technetium-tc-99m-medronate and Adenocarcinoma

Accumulation of 99mTc-HMDP was recognized by three-phase bone scintigraphy in a case of primary breast cancer. A 67-year-old female was found to have a 14 x 13 mm mass in the upper lateral area of the left breast. At operation the histopathological finding was a proven solid-tubular carcinoma. On the first phase images, there was no abnormal accumulation in the tumor. On the second phase images, there was abnormal accumulation in the tumor, however, abnormal accumulation was observed followed by a decrease in accumulation. The third phase image showed no abnormal extra-skeletal accumulation. Color Doppler ultrasound sonography showed an abundance of color signals within the breast tumor. Increased 99mTc-HMDP accumulation in the second phase image might reflect tumor hypervascularization. It is concluded that three-phase bone scintigraphy using 99mTc-HMDP has the ability of positive description in primary breast cancer.

Topics: Adenocarcinoma; Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Ultrasonography

Our goal was to determine if a healing flare response seen on bone scintigraphy occurs following chemotherapy with Taxol (paclitaxel; Bristol-Myers Squibb Co., Princeton, NJ), a novel antimicrotubule agent for metastatic breast cancer.. We performed 74 bone scans on 21 females with breast cancer and bone metastases entering a Phase II trial of Taxol chemotherapy with granulocyte colony stimulating factor (G-CSF). All patients had baseline scans within 6 wk prior to therapy, after the second cycle (4-6 wk) of Taxol, and then after 6-12 mo. All bone scans were reviewed by two nuclear medicine physicians, without knowledge of the patients' clinical history. Skeletal radiographs, CT and MRI scans, as well as clinical history were compared with scan findings.. Seven of the 21 patients showed improvement in bone scan findings. Of these seven, three had a flare response following two cycles (4-6 wk) of Taxol, characterized by increased activity in baseline lesions and the appearance of new lesions, followed by improvement on follow-up scans. Evidence of clinical response (> or = 50% reduction in tumor mass) was seen in all of these patients. Seven patients showed no change in baseline findings on follow-up bone scans. Seven patients had post-Taxol scans showing new lesions, with no overall improvement on later follow-up.. Flare on bone scintigraphy may be seen shortly after commencing Taxol chemotherapy. Bone scans done within the first 3 mo must be interpreted with caution and should be correlated with clinical and radiological findings to avoid inappropriate discontinuation of Taxol chemotherapy.

Topics: Adenocarcinoma; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Granulocyte Colony-Stimulating Factor; Humans; Middle Aged; Paclitaxel; Radionuclide Imaging; Recombinant Proteins; Technetium Tc 99m Medronate; Time Factors

Metastases of prostate carcinoma in the skeleton are usually multiple. Solitary metastasis in appendicular skeleton is extremely rare. We present bone scan findings of solitary scapular metastasis from prostate adenocarcinoma as the initial presentation of his malignancy in a 62-year-old man. The 99mTc-MDP SPECT/CT demonstrated intense activity in the coracoid process of left scapula, whereas the tracer uptakes in other bones were not typical of metastases. The subsequent pathological results of the punctured left scapula confirmed as metastasis from prostate adenocarcinoma.

Topics: Adenocarcinoma; Bone Neoplasms; Humans; Male; Middle Aged; Prostate; Prostatic Neoplasms; Scapula; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Prostate cancer (PC) is the second most common malignancy in men. According to International agency for research on cancer,4552 new cases of PC were registered in 2018 in Pakistan.Although majority of cases are confined to prostate on initial presentation, there is a high tendency for advanced PC to metastasize to bone. Metastatic lesions are typically osteoblastic rather than osteolytic. Therefore, these are easily identified by Technetium labeled Methylene Diphosphonate (Tc99m-MDP) uptake on Whole body Bone Scan (BS). Hybrid scanning offers anatomic details for differentiation between aggressive or non-aggressive lesions. Most common axial sites include pelvic bones and spine. Metastases to appendicular skeleton is rare and uncommon . We present a case of 62-years-old male with PC. Follow-up WBS, showed interval development of multiple sites of skeletal metastases. SPECT-CT scan acquired for characterization of atypical site of abnormal MDP uptake in appendicular skeleton, which showed features suggesting skeletal metastasis.

Topics: Adenocarcinoma; Bone Neoplasms; Fibula; Humans; Ilium; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma. Tc-MDP total-body bone scintigraphy was ordered for possible other bony lesions, and only left calcaneus lesion was identified on bone scan. CT scan of the chest revealed a soft tissue mass in the superior aspect of the right lower lobe. Staging FDG PET/CT showed hypermetabolic right lung mass and left calcaneus lesion. She received chemotherapy and local radiation to the left calcaneus metastatic lesion.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Bone Neoplasms; Calcaneus; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Middle Aged; Multimodal Imaging; Pain; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 64-year-old man with history of prostate adenocarcinoma underwent radical prostatectomy in 2003. He remained with undetectable prostate-specific antigen (PSA) levels until 2014, when he then presented rising serum PSA levels and performed a Tc-MDP bone scan that was negative for metastases. In August 2015, his PSA was 4.89 ng/dL, and restaging images with pelvic MR and F-FDG PET/CT were both negative. Therefore, the patient underwent a Ga-PSMA PET/CT that showed marked tracer uptake in a single mediastinal lymph node. Histopathology demonstrated metastatic adenocarcinoma secondary to prostate cancer, altering patient management to hormone therapy instead of pelvic radiotherapy.

Topics: Adenocarcinoma; Antigens, Surface; Fluorodeoxyglucose F18; Gallium Radioisotopes; Glutamate Carboxypeptidase II; Humans; Lymph Nodes; Lymphatic Metastasis; Magnetic Resonance Imaging; Male; Mediastinum; Middle Aged; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 49-year-old man was admitted to a hospital with chest pain and polyarthralgia. Chest radiography showed abnormal findings, and chest computed tomography showed a mass in the right lung. A transbronchial lung biopsy led to a diagnosis of anaplastic lymphoma kinase (ALK)-positive adenocarcinoma. Bone scintigraphy revealed bilateral symmetrical accumulations of (99m)Technetium complexes in the long bones, suggesting co-existing hypertrophic pulmonary osteoarthropathy (HPO). The patient underwent four courses of chemotherapy with cisplatin plus pemetrexed, which led to decreased (99m)Technetium accumulations in the long bones. To the best of our knowledge, this is the first reported case of HPO associated with ALK-positive lung cancer.

