Tc-99m Methylene Diphosphonate Bone Scan Research Articles

Diffused Pulmonary Uptake of Tc-99m Methylene Diphosphonate Bone Scan in Patient with Prostate Cancer without Blood Test and Correlative/Cross-Sectional Imaging Abnormalities: A Case Report

Introduction: Bone scan using Tc-99m methylene diphosphonate (MDP) is a commonly used procedure for evaluating bone metastasis in cancer patients. Extra-osseous pulmonary uptake in bone scans is mostly an incidental finding and occurs in a multitude of disorders. Clinicians should be alert to any findings on clinical or complementary diagnostic tools. We presented a case of prostate cancer male patients who demonstrated diffuse pulmonary uptake on Tc-99m MDP bone scan without any blood test and correlative/cross-sectional imaging abnormality Case Presentation: An 80-year-old male with adenocarcinoma of the prostate with a Gleason score of 6 (3+3). The PSA level was 0.009. The patient had a history of recurrent atrial fibrillation (AF), postural dizziness, HTN, Gout, and chronic renal failure, but all of these comorbidities were under control. The patient underwent a bone scan to annually check for the presence of bone metastases. Three hours after administering 740 MBq Tc-99m MDP intravenously. The reports didn’t show any increased uptake that would indicate metastases in the bones. Instead, diffuse bilateral pulmonary uptake and a mild increase in cardiac uptake were present. On the same day, a computed tomography (CT) scan of the thorax revealed 3 micro-nodules in the right upper lung that were described as benign lesions, and a chest X-ray confirmed normal results. The patient’s laboratory results were within normal range, and there were no clinical lung symptoms or complaints. Considering the patient history of persistent AF, chronic renal failure, and a complaint of postural dizziness, the bone scan finding may indicate involvement of amyloidosis. The relationship between amyloidosis and cancer was also widely noted. Conclusions: Tc-99m MDP may play a role in evaluating amyloidosis involvement in an uncommon place such as the lungs. Future research should focus on analyzing diagnostic options in the patient’s condition in this situation. Keywords: cancer, diffused pulmonary uptake, amyloidosis, bone scan

Evaluating Treatment Response in Breast Cancer: A Case Report on Static Metastatic Disease on Bone Scans

Background: We report a case of a 54-year-old female patient with carcinoma of the left breast with persistent methylene diphosphonate (MDP) uptake in sclerotic osseous lesions. These lesions were finally declared treated osseous metastatic lesions due to non-avidity on the F18 FDG PET-CT scan, normalization of CA-15.3, and resolution of bone pains. To the best of our knowledge, this has not been reported previously. Case presentation: A 54-year-old woman with persistent backache was referred for further evaluation by a Tc99m MDP bone scan. A Tc-99mmMDP bone scan showed wide-spread skeletal metastatic disease. Magnetic resonance imaging (MRI) showed extensive marrow disease involving the spine and iliac bones. A bone marrow biopsy revealed metastatic carcinoma with a tumor phenotype favoring breast primary. On further workup, the patient was diagnosed with invasive ductal carcinoma of the left breast and was treated with cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors along with hormone therapy and bisphosphonates, followed by radiation therapy for bone metastasis. The skeletal metastatic disease remains static on three consecutive Tc99m MDP bone scans, despite the clinical improvement and decreased tumor marker levels. The F18-FDG-FDG-CT scan done for monitoring treatment response revealed multiple non-avid sclerotic osseous lesions, favoring treatment response. The patient was continued with the same treatment, and a follow-up Tc99m MDP bone scan after 6 months revealed no interval change in the reported lesions compared to the initial scan. However, a synergistically performed F18 FDG PET-CT scan again showed multiple non-avid sclerotic osseous lesions suggestive of treated metastasis. Conclusion: This case highlights the importance of 18F-FDG PET-CT in evaluating the treatment response, especially in patients with symptomatic improvement and falling tumor marker levels with static disease on repeated Tc99m MDP bone scans.

Vertebral and ribs enhancement in Tc-99m methylene diphosphonate bone scan image by blind deconvolution algorithm.

