Uptake Of Tc-99m Methylene Diphosphonate Research Articles

Unusual Soft Tissue Uptake of Tc-99m MDP in Radiation-induced Sarcoma: Diagnostic Conundrum.

Tc-99m methylene diphosphonate (MDP) is a bone imaging agent used for skeletal staging, but it can also be localized in extraosseous calcifying lesions. We report a case of an 84-year-old woman with breast carcinoma who underwent surgery followed by radiotherapy 10 years ago and now presented with a right axillary mass referred for Tc-99m MDP to exclude bone metastasis. Tc-99m MDP shows intense tracer uptake in the right thoracic region corresponding to the site of calcified soft tissue mass in the right lateral chest wall. Subsequent ultrasonography revealed an ill-defined lesion containing coarse calcifications. Biopsy showed radiation-induced sarcoma. Extra osseous Tc-99m MDP uptake may provide important diagnostic information that may alter patient management.

Incidental Tc-99m MDP Uptake in Cortical-subcortical Parietotemporal Cerebral Area in a Patient with a History of Recent Ischemic Cerebrovascular Event who Underwent Whole-body Bone Scan.

The authors present Tc-99m methylene diphosphonate (MDP) uptake in the right parietotemporal area at whole-body bone scan (WBBS) in 75 years male patient with prostate adenocarcinoma Gleason score 3+4 (pT2N0Mx). No residual or metastatic disease was detected in the patient's Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography four months before WBBS. The patient had undetectable prostate-specific antigen levels and underwent WBBS to restage prostate cancer due to equivocal findings in previous WBBS. Current WBBS planar views revealed heterogeneous Tc-99m MDP uptake in the right parietotemporal area and the sphenoid bone in addition to equivocal uptake on the lower lumbar vertebrae. Single-photon emission computed tomography study to identify the MDP-avid lesion on the right cranial area revealed heterogeneous Tc-99m MDP uptake in the right parietotemporal area and sphenoid bone. The patient had a history of transsphenoidal surgery for a hypophyseal tumor two years ago and a recent cerebrovascular event (CVE). Diffusion-weighted magnetic resonance imaging revealed a cortical-subcortical patchy area of restricted diffusion in the parietotemporal region compatible with acute ischemia. Heterogeneous Tc-99m MDP uptake in the right parietotemporal area was attributed to recent CVE and secondary vascular-tissue change-related dystrophic calcification.

99mTc-Methylene Diphosphonate Uptake in Soft Tissue Tumors on Bone Scintigraphy Differs Between Pediatric and Adult Patients and Is Correlated with Tumor Differentiation.

ObjectiveTo analyze the difference in 99mTc-methylene diphosphonate (MDP) uptake on bone scintigraphy in extraosseous soft tissue tumors between children and adults and the correlation between tracer uptake and tumor differentiation and histopathology.MethodsPatients with neoplasms with MDP uptake were retrospectively identified. Based on histopathology, tumors were categorized as epithelial malignant tumors, mesenchymal tumors, blastomas and germ cell tumors. The degree of radioactivity accumulation in lesions relative to the uptake in ribs and sternum or spine was classified as “+”, “++” and “+++”. The results were compared between children and adults. The correlations between MDP uptake in soft tumors and tumor differentiation and pathology were investigated.ResultsExtraosseous soft tissue tumors that accumulated MDP were found in 33 children and 31 adults. In children, neuroblastoma was the most common extraosseous soft tissue tumor that accumulated MDP; in adults, MDP uptake was mostly found in lung cancer. MDP uptake in pediatric soft tissue tumors was higher than that in adults. MDP uptake in extraosseous soft tissue tumors with different histopathologic classifications was significantly different among 64 patients. In 41 patients with available tumor differentiation data from histopathology, MDP uptake in low or poorly differentiated soft tumors was higher than that in the moderately or well-differentiated lesions. Necrosis and/or calcifications were showed in most of pediatric and adult neoplasms.ConclusionSignificant elevations in MDP uptake in extraosseous soft tissue tumors are associated with poorly differentiated tumors in both children and adults. The mechanism of bone tracer uptake in pediatric and adult neoplasms was mostly related to necrosis and/or necrosis and calcification. The extraosseous soft tissue tumors with MDP uptake in pediatric patients were different from those in adults. In addition, consistent with the inherent degree of tumor malignancy, MDP uptake in children was higher than that in adults.