Topics: Adenocarcinoma; Anaplastic Lymphoma Kinase; Bone and Bones; Chest Pain; Humans; Lung Neoplasms; Male; Middle Aged; Osteoarthropathy, Secondary Hypertrophic; Positron-Emission Tomography; Receptor Protein-Tyrosine Kinases; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole Body Imaging

To explore the image characteristics of bone metastasis of primary lung carcinoma.. Whole-body bone imaging ((99)Tc(m)-MDP) was performed in 258 patients with pathologically proven lung carcinoma. The rate of bone metastasis, distribution of the metastatic lesions and their characteristics were analyzed.. Among the 258 cases, 142 patients developed bone metastasis. The overall rate of bone metastasis was 55.0%. The metastases located in axial skeleton were 49.6%, appendicular skeleton 36.0%, trunk bones of the axial skeleton 48.4%, and appendicular girdle skeleton 31.4%. Ribs, thoracic vertebrae, ilium and lumbar vertebrae had a higher rate of bone metastasis, higher than 20%, respectively. 1252 lesions were detected including 406 at the left side of the body, 387 in the axial skeleton and 459 at the right side of the body. There was no significant difference in terms of number of lesions between left side and right side (chi(2) = 3.3, P = 0.072). 1224 bone metastatic foci (97.8%) were presented as strong radioactive, 26 (2.1%) mixed lesion, and 2 (0.2%) low radioactive. According to the shape of the lesions, there were 810 punctate lesions (71.5%), 159 (14.0%) lump form, 108 (9.5%) strip form and 56 (4.9%) lamellar form. The accumulative bone metastasis rate was 28.7% for the patients with one to three lesions. The metastasis rate decreased gradually with the increasing number of metastatic lesions.. Bone metastasis is very common in patients with lung cancer. Most bone metastases are characterized by strong radioactive and earlier punctate form, often occurs in the trunk bones of axial skeleton or appendicular girdles. The distribution of earlier metastases has not obvious regularity, and advanced bone metastases are often concurrent, multiple and multiform, widely and randomly distributed in the body.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Bone metastasis is one of the most common clinical phenomena of late stage lung cancer. A major impediment to understanding the pathogenesis of bone metastasis has been the lack of an appropriate animal and cell model. This study aims to establish human lung adenocarcinoma cell line with highly bone metastases potency with (99m)Tc-MDP bone scintigraphy.. The human lung adenocarcinoma cancer cells SPC-A-1 were injected into the left cardiac ventricle of NIH-Beige-Nude-XID (NIH-BNX) immunodeficient mice. The metastatic lesions of tumor-bearing mice were imaged with (99m)Tc-MDP bone scintigraphy on a Siemens multi-single photon emission computed tomography. Pinhole images were acquired on a GZ-B conventional gamma camera with a self-designed pinhole collimator. The mice with bone metastasis were sacrificed under deep anesthesia, and the lesions were resected. Bone metastatic cancer cells in the resected lesions were subjected for culture and then reinoculated into the NIH-BNX mice through left cardiac ventricle. The process was repeated for eight cycles to obtain a novel cell subline SPC-A-1BM. Real-time polymerase chain reaction (PCR) was used to compare the gene expression differences in the parental and SPC-A-1BM cells.. The bone metastasis sites were successfully revealed by bone scintigraphy. The established bone metastasis cell line SPC-A-1BM had a high potential to metastasize in bone, including mandible, humerus, thoracic vertebra, lumbar, femur, patella, ilium and cartilage rib. The expression level of vascular endothelial growth factor gene family, Bcl-2 and cell adhesion-related genes ECM1, ESM1, AF1Q, SERPINE2 and FN1 were examined. Gene expression difference was found between parental and bone-seeking metastasis cell SPC-A-1BM, which indicates SPC-A-1BM has metastatic capacity vs. its parental cells.. SPC-A-1BM is a bone-seeking metastasis human lung adenocarcinoma cell line. Bone scintigraphy may be used as an accurate, sensitive, noninvasive tool to detect experimental bone metastases in intact live NIH-BNX mice.

Topics: Adenocarcinoma; Animals; Bone and Bones; Bone Neoplasms; Cell Line, Tumor; Humans; Lung Neoplasms; Mice; Polymerase Chain Reaction; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Topics: Adenocarcinoma; Bone Marrow Neoplasms; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Stomach Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

We present a 73-year-old man with a new diagnosis of right upper lung adenocarcinoma. Right elbow x-ray and Tc-99m MDP whole body bone scan were performed due to a reddish, swollen, and painful right forearm for 1 week. X-ray, performed on March 25, 2008, showed an osteolytic lesion in the proximal right radius with surrounding soft tissue swelling. Tc-99m whole body bone scan, performed on March 19, 2008, had shown a single area of intense tracer uptake in the proximal right radius and no other bony lesion was identified. Infectious processes were considered initially, but the clinical symptoms and signs didn't improve after antibiotic treatment for 10 days. Incisional biopsy of the proximal right forearm was performed for diagnosis. Histopathologic examination confirmed a bone metastasis in the proximal right radius.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Humans; Lung Neoplasms; Male; Radiography; Radionuclide Imaging; Radius; Technetium Tc 99m Medronate; Whole Body Imaging

About 10 per cent of patients undergoing radical oesophagectomy for transmural (T3) carcinoma with lymph node involvement (N1) develop symptomatic bone metastases within 12 months of surgery. The aim of this study was to evaluate the introduction of targeted preoperative bone scintigraphy.. Of 790 patients with oesophageal carcinoma staged between December 2000 and December 2004, 189 were eligible for potentially curative treatment. (99m)Tc-labelled hydroxymethylene diphosphonate bone scintigraphy was performed in those with stage T3 N1 disease (identified by computed tomography and endoscopic ultrasonography) who were suitable for radical treatment.. A total of 115 patients had bone scintigraphy. The histological diagnosis was adenocarcinoma in 82 patients and squamous cell carcinoma in 33. Bone scintigraphy was normal or showed degenerative changes in 93 patients, and abnormal requiring further investigation in 22. Plain radiography, magnetic resonance imaging and biopsy confirmed the presence of bone metastases in 11 patients (9.6 per cent).. Bone is frequently the first site of identifiable distant metastatic spread, and bone scintigraphy is recommended to exclude metastatic disease before radical treatment of advanced oesophageal carcinoma.

Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma, Squamous Cell; Esophageal Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We present a case of a lonely bone lesion after a prostatic adenocarcinoma with recurrent increased PSA. The localization of the metastasis at the level of a rib is infrequent. The precise localization of the lesion was made possible by intraoperative scintigraphy. Histology confirmed the complete resection of the lesion with safe margins.

Topics: Adenocarcinoma; Bone Neoplasms; Humans; Intraoperative Care; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Calcinosis; Chronic Disease; Female; Humans; Hypercalcemia; Hyperparathyroidism; Kidney Failure, Chronic; Lung; Lung Neoplasms; Middle Aged; Ossification, Heterotopic; Peritoneal Dialysis, Continuous Ambulatory; Radiopharmaceuticals; Respiratory Function Tests; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Topics: Adenocarcinoma; Duodenal Neoplasms; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 54 year old man presenting a so-called super bone scan is reported. The patient had a past history of subtotal gastrectomy due to early gastric cancer 19 years previously. Laboratory data indicated microcytic anemia and high serum alkaline phosphatase. Both the serum calcium and phosphate levels were within normal ranges. In spite of extensive examination for a primary malignant lesion in the organs including the remaining stomach, no solid tumors were identified. Pathological examinations revealed that the tumor cells in the biopsy specimen from the lumbar spine were almost identical to those in the gastric cancer excised 19 years previously. We considered that micrometastases in the bone marrow existed at the time of the initial surgery for gastric cancer and reappeared 19 years later showing super bone scan.

