technetium-tc-99m-medronate and Bone-Diseases--Metabolic

Bone scintigraphy with 99mTc-phosphate compounds is the most popular examination in clinical nuclear medicine. This was developed more than 20 years ago and its roles in various skeletal disorders are well established. Furthermore, improvement of imaging apparatus and application of SPECT strengthened its value extensively. From scintigram alone, in many cases, differentiation between bone metastasis and other "benign" disorders is easily capable. Further improvement in resolution of scinticamera should strengthen its value more. Other recent developments in skeletal nuclear medicine are those in bone densitometry and in measurement of metabolic bone markers. Bone densitometry using DXA is applied on diagnosis and monitoring of therapeutic effects in various metabolic bone diseases, especially, in osteoporosis. Bone mass measurement combined with assessments of specific bone markers such as bone specific alkaline phosphatase and collagen cross-link metabolites might replace the bone biopsy in evaluating bone metabolism. Treatment of bone metastasis in patients with prostate cancer by administering radiolabeled bone seeking substances is another topics in this field and awaits for more extensive clinical evaluation.

Topics: Absorptiometry, Photon; Biomarkers; Bone and Bones; Bone Density; Bone Diseases, Metabolic; Bone Neoplasms; Female; Humans; Male; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Alkaline Phosphatase; Bone and Bones; Bone Development; Bone Diseases, Metabolic; Bone Regeneration; Circadian Rhythm; Humans; Osteocalcin; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole-Body Counting

Radionuclide imaging with Tc-99m diphosphonates is not an effective method for detecting or ruling out most osteoporotic diseases including senile osteoporosis or accelerated postmenopausal osteoporosis, and the slow loss of bone tissue generally remains undetected by this modality. Nonetheless, it frequently surpasses or supplements radiographic findings in evaluating the focal complications of metabolic bone disease, including fractures, microfractures, stress fractures, vertebral compressions, Milkman-Looser zones, aseptic necrosis, and acute infarction. In contrast to its secondary role in osteoporosis, bone imaging is of prime importance in investigating hypercalcemia, because the major cause of this abnormality is skeletal metastatic malignancy. In defective bone mineralization due to hyperparathyroidism or osteomalacia, a general increase in diphosphonate skeletal uptake is detected more frequently than radiographic abnormalities. However, normal skeletal images do not rule out metabolic bone disease. Biochemical testing is more reliable in detecting primary hyperparathyroidism. On the other hand, in renal osteodystrophy, biochemical abnormalities are variable and bone imaging is helpful in assessing the severity of skeletal involvement, but not its etiology. Many methods of quantitating the kinetics of Tc-99m diphosphonates have been explored, such as plasma clearance, bone-to-soft-tissue ratios, 24-hour total body retention and 24-hour urinary excretion. None of these have been widely accepted. The value of bone imaging is established in other systemic diseases, most notably in Paget's disease, hypertrophic pulmonary osteoarthropathy, sickle cell disease, fibrous dysplasia, and sympathetic dystrophy.

Topics: Bone Diseases; Bone Diseases, Metabolic; Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Hypercalcemia; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Because osteopenia increases morbidity of primary biliary cirrhosis (PBC), the effects of cyclical etidronate vs. sodium fluoride on bone mass were compared in patients with PBC.. Thirty-two women with PBC were randomly assigned to receive etidronate (400 mg/day during 14 days every 3 months) or fluoride (50 mg/day, enteric-coated tablets). Bone mineral density of the lumbar spine and proximal femur were measured initially and every 6 months. Bone fractures were also evaluated.. Sixteen patients were allocated into each group, which were comparable with respect to the severity of PBC and osteopenia. Thirteen patients with etidronate and 10 patients with fluoride completed 2 years in the study. In the etidronate group, bone mineral density increased in the lumbar spine (P = 0.02) and did not change in the proximal femur. In the fluoride group, lumbar bone mineral density did not change but femoral bone mass decreased, particularly in the Ward's triangle. Two patients in the fluoride and none in the etidronate group developed new vertebral fractures, and the number of new nonvertebral fractures was similar in both groups. Neither treatment impaired liver function or cholestasis.. Cyclical etidronate is more effective and better tolerated than sodium fluoride in preventing bone loss in PBC.

