Tc-methylene Diphosphonate Bone Scan Research Articles

Recurrent Intra Articular Osteochondroma of Left 4th Finger.

Osteochondromas are common benign bone tumors arising from metaphyseal region of long bones. They are notorious for undergoing malignant transformation. We present a case of a middle aged woman with recurrent episodes of swelling in the middle of left 4th finger post excision. Bone scan was performed to look for any malignant transformation of finger lesion and also to rule out skeletal metastases due to recent onset bone pains. 99m Tc MDP (Technetium methylene diphosphonate) bone scan demonstrated a focal hot spot in middle of left 4th finger along the radial side. There was no evidence of skeletal metastases. Surgery is usually curative (70-90%). Limb sparing wide local excision is treatment of choice.

Asymmetrical Uptakes in 99m Tc MDP Bone Scan in Upper Extremity in Patient with Prostate Cancer: an Interesting Case

<p>Asymmetrical uptake of 99m Tc MDP (methylene diphosphonate) in skeletal scintigraphy in extremity may lead to confusion in the diagnosis of metastasis or complex regional pain syndrome. After the exclusion of possible contamination in this report a case was presented with asymmetrical uptake of MDP in the upper extremity from accidental intra-arterial injection.</p><p>Bangladesh J. Nuclear Med. 19(2): 152-154, July 2016</p>

Identification of optimal mask size parameter for noise filtering in 99mTc-methylene diphosphonate bone scintigraphy images.

Tc-methylene diphosphonate (Tc-MDP) bone scintigraphy images have limited number of counts per pixel. A noise filtering method based on local statistics of the image produces better results than a linear filter. However, the mask size has a significant effect on image quality. In this study, we have identified the optimal mask size that yields a good smooth bone scan image. Forty four bone scan images were processed using mask sizes 3, 5, 7, 9, 11, 13, and 15 pixels. The input and processed images were reviewed in two steps. In the first step, the images were inspected and the mask sizes that produced images with significant loss of clinical details in comparison with the input image were excluded. In the second step, the image quality of the 40 sets of images (each set had input image, and its corresponding three processed images with 3, 5, and 7-pixel masks) was assessed by two nuclear medicine physicians. They selected one good smooth image from each set of images. The image quality was also assessed quantitatively with a line profile. Fisher's exact test was used to find statistically significant differences in image quality processed with 5 and 7-pixel mask at a 5% cut-off. A statistically significant difference was found between the image quality processed with 5 and 7-pixel mask at P=0.00528. The identified optimal mask size to produce a good smooth image was found to be 7 pixels. The best mask size for the John-Sen Lee filter was found to be 7×7 pixels, which yielded Tc-methylene diphosphonate bone scan images with the highest acceptable smoothness.

18F-FDG PET/CT for Diagnosis of Osteosclerotic and Osteolytic Vertebral Metastatic Lesions: Comparison with Bone Scintigraphy

Study DesignA retrospective study.PurposeThe aims of this study were to investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in PET/computed tomography (CT) in the evaluation of spinal metastatic lesions.Overview of LiteratureRecent studies described limitations regarding how many lesions with abnormal 18F-FDG PET findings in the bone show corresponding morphologic abnormalities.MethodsThe subjects for this retrospective study were 227 patients with primary malignant tumors, who were suspected of having spinal metastases. They underwent combined whole-body 18F-FDG PET/CT scanning for evaluation of known neoplasms in the whole spine. 99mTc-methylene diphosphonate bone scan was performed within 2 weeks following PET/CT examinations. The final diagnosis of spinal metastasis was established by histopathological examination regarding bone biopsy or magnetic resonance imaging (MRI) findings, and follow-up MRI, CT and 18F-FDG PET for extensively wide lesions with subsequent progression.ResultsFrom a total of 504 spinal lesions in 227 patients, 224 lesions showed discordant image findings. For 122 metastatic lesions with confirmed diagnosis, the sensitivity/specificity of bone scan and FDG PET were 84%/21% and 89%/76%, respectively. In 102 true-positive metastatic lesions, the bone scan depicted predominantly osteosclerotic changes in 36% and osteolytic changes in 19%. In 109 true-positive lesions of FDG PET, osteolytic changes were depicted predominantly in 38% while osteosclerotic changes were portrayed in 15%.Conclusions18F-FDG PET in PET/CT could be used as a substitute for bone scan in the evaluation of spinal metastasis, especially for patients with spinal osteolytic lesions on CT.

