoporosis

Objective To evaluate the value of 99Tcm-MDP uptake by left femoral neck for diagnosing osteopomsis.Methods A total of 58 cases (23 males,35 females,mean age:(66.15±8.45) years) with spondyloarthmpathies from May to December of 2012 were selected.Serum concentrations of type Ⅰ collagen telopeptide (sCTX-1) and bone ALP (BALP) were determined.All patients underwent dual-energy X-ray absorptiometry (DXA) to detect bone mineral density (BMD).According to the T scores,patients were divided into 2 groups:normal group (NG) (T＞-1.0) and osteoporosis group (OG) (T≤-2.5).99TcmMDP bone scan was further performed.The average radioactive ratio of the left femoral neck to the medial soft tissue of left femur (T/N) was measured.Data differences between the 2 groups were compared by twosample t test and Pearson correlation analysis.Results According to BMD,13 patients (7 males,6 females) were included in NG and 28 patients (10 males,18 females) were included in OG.The mean ages of OG and NG were significantly different ((68.82± 10.41) years vs (62.46± 11.77) years; t =3.560,P＜0.05).The BMD of left femoral neck in OG was significantly lower than that in NG ((0.67±0.08) g/cm2 vs (0.91±0.10) g/cm2 ; t=9.917,P＜0.01).Although BALP level of OG was significantly higher than that of NG ((35.92±11.58) U/L vs (22.38±6.34) U/L; t=-3.397,P＜0.05),no significant difference was observed on sCTX-1 between the 2 groups (t=-0.463,P＞0.05).T/N ratio of OG (11.63±6.22) was higher than that of NG (9.74±4.44) (t =-3.027,P＜ 0.05).There were significant correlations between the T/N ratio of the left femoral neck and the sCTX-1 and BALP concentrations (r=0.376,0.483,both P＜0.01).No correlations between the T/N ratio of the left femoral neck and age,BMI and BMD were observed (r=-2.031,-0.017,0.134,all P＞0.05).Conclusion The uptake ratio of the left femoral neck in 99Tcm-MDP bone scan could evaluate the metabolism of bone,and it is useful for the early diagnosis of osteoporosis. Key words: Osteoporosis ; Radionuclide imaging; MDP

Bone Marrow Metastases From Alveolar Rhabdomyosarcoma With Impressive FDG PET/CT Finding But Less-Revealing Bone Scintigraphy

An 18F-FDG PET/CT scan was performed in a 26-year-old man with a known alveolar rhabdomyosarcoma for staging. The PET/CT scan showed abnormally increased FDG activity involving almost all bones in the imaged regions. In contrast, 99mTc-MDP whole-body bone scan demonstrated only very limited bone metastases.

Intense Splenic 99mTc-MDP Uptake in a Patient With Myelofibrosis

99mTc-MDP bone scan was performed in a 49-year-old woman with breast cancer. Whole-body bone scan showed multiple foci of increased MDP activity in the bone and intense splenic 99mTc-MDP uptake. Initial bone marrow aspiration in multiple locations yielded no blood cells. A subsequent bone marrow biopsy in the left anterior superior iliac spine showed myelofibrosis in addition to the known bone metastasis.

Hallucal Sesamoiditis Manifested on Bone Scan

The first metatarsal articulation bears one third of the weight of the forefoot. The hallucal sesamoids are embedded in the flexor hallucis brevis and connected by the intersesamoid ligament and plantar plate. The sesamoid apparatus acts as a pulley to help pull the big toe down against the ground during walking. Repetitive pressure, force, or tension can cause sesamoiditis. If the impact is great enough, the bones can break. Here we present a woman with big toe pain during walking. Our case highlights the role of 99mTc-MDP bone scan in reaching the diagnosis of hallucal sesamoiditis.