Topics: Absorptiometry, Photon; Bone Density; Bone Diseases, Metabolic; Drug Administration Schedule; Etidronic Acid; Female; Femur; Follow-Up Studies; Humans; Liver Cirrhosis, Biliary; Lumbar Vertebrae; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Time Factors

Topics: Bone Diseases, Metabolic; Bone Neoplasms; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Hyperthyroid patients commonly complain of generalized bony aches, which are frequently overlooked due to the more prominent symptoms of cardiovascular and nervous disturbances. Hyperthyroid patients are expected to have abnormal bone metabolism as part of the generalized hypermetabolic status. The aim of this study is to verify the presence of metabolic bone superscan in association with the hypermetabolic stats in various groups of hyperthyroidism. Secondly, to correlate these superscan features with the various laboratory results in hyperthyroid patients.. Forty-five hyperthyroid patients confirmed by clinical and laboratory results were enrolled in this work. In all patients, a (99m)Tc-pertechnetate thyroid uptake scan was acquired. On a different day, total body bone scan was acquired three hours post IV injection of 555-925 MBq of (99m)Tc-MDP. Serum FT3, FT4, TSH, Ca++, alkaline phosphatase (AP) and parathyroid hormone (PTH) were monitored in all patients as markers of thyroid and bone metabolism. Ten cases with no thyroid diseases were included as a control group. Patients with thyroiditis or long history of antithyroid drugs for more than one year were excluded from the study.. The patients were subdivided into three groups: Graves disease (GD) (n = 30), toxic nodular goiter (TNG) (n = 10) and autonomous toxic adenoma (AT) (n = 5). The TSH for the whole group was significantly suppressed compared to the control group with higher suppression in the Graves disease group than in the TNG or AT groups. (99m)Tc-pertechnetate uptake values in the Graves disease group were significantly higher than the TNG and AT groups (p < 0.05). Metabolic superscan (MSS) was noted in 90% of the Graves cases, 20% in TNG and in none of the AT group. There were no significant differences regarding Ca+, AP and PTH between the Graves and non-Graves groups (p > 0.05).. Disturbances in bone metabolism are more prevalent in Graves disease than in other types of hyperthyroidism. The addition of the bone scan to the diagnostic work up of patients with Graves disease is a sensitive indicator for metabolic bone changes and could help in the future management and follow up for this group of patients.

Topics: Adult; Bone Diseases, Metabolic; Female; Humans; Hyperthyroidism; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate

Topics: Arthralgia; Bone Diseases, Metabolic; Bone Neoplasms; Diagnosis, Differential; Erdheim-Chester Disease; Female; Hip Joint; Humans; Middle Aged; Muscle Neoplasms; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The authors report a case of methotrexate osteopathy as revealed by Tc-99m HDP bone scintigraphy in a patient with rheumatoid arthritis. Methotrexate is used widely in high doses as a chemotherapeutic agent. Lower doses are given in rheumatoid and psoriatric arthritis. Methotrexate affects bone metabolism, resulting in methotrexate osteopathy, characterized by osteoporosis, osseus pain, and even spontaneous (micro)fractures. Radiographic visualization of microfractures is difficult. Tc-99m HDP bone scans have been shown to be very sensitive in the visualization of changes in bone metabolism as a result of methotrexate osteopathy.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Bone Diseases, Metabolic; Humans; Male; Methotrexate; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

The purpose of this study was to estimate clinical validity of a new available immunoradiometric assay for circulating intact human BGP (N-tact Osteo SP) by measuring this protein in a large number of normal subjects and patients with the most common metabolic bone diseases. One hundred normal subjects were studied in order to obtain our normal ranges (4.9 +/- 1.7 ng/ml). The mean values found in 28 patients with primary hyperparathyroidism (17.5 +/- 22.8 ng/ml, P < 0.001), 15 glucocorticoid-treated patients (1.9 +/- 1.5, P < 0. 001), 10 patients with hypoparathyroidism (1.5 +/- 0.7, P < 0.001), 9 with hyperthyroidism (8.3 +/- 3.8, P < 0.001), 8 with skeletal metastases (7.2 +/- 2.3, P < 0.001), and 4 with humoral hypercalcemia of malignancy (2.42 +/- 1.91, P < 0.005) were significantly different from mean values found in normal subjects. Mean decrease of serum osteocalcin T-score values was significantly greater when evaluated by N-tact Osteo SP assay in 15 steroid-treated patients (-1.4 +/- 1.0) and 19 primary hyperparathyroid (PHPT) patients (3.6 +/- 1.9), compared with the mean values obtained with the Elsa-Osteo assay (-0.67 +/- 1.2, P < 0. 002 and 4.3 +/- 2.8, P < 0.04, respectively). We found significant correlations between the global skeletal uptake of 99mTc-methylendiphosphonate and serum BGP levels assayed by both N-tact Osteo SP (P < 0.01) and Elsa-Ost-Nat assay (P < 0.05). Our results indicate that this new immunoradiometric assay for the intact human osteocalcin has the potential for good discrimination between normal subjects and patients with both low and high bone turnover. Furthermore, our findings emphasize the fact that, in the absence of available standardized commercial assays, one should rely on only one assay because different results are obtained by different assays under different clinical conditions.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Evaluation Studies as Topic; Female; Humans; Immunoradiometric Assay; Male; Middle Aged; Osteocalcin; Postmenopause; Premenopause; Radionuclide Imaging; Reference Values; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Bone Diseases, Metabolic; Female; Graves Disease; Humans; Hyperthyroidism; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Gland