Topics: Adenocarcinoma; Bone Marrow Neoplasms; Gastrectomy; Humans; Immunochemistry; Lumbar Vertebrae; Male; Middle Aged; Stomach Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adenocarcinoma; Bone and Bones; Bone Marrow Neoplasms; Diagnosis, Differential; Humans; Male; Middle Aged; Polycythemia Vera; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Splenomegaly; Technetium Tc 99m Medronate

A 78-year-old Korean woman was referred to Chonbuk National University Dental Hospital complaining of facial palsy and palpable mass in the right parotid gland area for 4 years. Clinical examination showed an asymmetrical facial appearance due to a 4 cmx5 cm hard, fixed, non-tender mass in the right parotid gland area, incomplete eye closure and a slight tremor at the corner of the mouth. A panoramic radiograph showed an amorphous calcified mass on the posterior mandibular ramus with thinning of the cortical plate adjacent to the mass. A sialogram showed constriction of the main duct and no further filling of striated, intercalated ducts and parenchymal areas. CT indicated an expansile mass with slight contrast enhancement involving the right parotid gland. The large mass showed necrotic areas and calcifications. A bone scan showed marked accumulation of (99)Tc(m)-methylene diphosphonate on the right posterior maxilla. Microscopic findings revealed minimal morphological alterations and rare mitotic figures within tumour cells, and the lesion was diagnosed as adenocarcinoma not otherwise specified (NOS, grade II).

Topics: Adenocarcinoma; Aged; Calcinosis; Female; Humans; Parotid Neoplasms; Radiography, Panoramic; Radiopharmaceuticals; Sialography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To assess the clinical usefulness of quantifying the extent of disease on bone scans in monitoring treatment response in patients with advanced prostate cancer, using computer-assisted image analysis.. The percentage of the positive area on the bone scan (%PABS) was quantified automatically using a personal computer with an image-analysis program. Serial measurements of %PABS in 42 patients with bone metastasis from prostate cancer followed for a mean (range) of 33 (4-72) months with hormonal therapy were compared with those of the extent of disease (EOD) grades in bone lesions and serum prostate specific antigen (PSA) levels according to treatment response.. Serial values of EOD grades and %PABS decreased during treatment in 11 patients with a partial response and in 12 with progressive disease who had no bone metastasis progression. However, EOD grades and %PABS increased in the remaining 19 patients with progressive disease who had bone metastatic progression. Estimated survival curves showed that %PABS was a useful prognostic indicator, in that patients with a > 25% decline in %PABS survived longer than those with a < 25% decline after treatment (P = 0.0207).. The %PABS is a simple and reproducible estimate of the proportion of the skeleton involving tumours in patients with advanced prostate cancer, and serial measurements of %PABS can assist in monitoring the treatment response in patients with bone metastatic prostate cancer.

Topics: Adenocarcinoma; Aged; Aged, 80 and over; Bone Neoplasms; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Survival Analysis; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Aged; Bone and Bones; Female; Humans; Lung Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 63-year-old woman with previously treated stage I lung cancer was reexamined 5 years later for recurrence. A conventional work-up using computed tomographic scanning and transbronchial biopsy showed nothing abnormal. A Tc-99m depreotide scan, however, led to a noninvasive diagnosis of lung cancer recurrence with metastases, and it directed a noninvasive tissue diagnosis.

Topics: Adenocarcinoma; Bone Neoplasms; Female; Humans; Leg; Lung Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Scapula; Soft Tissue Neoplasms; Somatostatin; Technetium Tc 99m Medronate; Thoracic Vertebrae; Whole-Body Counting

Topics: Adenocarcinoma; Artifacts; Bone Neoplasms; Humans; Humerus; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Stomach Neoplasms; Technetium Tc 99m Medronate

A rare case of intraosseous, polymorphous low-grade adenocarcinoma (PLGA) of the maxilla is presented. The lesion appeared to be cystic radiographically and the only finding which suggested malignancy was an irregular cortical border.

Topics: Adenocarcinoma; Cysts; Diagnosis, Differential; Female; Follow-Up Studies; Gallium Radioisotopes; Humans; Maxillary Diseases; Maxillary Neoplasms; Middle Aged; Palatal Neoplasms; Radiography, Panoramic; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Acid Phosphatase; Adenocarcinoma; Bone Neoplasms; Humans; Male; Middle Aged; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 47-year-old woman with adenocarcinoma of the right breast had bone scintigraphy with Tc-99m MDP. Bone imaging did not show any metastases. However, a large area of increased tracer uptake was seen extending from the abdomen to the pelvis. Abdominal ultrasound revealed a large solid and heterogeneous mass, measuring 18 x 11 x 14.3 cm, that originated in an empty uterus. A biopsy of the surgical specimen showed a leiomyoma of the uterus.

Topics: Adenocarcinoma; Biopsy; Breast Neoplasms; Female; Humans; Leiomyoma; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ultrasonography; Uterine Neoplasms

Topics: Adenocarcinoma; Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Neoplasms, Unknown Primary; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Aged; Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

To determine whether serum prostate-specific antigen (PSA) can be reliably used to predict the absence or presence of skeletal metastases on the bone scan in patients with adenocarcinoma of the prostate.. We studied 450 consecutive men presenting with adenocarcinoma of the prostate between 1991 and 1995. Serum PSA was measured by the Hybritech Tandem-R monoclonal immunoradiometric assay and bone scanning was performed with 99m-technetium-labelled methylene diphosphonate. In total, 46 patients were excluded for one or more of the following reasons: serum PSA not available; radionuclide bone scan inconclusive; histology of the prostate other than adenocarcinoma; hormonal or other therapy given prior to obtaining the serum PSA and/or bone scan.. Of the 404 patients included, 43% had poorly differentiated (grade 3), 74% had locally advanced (stages T3-4) tumours and 50% had skeletal metastases. The mean and median serum PSA were 348 and 52 ng/ml, respectively, and 77% of the patients had a serum PSA >20 ng/ml. The negative predictive value (for the absence of metastases on bone scan) of a serum PSA <20 ng/ml was 87% for the whole group of patients, 92, 94 and 70% for grade 1, 2 and 3 tumours, and 95, 83 and 50% for stage T1-2, T3 and T4 tumours, respectively. The positive predictive value (for the presence of metastases on bone scan) of a serum PSA >100 ng/ml was 80% for the whole group of patients.. In patients presenting with adenocarcinoma of the prostate, serum PSA alone is not sufficiently reliable to predict the absence or presence of metastases on the radionuclide bone scan. In patients with grade 3 and clinical stage T3-4 tumours, a bone scan should be obtained for accurate staging, regardless of the serum PSA value.

Topics: Adenocarcinoma; Aged; Bone and Bones; Bone Neoplasms; Humans; Immunoradiometric Assay; Male; Neoplasm Staging; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Colonic Neoplasms; Humans; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

We present the bone scintigrams of two patients, which demonstrate diffuse extraosseous uptake of a bone agent in metastatic masses in the liver, one from a primary lung tumor and one from a primary breast tumor. The bone imaging agent did not localize in the brain metastases in these patients. CTs of the abdomen in both patients showed massive metastases in the liver with multiple areas of tumor necrosis. The CT of the abdomen of the breast cancer patient showed multiple small hepatic calcifications. Autopsy revealed massive tumor necrosis with calcifications in the enlarged liver. In routine bone scintigraphy, diffuse uptake of bone agents in the liver of a patient with a known malignancy should be considered suggestive of massive hepatic metastases.