Bone metabolism of the jaw in response to bisphosphonate: a quantitative analysis of bone scintigraphy images.

We examined the changes in the bone metabolism of the jaw in response to BP treatment, and we used bone SPECT-CT to analyze the site-specific bone metabolism between the jaw and other sites of bone. We compared the changes in the bone metabolism of each part of bone in response to BP treatment by performing a quantitative analysis of bone scintigraphy images between patients treated with low-dose BP for osteoporosis (LBP group; n = 17), those treated with high-dose BP for metastatic bone tumor (HBP group; n = 11), and patients with other oral disease who required bone scintigraphy, with no history of BP treatment (control group; n = 40). The study endpoint was the mean standardized uptake value (SUV) of the uptake of Tc-99m methylene diphosphonate (MDP) in each group. The mean SUVs of the HBP group were significantly lower at the axial bone of the cervical vertebra, thoracic vertebra, sternum, and rib compared to those of the LBP and control groups. The LBP group's mean SUV was significantly higher at the temporal bone, the anodontia part of the alveolar bone in maxilla, the vital teeth part of alveolar bone in the mandible, and the temporomandibular joint. There was no significant difference among the three groups at the mandibular angle and mandibular ramus. Our analyses revealed that the bone metabolism of the jaw and temporal bone in the BP-treated patients was enhanced, and no suppression of bone remodeling in the jaw by BP was observed.

Incidental Tc-99m Methylene Diphosphonate Uptake in an Active Thyroid Nodule.

Tc-99m-methylene diphosphonate (MDP) whole body scintigraphy is the method of choice for detection of metastatic bone diseases. It is primarily used to help diagnose various bone-related conditions such as primary or metastatic cancer of the bone, location of bone inflammation, and fractures that may not be visible on traditional X-ray images, as well as detection of bone damage due to infections and other conditions. In addition, bone scanning is often used for the follow-up or evaluation of response to treatment in some malignancies like prostate and breast cancers. Pathologies of other systems can also be incidentally detected on whole body bone scan. Herein we present an interesting image of an active thyroid nodule that showed Tc-99m MDP uptake in a prostate cancer patient.

Focal Increased Tc-99m MDP Uptake in the Nutrient Foramen of the Femoral Diaphysis on Bone SPECT/CT.

We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the knee was reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.

Incidental 99mTc MDP uptake in the intestines and intravenous CT contrast.

We evaluated the association between intestinal visualization on bone scintigraphy and IV CT contrast in patients with breast cancer. 452 patients with breast cancer underwent a 99mTc methylene diphosphonate (MDP) bone scan for surveillance of bone metastasis. Presence, site and intensity of intestinal uptake were visually assessed. For patients with intestinal visualization, medical records were reviewed to identify the alleged potential causes. WhenIV CT contrast was administrated on the same day as bone scan, the time between IV CT contrast injection, 99mTc MDP administration and bone scan was assessed. Intestinal 99mTc MDP uptake was observed in 44 of the 452 patients (9.7%). Bone scansshowed no thyroid or gastric uptake that suggested free pertechnetate. There were no patients withdocumented causes of intestinal uptake except for one patient with vesicoenteric fistula. Of the 452 patients, 149 (33.0%) underwent IV contrast-enhanced CT on the same day as bone scan. Forty of the 44 patients (90.9%) with intestinal uptake on bone scan underwent IV contrast-enhanced CT on the same day, whereas 109 of 408 (26.7%) patients without intestinal uptake on bone scintigraphy underwent IV contrast-enhanced CT on the same day (p < 0.001). The patients who underwent IV contrast injection between Tc-99m MDP administration and acquisition of bone scans had significantly more frequent intestinal uptake than patients who underwent IV contrast injection either before 99mTc MDP administration or after bone scanning (42.4% vs.1.8%, p < 0.001). IVCT contrast injection administered on the same day as bone scintigraphy is significantly associated with 99mTc MDP uptake in the intestines among patients with breast cancer.

(99m)TC-Methylene diphosphonate uptake at injury site correlates with osteoblast differentiation and mineralization during bone healing in mice.