Parathyroid carcinoma is a rare cause of hyperparathyroidism and metabolic osteopathy. The authors report a patient with parathyroid carcinoma who underwent 99mTc-Sestamibi parathyroid and 99mTc-MDP bone scanning. These techniques showed the parathyroid lesion and typical features of severe metabolic osteopathy respectively. The bone scan performed at only four months after surgery showed near complete resolution.

Topics: Bone and Bones; Bone Diseases, Metabolic; Carcinoma; Contrast Media; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Time Factors

To investigate the incidence rate, pathologic changes, mechanisms and diagnostic methods in renal bone disease.. The blood levels of carboxyterminal parpthyriod hormone (C-PTH), 1,25(OH)2D3, calcium and phosphate, aluminum in serum and bone tissue were measured. The bone biopsy and bone scan with 99m technetium methylene diphosphonate (99mTC-MDP) were performed in 51 uremic patients.. One hundred per cent of the patients had varying degree of pathologic changes in bone, in which 50.9% of the patients presented high-turnover bone disease, 7.8% of the patients presented low-turnover bone disease and 41.8% of the patients had mixed-type bone disease. The levels of serum C-PTH were predominently high in high-turnover bone disease while the levels of serum 1,25(OH)2D3 were significantly decreased in low-turnover bone disease. There was a high positive rate for the diagnosis of renal bone disease by bone scan with 99mTC-MDP.. The examination of bone pathology is the most valuable method for the diagnosis of renal bone disease. Bone scan with 99mTC-MDP has reference value when clinical conditions do not allow to make bone biopsy.

Topics: Adult; Aged; Biopsy; Bone Diseases, Metabolic; Female; Glomerulonephritis; Humans; Ilium; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Uremia

Up to now there has been no routinely used and easy-to-perform method for the quantification of bone uptake. Therefore, we have evaluated the clinical practicability of a new and simple method for the measurement of bone uptake based upon conventional three-phase bone scanning. In 13 patients with normal bone scans, whole-body scintigrams were obtained at 3 min and 1, 2, 3, 4, 5, 6 and 24 h after injection of 600 MBq technetium-99m hydroxymethylene diphosphonate (HMDP). Using a conventional region of interest technique, fitted time-activity curves of soft tissue and urinary excretion were established, and bone uptake was calculated from these data as the total whole-body activity minus both soft tissue activity and urinary excretion. Subsequently, the new method was tested in routine patient management: 32 healthy patients and five patients with different types of metabolic bone disease were investigated, measurements being performed only at 3 min and 3-4 h p. i. during conventional three-phase bone scanning. In the multi-imaged patient subset, soft tissue activity decreased exponentially, reaching a plateau after 6 h with a residual activity of about 14% of initial total whole-body activity. Bone uptake reached quite a stable plateau of about 27% as early as 3 h p.i., with no significant changes up to 24 h. Healthy patients of the two-scan group showed no differences in bone uptake (mean uptake values were 24.1% in women and 26.9% in men), whereas in patients with metabolic bone disease bone uptake was significantly higher, with a mean of 48% (P <0.05). Thus, the results of this method are in good agreement with the findings of standard 24-h whole-body retention measurements. The new method, however, is easy to perform, allows assessment of pure bone uptake instead of whole-body retention, and permits calculation of bone uptake by only two measurements during routine three-phase bone scanning.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Case-Control Studies; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution

A 59-yr-old man with chronic renal failure was admitted for evaluation of generalized skeletal pain and frontal bone mass, which was lytic on radiography. Bone scintigraphy demonstrated several foci of moderately increased uptake, without involvement of the skull mass. Radiographs of these lesions were compatible with brown tumors. Serum parathormone level was elevated and CT demonstrated a lower right cervical mass, consistent with parathyroid tumor. Following the removal of the mass and decrease in parathormone levels, the patient suffered from a prolonged period of hypocalcemia and his bone pain worsened. Repeat bone scintigraphy showed an increase in the number and intensity of the areas of focal uptake, consistent with hungry bone syndrome. This flare-up phenomenon is due to an increase in bone metabolism and is an uncommon finding following parathyroidectomy for primary hyperparathyroidism.