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Breast Neoplasms; Carcinoma, Small Cell; Female; Humans; Liver; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Antibodies, Monoclonal; Bone Neoplasms; Humans; Indium Radioisotopes; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 67-year-old man presented with malaise and marked anemia. A diagnostic workup revealed severe pancytopenia on a complete blood count and diffuse sclerotic change in the axial skeleton on a plain abdominal radiograph. Bone metastases being suspected from these findings, bone scintigraphy was performed. The bone scan demonstrated uniformly increased skeletal activity with faint soft-tissue activity. The findings of the bone scan, however, appeared atypical of the super scan caused by diffuse bone metastases, without any decrease in radioactivities of the appendicular skeleton and kidneys. Bone marrow scintigraphy with In-111 chloride demonstrated central marrow failure and peripheral expansion, which indicated the possibility of myelophthisis. The patient underwent bone marrow biopsy, which revealed replacement of the bone marrow by metastatic adenocarcinoma. Further examinations detected the primary lesion in the prostate. In this case, the findings of the bone scan were insufficient for the super scan, and might be categorized as a sub-super scan. It would be important to recognize this incomplete form of super scan as a rare scintigraphic pattern of diffuse bone marrow metastases.

Topics: Adenocarcinoma; Bone Marrow Neoplasms; Bone Neoplasms; Humans; Indium; Indium Radioisotopes; Magnetic Resonance Imaging; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Radioisotope bone scanning is frequently used in staging malignancies. However, false-positive results are common, and biopsy is usually required. In the absence of plain radiographic abnormalities or local symptoms, localization of the area of abnormal tracer activity at the time of open rib or sternum biopsy may be difficult. It often requires resection of a large portion of one or more ribs or the sternum to assure that biopsy of the target area was performed. In this setting, a small gamma probe underwent evaluation as an aid to precise intraoperative localization of increased tracer activity in the target bone.. Ten patients with asymptomatic suspected osseous chest metastases by radioisotope bone scanning but with normal plain radiographs underwent open biopsy of 13 ribs and 1 sternum. Six to 12 hours before operation, each received an intravenous injection of 28 mCi of technetium-99m oxidronate. The hand-held, pencil-sized gamma probe in a sterile sleeve was used to localize the area of greatest activity in the target bone, once the bone was exposed through a small incision. Biopsy of a 3-cm length of rib or portion of sternum was performed. In the first two rib biopsies, an intraoperative radiograph with a radiopaque marker on the rib confirmed that the correct rib was selected for biopsy. Intraoperative radiographs were not done on later cases.. The mean ratio of hot spot activity on the targeted rib to background counts on adjacent ribs was 1.65 +/- 0.22 (range, 1.35 to 2.05), and the difference was easily discernible intraoperatively. The ratio of hot spot activity on the sternum was somewhat lower (1.22), but the target area was still easy to detect. An abnormal diagnosis to account for the increased tracer activity was found in each of the 13 ribs and 1 sternal biopsy in all 10 patients: metastatic squamous cell carcinoma (1 rib), metastatic prostatic adenocarcinoma (1 rib), lymphoma (2 ribs), localized hypercellular marrow (1 rib), medullary fibrosis/Paget's disease of the bone (2 ribs), localized fibrosis/granulation tissue (1 rib), enchondroma (3 ribs), and chondroma (2 ribs, 1 sternum). The difference in background counts to hot spot activity was best with injection of the tracer 6 hours before operation.. The intraoperative use of gamma counting is an easy, highly accurate aid (100% sensitivity) to localize areas of abnormal radioisotope uptake in suspected asymptomatic rib and sternal metastases. Use of this technique obviates the need to obtain intraoperative localizing radiographs to confirm accurate rib identification, thereby decreasing operative time.

Topics: Adenocarcinoma; Adult; Aged; Biopsy; Bone Marrow Diseases; Bone Neoplasms; Carcinoma, Squamous Cell; Chondroma; Contrast Media; Female; Fibrosis; Gamma Cameras; Granulation Tissue; Humans; Injections, Intravenous; Intraoperative Care; Lymphoma; Male; Middle Aged; Osteitis Deformans; Primary Myelofibrosis; Prostatic Neoplasms; Radiography, Interventional; Radiology, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Sensitivity and Specificity; Sternum; Technetium Tc 99m Medronate

A patient with initial complaints of leg pain and difficulty walking was found to have a large right tibial metastatic tumor and poorly differentiated adenocarcinoma of the lung. Findings from total-body bone scintigraphy include a large area of increased uptake in the proximal half of the right tibia with a photon-deficient area medially, and focal areas of uptake in a right rib, in the femoral neck and the left ileum. An irregular area of increased uptake in the left lung mass was shown by thoracic bone SPECT. This is an unusual case of a tibial metastasis as the first clinical presentation of bronchogenic adenocarcinoma.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Femoral Neoplasms; Femur Neck; Humans; Ileal Neoplasms; Ileum; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate; Tibia; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Whole-Body Counting

Organ and tissue uptake and retention of Sn-117m(4+)DTPA were studied in a human subject treated for metastatic bone pain, and the results were compared with the biodistribution studies in five normal mice. The explanted organs from a patient who received a therapy dose of 18.6 mCi (688.2 MBq) Sn-117m(4+)DTPA and who died 47 days later were imaged with a gamma-camera, and tissue samples were counted and also autoradiographed. Bone, muscle, liver, fat, lungs, kidneys, spleen, heart and pancreas tissue samples were assayed in a well counter for radioactivity. Regions of interest were drawn over bone and major organs to calculate and quantify clearance times using three in vivo Sn-117m(4+)DTPA whole-body scintigrams acquired at 1, 24 and 168 h after injection. Five normal mice injected with the same batch of Sn-117m(4+)DTPA as used for the human subject were sacrificed at 24 h, and tissue samples were collected and assayed for radioactivity for comparison with the human data. For the human subject, whole-body retention at 47 days postinjection was 81% of the injected dose, and the rest (19%) was excreted in urine. Of the whole-body retained activity at 47 days, 82.4% was in bone, 7.8% in the muscle and 1.5% in the liver, and the rest was distributed among other tissues. Gamma-ray scintigrams and electron autoradiographs of coronal slices of the thoracolumbar vertebral body showed heterogeneous metastatic involvement with normal bone between metastatic lesions. There was nonuniform distribution of radioactivity even within a single vertebral body, indicating normal bone between metastatic lesions. Lesion-to-nonlesion ratios ranged from 3 to 5. However, the osteoid-to-marrow cavity deposition ratio, from the microautoradiographs, was 11:1. The peak uptake in the human bone was seen at 137 h with no biological clearance. Soft tissues showed peak uptake at 1 h and exhibited three compartmental clearance components. Whole-body retention in normal mice was 38.7% of the injected dose at 24 h and the rest was excreted. At 24 h postinjection, bone in mice showed 84.2% of the whole-body retention, muscle 1.7% and liver 1.4%, and the rest was distributed in other soft tissues. Percent distribution of the retained dose among bone, muscle, liver and other soft tissues is very similar between mice and a human subject. To calculate precise radiation absorbed doses from bone pain palliation radionuclides, it is necessary to take into account soft-tissue uptake and retention

Topics: Adenocarcinoma; Animals; Bone Neoplasms; Humans; Kidney; Liver; Male; Mice; Mice, Inbred BALB C; Middle Aged; Pain; Pentetic Acid; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tin Radioisotopes; Tissue Distribution; Urinary Bladder

Topics: Adenocarcinoma; Aged; Bone and Bones; Colonic Neoplasms; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 5-year-old Arabian horse was admitted with a 5-day history of undulant pyrexia of unknown origin, inappetence, obtundation, and acute collapse. Physical examination results were unremarkable except for a grade II/VI left-sided systolic cardiac murmur and abdominal splinting. Mild chronic inflammatory changes were evident on clinicopathologic evaluation. Echocardiography revealed moderate aortic insufficiency. A solitary soft tissue opacity was found on thoracic radiography but not on ultrasonography. Palliative treatment was ineffective. Nuclear scintigraphy with WBC labeled with technetium Tc 99m hexamethylpropyleneamine oxime did not identify abnormalities, but a second nuclear scan with technetium Tc 99m hydroxymethylene diphosphate identified polyostotic disease. Examination of a biopsy specimen from an affected rib revealed disseminated adenocarcinoma. The horse was euthanatized. Necropsy and histologic examination revealed a colonic adenocarcinoma with osseous metaplasia that had disseminated to multiple parenchymal organs, muscle, and bone.

Topics: Adenocarcinoma; Animals; Bone Neoplasms; Colonic Neoplasms; Diagnosis, Differential; Horse Diseases; Horses; Male; Palliative Care; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Aged; Citrates; Female; Gallium; Gallium Radioisotopes; Humans; Peritoneal Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Uterine Cervical Neoplasms

Topics: Adenocarcinoma; Bone Neoplasms; Brain Neoplasms; Female; Humans; Middle Aged; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Skull; Spinal Neoplasms; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

The purpose of this study was to evaluate the frequency and the extent of extraosseous 99mTc-HMDP accumulation in 412 patients with primary lung cancer. CT scanning was also performed and we compared the extraosseous uptake by lung cancer with the internal structure of the tumor on CT scans. The extent of ectopic 99mTc-HMDP accumulation was classified as low, moderate or high. CT scans were used to evaluate the size and internal structure of the tumor, including calcification and necrosis. Ectopic 99mTc-HMDP accumulation in primary lung cancer was found in 32 patients (7.7%), and included 2 cases (0.5%) of high uptake, 8 cases (1.9%) of moderate uptake, and 22 cases (5%) of low uptake. No difference in uptake was observed among the histological types, but a relationship between tumor size and 99mTc-HMDP extraosseous accumulation was observed. CT scans of the 32 tumors exhibiting ectopic 99mTc-HMDP accumulation revealed 5 cases of calcification in the tumor and 18 cases of tumor necrosis. The factors promoting ectopic 99mTc-HMDP accumulation were considered to be tumor size and calcification or necrotic change. In patients with neither calcification nor necrosis, other factors such as increased calcium metabolism and altered vascular permeability may be involved.

Topics: Adenocarcinoma; Calcinosis; Carcinoma, Large Cell; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Necrosis; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

The decision of whether to perform continuity-sparing or resecting surgery of the jaw in cases of malignant oral tumors is often difficult.. To aid in this decision, bone scintigraphy was evaluated retrospectively in 304 patients with a squamous cell carcinoma.. One hundred forty-five patients showed no accumulation of the radionuclide, and none of them had infiltration by tumor histologically.. It was concluded that a bone-sparing resection of tumors close to the jaw may be justified when there is a negative bone scan.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Adenoid Cystic; Carcinoma, Squamous Cell; Cheek; Child; Diphosphonates; False Negative Reactions; Female; Humans; Jaw Neoplasms; Lip Neoplasms; Male; Middle Aged; Mouth Floor; Mouth Neoplasms; Organotechnetium Compounds; Patient Care Planning; Predictive Value of Tests; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tongue Neoplasms

We report a total of 169 serial bone scan studies conducted in 21 patients with histologically proven metastatic cancer of the prostate. Aim of the study was to investigate the concordance of findings on bone scans with serum acid phosphate (AP) levels and the clinical performance status (CPS) of the patients, and to see how important bone scan is by itself in determining the metastatic progression in the follow-up. Eighty-seven and 86% of scans demonstrated changes concordant with AP and CPS levels subsequently. It was also found that 100% of the progressions on bone scans along with elevated levels of AP had been confirmed as metastatic progression, whereas only 41% of progressions on bone scans solely had been shown to be metastases in the follow-up investigations. Findings on bone scans not in correlation with clinical findings and serum AP levels are mostly misleading. Use of bone scans in conjunction with serum AP levels and most probably with prostate-specific antigen and CPS is the most reliable and therefore treatment modality changes should not be based on bone scans only.

Topics: Acid Phosphatase; Adenocarcinoma; Bone and Bones; Bone Neoplasms; Clinical Enzyme Tests; Follow-Up Studies; Humans; Karnofsky Performance Status; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

We examined clinical characteristics of patients with primary lung cancer associated with clubbing of the fingers or pulmonary hypertrophic osteoarthropathy. Clubbing was observed in 12.5% of patients with lung cancer. Squamous cell carcinoma was frequently associated with clubbing. Clubbing was found in all clinical stages. PaO2 and PaCO2 were normal in patients with lung cancer, which suggests that neither hypoxemia nor hypercapnia caused the clubbing in these patients. Pulmonary hypertrophic osteoarthropathy was found in three patients with lung cancer (two men and one woman, mean age 49 years). The incidence was 2.9% among lung cancer patients with clubbing, 0.22% in all lung cancer patients, and was apparently lower than those in reports from outside Japan. One of these patients has stage IIIA squamous cell carcinoma, one had stage IV large cell carcinoma, and one had stage IV adenocarcinoma. In all cases bone scans were useful for diagnosis and for following the clinical course.

Topics: Adenocarcinoma; Aged; Carcinoma, Large Cell; Carcinoma, Squamous Cell; Female; Humans; Lung Neoplasms; Male; Middle Aged; Osteoarthropathy, Secondary Hypertrophic; Radionuclide Imaging; Technetium Tc 99m Medronate

The importance of evaluating nonfunctional adrenal masses in the right clinical setting is discussed. A 60-year-old man was initially diagnosed of having a localized lung carcinoma. Metastatic work-up showed an adrenal mass that was not deemed to be related to the lung primary. Although biochemical testing revealed that the adrenal mass was nonfunctional, adrenal scintigraphy was not performed. On resection, the lung neoplasm was shown to be a poorly differentiated adenocarcinoma. Radiologic follow-up of the adrenal finding was recommended. A year later, the patient presented with an abdominal mass that was visualized by bone scintigraphy and, on resection, proved to be adrenocortical carcinoma. In retrospect, the lung mass was a metastasis of an adrenocortical carcinoma.

Topics: Adenocarcinoma; Adrenal Cortex Neoplasms; Bone and Bones; Bone Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Although bone scintigraphy is an extremely sensitive method for the detection of focal bone disease, small lesions below the resolution of planar imaging may be missed. This is a report of a patient with carcinoma of the breast who showed tumor progression 1 year after initial treatment. Complete evaluation was performed in order to detect the origin of increased level of a tumor marker. Although planar bone scintigraphy could not demonstrate any lesion in the spine, multiple metastases were detected in the lumbar and the thoracic spines on SPECT imaging. Only some of these lesions were seen with MRI. Repeat planar bone imaging 6 weeks later showed multiple bone lesions in the lumbar and thoracic areas.