Pulmonary alveolar microlithiasis: imaging characteristics of planar and SPECT/CT bone scan versus 18F-FDG and 18F-sodium fluoride PET/CT scanning

Pulmonary alveolar microlithiasis (PAM) is a very rare disease in which multiple microscopic calcium phosphate microliths are deposited within the alveoli of both lungs. A lung biopsy is considered to be definitive for final diagnosis; however, non-invasive imaging modalities such as chest X-ray, HRCT scan and (99m)Tc-MDP bone scan suggest the diagnosis in the vast majority of patients. Although (18)F-FDG PET/CT has been tried to characterize the disease, (18)F-sodium fluoride PET/CT as a 'proof-of-principle' was tried for the first time in a known case of PAM in order to characterize the lung lesions. Interestingly, we noted that (18)F-sodium fluoride PET/CT is a superior modality in characterization and assessment of the extent of disease in PAM compared to all other non-invasive imaging modalities. Thus, we recommend that (18)F-sodium fluoride PET/CT should be the investigation of choice in PAM.

Acute Kidney Injury Secondary to NSAID Diagnosed on 99mTc MDP Bone Scan

A bone scan with 99mTc MDP was obtained to rule out the presence of micro fractures in a patient with the diagnosis of idiopathic osteoporosis. There was not any sign of micro fractures, but interestingly, both kidneys were diffusely very active. A differential diagnosis of acute kidney injury secondary to the use of nonsteroidal anti-inflammatory drug was made and reported after elimination of other clinical situations. The renal functions obtained following bone scan were impaired. The anti-inflammatory drug was discontinued. The renal functions were recovered starting with the following day.Conflict of interest:None declared.

Comparison of 18F Fluoride PET/CT and 99mTc-MDP Bone Scan in the Detection of Skeletal Metastases in Urinary Bladder Carcinoma

The aim of this study was to compare (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma. In this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35-80 years) underwent (99m)Tc-MDP planar and SPECT/CT bone scan (BS) followed by (18)F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation. (18)F-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of (99m)Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of (99m)Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of (18)F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between (99m)Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and (18)F-fluoride PET/CT (κ = 0.74) were found. ( 18)F-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional (99m)Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.

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

The aim of this study was to compare 99mTc-MDP bone scanning, 18F NaF PET/CT, 18F FDG PET/CT, and whole-body MRI (WBMRI) for detection of known osseous metastases. This prospective pilot trial (September 2007-April 2009) enrolled 10 participants (5 men, 5 women, 47-81 years old) diagnosed with cancer and known osseous metastases. 18F NaF PET/CT, 18F FDG PET/CT, and WBMRI were performed within 1 month for each participant. The image quality and evaluation of extent of disease were superior by 18F NaF PET/CT compared to 99mTc-MDP scintigraphy in all patients with skeletal lesions and compared to 18F FDG PET/CT in 3 of the patients with skeletal metastases. 18F NaF PET/CT showed osseous metastases where 18F FDG PET/CT was negative in another 3 participants. Extraskeletal metastases were identified by 18F FDG PET/CT in 6 participants. WBMRI with the combination of iterative decomposition of water and fat with echo asymmetry and least-squares estimation, short tau inversion recovery, and diffusion-weighted imaging pulse sequences showed fewer lesions than 18F NaF PET/CT in 5 patients, same number of lesions in 2 patients, and more lesions in 1 patient. WBMRI showed fewer lesions than 18F FDG in 3 patients and same lesions in 6 patients. Our pilot phase prospective trial demonstrated superior image quality and evaluation of skeletal disease extent with 18F NaF PET/CT compared to 99mTc-MDP scintigraphy and 18F FDG PET/CT, as well as the feasibility of multisequence WBMRI. In addition, 18F FDG PET/CT provided valuable soft-tissue information that can change disease management. Further evaluation of these findings using the recently introduced PET/MRI scanners is warranted.