Topics: Bone and Bones; Bone Diseases, Metabolic; Carcinoma; Humans; Hyperparathyroidism; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Technetium Tc 99m Medronate

The 24-h whole-body retention (24-h WBR) of 47Ca-chloride and 99mTc-MDP was measured in four rat models over a 6-week period at 2 week intervals. Fine detail bone radiographs of the femurs and histologic bone specimens were also obtained simultaneously. In the osteomalacic (M) and steroid-induced osteoporotic (S) groups the 24-h WBR values of 47Ca were significantly lower, and in the osteoporotic (P) group were higher than in the control (C) group from the second week. The 24-h WBR values of 99mTc-MDP were significantly higher in the M group and were lower in the S group from the second week. Simultaneous measurements of 24-h WBR of these two radiopharmaceuticals facilitated the early differentiation of metabolic bone diseases in the animal models prior to the detection of radiologic bone changes.

Topics: Animals; Autoradiography; Bone and Bones; Bone Diseases, Metabolic; Calcium Chloride; Calcium Radioisotopes; Disease Models, Animal; Male; Radiography; Rats; Rats, Wistar; Scintillation Counting; Technetium Tc 99m Medronate

The authors describe the radiographic-scintigraphic features of an unusual craniotubular dysplasia characterized by diffuse osteopenia with bone expansion and a "ground glass" appearance, markedly increased skeletal turnover, myelofibrosis, hypophosphatemia, and pigmented "coast-of-Maine" patches. This syndrome, termed panostotic fibrous dysplasia, is distinct from previously reported disorders.

Topics: Adolescent; Bone Diseases, Metabolic; Fibrous Dysplasia of Bone; Humans; Male; Phosphates; Primary Myelofibrosis; Radiography; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate

The multiphase bone scan features of melorheostosis are presented. Early increased tracer delivery demonstrated by blood pool imaging supports the concept of ongoing accelerated bony metabolism as a cause of tracer uptake within the osteosclerotic lesions of melorheostosis. There is excellent correlation between the scintigraphic and radiographic distribution of these lesions.

Topics: Adult; Bone Diseases, Metabolic; Female; Femur; Humans; Melorheostosis; Patella; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

To investigate osteodystrophy in liver cirrhosis, 99Tcm MDP (methylene diphosphonate) bone scintigraphy was performed on 36 patients with liver cirrhosis. Abnormal lesions were detected in 17 out of 36 scans (47.2%). On the other hand, areas of increased uptake were uncommon in patients with chronic active hepatitis (1/11 cases). Plasma vitamin D3 fractions [25(OH)D3, 24.25(OH)2D3 and 1.25(OH)2D3] were decreased. Statistically significant depletion of 1.25(OH)2D3 was observed in cases with positive bone scintigraphy. 1 alpha(OH)D3 (1-2 micrograms/day) was administered for 6 months to nine patients having abnormal bone scans. Six of them showed improvement without any apparent side-effects. We conclude that hepatic cirrhotic osteodystrophy can be diagnosed positively by 99Tcm MDP bone scintigraphy and can be treated accordingly.

Topics: Adult; Aged; Aged, 80 and over; Bone Diseases, Metabolic; Cholecalciferol; Evaluation Studies as Topic; Female; Hepatitis, Chronic; Humans; Hydroxycholecalciferols; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Ribs; Spine; Technetium Tc 99m Medronate

Topics: Bone Diseases, Metabolic; Humans; Hypercalcemia; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The usefulness of radionuclide techniques for early differential diagnosis of metabolic bone disease has been controversial. We tried to develop a new method to distinguish alterations in bone metabolism prior to radiologic changes, measuring 24-hr whole-body retention (WBR) and femoral uptake of two radiopharmaceuticals (47Ca-chloride, 99mTc-MDP). Control normal (C), osteoporosis (P) osteomalacia (M) and steroid-induced osteoporosis (S) were produced in 60 eight-week old Wistar male rats by means of dietary manipulation and steroid administration. Fine detail radiographs of the femurs and bone specimens were obtained over six weeks at two week intervals. Good correlation between WBR and femoral uptake of 47Ca was noted (r = 0.86, p less than 0.01). WBR ratios of 47Ca were significantly higher in the M and S groups and were lower in the P group when compared to the C group throughout the study. WBR ratios of 99mTc-MDP were significantly higher in the M group and were lower in the S group from the 2nd week. Fine detail radiographs analysis by microdensitometry revealed significant osteopenia in the S, M and P groups from the 4th week. The dual tracer method was found to distinguish alterations in bone metabolism in the groups examined prior to detectable radiologic changes.