Q Fever Masquerading as Prostate Cancer Metastases

We report a case of Q fever demonstrated on (99m)Tc methylene diphosphonate bone scan and fluorodeoxyglucose (FDG) PET/CT. A 66-year-old man with newly diagnosed, low-grade prostate cancer presented with abdominal and bone pain. Bone scan revealed multiple lesions suspicious for prostate cancer metastases. Because of liver abnormalities on noncontrast CT, an FDG PET/CT was performed and demonstrated FDG-avid sclerotic bone lesions, infiltrative liver disease, and retroperitoneal adenopathy. This appearance, thought unusual for low-grade prostate cancer, prompted extensive clinical evaluation for several months. Liver and iliac bone biopsies showed noncaseating granulomas without neoplasia. Extensive serologic evaluation eventually demonstrated elevated Q fever titers.

Imaging in Sarcoma

Imaging has contributed to diagnosis and treatment decision making for patients with sarcomas, a highly heterogeneous tumor group. Derived from mesenchymal tissues, sarcomas occur in all parts of the body and in all patient age groups, with a highly variable histologic appearance and behavior. They are commonly separated into soft-tissue-derived and bone-derived groups; however, many exceptions to these classifications are seen clinically. Tumor size, cellular type and differentiation, and presence of necrosis are tumor features that can be used clinically to predict the risk of aggressive behavior. At present for soft-tissue sarcomas, the 5-y survival is approximately 60%, with substantially better survival for patients with bone tumors, particularly pediatric patients. Imaging with nuclear medicine techniques plays an important role in diagnosis, treatment planning, and follow-up. Conventional (99m)Tc-methylene diphosphonate bone scans, (201)Tl tumor imaging, and PET techniques have contributed to the care of sarcoma patients. Newer PET techniques with biologically specific imaging agents have also been evaluated to characterize sarcomas and contribute to risk stratification for poor outcome.

Clinical implications of brown tumor uptake in whole-body 99mTc-sestamibi scans for primary hyperparathyroidism

Technetium-99m (Tc)-sestamibi is the current radionuclide of choice for parathyroid localization in primary hyperparathyroidism (PH). However, there are only sporadic reports about brown tumor visualization in whole-body Tc-sestamibi scans. This study aimed to systematically evaluate brown tumor uptake in whole-body Tc-sestamibi scans and in whole-body bone scans as well. Clinical factors were statistically analyzed for imaging outcome predictions. Forty-two patients with PH were recruited consecutively. A dual-tracer, dual-phase parathyroid imaging protocol was applied. A Tc-sestamibi whole-body scan was performed immediately after delayed phase acquisition. A Tc-methylene diphosphonate bone scan was performed on day 3. Parathormone (PTH), calcium, alkaline phosphatase (ALP), and parathyroid lesion volume were compared. The t-test, one-way analysis of variance, and receiver operating characteristic curves were performed for statistical analyses. Brown tumors showed Tc-sestamibi uptake in 10 cases, and Tc-methylene diphosphonate uptake in 17 cases. All parameters in double-scan positive cases were significantly higher than in double-scan negative cases; PTH and ALP were significantly higher in only bone scan positive cases than in double-scan negative cases. Data from receiver operating characteristic curves showed the order of PTH>ALP>Ca>parathyroid lesion volume for diagnostic accuracies of both positive Tc-sestamibi scans and positive bone scans. PTH showed the best positive predictive value and ALP showed the best negative predictive value. A Tc-sestamibi whole-body scan could be used to assess brown tumors in PH, although it may be less sensitive than a bone scan. PTH possessed the best diagnostic accuracy and predictive value for a positive imaging outcome. ALP was useful for negative imaging outcome prediction.