99mTc-Methylene diphosphonate (99mTc-MDP) is widely used in clinical settings to detect bone abnormalities. However, the mechanism of 99mTc-MDP uptake in bone is not well elucidated. In this study, we utilized a mouse tibia injury model, single-photon emission computed tomography (gamma scintigraphy or SPECT), ex vivo micro-computed tomography, and histology to monitor 99mTc-MDP uptake in injury sites during skeletal healing. In an ex vivo culture system, calvarial cells were differentiated into osteoblasts with osteogenic medium, pulsed with 99mTc-MDP at different time points, and quantitated for 99mTc-MDP uptake with a gamma counter. We demonstrated that 99mTc-MDP uptake in the injury sites corresponded to osteoblast generation in those sites throughout the healing process. The 99mTc-MDP uptake within the injury sites peaked on day 7 post-injury, while the injury sites were occupied by mature osteoblasts also starting from day 7. 99mTc-MDP uptake started to decrease 14 days post-surgery, when we observed the highest level of bony tissue in the injury sites. We also found that 99mTc-MDP uptake was associated with osteoblast maturation and mineralization in vitro. This study provides direct and biological evidence for 99mTc-MDP uptake in osteoblasts during bone healing in vivo and in vitro.

Cardiac amyloidosis detected on tc-99m bone scan.

Cardiac amyloidosis is an important cause of restrictive cardiomyopathy and congestive heart failure. There are two major types of cardiac amyloidosis: cardiac amyloid light-chain (AL) and transthyretin-related cardiac amyloidosis (ATTR) [1, 2]. The treatment options and prognosis for these two subtypes are different. The AL subtype cardiac amyloidosis is associated with greater than 50 % mortality within 6 months after the diagnosis, while the ATTR subtype has a more favorable prognosis of 98–100 % 2-year survival [3, 4]. Therefore, differentiating the type of cardiac amyloidosis (AL vs. ATTR) is crucial in guiding patient care. Due to its variable clinical symptoms, as well as the nonspecific ECG and echocardiographic presentations, cardiac amyloidosis is a diagnostic challenge and usually underdiagnosed [5, 6]. Endomyocardial biopsy remains the gold standard for diagnosis (Fig. 1). Fig. 1 A 68-year-old male with prostate cancer underwent a bone scan for disease staging. Diffuse cardiac uptake of the bone-seeking radiotracer, Tc-99m MDP (methylene diphosphonate), was incidentally found (arrow, a: bone scan). Given the patient’s ... Perugini et al. [7] demonstrated Tc-99m 3,3-diphosphono-1,2-propanodicarboxylic acid (Tc-99m DPD) bone scan findings among patients with cardiac amyloidosis of ATTR (n = 15) and AL (n = 10) subtypes in which cardiac Tc-99m DPD uptake was present in all ATTR patients and absent in all AL patients at visual assessment. Rapezzi et al. [8] evaluated myocardial uptake of Tc-99m DPD in patients with ATTR-related (n = 45, 28 mutant and 17 wild-type) and AL-related (n = 34) cardiac amyloidosis as well as 15 nonaffected controls. On semiquatitative analysis, patients with ATTR had higher visual scoring of cardiac retention (range: score 0, absent cardiac uptake and normal bone uptake; score 1, mild cardiac uptake, inferior to bone uptake; score 2, moderate cardiac uptake accompanied by attenuated bone uptake; score 3, strong cardiac uptake with attenuated bone uptake), with positive and negative predictive values of 88 and 100 % (visual score ≥2). On quantitative analyses, compared to AL and unaffected controls, ATTR patients also had significantly higher (p < 0.0001) heart retention (HR, 7.8 %) and heart-to-whole-body retention ratios (H/WB 10.4), while both unaffected controls (HR 3.5 %; H/WB 5.7) and AL subtypes (HR 4.0 %; H/WB 6.1) were similarly low. Another bone scintigraphic tracer, Tc-99m hydroxymethylene diphosphonate (Tc-99m HDP), has shown high cardiac retention and H/WB ratios in 19 of 30 patients with ATTR cardiac amyloidosis [9]. Bokhari et al. [10] reported that 45 subjects (12 AL, 16 ATTR wild type and 17 ATTR mutants) underwent Tc-99m pyrophosphate (Tc-99m PYP) cardiac imaging. Subjects with ATTR cardiac amyloid had a significantly higher semiquantitative cardiac visual score (range, 0; no uptake to 3, diffuse uptake) than the AL cohort (2.9 ± 0.06 versus 0.8 ± 0.27; P < 0.0001) as well as a higher quantitative score (1.80 ± 0.04 versus 1.21 ± 0.04; P < 0.0001). Using a heart-to-contralateral-lung ratio of 1.5 on Tc-99m PYP cardiac imaging distinguished ATTR amyloidosis (≥1.5) from AL amyloidosis (<1.5), with 97 % sensitivity and 100 % specificity. Sporadic case reports [11, 12] have shown that Tc-99m MDP radiotracers can accumulate in the heart in patients with cardiac amyloidosis; however, there were no corresponding myocardium tissue biopsy results. Our case demonstrated that intense cardiac uptake of Tc-99m MDP correlates with biopsy-proven ATTR cardiac amyloidosis. We think that the preferential binding of Tc-99m MDP to ATTR is similar to those of Tc-99m PYP, Tc-99m DPD (not available in the USA) and Tc-99m HDP, which may be due to the fact that transthyretin amyloid fibrils have higher calcium contents. Given its universal availability, Tc-99m MDP imaging may serve as a noninvasive adjunct in the differential diagnosis of cardiac amyloid.