Topics: Animals; Bone and Bones; Bone Diseases, Metabolic; Calcium Chloride; Calcium Radioisotopes; Diagnosis, Differential; Male; Methods; Radiography; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium Tc 99m Medronate

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Diseases, Metabolic; Cholecalciferol; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Vitamin D Deficiency

The bisphosphonate whole body retention test (WBR) has been used to estimate bone mineralization rate (bone turnover). Bisphosphonates given i.v. are taken up by bone or excreted in urine. The aim of the present investigation was to test the efficacy of WBR in estimating bone mineralization rate (m) and to evaluate the influence of renal function (Clcr) and bone mass (forearm bone mineral content; BMC) on WBR. The 24-h retention of 3.7 MBq 99mTc-HMBP (1-hydroxymethylene-1,1-bisphosphonate) (Osteoscan) given i.v. was measured by a medium sensitive whole body counter in thirty-one patients with hyperparathyroidism (n = 14), hyperthyroidism (n = 8) or hypothyroidism (n = 9) (group 1) and in seventy-six females with postmenopausal spinal crush fracture osteoporosis (group 2). In the same individuals m was calculated from a 7-day 47Ca-kinetic study using the expanding calcium pool model. Multiple regression analysis of WBR vs. m and Clcr in group 1 disclosed that WBR correlated positively to m [rp = 0.49, P less than 0.01 (rp = partial correlation coefficient)] and inversely to Clcr (rp = -0.44, P less than 0.02). Inclusion of BMC in the analysis did not reveal any significant partial correlation between WBR and BMC (rp = -0.33, 0.05 less than P less than 0.10). In group 2 WBR correlated inversely to Clcr (rp = -0.48, P less than 0.001) but showed no significant relation to m (rp = 0.10, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Female; Humans; Kidney; Male; Middle Aged; Minerals; Osteoporosis; Regression Analysis; Technetium Tc 99m Medronate

Mature and old B6AF1 and B6D2F1 mice were given acidified tap water or promethazine HCl (a phenothiazine with H1 receptor blocking activity), chlorpheniramine (an H1 blocker) or trifluoperazine (a phenothiazine with no H1 blocking activity) in their drinking water, and the effects of these agents on bone mineral content were assessed by intermittently measuring the 24-h whole body retention of Tc 99m methylene diphosphonate (Tc 99m MDP, an indicator of bone metabolism) and at the end of the studies by determining ash weights of femur, ilium and sacrum. It was found that 24-h retention of Tc 99m MDP was elevated in old mice as it is in old osteopenic humans, that promethazine but not chlorpheniramine or trifluoperazine inhibited bone loss in aging mice, and that there was a correlation between decrease in retention of Tc 99m MDP and decreased bone loss. These preliminary results suggest that the ability of promethazine to inhibit age-related bone loss may not be mediated through its action as an H1 blocker or as a phenothiazine. However, more agents of each type need to be tested before this point can be established.

Topics: Age Factors; Animals; Bone Diseases, Metabolic; Bone Resorption; Chlorpheniramine; Female; Histamine H1 Antagonists; Male; Mice; Mice, Inbred Strains; Promethazine; Radionuclide Imaging; Technetium Tc 99m Medronate; Trifluoperazine

Topics: Acromegaly; Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Connective Tissue; Female; Femur; Humans; Hyperthyroidism; Kidney Diseases; Male; Middle Aged; Radionuclide Imaging; Renal Dialysis; Skull; Technetium Tc 99m Medronate