Scintigraphic characteristics of non-ossifying fibroma in military recruits undergoing bone scintigraphy for suspected stress fractures and lower limb pains

Non-ossifying fibroma (NOF) is the most common fibrous bone lesion in children and young adults. This benign lesion is not a true neoplasm but is considered a developmental defect. Clinically, the lesion is asymptomatic and has a predilection for the long bones, particularly the femur and the tibia. NOF that ossify can show increased uptake on bone scintigraphy. Although the radiographic and histopathological findings of NOF have been well described, the scintigraphic findings of the abnormality have only been incidentally mentioned in the literature. To document the scintigraphic features of NOF in a group of military recruits undergoing bone scintigraphy for suspected stress fractures. Features to differentiate co-existent NOF and stress fractures lesions are discussed. Eighty-three military recruits, 67 male and 16 female, aged 18 to 22 years (mean, 19.4 years), who underwent Tc-methylene diphosphonate bone scans for suspected stress fractures or because of pain of the lower limbs had 91 focal lesions on bone scan which on further evaluation demonstrated characteristic radiographic findings of NOF. We evaluated the anatomical site of the lesions, documented the intensity of uptake on bone scan and compared the findings with the radiographic description of the lesions. Comparison with the characteristic scintigraphic pattern of co-existent stress fracture lesions and with previously reported data was performed. A total of 91 NOF lesions were detected. Overall, 89% of NOF were located about the knee. Anatomic distribution of NOF lesions was as follows: 43 (47.3%, R=25, L=18) were located in the postero-medial aspect of the distal femur, 18 (19.8%, R=12, L=6) in the postero-medial aspect of the proximal tibia, 11 (12%, R=5, L=6) in the postero-lateral aspect of the distal femur, 10 (11%, R=4, L=6) in the postero-lateral aspect of the distal tibia, 4 (4.4%, R=2, L=2) in the postero-lateral aspect of the proximal tibia, 3 (3.3%, L=3) in the antero-central aspect of proximal tibia, 1 (1.1%, L=1) in the antero-lateral aspect of distal femur, 1 (1.1%, L=1) in the medial-central aspect of the proximal tibia. In this series NOF lesions were not found in the fibula. Eighty five of 91 (93.4%) of all NOF were located at the metaphysis of the long bones, 2/91 (2.2%) were located at the meta-diaphyseal region of the long bones and only 4/91 (4.4%) of the lesions were located at the diaphysis. All the NOF showed variable degrees of focal increased tracer uptake on bone scan. The bone scan appearance of the focal lesions was: faint uptake in 29 (31.9%), mild uptake in 27 (29.7%), moderate uptake in 28 (30.7%) and intensely increased uptake in seven (7.7%). The radiographic description of the NOF was: lucent NOF three (3.3%), mixed sclerotic and lucent 68 (74.7%) and sclerotic in 20 (22%). Most of the NOF which demonstrated moderate or intensely increased tracer uptake had mixed lucent and sclerotic radiographic appearance (healing). Most of the sclerotic lesions (healed) showed faint uptake. Co-existent stress fractures were predominantly located in the diaphysis of the long bones, characteristically in the postero-medial aspect of the mid-third of the tibia or femur. Military recruits undergoing bone scan for suspected stress fracture might have incidental findings which require further evaluation. Focal lesions on bone scan located about the knee in the lateral aspect of the distal femur or lateral aspect of the proximal tibia in the metaphyseal region of these bones are not compatible with the characteristic scintigraphic features of stress fracture. Such a finding should raise the suspicion for other bony lesions such as NOF, which is commonly located in this region. During the healing phase of the NOF which commonly occur in the age range of this group, the lesion shows mild-to-moderate increased tracer uptake on bone scan. Plain film radiography is usually diagnostic and patients are followed up conservatively. Some NOF lesions are still indistinguishable from stress fracture or splints on bone scan.

Evaluation of Activity of Epiphyseal Plates in Growing Males and Females

To investigate the age-related activity of the epiphyseal plates, a retrospective study of (99m)Tc-methylene diphosphonate bone scans was undertaken. The study comprised 81 males and 46 females aged 2 weeks to 24 years. The total percentage (%) whole-body (ratio of total physis activity to whole-body activity) and the regional % whole-body (ratio of physis activity of one region to whole-body activity) were derived. The ratio of physis activity of one region to the total physis activity was defined as % physis. Before age 12, total physis activity was found to contribute about 10% to whole-body activity. All total and regional % whole-body activities followed sigmoid curves with age. The differences of the parameters (transition centers and widths) suggested that there might be a later and longer period for the disappearance of physis activity in males than in females. For all the regions, % physis changed little with age until after puberty. At age <1, the proportion of bone activity in the body was about 30-35% for skull, 20-25% for lower limbs, and 5-15% for the rest of the regions. The maximal changes during growth occurred in the skull and the lower limbs. The age-related changes of physis activity during growth reflect a combination of the potential of bone to grow and the processes of bone growth and bone turnover. Bone scintigraphy is useful in understanding the changes of physis activity during growth.

Role of 99mTc-hexakis-2-methoxyisobutylisonitrile for detecting marrow metastases in childhood solid tumours

To evaluate the role of 99mTc-hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) for detecting bone marrow metastases in childhood solid tumours, including lymphomas. Twenty-six children (18 males, eight females) were studied. They all had proven malignant solid tumours [Hodgkin's lymphoma (5), non-Hodgkin's lymphoma (3), neuroblastoma (9), Ewing's sarcoma (3), Langerhans cell histiocytosis (4), rhabdomyosarcoma (1) and germ cell tumour (1)] with suspected bone marrow metastases. All patients underwent computed tomography and/or magnetic resonance imaging, 99mTc-MIBI and Tc-methylene diphosphonate bone scans and bone marrow aspiration and/or biopsy. The scintigraphic evaluation of 99mTc-MIBI scans was performed according to the visual assessment of the extent and intensity of uptake. The scintigraphic score, which is the sum of the extent and intensity of uptake, was calculated for each patient. Scores of more than 2 were considered to be positive for bone marrow involvement. Twenty-seven 99mTc-MIBI scans were studied for 26 patients. Twenty-two 99mTc-MIBI scans were accepted as normal bone marrow. Bone scans were also normal in these patients. Five of the 27 99mTc-MIBI scans had scores of more than 2. Bone marrow cytology revealed bone marrow metastases in these patients. Abnormal 99mTc-MIBI uptake correlated extremely well with bone marrow aspiration/biopsy cytology results. Non-invasive 99mTc-MIBI imaging in children with malignant solid tumours appears to be promising for the evaluation of bone marrow metastases.

Reversible metastatic visceral calcification detected by 99mTc-methylene diphosphonate bone scanning in breast cancer

Diffuse metastatic visceral calcification is rare in breast cancer. We report on a 57-year-old woman with breast cancer and hypercalcemia who had diffuse metastatic visceral calcifications on lungs, myocardium, stomach, and thyroid on a (99m)Tc-methylene diphosphonate bone scan. Visceral calcifications were completely resolved 6 months after successful anticancer and zoledronic acid treatments. Bone scanning offers a useful diagnostic tool for both identifying visceral calcification and assessing the response to therapy in chemosensitive malignities with hypercalcemia such as breast cancer.

Soft tissue uptake on 99mTc methylene diphosphonate bone scan imaging: pictorial review.

99mTechnetium methylene diphosphonate (MDP) bone isotope may accumulate in many extra-osseous sites due to a variety of both benign and malignant conditions. This finding on a bone scan can be crucial to the diagnosis and may not be apparent in other imaging or the clinical evaluation of the patient. We present a pictorial review sampling some of the many causes of extra-osseous 99mTc MDP accumulation.