Topics: Adenocarcinoma; Biomarkers, Tumor; Breast Neoplasms; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Mucin-1; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

Topics: Acromegaly; Adenocarcinoma; Adult; Bone and Bones; Bone Neoplasms; Female; Humans; Pituitary Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

We describe the case of a man with known prostatic carcinoma and bone metastases who was admitted with jaundice and hepatomegaly. A bone scan showed uptake of diphosphonate by the liver and ultrasound suggested the presence of diffuse metastatic disease. Liver biopsy revealed foci of carcinoma cells in the portal tracts which exhibited positive cytoplasmic staining for prostate-specific antigen, thus confirming the presence of metastatic prostatic adenocarcinoma.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Humans; Liver Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Fifty patients (43 male, 7 female, age 31-77 years) with single solid masses in their lungs based on the findings of a chest X-radiograph [40 malignancies: 5 small cell carcinoma (Ca), 17 epidermoid Ca, 12 adeno Ca, 6 undifferentiated large cell Ca] and 10 benign lesions underwent technetium-99m (V) dimercaptosuccinic acid [99m-(V)DMSA] scans to evaluate the usefulness of 99mTc-(V)DMSA in the detection of lung Ca with different cell types and benign lesions. Only 43% (17/40) of the malignancies in the lungs were detected by 99mTc-(V)DMSA, including 29% (5/17) epidermoid Ca, 50% (6/12) adeno Ca and 17% (1/6) undifferentiated large cell Ca of the lungs. However, all 5 cases of small cell Ca and 11 cases combined with bone metastasis were revealed by 99mTc-(V)DMSA. In addition, 3 of the 10 benign lesions (2 organizing pneumonias, 1 benign tumor) presented with an uptake of 99mTc-(V)DMSA. The diagnostic sensitivity, specificity and accuracy were 43%, 70% and 48%, respectively, in differentiating malignant from benign lesions for the single solid mass in the lungs. In conclusion, 99mTc-(V)DMSA is of little or no use in the differentiation of lung Ca from single solid masses in the lungs.

Topics: Adenocarcinoma; Adult; Aged; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Diagnosis, Differential; Female; Humans; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Bone scintigraphy of metastatic lesion on 128 patients with prostatic cancer were classified according to the proposal by Soloway et al (Cancer, 61; 195-202, 1988). Since all patients received endocrine therapy, the response to therapy and survival were examined in relation to bone lesion. In extent of disease (EOD) 1, main metastatic lesions were located in the pelvis, lumbar spine, and with increasing number of EOD, metastases in the upper spine, rib, and skull appeared. Longer survival were noticed in EOD 1, followed by EOD 2 and EOD 3, and EOD 4 revealed the shortest survival. The survival of EOD 2 was similar to thus of EOD 3. However, when grades of tumor were considered, moderately differentiated cancer showed longer survival than poorly differentiated cancer in EOD 2 and EOD 3. The response as assessed by bone scintigraphy following 6-month therapy was well correlated with the number of EOD. When individual items for evaluation of response were examined, the results of local response of the prostate and values of PAP showed good correlation with survivals, however, that of bone lesions with bone scintigraphy failed to show such a correlation with prognosis. Therefore, it is concluded that the therapeutic evaluation of bone lesions with bone scintigraphy is difficult to interpret 6 months after initiation of treatment.

Topics: Adenocarcinoma; Aged; Bone and Bones; Bone Neoplasms; Castration; Diethylstilbestrol; Ethinyl Estradiol; Humans; Male; Middle Aged; Neoplasm Staging; Prognosis; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Presently, the standard staging evaluation of prostate cancer includes digital rectal examination, measurement of serum tumor markers and a radionuclide bone scan. To evaluate the ability of local clinical stage, tumor grade, serum acid phosphatase, serum prostatic acid phosphatase (PAP) and serum prostate specific antigen (PSA) to predict bone scan findings, a retrospective review of 521 randomly chosen patients (mean age 70 years, range 44 to 92 years) with newly diagnosed, untreated prostate cancer was performed. Local clinical stage, tumor grade, acid phosphatase, PAP and PSA all correlated positively with bone scan findings (p less than 0.0001). Using receiver operating characteristic curves, however, PSA had the best over-all correlation with bone scan results. The median serum PSA concentration in patients with a positive bone scan was 158.0 ng./ml., whereas men with a negative bone scan had a median serum PSA level of 11.3 ng./ml. (p less than 0.0001). Using multivariate logistic regression analysis, local clinical stage, tumor grade, acid phosphatase and PAP were evaluated in combination with PSA to assess whether these parameters increased the ability of PSA alone to predict bone scan findings. None of these clinical parameters, irrespective of the combination used, contributed appreciably to the predictive power of PSA alone. A probability plot with 95% confidence intervals was constructed that allows the practicing urologist to estimate on an individual basis the probability of a positive bone scan for any given serum PSA value. The most significant finding of this study, however, was the negative predictive value of a low serum PSA concentration for bone scan findings. In 306 men with a serum PSA level of 20 ng./ml. or less only 1 (PSA 18.2 ng./ml.) had a positive bone scan (negative predictive value 99.7%). This finding would suggest that a staging radionuclide bone scan in a previously untreated prostate cancer patient with a low serum PSA concentration may not be necessary.

Topics: Adenocarcinoma; Aged; Antigens, Neoplasm; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Humans; Male; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Regression Analysis; Retrospective Studies; Technetium Tc 99m Medronate

To assess the value of serum prostate-specific antigen (PSA) in prostate cancer follow-up, we prospectively studied 107 consecutive patients with: (1) pathologically confirmed prostate cancer; (2) definitive prostatectomy and/or radiation therapy greater than or equal to 3 mo prior to bone scanning; and (3) one bone scan and serum PSA sampling within 3 mo of each other. The mean and range of patient follow-up since definitive therapy was 1.6 and 0.5-8 yr, respectively. Abnormal bone scans were correlated with pertinent radiographs. Of 107 bone scans, 16 demonstrated metastatic bone disease. A PSA value of less than or equal to 8 ng/ml excluded bone metastases with a predictive value of a negative test of 98.5%. Without radiographic correlation, abnormal bone scans rarely represented metastases if the PSA value was less than or equal to 8 ng/ml. In summary, serum PSA concentration determines the need for follow-up bone scanning and assists in scan interpretation in patients status post definitive therapy for prostate cancer.

Topics: Adenocarcinoma; Antigens, Neoplasm; Biomarkers, Tumor; Bone Neoplasms; Follow-Up Studies; Humans; Male; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Follow-up evaluation of patients who have undergone radical prostatectomy routinely consists of serial bone scintigraphy and, more recently, prostate-specific antigen (PSA) levels. The utility of serial bone scans in combination with PSA levels is retrospectively reviewed in 118 men treated by radical prostatectomy for clinical Stage A or B disease who, at the time of surgery, had no evidence of metastatic disease. Of the 118 patients, 75.4% had no abnormality on either test (mean follow-up 32.4 mo), 9.3% demonstrated a detectable or rising PSA level with negative bone scan (mean follow-up 35 mo), and 8.5% exhibited a detectable and or rising PSA level and positive bone scan (mean follow-up 30.7 mo). Follow-up bone scans were read as either positive or indeterminate with undetectable PSA levels in 6.8% of patients (mean follow-up 27.3 mo). Critical review of the equivocal studies suggests that postoperative PSA levels more truly represent the clinical situation than bone scans. Following radical prostatectomy, routine bone scintigraphy provides little additional information when PSA levels are negative. If PSA becomes detectable or the patient develops symptoms, bone scintigraphy should then be performed.

Topics: Adenocarcinoma; Aged; Antigens, Neoplasm; Bone Neoplasms; Follow-Up Studies; Humans; Male; Middle Aged; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate a relationship between Gleason scores and Tc-99m HMDP bone imaging findings, data from 48 men (aged 45 to 77; mean, 67) with prostate carcinoma who had a bone imaging study at the time of presentation were reviewed. Cumulative Gleason scores were divided into two groups: high scores (6-10), 32 men; low scores (2-5), 16 men. Of the 32 men with high Gleason scores, 15 tested positive for multiple metastases and 17 tested negative. Tumors of the 16 men with low Gleason scores were negative for metastasis. A chi-square association between Gleason scores and the presence of metastases, either of a superscan pattern or multiple metastases, was 10.9 (1 df, P less than 0.001). The results indicate that a superscan pattern or multiple metastases were found exclusively in the bone images of patients with high histologic grades; bone images negative for metastases were associated with low-grade tumors. We conclude that positive bone imaging for metastases at the initial scan occurs only in patients who have high Gleason scores, that patients with high Gleason scores might or might not have skeletal metastasis, and that skeletal metastasis is not predictable in patients with low Gleason scores.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Bone Neoplasms; Humans; Male; Middle Aged; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thyroid Neoplasms

Within the imaging literature, the super bone scan has emerged as a distinct type of bone scan with a specific differential diagnosis. Previous reviews have included prostate, breast, bladder and colon cancer, and lymphoma among the causes of a super bone scan but have not included stomach cancer. We report a super bone scan caused by late recurrence of stomach cancer in the bone marrow. Because the management of stomach cancer is significantly different than the management of other causes of a super bone scan, the distinction is clinically relevant. We conclude that stomach cancer should be considered in the differential diagnosis of a super bone scan.

Topics: Adenocarcinoma; Bone and Bones; Bone Marrow; Bone Neoplasms; Diagnosis, Differential; Humans; Male; Middle Aged; Radionuclide Imaging; Stomach Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone imaging using Tc-99m MDP was performed on a 68-year-old man with a newly diagnosed adenocarcinoma of the lung. The image unexpectedly showed increased activity in the heart area. Emergent echocardiography demonstrated impending pericardial tamponade. A malignant pericardial effusion was verified by pericardiocentesis.

Topics: Adenocarcinoma; Aged; Bone and Bones; Cardiac Tamponade; Heart Neoplasms; Humans; Lung Neoplasms; Male; Pericardial Effusion; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Bone and Bones; Gallium Radioisotopes; Humans; Male; Mandibular Neoplasms; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Pancreatic inflammation and tumors can induce various systemic lesions of steatonecrosis. We report here the case of a 73-year-old woman presenting a painful left leg. Roentgenograms and tomograms of the left tibia were normal. Radionuclide bone scan showed diffuse increased uptake in the whole tibia and a CT scan of the same region demonstrated an unusual pattern of bone tumor. Tibial biopsy revealed intra medullary steatonecrosis and led to the discovery of a pancreatic carcinoma.

Topics: Adenocarcinoma; Aged; Bone Marrow; Fat Necrosis; Female; Humans; Necrosis; Pancreatic Neoplasms; Technetium Tc 99m Medronate; Tibia

Five cases of metastatic prostatic carcinoma are presented. In each case, skeletal metastases were extensive, but the calvaria was not involved, resulting in a headless appearance. The mechanism for this scintigraphic manifestation is presented, and its value is emphasized.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Bone Neoplasms; Gallium Radioisotopes; Humans; Male; Middle Aged; Neoplasms, Unknown Primary; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Abdominal Muscles; Adenocarcinoma; Humans; Kidney Failure, Chronic; Kidney Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Postoperative Care; Technetium Tc 99m Medronate

Topics: Abdominal Neoplasms; Adenocarcinoma; Bone Neoplasms; Colonic Neoplasms; Diagnosis, Differential; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Female; Humans; Middle Aged; Orbital Neoplasms; Radionuclide Imaging; Skin Neoplasms; Technetium Tc 99m Medronate

A new use for intraoperative bone imaging is described. The technique allowed accurate localization of bone pathology for biopsy where plain radiographs and bone morphology were otherwise normal. The technique should increase diagnostic accuracy and eliminate false-negative biopsy results.

Topics: Adenocarcinoma; Biopsy; Bone Neoplasms; Humans; Intraoperative Period; Male; Middle Aged; Prostatic Neoplasms; Pubic Bone; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

A case of a "cold" lesion on sodium pertechnetate Tc 99m (99mTc) bone scan of the pelvis of a patient with an adenocarcinoma of the thyroid gland is reported. X-ray demonstrated an osteolytic metastasis, and biopsy revealed its origin to be a thyroid adenocarcinoma.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Diphosphonates; Female; Humans; Radionuclide Imaging; Sacrococcygeal Region; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

The radionuclide bone scan 3 months after the initiation of treatment for advanced cancer of the prostate occasionally shows apparent progression of individual lesions despite clinical improvement. To determine the incidence and clinical significance of this so-called flare phenomenon, serial bone scans were reviewed in 33 patients with carcinoma of the prostate and bony metastases, who were receiving endocrine treatment for the first time. A flare reaction was seen in two (6%) of 33 bone scans obtained 3 months after initiation of treatment. A flare reaction on bone scan is an unusual phenomenon in prostatic cancer; in general, serial scans accurately depict the activity of bony metastases in these patients.

Topics: Adenocarcinoma; Aged; Bone and Bones; Bone Neoplasms; Castration; Diethylstilbestrol; Diphosphonates; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

A retrospective analysis of 104 chest radionuclide angiography (CRNA) studies establishes the utility of this procedure in the evaluation of pulmonary malignancies and benign masses. Remarkable abnormalities in the perfusion of the lungs were identified in 36 (58%) of 62 cases that were not predictably normal or predictably abnormal form the clinical setting. While 60 of these 62 cases involved malignancy being evaluated for metastases, only 21 (34%) had metastases identified by radionuclide bone or liver-spleen scintigraphy. In addition to diagnosis of superior vena cava obstruction, the CRNA may have a more frequent application as an adjunct to routine scintigraphic studies directed to the identification of metastatic disease.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Vena Cava, Superior

Solitary lesions on bone scans obtained as part of metastatic diagnostic studies for genitourinary malignancy require identification as to whether they represent nonneoplastic or neoplastic disease and, if neoplastic, whether metastatic genitourinary cancer or another primary is present. Such definition requires at least plain film tomograms of the area as well as computerized tomography (for inaccessible lesions) and/or biopsy of lesions still in doubt after tomography. Of the 9 patients in our study 4 had true positive scans for metastatic disease, 3 had false positive scans, 1 had a true positive scan for a second bone primary and 1 is indeterminate, since a negative biopsy of a positive area on a bone scan was followed rapidly by the appearance of other widespread metastases.

Topics: Adenocarcinoma; Adult; Aged; Bone Neoplasms; Carcinoma, Renal Cell; Carcinoma, Transitional Cell; Diphosphonates; False Positive Reactions; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Urinary Bladder Neoplasms; Urogenital Neoplasms

Patients with prostatic cancer frequently require evaluation of bony metastases as well as renal function. 99mTc-methylene diphosphonate, a commonly used bone-imaging agent, is about 60 per cent localized in the bony skeleton and about 40 per cent excreted by the kidneys. Immediate imaging after intravenous injection of the isotope may yield high-quality radionuclide nephrourograms, which provide excellent visual and graphic displays of renal anatomy and excretory function. Our preliminary studies suggest that the immediate 99mTc-methylene diphosphonate scan may usefully expand the value of a routine bone scan to screen for ureteral obstruction. Patients with underlying malignancy who require simultaneous evaluation and follow-up of bony metastases and renal function might be conveniently served by the dual functions of the expanded bone scan to include immediate imaging of the kidneys.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Diphosphonates; Humans; Kidney; Kidney Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Ureteral Neoplasms; Ureteral Obstruction

A total of 2530 consecutive bone scans were examined to evaluate the number and the type of soft tissue neoplasms detected with bone-seeking phosphonates. Sixty-eight primary or secondary soft tissue neoplasms of 63 patients accumulated 99mTc -methylene diphosphonate and 2 accumulated 99mTc -diphosphonate, and one metastasis was seen as a nonactive 'cold' focus in the urinary bladder. The localization of tumors was: 19 in the lung, 15 in the liver, 11 in the kidney, 10 in the peritoneal cavity or ascites, 5 in the large bowel, 4 in the vascular or lymphatic system, 3 in the connective tissue or muscles, 2 in the ovary, 1 in the urinary bladder, and 1 in the brain. Our results differ in many respects from those reported in the literature. The causes of the differences are discussed.

Topics: Abdominal Neoplasms; Adenocarcinoma; Adolescent; Adult; Aged; Bone and Bones; Carcinoma, Small Cell; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphoma, Non-Hodgkin; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Retroperitoneal Neoplasms; Soft Tissue Neoplasms; Technetium; Technetium Compounds; Technetium Tc 99m Medronate

When abnormally increased radioactivity is seen in a rib or ribs by bone imaging in a patient with suspected or known malignancy, it frequently is difficult to differentiate fracture from metastatic disease. Histological examination of the lesion is crucial for diagnosis, staging, and planning of therapy. To assess the value of external localization of the site or sites of abnormal uptake in a rib as a guide for open rib biopsy, 10 patients (7 men, 3 women; age range, 34 to 68 years) with known or suspected malignancy were studied. With reference to the oscilloscope image, a cobalt 57 marker was placed on the skin overlying the focus of increased uptake, and the area of increased activity was marked on the skin as a guide to surgical resection. Of ten resected ribs, four showed metastatic disease and five had fractures. (One patient underwent two external marking procedures and two surgical procedures.) Rib biopsy was not performed in 1 patient because prior to the surgical procedure, a small subcutaneous nodule adjacent to the skin marker was excised and confirmed to be carcinoma. Appropriate courses of management (operation, irradiation, chemotherapy) were taken after the biopsies. The surgeon responsible for the biopsy should be present during the skin-marking procedure, and the area beneath the scapula and the region adjacent to the spine should be avoided. Our results indicate that the technique is a very useful aid for approaching open rib biopsies more precisely.

Topics: Adenocarcinoma; Adult; Aged; Biopsy; Bone Neoplasms; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Diagnosis, Differential; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Rib Fractures; Ribs; Technetium; Technetium Tc 99m Medronate

68 metastatic bone lesions proven by biopsy, follow-up radionuclide bone imaging, or radiographs in 18 patients with surgically confirmed renal cell carcinoma were retrospectively analyzed. Bone imaging demonstrated 62 lesions (91%): 48 definite, 7 questionable 'hot' lesions, and, 2 definite, 5 questionable 'cold' lesions. The spine was the most common site. 15 patients had more than one metastasis. 27 lesions were undiscovered by radiographs. Serum alkaline phosphatase was elevated in 12 of 18 patients. It is concluded that radionuclide bone imaging is more sensitive than radiographic examination for bony metastasis from renal cell carcinoma, and that it is important to recognize 'cold' metastatic lesions on the bone imaging in patients with renal cell carcinoma.

Topics: Adenocarcinoma; Bone Neoplasms; Diphosphonates; Humans; Kidney Neoplasms; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

Asymptomatic prostatic carcinoma presented as multiple bilateral pulmonary nodules in a patient without any evidence of skeletal involvement by normal bone image. Percutaneous biopsy provided the initial clue to diagnosis. We recommend that asymptomatic prostatic carcinoma be included in the differential diagnosis of pulmonary nodules, even when there is no evidence of skeletal metastasis.

Topics: Adenocarcinoma; Bone Neoplasms; Diphosphonates; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Colonic Neoplasms; Diphosphonates; Gallium Radioisotopes; Humans; Male; Middle Aged; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

A patient with adenocarcinoma of the prostate presented with right upper quadrant abdominal pain and weight loss. Liver biopsy revealed hepatic metastases from prostate carcinoma. A bone scan demonstrated marked uptake of Tc-99m MDP within the hepatic metastases.

Topics: Adenocarcinoma; Bone and Bones; Diphosphonates; Humans; Liver Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Breast Neoplasms; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Radionuclide bone scans and skeletal radiographs were obtained before and during combination chemotherapy or initial hormonal treatment in 46 patients with disseminated adenocarcinoma of the prostate. The purpose of the study was to determine the usefulness of these two modalities in evaluating tumor response to therapy. Prior to treatment, bone scans were positive in 44 patients (96%). In all but one patient either bone radiographs or bone marrow biopsy revealed evidence of osseous metastases. In 22 patients partial response to therapy was documented by a variety of other staging tests. Eleven of these patients showed concurrent or later improvement on bone scans; one showed improvement on a radiograph. "Flare phenomena" were observed relatively frequently since 23% of the scans and 50% of the radiographs showed worsening at the time of response. Bone scans revealed worsening in 79% of 33 patients with disease progression of extraosseous tumor; radiographs were equally sensitive (82% worsening). It is concluded that bone scans in particular are useful for monitoring tumor status in systemically treated patients with prostate cancer. However, because of the lack of sensitivity for response and paradoxical worsening with tumor regression in some patients, scans are not accurate enough to be employed as the sole test in following these patients.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Castration; Cisplatin; Cyclophosphamide; Diphosphates; Diphosphonates; Doxorubicin; Drug Therapy, Combination; Humans; Male; Middle Aged; Prostatic Neoplasms; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Diphosphonates; Etidronic Acid; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The records of 100 patients with localized prostatic cancer were examined retrospectively in an effort to determine the usefulness of routine 99mtechnetium bone scans following definitive therapy with 125iodine implantation or external beam irradiation. With a mean followup of 47 months per patient 19 per cent of these patients had positive scans and an additional 15 per cent had scans that were considered equivocal. Of the 100 patients none had a positive scan in the absence of either an elevated serum acid phosphatase or bone pain. In our series the low incidence of positive scans as the sole evidence of disease progression does not support its routine use after definitive therapy for localized carcinoma of the prostate.

Topics: Acid Phosphatase; Adenocarcinoma; Bone and Bones; Brachytherapy; Diphosphonates; Humans; Iodine Radioisotopes; Male; Pain; Prostatic Neoplasms; Radioisotope Teletherapy; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Bone and Bones; Breast Neoplasms; Calcinosis; Diphosphonates; Female; Humans; Lung; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Adult; Carcinoma, Small Cell; Diphosphonates; Female; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Diphosphonates; Female; Gallium Radioisotopes; Humans; Kidney; Kidney Neoplasms; Male; Middle Aged; Radionuclide Imaging; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Aged; Diphosphonates; Female; Humans; Kidney Neoplasms; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

Topics: Abdomen; Adenocarcinoma; Adult; Aged; Ascitic Fluid; Diphosphonates; Female; Humans; Leukemia, Myeloid; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Stomach Neoplasms; Technetium; Technetium Tc 99m Medronate; Teratoma; Testicular Neoplasms; Urethral Neoplasms