Liver and lymph node metastases of prostate cancer visualized on post-therapy imaging after treatment with 188Re-HEDP

A 76-year-old man with bone metastases of prostate cancer diagnosed a year ago was admitted for relief of bone pain (visual analogue scale: 90%) most markedly in cervical spine and upper extremities due to skeletal metastases. His serum prostate specific antigen level was markedly increased (351 ng/ml). After documentation of sufficient tracer uptake in multiple bone metastases on whole-body 99mTc-MDP bone scan, we treated him with a single intravenous injection of 2.4 GBq 188Re-HEDP. Quality control of 188Re-HEDP was performed with TLC within 30 min prior to injection, radiochemical purity was >95%, free rhenium and colloid ratios were less than 3%. For pain, he was taking Novalgin 30 drops t.i.d. and used Fentanyl patch 50 g/72 h. Fig. 1 shows increased activity localization in multiple bone metastases and the liver lesion after treatment with 188Re-HEDP, as well as on the whole-body scans obtained a week prior to treatment. This metastatic liver lesion was diagnosed on a conventional CT scan 6 months before treatment. The SPECT/CT study (obtained at 24 h after injection) shows tracer accumulation in the liver lesion, in abdominal lymph nodes (in the hepatoduodenal ligament) and in stomach (Fig. 2A and B). An abdominal section of the SPECT/CT study shows that the area of activity localization on right side of abdomen on whole body image corresponds to intestinal contents (Fig. 2C). Liver metastases of various malignant tumors such as breast cancer have been reported to show accumulation on bone scintigraphy with 99mTc-MDP. Limouris and Skukla reported 186Re-HEDP uptake in the stomach in two patients with osseous metastases because of prostate and breast cancer1; however, we could not find any reports on visualization of lymph node metastases on posttherapy scan after administration of 188Re-HEDP. Accumulation of

Role of bone scan in routine practice for early recognition of bisphosphonate-related osteonecrosis of the jaws (ONJ): Pro and con.

e20694 Background: The literature on the role of 99mTc-MDP bone scan (BS) in the diagnosis and follow-up of bisphosphonate-related ONJ is limited and unconsistent. Following data are in favour: a) BS is an imaging technique with high sensitivity; b) sporadic cases of early jawbone (maxilla or mandible) uptake have been reported, occasionally even months or years before the clinical evidence of ONJ (bone exposure); c) the jaw BS uptakes can change on different stages of ONJ disease (acute/symptomatic or less); d) the BS is performed periodically in patients with skeletal metastases to check out the status of disease activity and the response to specific treatments; consequently the research of ONJ does not involve additional costs. Vice versa, some limitations include: a) BS is a technique with low specificity; bone traumatic, inflammatory, degenerative lesions can determine an uptake; b) a non-negligible proportion of patients (even without any tumor disease) shows jaw uptakes, due to dental diseases widely seen in the general population (abscesses, denture ulcers,periodontal disease,etc.); c) even in BP-related ONJ suspected cases, jaw uptake may be due to infections that are not necessarily connected to the osteomyelitis component of ONJ; d) bone necrosis (sequestrum) is usually not uptaking at the BS, but it can appear as a downtaking area surrounded by an uptaking area. Methods: We conducted a retrospective study of 59 BS performed in 15 ONJ patients treated with BPs (8 with breast cancer,6 prostate cancer,1 renal cell carcinoma). Two Nuclear Medicine specialists reviewed 18 "baseline" BS (before treatment with BP), 14 BS in the 6-12 months prior to diagnosis of ONJ, 13 BS performed at the diagnosis time of ONJ (or within 6 months), 14 BS collected after the diagnosis of ONJ. Results: 6-12 months prior to diagnosis, 10 BS were positive (jaw uptakes in ONJ sites) and 4 negative. At the moment of ONJ diagnosis, 12 out of 13 exams resulted positive and one doubtful. Conclusions: These retrospective data will be used to design a case-control study with different patient groups, inluding ONJ cases, patients treated with BP and not suffering from ONJ, and cancer patients not receiving BPs.