Is femoral uptake of Tc99m-methylene diphosphonate on bone scintigraphy in bronchogenic carcinoma an alarming sign: A case report and brief review of literature?

Detection of skeletal metastasis in patients with lung cancer is important from management point of view. We report the bone scan finding in a patient with non-small cell lung carcinoma showing isolated abnormal tracer in femur and having a characteristic appearance in computed tomography, highlighting the importance of bone scan in patients with bronchogenic carcinoma.

SPECT-CT for characterization of extraosseous uptake of 99mTc-methylene diphosphonate on bone scintigraphy

Bone scintigraphy is a sensitive and popular method for imaging a wide array of benign or malignant skeletal abnormalities. However, the uptake of tracers used for bone scintigraphy may be observed in various extraosseous sites, thereby limiting its specificity. It is difficult to correctly localize such sites of uptake on planar bone scintigraphy alone. The addition of hybrid single-photon emission computed tomography-computed tomography (SPECT-CT) under such circumstances is very useful. The present essay illustrates the commonly encountered extraosseous uptake of 99mTc-methylene diphosphonate (MDP) and the usefulness of hybrid SPECT-CT in clarifying 99mTc-MDP uptake.

Schmorl’s Node Mimicking Metastasis in a Patient With Breast Cancer

Schmorl's node (SN) is a common entity characterized by protrusion of intervertebral disc material through a break in the subchondral end plate of a vertebral body. They can show increased 99mTC methylene diphosphonate uptake on bone scintigraphy mimicking metastasis and can be symptomatic. Differentiation of SN from metastasis is essential for appropriate patient management. Here, we present a case where increased 99mTC methylene diphosphonate uptake in a dorsal vertebra was found to be because of SN by using single-photon emission computed tomography-computed tomography.

Multiple Vertebral Hemangiomas Mimicking Metastases in a Patient with Renal Carcinoma: Importance of Hybrid Imaging with SPECT/CT and FDG PET/CT

ABSTRACT Vertebral hemangiomas are the most common benign tumors of the spine and usually present as cold defects on skeletal scintigraphy. However, these lesions may rarely show uptake of Tc-99m methylene diphosphonate, mimicking metastases. In this patient with renal carcinoma, abnormal vertebral tracer uptake (indicative of skeletal metastases on planar bone scintigraphy) was subsequently localized to vertebral lesions identified as hemangiomas on the CT component of single photon emission computed tomography/computed tomography (SPECT/CT). None of these hemangiomas showed any uptake of F-18 fluorodeoxyglucose on positron emission tomography/ computed tomography (PET/CT). How to cite this article Manohar K, Parghane RVR, Kumari S, Bhattacharya A, Mandal AK, Mittal BR. Multiple Vertebral Hemangiomas Mimicking Metastases in a Patient with Rena Carcinoma: Importance of Hybrid Imaging with SPECT/CT and FDG PET/CT. J Postgrad Med Edu Res 2012;46(4):196-197.

Sacrococcygeal chordoma: Increased 99m Tc methylene diphosphonate uptake on single photon emission computed tomography/computed tomography bone scintigraphy

Chordoma is a malignant tumor arising from the remnants of the notochord, and is the most frequent primitive tumor of the sacrum. While most sacral tumors show increased concentration of bone-seeking radiopharmaceuticals, chordomas usually exhibit decreased uptake. The authors present an image of a sacrococcygeal chordoma with osteolysis and increased uptake of 99mTc methylene diphosphonate on planar and single photon emission computed tomography/computed tomography bone scintigraphy.