The objective of the study was to restore Tc-99m methylene diphosphonate (MDP) bone scan image using blind deconvolution (BD) algorithm so that ribs, vertebrae, and lesions present in them become prominent. Our study consists of retrospective data in which 356 Tc-99m MDP bone scan images (178 anterior and 178 posterior) were processed using dynamic stochastic resonance algorithm, block-matching 3D filter, and then restored using BD algorithm. Two nuclear medicine (NM) physicians compared restored image with its input image; they especially lookedfor: (a) improvement in lesions detectability, (b) artifacts if any, (c) deterioration in ribs and vertebra, and (d) contrast enhancement in adjacent vertebra and adjacent ribs. They selected one out of two (restored and input) images, which had better quality. The overall image quality was also assessed using the following image quality metrics: brightness, blur, global contrast factor, and contrast per pixel. The Wilcoxon signed-rank test was applied for finding significant difference between the value of image quality metrics of restored image and input image at level of significance alpha = 0.05. According to NM physicians, 80.3% (286 out of 356) of restored images were acceptable, whereas 19.6% (70 out of 356) were unacceptable. Ribs and vertebrae were prominent in 161 out of 178 posterior restored images. Lumbar vertebrae were enhanced and well differentiated from adjacent vertebrae in 125 out of 178 anterior restored images. The value of image quality metrics of restored and input images were found to be significantly different ( P -value < 0.0001). Ribs, vertebrae, and lesions present in them become prominent in the most of Tc-99m MDP bone scan images (80.3%) restored using BD algorithm.

A Case of Extracranial Metastasis of Glioblastoma Multiforme Seen on Bone Scintigraphy.

Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system in adults. It is known for its devastating intracranial progress thus attributing to its very short survival. Here, we report a case of 37-year-old female with GBM post surgery, chemotherapy and radiotherapy who presented with pain in right hip region. She was referred to our department for evaluation of skeletal metastasis. Tc-99m methylene diphosphonate bone scan revealed an expansile lesion involving the right iliac blade along with extensive lytic bony lesions throughout the axial skeleton.

Unusual Case of Neuroblastoma with Only Growth Plate Metastasis in Bilateral Lower Limbs on Metaiodobenzylguanidine Scintigraphy.

Neuroblastoma is the most common extracranial solid tumor in childhood developing from primitive neural crest cells. I-131-metaiodobenzylguanidine (MIBG) a norepinephrine analog is highly sensitive and specific to identify primary and distant metastatic sites. We report the case of a 2-year-old female child with progressively increasing abdominal distention. Computed tomography (CT) revealed a large mass lesion involving the right suprarenal region with no hepatic or lymph node metastasis. No obvious skeletal abnormality was detected on the whole-body skeletal survey and Tc-99 m-methylene diphosphonate bone scan to suggest metastasis. I-131-MIBG scintigraphy with single-photon emission computerized tomography-CT showed MIBG-avid primary tumor in a suprarenal location with bilateral lower limbs growth plate as the only site of metastasis.

Emphysematous osteomyelitis diagnosed on Tc99m MDP SPECT-CT scintigraphy: a case report

Background: Emphysematous osteomyelitis is a rare but fatal condition, caused by gas-forming bacteria. We reported a rare case of emphysematous osteomyelitis of left femur in a 27-year-old diabetic male, diagnosed on Tc99m methylene diphosphonate (MDP) single photon emission computed tomography-computed tomography (SPECT-CT) scintigraphy. The pattern of uptake in emphysematous osteomyelitis on Tc99m MDP SPECT-CT scintigraphy was not reported previously. Case Presentation: A 27-year-old diabetic male patient presented with history of pain in left thigh and fever for 10 days. He was referred to nuclear medicine department for Tc99m MDP bone scan. He had no history of trauma or surgery, and his radiograph of left femur was unremarkable at presentation. Tc99m MDP SPECT-CT scintigraphy showed abnormal uptake in femur with intraosseous air, pathognomic of emphysematous osteomyelitis. Further imaging by magnetic resonant imaging (MRI) showed edematous changes in the musculature of left thigh with marrow replacement changes in left femur favoring the diagnosis of emphysematous osteomyelitis. However, no bacterial growth was detected on blood culture due to prior administration of intravenous antibiotics. Conclusion: Tc99m MDP SPECT-CT scintigraphy is helpful in diagnosis of such rare conditions like emphysematous osteomyelitis, in addition to common pathologies of bone. Furthermore, this report is helpful for nuclear physicians to know about the pattern of uptake on planner bone scan and SPECT-CT images in such a rare infection of bone, by gas forming bacteria.

Pattern of Skeletal Metastasis in Breast Cancer Patients Attending INMAS, Rajshahi

Breast cancer is the most common malignant tumor of females, the incidence increases with age. Bone is the most common site to which breast cancer metastasizes. Between 30% to 85% of patients with metastatic breast cancer develop bone metastases during the course of the disease. Bone scan is the most commonly used means of detecting bone metastasis; it visualizes increases in osteoblastic activity and skeletal vascularity. Many radio-pharmaceuticals (radionuclides) have been used in bone scan including technetium-99m bound to methylene diphosphonate (MDP). Published sensitivity and specificity rates of bone scan for diagnosis varies, with sensitivity ranging from 62% to 100% and specificity from 78% to 100%. However, bone scan is generally considered sensitive for detecting bone metastases on whole-body images.The aim of this study was to evaluate the pattern of distribution of skeletal metastases in patients with breast carcinoma by using Tc-99m MDP bone scan. A retrospective study was conducted on 245 consecutive female breast carcinoma patients irrespective of clinical staging, menopausal status and pre-operative / post- mastectomy status, referred for bone scan to Institute of Nuclear Medicine and Allied Sciences, Rajshahi from July 2015 to June 2017. The mean age of the patients was 43.4 ± 13.8 years (mean ± SD) with range from 29 to 66 years. Bone scan was performed by an intravenous bolus injection of 20 mCi Tc99m-MDP. Bone phase images were taken at three hours after injection of the radiotracer. Out of 245 studied patients, 163 patients (66.53%) were negative for skeletal metastasis and 82 patients (33.47%) were positive for skeletal metastasis. Out of 82 patients with positive skeletal metastasis, 68 (82.93%) patients had multiple sites (two or more) and 14 (17.07%) patients had solitary site of bony involvement. Out of 68 patients with multiple sites of skeletal metastasis, highest number was noted in thoraco-lumbar spine (80.89%), followed by ribs including sternum and clavicle (57.35%), pelvic bones (47.06%), upper extremities including scapula (41.18%), lower extremities (33.82%), cervical spine (23.53%) and skull bone (8.82%). Among 14 patients with solitary skeletal metastasis, maximum number was noted in thoraco-lumbar spine (64.29%), followed by cervical spine (14.29%), pelvic bone (07.14%), ribs (07.14%) and sternum (07.14%). Skeletal metastases were much more common in multiple sites than solitary lesion in breast cancer patients. Thoraco-lumbar spine was the most common site of involvement in both solitary and multiple lesions in our study. Axial skeleton was more commonly involved than the appendicular skeleton. Bone scan may pick up bone metastases up to 18 months earlier than conventional radiology, with an average lead of four months. 99m Tc- MDP bone scan is very cost effective in comparison to other imaging modalities (CT, MRI, and PET) and play a major role in early detection of skeletal metastasis in breast cancer patients.&#x0D; Bangladesh J. Nuclear Med. 21(1): 21-25, January 2018

Potential role of multislice SPECT/CT in impingement syndrome and soft-tissue pathology of the ankle and foot

Impingement syndrome and soft-tissue pathology have been recognized as significant causes of chronic ankle pain. Conventional bone scintigraphy was traditionally used for osseous pathology, but with the advent of single photon emission computed tomography/computed tomography (SPECT/CT) the role of bone scintigraphy in these patients is being reconsidered. The aim of this study was to assess the potential role of multislice SPECT/CT in diagnosing impingement syndrome and soft-tissue pathology of the ankle and foot. A total of 209 patients (age range: 19-80 years) underwent a two-phase Tc-99m methylene diphosphonate bone scan followed by SPECT/CT between 2006 and 2009 for various ankle and foot pathologies. These scans were reviewed for impingement syndrome and soft-tissue pathology. The diagnosis made on SPECT/CT was compared with the clinical diagnosis, and two-phase bone scan findings and additional findings obtained from SPECT/CT were noted. Out of the 209 patients, 43 (21%) were diagnosed with impingement syndrome or soft-tissue pathology. Clinical diagnosis versus bone SPECT/CT: in 24/43 (56%) patients, SPECT/CT provided information not suspected on clinical diagnosis. In 19/43 (44%) patients, SPECT/CT confirmed the clinical diagnosis. Two-phase bone scan versus SPECT/CT: in 31/43 (72%) patients, SPECT/CT provided additional information, which was not diagnosed on the conventional two-phase bone scan. The findings of the two-phase bone scan and SPECT/CT were concordant in 12/43 (28%) patients. Tc-99m methylene diphosphonate bone SPECT/CT is useful in localizing and characterizing impingement syndrome and soft-tissue pathology in patients with ankle/foot pain. SPECT/CT may complement MRI and ultrasonography in the investigation of impingement syndrome and soft-tissue pathology.

Superscan caused by renal osteodystrophy: Observed on 18F FDG PET/CT scan

Superscans have been described in variety of conditions such as metastatic disease, metabolic bone disease, and myeloproliferative disorders. We describe a rare case of supercan from metabolic bone disease/renal osteodystrophy observed on F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan. A 35-year-old woman patient with history of human immunodeficiency virus (HIV), end stage renal disease, and recently diagnosed with breast carcinoma had undergone neoadjuvant chemotherapy followed by mastectomy with sentinel lymph node dissection and adjuvant chemoradiation. The patient has been in remission for the last 10 years of follow-up visits. She was subjected to F-18 FDG PET/CT scan and Tc-99m methylene diphosphonate (MDP) bone scan 2 weeks apart for initial staging workup of locally advanced ductal carcinoma of the right breast. Whole body F-18 FDG PET/CT scan [Figure 1a and b] apart from radiotracer uptake in the primary neoplasm in the right breast, demonstrated diffusely increased FDG uptake in the osseous structure without any abnormalities on corresponding CT scan and absence of radiotracer excretion in the kidneys and urinary bladder. Subsequent Tc99m MDP bone scan [Figure 2] demonstrated classic findings of super scan of diffuse, uniform radiotracer uptake in the axial and appendicular skeleton, faint visualization of soft tissue, and absence of radiotracer excretion in the kidneys and urinary bladder.[1] As both bone scan and F-18 FDG PET/CT scan demonstrated diffuse uniform radiotracer uptake in osseous structure indicative of metabolic bone disease rather than patchy, heterogeneous radiotracer uptake observed with skeletal metastasis and corresponding CT scan images being unremarkable, skeletal metastasis was felt less likely.

Unusual Presentation of Extraosseous Metastases on Bone Scintigraphy

Osteosarcoma metastases frequently occur in the lungs or the skeleton. Bone scans play an important role in disease staging by identifying other skip areas of skeletal involvement as well as extraosseous metastases. We report a case of aggressive osteosarcoma, with bone metastases and extraosseous areas of involvement in the lungs, distant lymph nodes, and peritoneal and subcutaneous metastasis seen in a preoperative Tc-99m methylene diphosphonate bone scan. These findings were confirmed with histology and correlative cross-sectional imaging.

Reversal of Drug-Induced Rhabdomyolysis on Bone Scan

A 75-year-old man with prostate cancer was referred for metastatic workup. A Tc-99m methylene diphosphonate bone scan was performed which revealed diffusely increased radiopharmaceutical uptake in the muscles of the arms and thighs. The patient was taking simvastatin 80 mg per day and gemfibrozil 600 mg twice a day for high cholesterol. The patient reported myalgias, and laboratory evaluation was consistent with rhabdomyolysis. After discontinuation of the anticholesterol medications, the clinical and laboratory evaluations normalized. Bone scan performed 1 year later demonstrated complete resolution of muscle uptake.

Tc-99m MDP bone scintigraphy in a case of Touraine-Solente-Gole syndrome

Pachydermoperiostosis is a form of primary hypertrophic osteoarthropathy, also known as Touraine-Solente-Gole syndrome. It is a rare disease. In this report, we present the case of a 29-year-old man with this rare disorder, having significant findings on Tc-99m methylene diphosphonate bone scan.

Comparison of Tc-99m MDP and Sm-153 EDTMP bone scan

A 72-year-old male, a known case of carcinoma of prostate, had bilateral orchidectomy in 2002 and while on hormones developed multiple bone metastases in 2010. He was treated with 153Samarium ethylene diamine tetra methylene phosphonate (EDTMP). The author compares the features of 99mTc methylene diphosphonate (MDP) scan and 153Sm EDTMP bone scan, highlighting the similarities of skeletal uptake.

Bilateral Tarsal Coalitions Detected on Tc-99m Methylene Diphosphonate Bone Scan With SPECT/CT

Bilateral Tarsal Coalitions Detected on Tc-99m Methylene Diphosphonate Bone Scan With SPECT/CT

Diagnostic role of whole body bone scintigraphy in atypical skeletal tuberculosis resembling multiple metastases: a case report

IntroductionOsseous tuberculosis can be present with unifocal or multifocal bony involvement. Although multifocal involvement of the skeletal system in areas where tuberculosis is endemic is not a rare presentation, its exact prevalence is not well known. A case of atypical skeletal tuberculosis mimicking multiple secondary metastases on radiologic and scintigraphic imaging is presented to emphasize the contribution of bone scintigraphy in the assessment of osseous tuberculosis in typical and atypical presentations.Case presentationA 73-year-old cachectic Asian man (Iranian) presented with a general feeling of being unwell and an acute loss of vision in his left eye accompanied by a severe headache. A Tc-99 m-methylene diphosphonate bone scan demonstrated multiple regions of intense activity in the appendicular and axial skeleton, suggesting metastatic involvement. Tumor markers (PSA, CA125, CA 19-9 and AFP) were within normal ranges. Based on clinical presentation and laboratory, radiological and scintigraphic findings, a presumptive diagnosis of tuberculosis was made. Quadruple antituberculous chemotherapy was consequently started and the patient later showed marked improvement.ConclusionScintigraphic bone scanning should be kept in mind when assessing bone pain in patients at a high risk of tuberculosis infection or reactivation. We present this unusual case of multifocal skeletal tuberculosis, and stress the related clinical and diagnostic points with the aim of stimulating a high index of suspicion that could facilitate early diagnosis and appropriate treatment.

The “Bat Sign” of Pectoral Rhabdomyolysis

A 22-year-old man with foot pain was referred for evaluation of sesamoiditis. A Tc-99m methylene-diphosphonate bone scan was performed which revealed increased radiopharmaceutical uptake in the big toes, but also showed curious abnormal thoracic activity. Normal activity at sternoclavicular joints and sternum mimics ears, head and body of a bat, and the pectorals mimic the wings. The patient mentioned that he had started lifting weights a few days earlier. Clinical and echographic evaluations were diagnostic of pectoral inflammation suggesting rhabdomyolysis.

Chronic Recurrent Multifocal Osteomyelitis Demonstrated by Tc-99m Methylene Diphosphonate Bone Scan

A 12-year-old Middle Eastern girl presented with abdominal pain, weight loss, and intermittent pain in both thighs. She was initially suspected of Crohn disease, but this diagnosis was excluded after extensive gastromedical evaluation. Plain x-rays of the femora were normal, whereas the initial Tc-99m methylene diphosphonate (MDP) bone scan showed several foci with increased activity in both femurs. MR scan showed excessive periostal inflammatory and mild intramedullary changes in both femurs. A percutaneous bone biopsy demonstrated changes consistent with chronic recurrent multifocal osteomyelitis (CRMO). The patient's symptoms disappeared spontaneously, but reappeared 1.5 years later, which led to a new MDP bone scan that showed normal findings.

Hip Pain in an 18-year-old Man

An 18-year-old man presented with a 6-month history of left hip pain. There was no antecedent trauma but a gradual onset of pain that became persistent over the 6-month period. The patient’s pain intensified with time and a bothersome limp on the left side was affecting his activity level. He had no other complaints or constitutional symptoms, nor did he report any chest pain or shortness of breath. His medical history was unremarkable. Family medical history was significant for B cell lymphoma in the patient’s maternal grandfather. On physical examination, the patient appeared healthy with stable vital signs and no apparent distress. No regional or distant lymphadenopathy and no soft tissue mass were present around the hip. He was tender to palpation in the left groin and greater trochanter. Range of motion of the hip revealed pain with rotation, greater with external than internal rotation. Flexion and extension did not produce pain. The neurovascular exam was normal, with 2 + dorsalis pedis and posterior tibial pulses. Motor examination was 5/5 and sensation was intact throughout all dermatomes. Laboratory examination revealed an elevated white blood cell count of 12.7 · 10/lL, an elevated sedimentation rate of 21 mm/hour, and an elevated C-reactive protein of 15.4 mg/L. Imaging studies included anteroposterior and lateral radiographs (Fig. 1), radionuclide Tc-99m methylene diphosphonate bone scan (Fig. 2), computed tomography (CT) scan (Fig. 3), and magnetic resonance imaging (MRI) (Fig. 4). Based on the history, physical examination, laboratory studies, and imaging studies, what is the differential diagnosis?

Compartment Syndrome Caused by Computed Tomography Contrast Infiltration Seen on a Tc-99m Methylene Diphosphonate Bone Scan

A 72-year-old man was hospitalized for transurethral resection of bladder cancer. Two days after the procedure, the patient continued to have gross hematuria and a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast was performed to check the integrity of the resection site. Later that day, the patient underwent technetium-99m methylene diphosphonate (MDP) bone scintigraphy to investigate the possibility of bone metastasis. The bone scan showed no signs of metastasis but did reveal increased uptake of the left hand and forearm on the opposite side of the injection site.

Cardiac amyloidosis diagnosed incidentally by bone scintigraphy

Case history. An 84-year-old man with systemic hypertension had papillary carcinoma of the thyroid and lymph node metastases that were treated with thyroidectomy. He also had atrial fibrillation with a slow ventricular response (minimum heart rate on 24-hour Holter monitoring of 42 beats/min) and left bundle branch block. The patient had a good exercise tolerance (600 yd on flat ground), with no cardiac symptoms. The results of his examination were otherwise unremarkable. Transthoracic echocardiogram showed a normal left ventricular size but a dilated left atrium, with mild mitral, aortic, and tricuspid regurgitation. Technetium 99m sestamibi myocardial perfusion scintigraphy after 1 month of echocardiography (Figure 1) showed no evidence of ischemia but an ejection fraction of 28% (Figure 2), suggesting the possibility of primary or secondary muscle disorder. A VVIR pacemaker was inserted, and thyroxine administration was started. While receiving thyroxine, the patient had residual papillary thyroid carcinoma and pulmonary metastases developed. Twelve months after thyroidectomy, fluid overload and pulmonary congestion developed, and he started taking furosemide, with resolution of symptoms to New York Heart Association class II. Eighteen months after thyroidectomy, lower back pain developed, and a Tc-99m methylene diphosphonate bone scan showed no bone metastases, but there was unusually high and homogeneous myocardial uptake of Tc-99mMDP, suggesting an infiltrative disease, possibly amyloidosis (Figure 3). Repeat echocardiography showed features suggestive of cardiac amyloidosis (Figure 4), with increased septal thickness (2.8 cm) relative to the posterior wall (1.9 cm), reduced left ventricular systolic function, a dilated left atrium (5.0 cm) with no evidence of organic mitral valve disease, and a biventricular restrictive filling pattern. The electrocardiogram at that time showed a low-voltage pattern. The patient’s condition deteriorated, and he died 2 months later at home. Postmortem examination was not performed. Discussion. This case illustrates presumed cardiac amyloidosis diagnosed incidentally by bone scan. Bone scintigraphy does not show appreciable uptake of tracer in the normal heart. Myocardial uptake of the Tc-99m– labeled bone-seeking agents was shown in the 1980s to be suggestive of cardiac amyloidosis. However, endomyocardial biopsy remains the standard for the diagnosis of myocardial amyloidosis. In a prospective study of endomyocardial biopsy–proven amyloidosis, only 1 of 5 patients had intense uptake. The authors concluded that uptake of the bone agent (pyrophosphate in their study) by the myocardium makes the diagnosis of amyloidosis highly likely but is not sufficiently sensitive to warrant routine screening of patients. In a separate study of patients with 5 different types of amyloidosis with bone scans, echocardiography was shown to be more sensitive than bone scintigraphy in the diagnosis of cardiac amyloidosis. Further uptake of bone agent in the myocardium has also been described in a patient with chronic renal failure undergoing hemodialysis and severe hyperparathyroidism. This was associated with other features of hyperparathyroidism on bone scan such as lytic bone lesion as a result of a brown tumor and diffuse extraskeletal uptake in the lungs, kidneys, and femoral arteries. This was reported to partially regress after 4 years of parathyroidectomy. Isolated uptake of bone agent in the heart would have high specificity for suspecting amyloidosis, but bone scintigraphy is not the most sensitive method for detecting cardiac amyloidosis. This would depend on the affinity of calcium for the bone agent between different types on amyloid fibrils. From the Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, and Royal Marsden Hospital, London, England. Reprint requests: Kshama Wechalekar, MBBS, DRM, DNB, Department of Nuclear Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, England; K.Wechalekar@rbht.nhs.uk. J Nucl Cardiol 2007;14:750-3. 1071-3581/$32.00 Copyright © 2007 by the American Society of Nuclear Cardiology. doi:10.1016/j.nuclcard.2007.07.002