Melioidosis as a cause of femoral osteomyelitis and multifocal intramuscular abscess around the hip joint in a farmer: a case report

Melioidosis is a potentially fatal infectious disease caused by the soil transmitted saprophyte Burkholderia pseudomallei. Though Sri Lanka being considered a non endemic country, with the increasing number of cases reported recently there is mounting evidence that the disease is emerging here. Osteomyelitis caused by Burkholderia psuedomallei infection is uncommon and only few cases were found in the literature. We report a case of proximal femoral osteomyelitis and multifocal intramuscular abscess around the hip joint caused by Burkholderia psuedomallei in a Sri Lankan farmer. A 57 year old Sinhalese male farmer was admitted with intermittent high grade fever and left hip pain for 3 weeks. He was found to have diabetes. Ultrasound scan of the left hip joint revealed a joint effusion of 1 cm. Whole body anterior and posterior delayed images of a Tc-99m MDP bone scan demonstrated intense tracer uptake in the left proximal femur and the CT pelvis revealed a left side multi focal intramuscular abscess around the hip joint and proximal femur osteomyelitis. The CT guided aspiration of the intramuscular abscess fluid yielded a growth of gram negative bacilli, identified as pseudomonas species. Blood for antibodies for Burkholderia psuedomallei revealed a positive result at a titre of 1:320. He was diagnosed as having probable melioidosis with multifocal intramuscular abscess around the left hip joint and left proximal femoral osteomyelitis. He responded to intravenous meropenem 1 g twice a day and was continued for 4 weeks and was discharged on maintenance regime of oral cotrimoxazole 1920 mg twice a day and oral doxycycline 100 mg twice a day for 20 weeks. Our patient remained asymptomatic after 6 months of follow up and a subsequent ultrasound and CT images showed full resolution of the osteomyelitis and failed to demonstrate any abscess formation. This case alerts clinicians regarding the unusual aetiology of osteomyelitis caused by Burkholderia psuedomallei especially in patients with diabetes and those who have prolonged contact with soil. In such situations early institution of appropriate antibiotics will be life saving and a prolonged maintenance therapy with oral antibiotics is essential to prevent recrudescence of the infection. DOI: http://dx.doi.org/10.4038/sljid.v3i1.4655

The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan

We aimed to compare the role of (18)F-fluoride PET/CT, FDG PET/CT and (99m)Tc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma. This was a prospective study including patients for staging (S) and restaging (R). Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a (99m)Tc-MDP bone scan, FDG PET/CT and (18)F-fluoride PET/CT within 2 weeks. All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey. Histological verification was done wherever feasible. Sensitivity and negative predictive value (NPV) of (18)F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer. Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer. As compared to the (99m)Tc-MDP bone scan, all parameters were superior for (18)F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC. The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV. To rule out bone metastases in cases where there is a high index of suspicion, (18)F-fluoride PET/CT is the most reliable investigation. (18)F-fluoride PET/CT has the potential to replace the (99m)Tc-MDP bone scan for the detection of bone metastases.

Clinical utility of fluoride-18 positron emission tomography/CT in temporomandibular disorder with osteoarthritis: comparisons with99mTc-MDP bone scan

The purpose of this study was to compare the clinical utility of fluoride-18 positron emission tomography (¹⁸F-PET)/CT with that of conventional (99m)Tc-methylene diphosphonate (MDP) bone scan in temporomandibular disorder (TMD) with osteoarthritis. 24 patients with TMD who underwent both ¹⁸F-PET/CT and (99m)Tc-MDP bone scans for diagnostic work-up were enrolled. The temporomandibular joint (TMJ)-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on ¹⁸F-PET/CT and the TMJ uptake ratio on bone scan were measured. Of the 48 TMJs in 24 patients, 35 TMJs were diagnosed as TMD with osteoarthritis, 8 TMJs as TMD with anterior disc displacement (ADD), and the remaining 5 TMJs showed no evidence of TMD (NED). All three uptake ratios on ¹⁸F-PET/CT and the TMJ uptake ratio on the bone scan tended to be higher in TMD with osteoarthritis than in TMD with ADD or NED. Receiver operating characteristic (ROC) curve analysis for detecting TMD with osteoarthritis indicated that the TMJ-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on PET/CT (0.819, 0.771 and 0.813, respectively) showed higher area under the ROC curve value than the TMJ ratio on bone scan (0.714). The TMJ-to-skull uptake ratio on PET/CT showed the highest sensitivity (89%) and accuracy (81%) of all uptake ratios. ¹⁸F-PET/CT can help diagnose TMD with osteoarthritis with superior diagnostic ability and is a suitable alternative modality to a conventional (99m)Tc-MDP bone scan.

Incidental detection of superior sternal cleft on Technetium-99m methylene diphosphonate bone scan

A sternal cleft is an extremely rare developmental anomaly, which results from failure of fusion of sternal bars which contribute to the formation of the sternum. Most cases are diagnosed in early childhood, where it is associated with serious other midline defects. A sternal cleft is seen as a photopenic area on technetium-99m methylene diphosphonate bone scan and can be confused with other conditions. We report an extremely rare case of isolated upper sternal cleft in a 45-years-old male, found incidentally on Tc-99m MDP bone scan.

Abnormal extraosseous activity in both lungs and stomach in pre-transplant 99mTc-MDP bone scan disappearing after renal transplant

A chronic kidney disease male patient presenting with bone pains, fever, weakness, and clinically ascites was subjected to four technetium-99m-methylene diphosphonate (Tc99m-MDP) bone scans, two before renal transplant and two after renal transplants. Pretransplant bone scan revealed metabolic bone disease with focal insufficiency fractures. Marked extraosseous activity in both lungs and stomach was also visualized. On regular hemodialysis (HD) after 4 months, repeat pretransplant bone scan showed persistent uptake in lungs and stomach, representing altered calcium metabolism with microcalcifications. He underwent human leukocyte antigen (HLA) matched live donor renal transplantation, started on immune-suppression and steroids. Posttransplant bone scan at 20 days revealed no definite interval change, but bone scan performed approximately 17 months posttransplant showed resolving metabolic bone disease and the tracer uptake in the lungs and stomach was no more visualized. Patient clinically followed-up until the date (February 2013) is asymptomatic with serum creatinine of 1.5 mg/dl, no bone scan done.

SMALL-ANIMAL MOLECULAR IMAGING WITH PORTABLE DEVICES ON CLINICAL PINHOLE SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY SYSTEMS

Objectives: We have developed a portable system compatible with various clinical gamma cameras to perform three-dimensional (3D) small-animal molecular imaging. The spatial resolution of this system is close to that of commercial animal imaging systems, although its cost is much lower. Methods: The portable system consists of a rotating stage, a leveling plate, a line source phantom, and a calibration phantom. To obtain high-resolution single-photon emission computed tomography (SPECT) images, we developed several methods for system alignment and applied geometric calibration. The projections of the subject were reimaged according to the calibration parameters and reconstructed by the 3D ordered subsets expectation maximization (OS-EM) algorithm. Results: The resulting images of the microdeluxe phantom showed 2.4-mm cold rods. The image quality of phantom scanning was stable when the portable system was applied to various gamma cameras from different manufacturers. The resultant images of a 99mTc-MDP bone scan of a mouse showed details of the spine, femur, pelvis, and tail. Furthermore, a radiopharmaceutical study of 99mTc-HYNIC-Annexin V on a liver inflammation-induced mouse was carried out to demonstrate the feasibility of this system for small-animal molecular imaging. Conclusions: The newly developed portable system was compatible with various gamma cameras and enabled successful performance of small-animal molecular imaging.