Non-osseous uptake on Tc99m methylene diphosphonate in multiple muscles confirmed on SPECT/computed tomography

A 55-year-old female presented with complaints of pain in the left hip radiating to the left lower limb since 1 year. Computed tomography (CT) abdomen and pelvis revealed bony destruction of pubic symphysis with associated soft tissue component suspicious of infective or metastatic etiology. Magnetic resonance imaging Lumbo-sacral spine performed later revealed altered bone marrow signal in sacral 1-3 vertebrae. Wholebody bone scan with 25 mCi of Tc-99m methylene diphosphonate (MDP) was performed, which revealed multiple skeletal metastases and extraosseous soft tissue uptake was seen involving multiple muscles. We performed single photon emission tomography single photon emission computed tomography (SPECT)/computed tomography (CT) images to precisely delineate the muscle involved and noted calcification on CT images in one of the muscle at site of Tc-99m MDP uptake, no definite calcification was noted in the other muscles. Thus, the final diagnosis was multiple skeletal metastasis with metastatic calcification in multiple muscle from an unknown primary.

Unusual Tc-99m Methylene Diphosphonate Uptake by Clinically Suspected Adrenal Metastases From Hepatocellular Carcinoma

Unusual Tc-99m Methylene Diphosphonate Uptake by Clinically Suspected Adrenal Metastases From Hepatocellular Carcinoma

Increased Liver and Spleen Accumulation of Tc-99m Methylene Diphosphonate Associated With Intravenous Injection of MRI Contrast Gadolinium-Diethylenetriaminepentaacetic Acid

Several conditions that can cause diffuse hepatic or splenic uptake of Tc-99m methylene diphosphonate (Tc-99m MDP) have been previously reported. Nevertheless, diffuse abnormal liver and spleen uptake of Tc-99m MDP associated with intravenous injection of magnetic resonance imaging contrast gadolinium-diethylenetriaminepentaacetic acid is not previously known. In our series, we reported diffuse increased Tc-99m MDP activity in the liver and spleen in bone scans in patients who received Tc-99m MDP injection shortly after contrast-enhanced magnetic resonance imaging.

A Case of Paranasal Sinuses Osteoma Detected on Bone SPECT/CT

We present a 51-year-old woman with a history of colectomy for colon cancer who was referred to our department for bone assessment. Planar image revealed a focus of increased uptake of Tc-99m methylene diphosphonate in the nose root. According to the images of SPECT combined with low-dose CT, the abnormal radiotracer uptake at the site of left frontal sinus was considered to be osteoma. We conclude that SPECT/CT provides an accurate evaluation of the localization of the lesions and supplies anatomic information that can be valuable for diagnosis of nonmalignant bone diseases.

MDP Uptake in Peritoneal Carcinomatosis and Krukenberg Tumors From Mucinous Adenocarcinoma

Altered biodistribution of Tc-99m methylene diphosphonate is a common occurrence on bone scintigraphy and mucin-producing neoplasms of the gastrointestinal tract are associated with dystrophic uptake. In addition to the uptake in the primary tumor, activity has been reported in metastasis within lymph nodes and liver. We present a case of Tc-99m methylene diphosphonate uptake in peritoneal carcinomatosis and metastatic Krukenberg tumors from a primary mucinous adenocarcinoma of the descending colon. Each of these findings is uncommon and their combination in this case is particularly unique.

Hypercalcemia with extraosseous MDP uptake in a bone scan as initial presentation in a case of cutaneous T-cell lymphoma

A middle-aged lady presented with headache, vomiting of sudden-onset with intermittent evening rise of temperature. She also had slurring of speech with no loss of consciousness or altered sensorium. The patient was under evaluation for hypercalcemia. A whole body bone scan was done to look for causes of hypercalcemia and the scan showed extraosseous 99m Tc MDP (Technetium Methylene Di Phosphonate) uptake. One of the causes of extraosseous MDP uptake is cutaneous T-cell lymphoma (CTCL). On close interrogation the patient gave a history of hypopigmented dermal patches for more than 2 years duration. The coexisting dermal patches raised suspicion of CTCL. Skin biopsy confirmed CTCL. The patient was referred to oncology and was planned for six cycles of chemotherapy.