A simple method of quantifying skeletal uptake of 99Tcm-methylene diphosphonate, using a rectilinear scanner and a simultaneously image standard, is described. The pattern of quantified uptake in ten regions of the skeleton, the sacro-iliac joints and kidneys in 57 controls and 54 patients with various metabolic bone disease is presented. This method distinguishes patients with primary hyperparathyroidism and osteomalacia from controls with a sensitivity adequate for clinical purposes. In primary hyperparathyroidism the increased skull uptake of tracer correlated well with levels of serum alkaline phosphatase, plasma parathyroid hormone, urinary hydroxyproline excretion and the degree of intracortical resorption in the metacarpal bones. The skull uptake in oestoporosis was normal or moderately elevated and correlated well with bone mass density measurements of the radius. Patients with osteomalacia also showed the greatest increase in tracer uptake in the skull. Patients with thyrotoxicosis differed from most other patients by showing moderately increased uptake in shafts of long bones. We propose our method of quantitative bone uptake as a useful noninvasive test to detect metabolic bone disease and to monitor responses to therapy of bone disease.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Diphosphonates; Female; Humans; Hyperparathyroidism; Hyperthyroidism; Male; Middle Aged; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A method is described for the quantitation of total skeletal activity during bone scans. The method requires a single plasma sample only, taken at the time of imaging. The ratio of % injected dose of 51Cr EDTA to that of 99Tcm MDP is calculated from this sample following combined injection of the two radiopharmaceuticals. The 51Cr EDTA level corrects for the glomerular filtration of 99Tcm MDP. Using this method, which only requires a gamma counter, significant differences from normal controls have been shown in patients with osteomalacia, renal osteodystrophy, Paget's disease and hypercalcaemia. The method provides routine quantitative data to add to the imaging information in the bone scan.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Chromium Radioisotopes; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Edetic Acid; Humans; Hypercalcemia; Metabolic Clearance Rate; Middle Aged; Osteitis Deformans; Osteomalacia; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Calcium Radioisotopes; Diphosphonates; Female; Fluorine; Half-Life; Humans; Male; Middle Aged; Radioisotopes; Radionuclide Imaging; Regional Blood Flow; Technetium; Technetium Tc 99m Medronate; Time Factors

The presence of the "hot patella" sign was evaluated in a prospective study of 200 consecutive bone scans, and in a review of scans from 148 patients with various metabolic bone disorders and 61 patients with lung carcinoma. The incidence was found to be 31%, 26% and 31% respectively. This sign is an extremely common scan finding and may be seen in association with a wide variety of disorders. It is concluded that this sign cannot be considered to be of diagnostic value.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Carcinoma, Bronchogenic; Diphosphonates; Humans; Lung Neoplasms; Middle Aged; Patella; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Plasma clearance and osseous accumulation rates of 99mTc methylene diphosphonate (MDP) in the lumbar spine were measured in 11 patients with osteoporosis (OP), 7 patients with hyperparathyroidism (HPT), 4 patients with osteomalacia (OM) and in 3 patients (N) who were studied to exclude metabolic bone disease. The findings in 19 patients were compared with the results of 47Ca kinetics. The plasma elimination of 99mTc-MDP during the first hour after application was normal in almost all the patients. The 99mTc-MDP accumulation rates in the lumbar spine were raised in patients with HPT and OM (p less than or equal to 0.01) and normal in patients with OP and N (p greater than 0.05). 47Ca kinetics were disturbed in most of the patients with metabolic bone disease, with minimal deviations in OP. The comparison of 99mTc-MDP accumulation rates with the results of 47Ca kinetics revealed significant correlations with exchangeable bone and soft tissue calcium. The correlations with total calcium turnover and calcium accretion were poor. Only half of the patients had equal results of 99mTc-MDP accumulation rates and bone calcium accretion rates. It is concluded that the 99mTc-MDP uptake by bone is an index of bone metabolism presumably of the organic matrix, whereas 47Ca kinetics represent the mineral metabolism of bone.

Topics: Adult; Aged; Bone Diseases, Metabolic; Calcium Radioisotopes; Diphosphonates; Female; Humans; Kinetics; Male; Middle Aged; Technetium; Technetium Tc 99m Medronate

The bone scan may be of value in the assessment of patients with metabolic bone disease. However the superiority of the bone scan when compared to radiology in conditions such as renal osteodystrophy, osteomalacia, primary hyperparathyroidism, and osteoporosis requires substantiation with the newer radiopharmaceuticals which have a higher affinity for bone. Two methods of quantitating skeletal uptake of tracer have been assessed to try to remove the subjective aspect of bone scan evaluation. Measurements of bone to soft tissue ratios have proved clinically disappointing, but 24 hour whole body retention of diphosphonate appears to provide a sensitive index of increased bone turnover.

Topics: Bone and Bones; Bone Diseases, Metabolic; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Etidronic Acid; Humans; Hyperthyroidism; Organotechnetium Compounds; Osteomalacia; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate