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

Recognizing the different mechanisms and imaging appearance of extraskeletal Tc-99m methylene diphosphonate uptake enhances the diagnostic value of bone scan interpretation. In this article, we present a pictorial review of the different mechanisms of extraskeletal Tc-99m methylene diphosphonate uptake on bone scintigraphy including neoplastic, inflammatory, ischemic, traumatic, excretory, and iatrogenic. We also illustrate through case examples the added value of correlation with cross-sectional and single photon emission computed tomography and computed tomography imaging in localizing and characterizing challenging cases of extraskeletal uptake.

Topics: Bone Diseases; Humans; Multimodal Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

This article provides a brief overview of the current state of hybrid single-photon emission computed tomography/computer tomography (SPECT/CT) imaging in musculoskeletal infections. SPECT/CT imaging, compared with conventional planar study and SPECT alone, provides improved anatomic localization of infection and more accurate delineation of the extent of infection. This article emphasizes three clinical aspects where SPECT/CT is found to be most useful: differentiating between soft tissue and bone infections, assessing suspected infected sites with underlying structural bone alterations, and defining infective focus when complex anatomy is involved. The accurate assessment of site of infection is vital for selecting the most appropriate therapeutic strategy. Other advantages of SPECT/CT imaging such as reducing the inconvenience of combination planar studies, providing additional CT information, and increasing interobserver agreement are also discussed.

Topics: Bone Diseases; Child; Foot Diseases; Gallium Radioisotopes; Humans; Indium Radioisotopes; Infections; Musculoskeletal Diseases; Postoperative Complications; Soft Tissue Infections; Spinal Diseases; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Wounds and Injuries

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

Topics: Adult; Animals; Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biopsy; Bone Diseases; Humans; Knee Joint; Menisci, Tibial; Middle Aged; Osteoarthritis; Patella; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate; Tibial Meniscus Injuries

Dynamic bone imaging differs from routine multiphase bone scintigraphy by the use of time-activity curves (TACs) and quantitation of data. TACs were divided into an arterial plus blood pool phase (first 60 s at 1 frame/s) and a subsequent early bone uptake phase (24 min at 1 frame/min). Ratios of normalized integrals, from analogous regions were calculated to determine whether blood flow was abnormal. A key feature of the technique is the monitoring of the flow proximally and distally to the area of involvement. This was of importance in distinguishing between two diseases producing the same degree of local hyperemia. Dynamic bone imaging was applied to the differential diagnosis of arthritis, septic arthritis, cellulitis, osteomyelitis, tumor, avascular necrosis, Charcot joint, Legg-Perthes (LP) disease, and Osteochondritis Dissecans (OCD). Although the method is straightforward, there are technical and clinical factors that may affect interpretation of data. Asymmetries in flow may arise due to injection technique, interfering activity of bladder and/or bowel, vascular abnormalities, AV malformation, and venous backflow. The dynamic study is also sensitive to the effects of various modes of therapy. Consideration must be given to these technical and clinical factors for the avoidance of pitfalls in interpretation of the dynamic study.

Topics: Arthritis; Arthritis, Infectious; Arthropathy, Neurogenic; Bone and Bones; Bone Diseases; Bone Neoplasms; Cellulitis; Diagnosis, Differential; Humans; Legg-Calve-Perthes Disease; Osteochondritis Dissecans; Osteomyelitis; Osteonecrosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Two cases of Erdheim-Chester disease are presented: a 26-year-old white male patient with lipoidgranulomatosis of numerous long and flat bones and infiltration of pericardium, pleura, liver, spleen, thyroid, skin, conjunctiva, gingiva, and false vocal cord; and a 54-year-old white male with involvement of bones, orbits, brain, pericardium, and retroperitoneum. The scintigraphic findings in this disease are described, and a comprehensive review of the 27 previously reported cases is given including an assessment of the value of scintigraphy for diagnosis and follow up of this rare disease.

Topics: Adult; Bone Diseases; Cholesterol; Follow-Up Studies; Granuloma; Humans; Lipidoses; Male; Middle Aged; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Reported here is a theoretical model based on a literature review correlating the 60 sec/25 min time activity curves (TAC) of dynamic bone imaging with the histologic components of bone. Information regarding healing versus nonhealing as well as a histophysiologic description of ongoing disease is obtainable from TACs of paired disease and nondiseased limbs. The TACs reflect the movement of Tc-99m MDP complexes across histologic compartments to reach the amorphous calcium phosphate (ACP) regions. These complexes must exit the bone capillaries, pass through the perivascular space, cross the osteoblastic barrier, enter the bone fluid space, and traverse collagen osteoid to reach ACP. The presence of diseases such as osteomyelitis, cellulitis, and degenerative arthritis and septic arthritis variously affect these spaces to cause typical perturbations in the TACs. The distinction of these patterns were observed in 48 patients, 12 per category. The model that explains how 60 sec/25 min TACs can reflect the histologic status of ongoing bone disease was applied to these disorders.

Topics: Bone and Bones; Bone Diseases; Humans; Models, Biological; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Single photon emission computed tomography (SPECT) is a valuable addition to bone scintigraphy. SPECT removes from the diagnostic image unwanted activity which originates from in front and behind the tomographic plane of medical interest. This tomographic procedure allows one to examine with greater contrast and anatomic clarity such structures as the spine, hips, knees, and temporomandibular joints (TMJ). Abnormalities also seen on planar bone scintigrams often are more convincingly identified and better localized by SPECT. SPECT may even detect skeletal abnormalities not evident on planar views. These advantages of SPECT must be weighed against the superior resolution of planar bone scintigraphy. For this reason, SPECT complements, but does not replace planar bone scintigraphy. Including SPECT as an additional component of the skeletal examination does not place excessive demands on either gamma camera use or technologist time. Those nuclear medicine facilities offering bone SPECT for the evaluation of back, hip, knee, and TMJ pain should anticipate a larger volume of patient referrals.

Topics: Bone and Bones; Bone Diseases; Humans; Joint Diseases; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, Emission-Computed

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

Over the past 5 years, we have encountered 6 cases of diffuse pulmonary uptake of 99m-Tc bone-scanning agents (incidence, 0.04%). To assess the significance of this phenomenon, we reviewed all of the cases reported since 1974 (Including our series, a total of 32 cases). Three groups can be discerned, the first consisting of 24 patients without radiological calcifications in the lungs and with hypercalcemia of different origins (mostly hyperparathyroidism). Of the eight autopsies performed in this group, seven revealed extensive calcifications in alveolar walls and lung vessels; the other autopsy showed no calcification at all and only bronchopneumonic lesions. The second group consists of 6 patients in chronic dialysis. The last group consists of 2 patients having diffuse pulmonary alveolar microlithiasis with extensive radiologic calcifications. The mechanism of lung uptake of 99m-Tc bone-imaging agents is probably the same as that of bone uptake (chemisorption on hydroxyapatite crystals), although other uptake mechanisms have also been discussed. Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray.

Topics: Adenoma; Adult; Aged; Bone Diseases; Calcinosis; Female; Humans; Hypercalcemia; Lung Diseases; Male; Middle Aged; Multiple Myeloma; Parathyroid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Vitamin D

To investigate the role of quantitative three phase bone scintigraphy (QTPBS) in the evaluation of efficacy of intravenous regional blockade treatment in patients having reflex sympathetic dystrophy (RSD) of the upper extremity.. Twenty-six patients with stage-I RSD were focused on in this study. Patients were treated with physical therapy and intravenous (I.V.) regional blockade therapy consisting of dexamethasone and lidocaine. All patients were clinically evaluated before and 1 month after the completion of the therapy protocol. QTPBS was applied to patients before therapy and 1 month after the therapy. As a control group, 11 healthy subjects also underwent QTPBS. Perfusion, hyperemic and fixation indices were calculated from three-phase bone scintigraphy.. All patients showed statistically significant clinical improvement after the therapy (p < 0.01). Pre-treatment, perfusion (1.67 +/- 0.63), hyperemic (1.44 +/- 0.48) and fixation (1.69 +/- 0.48) indices of patients were higher than those of healthy subjects (PI: 0.95 +/- 0.05, HI: 0.94 +/- 0.06, FI: 1.01 +/- 0.2) (p < 0.01) and all indices significantly decreased after the treatment (PI: 1.33 +/- 0.46, HI: 1.18 +/- 0.23, FI: 1.42 +/- 0.26) (p < 0.01).. I.V. regional blockade therapy combined with corticosteroids is a simple, safe and effective method for the treatment of patients with stage-I RSD in the upper extremity. QTPBS is a valuable and objective method to evaluate the response to therapy and may be useful for staging of patients and predicting the response to therapy.

Topics: Adult; Anesthesia, Conduction; Bone Diseases; Dexamethasone; Drug Combinations; Female; Humans; Injections, Intravenous; Lidocaine; Male; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reflex Sympathetic Dystrophy; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Technetium Tc 99m Medronate; Treatment Outcome

99Tcm-citrate has been shown to incorporate irreversibly in the skeleton with a biodistribution different to that on a conventional bone scan. The aims of this study were to confirm the bone-imaging properties of 99Tcm-citrate, to identify the variabilities influencing its skeletal uptake, to compare its uptake in bone with that of 99Tcm-MDP and to assess its possible role in bone scintigraphy. Appropriate animal and human studies (n = 45) were conducted. The 3 h lesion-to-bone ratio of 99Tcm-citrate was compared with that of 99Tcm-MDP in more than 150 lesions, including osteoblastic sites (Group A), lesions undergoing treatment or healing (Group B), and degenerative or old healed lesions (Group C). The uptake ratio was classified as concordant (< 20% variation), mildly discordant (20-50% variation) or significantly discordant (> 50% variation). Animal experiments showed most bone uptake of 99Tcm-citrate when prepared at a pH of 6.0-6.5. The two radiopharmaceuticals appeared to compete for bone uptake, suggesting related but different sites of bone accumulation. The 99Tcm-citrate/99Tcm-MDP uptake ratio in Group A was concordant (mean +/- S.D. = 0.92 +/- 0.15), while Group C lesions had a significantly lower 99Tcm-citrate/99Tcm-MDP uptake ratio (0.34 +/- 0.24, P < 0.01). A comparison of Group B lesions showed wide variation in intensity and area of involvement in many lesions (uptake ratio < 0.5 or > 1.5 in 13 of 30 sites). We conclude that 99Tcm-citrate has a different site of bone localization than phosphonates, possibly in the organic matrix. Although its skeletal uptake is lower than that of 99Tcm-MDP, it may have better specificity in differentiating osteoblastic from degenerated or healed bony lesions, and therefore be useful in predicting healing of bone secondaries, fractures or osteomyelitic lesions.

Topics: Adult; Bone and Bones; Bone Diseases; Bone Neoplasms; Citrates; Drug Stability; Female; Humans; Hydrogen-Ion Concentration; Male; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Compounds; Technetium Tc 99m Medronate; Tin Compounds; Tissue Distribution

Seventy-seven adult patients with suspected skeletal metastases were divided into two groups. In group A (n = 30), following intravenous administration of 20 mCi (740 MBq) of technetium-99m methylene diphosphonate (99mTc-MDP), 3- and 24-h scintigraphy of bone lesions was performed. The 24/3 h lesion to bone background radiouptake ratio (RUR) was calculated for each lesion. In group B (n = 47), the same procedure was followed with dexamethasone intervention (10 mg in 24 h) following the 3-h acquisition. In group A, after determination of the critical point, malignant and degenerative bone lesions could be separated with a sensitivity, specificity and accuracy of 0.76, 0.72 and 0.73, respectively. The mean RUR of the malignant lesions was 1.20 +/- 0.23, and that of the benign lesions, 0.95 +/- 0.15. In group B cases, significantly increased sensitivity, specificity and accuracy of 0.87, 0.94 and 0.92, respectively, were found (P < 0.001). The mean RUR of the malignant lesions was 1.48 +/- 0.34, and that of degenerative lesions, 0.88 +/- 0.19. Dexamethasone interventional bone scintigraphy seems to be a new cost-effective method for differentiating malignant from degenerative bone lesions using the RUR.

Topics: Bone and Bones; Bone Diseases; Bone Neoplasms; Dexamethasone; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

Tc-99m Methylene Diphosphonate (MDP) bone scintigraphy has been used for the assessment of benign as well as malignant skeletal conditions. Non-osseous radiotracer uptake on bone scan is an unusual finding. It is usually performed for metastatic bone disease, and is generally not an indication in multiple myeloma, as osteolytic lesions typically show no radiotracer uptake. Despite this, substantial number of multiple myeloma patients undergo bone scintigraphy due to their presentation imitating a metastatic bone disease. We describe a case of multiple myeloma, where extra osseous uptake in lung and diffuse hepatic, has been noted on bone scan.

Topics: Bone and Bones; Bone Diseases; Humans; Multiple Myeloma; Radiopharmaceuticals; Technetium Tc 99m Medronate

Management of osteochondral lesions of talus (OLT) remains controversial. 99Tc-MDP, a decay product of 99mTc-MDP which is widely used for bone scan, is effective in the clinical treatment of rheumatoid arthritis. The purpose of the study is to investigate the effects of 99Tc-MDP treatment on OLT.. In the clinical evaluation, 66 patients with a total of 83 lesions of OLT who failed appropriate non-operative treatment and surgery were retrospectively included and treated with intravenous injection of 99Tc-MDP and Chinese herbal fumigation (CHF). The effects of 99Tc-MDP and CHF on OLT were evaluated by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), Visual Analog Scale (VAS), activities of daily living (Barthel Index), and MRI, 99mTc-MDP SPECT/CT and CT. Radiographic changes were also assessed by the transverse long diameter of the cyst on CT.. At the last follow-up, AOFAS, VAS and Barthel Index improved significantly from 68.66±9.76, 3.05±0.34 and 85±8.31 to 85.4±8.31, 1.85±0.36 and 94.7±4.99 (P<0.01), respectively after one course treatment in 66 patients with OLT. Thirty one (31/66) patients had a second treatment course. Their AOFAS, VAS and Barthel Index also improved significantly after the mean follow-up of 7±2 (6-15) months. And the average diameter of the cysts decreased from 8.01±3.35 mm to 4.74±2.83 mm (P<0.01) in the 31 patients.. The retrospective study indicates that a combination treatment of 99Tc-MDP and CHF is effective in pain relief and return of function in a short term of follow-up for patients with OLT. Our results suggest that the small cystic lesions with increased uptake of 99mTc-MDP on SPECT/CT can be well treated by 99Tc-MDP and CHF. This novel technique holds the potential to emerge as an effective conservative treatment for OLT without adverse effects. The level of evidence for 99Tc-MDP is medium for the number of patients and retrospective study.

Topics: Adult; Aged; Bone Diseases; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Treatment Outcome; Young Adult

Osteotoxic effect is a common adverse effect of chemotherapy for childhood acute lymphoblastic leukemia. The pathophysiology of impaired bone growth is multifactorial and can affect both osteoblast and osteoclast function. Significant contribution in affecting skeletal metabolism belongs to high-dose corticosteroid treatment. We present the case of a 12-year-old adolescent girl who was treated for high-risk pro-B acute lymphoblastic leukemia. The Tc-MDP bone scan, as a sensitive indicator of osteoblastic activity, shows that growth plate inhibition after intensive treatment may be temporary and reversible.

Topics: Adolescent; Adrenal Cortex Hormones; Antineoplastic Agents; Bone Diseases; Female; Growth Plate; Humans; Magnetic Resonance Imaging; Positron Emission Tomography Computed Tomography; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Diseases; Bone Neoplasms; Humans; Radioisotopes; Technetium Tc 99m Medronate

Extraosseous radioactivity outside of the expected biodistribution is often encountered on (99m)Tc-methylene diphosphate (MDP) bone scintigraphy, and proper interpretation requires an understanding of the mechanisms underlying this uptake and knowledge of the possible causes, depending on the site or structure involved.. We present examples of extraosseous radiotracer uptake seen on (99m)Tc-MDP bone scans in which either SPECT with integrated CT or correlative imaging improved the study's interpretation.

Topics: Artifacts; Bone Diseases; Humans; Multimodal Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The usefulness of whole-body blood pool imaging as part of Tc-99m methylene diphosphonate (MDP) skeletal scintigraphy in detection of marrow infiltrative processes and unexpected soft-tissue and visceral abnormalities is demonstrated via illustrative case examples. Technical aspects of this simple and fast scanning technique are also highlighted.

Topics: Adolescent; Bone and Bones; Bone Diseases; Child; Child, Preschool; Female; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Bone Diseases; Granulomatosis with Polyangiitis; Humans; Male; Middle Aged; Nail Diseases; Nails; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The purpose of this study was to determine the diagnostic yield and clinical importance of delayed whole-body bone scintigraphy in directed three-phase examinations.. The records of 400 consecutively registered patients who underwent combined three-phase and delayed whole-body (99m)Tc-methylene diphosphonate bone scintigraphy for a variety of indications were reviewed. Clinical indications, findings, recommendations, and outcome were assessed.. Three-phase bone scintigraphy was performed on 156 men and boys and 244 women and girls (61%). Fifty-two patients (13%) were 17 years old or younger, and 236 patients (59%) were older than 40 years. The mean increase in study duration due to whole-body imaging was 25 minutes (range, 21-31 minutes). Excluding the three-phase area of interest, the whole-body examination had a normal tracer distribution in 131 examinations (33%), showed solely degenerative changes in 103 (26%), and showed findings unrelated to the area of interest in 166 patients (41%). In no case did the findings outside the area of interest alter the diagnosis or diagnostic certainty in the three-phase study, but those findings did generate 82 recommendations for additional diagnostic investigation. As a direct result of the recommendations, clinicians requested 18 radiographic, two CT, one MRI, and one ultrasound examinations, one additional bone scan, and two referrals to a consultant. Recommendations based on findings outside the three-phase area of interest affected treatment in one case: Temporomandibular joint uptake resulted in a referral for physical therapy.. For most indications, delayed whole-body imaging after directed three-phase bone scintigraphy does not improve diagnostic yield, does not alter patient care, and may be an unnecessary use of medical resources.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Cost-Benefit Analysis; Female; Humans; Incidental Findings; Infant; Male; Middle Aged; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Whole Body Imaging; Young Adult

Topics: Adult; Bone Diseases; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Waldenstrom Macroglobulinemia

In approximately 80-85% of patients with chronic nonspecific low back pain (NSLBP), a precise pathoanatomical diagnosis cannot be identified. Mechanisms of bone nociception may contribute to NSLBP.. To determine whether findings on bone scans, which provide a pathophysiological picture of functional activity, are associated with self-reports of NSLBP intensity.. A cross-sectional study of the relationship of self-reported chronic NSLBP intensity to the uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area.. Patients referred for bone scans who were at least 18 years old.. Subject reports of pain intensity and intensity of uptake of radiolabeled technetium-99m-methylene diphosphonate in the lumbosacral area.. Among subjects who were 65 years or younger, the age-adjusted worst pain intensity accounted for 45% of the variability in the amount of tracer uptake (r = 0.67, P = 0.0006). The association was not significant for those older than 65 years.. Further studies should be conducted on possible mechanisms relating bone nociception to chronic NSLBP in individuals who are 65 years or younger.

Topics: Adolescent; Adult; Bone Diseases; Child; Female; Humans; Low Back Pain; Male; Patient Selection; Radiography; Radiopharmaceuticals; Surveys and Questionnaires; Technetium Tc 99m Medronate

Topics: Adult; Bone Diseases; Female; Fever of Unknown Origin; Humans; Lung Abscess; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate; Thorax

A bone island represents a focus of mature compact bone within the cancellous bone, and it can be diagnosed based on characteristic clinical and radiologic features. The lesion is typically asymptomatic with a preference for the pelvis, femur, and other long bones. On radiographs, the lesion appears as an ovoid, round or oblong homogeneously dense and sclerotic focus in the cancellous bone. The characteristic features of this lesion are radiating bony streaks, known as thorny radiations or pseudopodia. Most bone islands are small, and the majority of these lesions measure from 0.1 to 2.0 cm. A giant bone island, defined as having a diameter greater than 2 cm, has been rarely reported in the English-language literature. We report here on a case of a giant bone island that measured 10 x 1.7 x 1 cm in the diaphysis of the right tibia in a 31-year-old man who complained of right lower leg pain for 3 weeks.

Topics: Adult; Biopsy; Bone Diseases; Curettage; Diagnosis, Differential; Diaphyses; Humans; Leg Injuries; Magnetic Resonance Imaging; Male; Pain; Pain Management; Radiographic Image Enhancement; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Technetium Tc 99m Medronate; Tibia

Topics: Adult; Bone Diseases; Calcaneus; Citrates; Gallium; Humans; Incidental Findings; Male; Radionuclide Imaging; Radiopharmaceuticals; Sarcoidosis; Technetium Tc 99m Medronate

Distraction osteogenesis is an effective method for lengthening long bones and filling bone defects that result from bone resection. Insufficiency of bone consolidation in the distraction segment is problematic. In this study, we examined whether 3-phase bone scintigraphy can predict the outcome of distraction osteogenesis. We also investigated the effects of chemotherapy and surgical treatment on distraction osteogenesis.. We performed 3-phase bone scintigraphy on 60 patients (9 high-grade malignant bone tumors as group A, 11 low-grade malignant or benign tumors as group B, 40 nontumoral conditions as group C) with distraction osteogenesis at the lengthening phase of the long bones. By setting the region of interest on the distraction segment and contralateral normal area, we calculated the perfusion index (PI), the uptake ratio of the blood-pool image (BPR), and the uptake ratio of the delayed image (DR). Patients were classified into poor and good consolidation groups from the radiographic findings of the distraction segment.. Good to fair correlations were obtained between the PI and BPR, the PI and DR, and the BPR and DR (r = 0.65, 0.45, and 0.57, respectively). The PI and BPR indicated no significant differences among group A-C (1.7 +/- 0.6, 2.1 +/- 0.7, and 1.8 +/- 0.8 in PI, respectively; 1.8 +/- 1.1, 1.9 +/- 0.5, and 2.0 +/- 0.7, in BPR, respectively). The DR of group A (2.4 +/- 1.2) was significantly lower than that of group B (6.3 +/- 1.8; P = 0.001) and group C (5.9 +/- 2.8; P < 0.001). Eleven patients were classified in the poor consolidation group. The other 49 patients showed good consolidation. The poor consolidation group showed lower values in all indices obtained by 3-phase bone scintigraphy than the good consolidation group. The optimal cutoff levels, sensitivity, specificity, and accuracy of each index for detection of patients with poor consolidation were as follows: 1.1, 36%, 90%, and 80% in the PI, respectively; 1.2, 55%, 94%, and 87% in the BPR, respectively; and 2.2, 82%, 96%, and 93% in the DR, respectively.. Three-phase bone scintigraphy is a promising method for the assessment of distraction osteogenesis. The delayed image of 3-phase bone scintigraphy, especially, is an excellent modality for predicting the outcome of distraction osteogenesis.

Topics: Adolescent; Adult; Bone and Bones; Bone Diseases; Bone Neoplasms; Female; Gamma Cameras; Humans; Male; Osteogenesis; Osteogenesis, Distraction; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

Bone scans showing solitary hot spots in the ribs pose diagnostic problems in patients with proved extraskeletal cancers. The authors wanted to determine the importance of solitary rib lesions and their correlation with other clinical manifestations.. The study included 199 patients with solitary rib hot spots on their bone scans. The follow-up radiographic and scintigraphic images were reviewed to determine their origin. The correlation between the occurrence of a malignant rib lesion and clinical data were determined using Pearson chi-square tests.. Ninety-three patients had an established cause of the rib hot spot. Eleven (11.8%) had a solitary malignant rib hot spot and 82 (88.2%) had a solitary benign rib hot spot. None of the hot spots at costochondral junctions were malignant. Of the 11 patients with proved metastatic rib hot spots, 1 of 11 (9.1%) had localized bone pain, 5 of 6 (83.3%) were concordant with primary tumors, 4 of 7 (57.1%) had elevated tumor markers, and 5 of 11 (45.5%) had concurrent extraskeletal metastases. For the 82 patients with benign rib hot spots, the figures were 2 of 82 (2.4%), 43 of 57 (75.4%), 26 of 69 (37.7%), and 19 of 82 (23.2%), respectively. Statistical analysis did not show a significant correlation between the incidence of metastases in solitary rib hot spots and clinical manifestations.. Most solitary rib hot spots on bone scans were benign. The interpretation of a solitary hot spot in the ribs is difficult even with the help of these clinical manifestations. Follow-up bone scintigrams or radiographs are needed for further investigation of solitary rib hot spots.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Bone Diseases; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Kidney Neoplasms; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Ribs; Statistics as Topic; Technetium Tc 99m Medronate

The purpose of this study was to assess the clinical spectrum of asymptomatic abnormal focal uptake of (99m)Tc-methylene diphosphonate (MDP) in the femoral neck.. Fifteen consecutive patients with asymptomatic abnormal focal uptake of (99m)Tc-MDP in the femoral neck were evaluated. Two patients had bilateral abnormal focal uptake. The patient's history, clinical findings, and plain hip radiograph were obtained in all cases. Scintigraphic, radiographic and clinical findings were correlated.. Eight of 17 (47%) femoral necks showed a definite herniation pit on radiography, 6 patients (35%) had normal radiographic findings, 1 patient had a bone island, 1 patient had a bone island and a herniation pit, and 1 patient had a subtle lesion suggestive of a herniation pit on radiography. All patients remained asymptomatic for at least a 10-mo follow-up period.. A herniation pit is the most common finding among asymptomatic abnormal femoral neck focal uptake. This condition should be distinguished from a wide variety of disorders associated with increased focal abnormal uptake of (99m)Tc-MDP in the femoral neck.

Topics: Adult; Bone Diseases; Diagnosis, Differential; Female; Femur Neck; Humans; Male; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To describe the radionuclide three-phase whole-body bone imaging (TPWBBI) technique and discuss the usefulness of its application.. TPWBBI was performed after a single intravenous injection of 555 to 925 MBq (15 to 25 mCi) Tc-99m MDP. Whole-body arterial flow (phase one) followed by blood-pool and tissue perfusion (phase two) images were obtained with the moving detector head speed set at 150 cm/minute and 40 cm/minute, respectively. Conventional whole-body static bone images (phase three) were obtained 3 hours later.. When 542 consecutive TPWBBI results were reviewed, 394 (166 extraskeletal and 228 skeletal) abnormalities were detected during phases one and two. The 166 extraosseous lesions included vascular diseases: abdominal aortic aneurysms and peripheral vascular diseases and renal abnormalities, liver abnormalities, ascites, and pleural effusions. Many of these were incidentally detected clinically significant findings and would not have been identified on conventional static bone images. It helps to differentiate among acute and chronic fractures, active and inactive inflammatory diseases such as arthritis or osteomyelitis, and Paget's disease.. With a single injection of Tc-99m MDP, whole-body images obtained in the arterial phase, the blood-pool and tissue perfusion phase, and the static bone phase can identify many clinically significant skeletal and soft tissue abnormalities. TPWBBI can differentiate between active and inactive phases of different disease processes and thereby provide a diagnosis that is more specific than a conventional single-phase bone scan. It may be applicable as a tool for nuclear physical examination.

Topics: Adult; Aged; Aged, 80 and over; Bone Diseases; Diagnosis, Differential; Digestive System Diseases; Feasibility Studies; Female; Female Urogenital Diseases; Humans; Male; Male Urogenital Diseases; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Vascular Diseases; Whole-Body Counting

Topics: Aged; Bone Diseases; Female; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Magnetic Resonance Imaging; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Diseases; Deferoxamine; Humans; Male; Middle Aged; Octreotide; Radionuclide Imaging; Radiopharmaceuticals; Sarcoidosis; Technetium Tc 99m Medronate

The authors describe a 38-year-old man who was referred to the nuclear medicine department because of pain and swelling of his fingers in both hands. Tc-99m MDP and Tl-201 scans were performed to evaluate the lesions. A Tc-99m MDP bone scan showed hyperemia and increased uptake in the lesions. A Tl-201 scan showed marked uptake in both early and delayed images in the lesions of his fingers. Bone biopsy and histologic examination confirmed sarcoidosis. This case indicates that Tl-201 uptake can be seen in bone lesions resulting from sarcoidosis.

Topics: Adult; Biopsy, Needle; Bone Diseases; Connective Tissue Diseases; Hand; Humans; Male; Radionuclide Imaging; Sarcoidosis; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thallium Radioisotopes

Routine use of diagnostic radioisotope bone scanning in patients with sarcoidosis has not previously been evaluated. The aim of this study was to assess whether routine radioisotope bone scanning might be of value in the detection of osseous lesions in sarcoidosis.. 63 consecutive Caucasian patients (32 men) with a median age of 39 years (range 17-66) and biopsy proven pulmonary sarcoidosis were included. None had symptoms suggesting osseous sarcoidosis. Extrathoracic, non-osseous sarcoidosis was present in 24 patients; 13 patients were on oral steroids. Radioisotope bone scanning was performed with a gammacamera after intravenous injection of 99mTechnetium-methylenediphosphonate. An abnormal bone scan was followed by a radiograph of the region of interest.. 39 patients (61.9%) had normal bone scans. Minor bone scan abnormalities were found in 24 patients (38.1%). Of these, 11 patients had bone foci (8 in the vertebral spine, 9 in the ribs, 1 in a finger). Radiographically only one of these 11 patients had a bony lesion being typical of sarcoidosis, located in the second finger. 17 patients had joint foci. Radiographs of the joints showed sequelae after a fracture in 1 patient, and degenerative osteoarthritis in 1 patient. There was no difference between clinical and paraclinical variables in patients with normal and abnormal bone scans.. There appears to be no indication for routine radioisotope bone scanning in patients with sarcoidosis. Scanning should be restricted to patients with clinical suspicion of osseous sarcoidosis.

Topics: Adult; Bone and Bones; Bone Diseases; Diagnostic Tests, Routine; Female; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sarcoidosis; Sarcoidosis, Pulmonary; Technetium Tc 99m Medronate

The aim of this study was to evaluate the healing of artificially induced bony defects in dogs by means of demineralized allogenous bone powder (DBP) implants covered with polyhydroxy lactic acid (PLA) casts compared with DBP implants without the casts.. Prospective animal study.. Research university.. Following a pilot study in which two dogs were used, four mongrel dogs between the ages of 18 and 24 months and weighing approximately 20 kg were used as subjects.. Each experimental animal had bilateral maxillary alveolar clefts created. In a later procedure, each defect was repaired with a DBP implant, half of which were covered with a PLA96 matrix. Each animal also had a circular defect created in each parietal bone that was immediately covered with DBP implants, half of which were similarly covered with a PLA96 disk.. Repeated technetium-99m methylene-diphosphate (99mTC MDP) uptake measurements were performed to evaluate bone metabolism during the healing period, while at relevant intervals, radiographs were taken of the healing alveolar cleft defects to register bone repair. After 1 year, the animals were euthanized for macroscopic and histologic evaluation.. Histologically, the grafts covered with PLA96 were at a more advanced stage of healing than those without, and the cranial defects similarly were more advanced in the healing process than the alveolar defects. Uptake of 99mTC MDP into the cranial implants was at its maximal level after 1 week and then gradually decreased until, after 7 weeks, it was not significantly different from zero. Cranial defects covered with a PLA95-enhanced implant showed a mean maximum count rate of 275, while the plain DBP side showed a mean maximal count rate of 150. Alveolar defects with the plain DBP implant showed a maximum count rate in the first week; those with the PLA95 enhanced implant showed maximum uptake during the second week. On both sides, there was a gradual decrease to the base value in the seventh week. The mean maximum count on the PLA96-enhanced side was 285, while on the plain DBP side, the corresponding value was 320.. Although an advantage of the combination was established for parietal cranial defects, no advantage was seen for alveolar cleft defects in this experimental setup.

Topics: Alveoloplasty; Animals; Bone Diseases; Bone Plates; Bone Transplantation; Cleft Palate; Decalcification Technique; Dogs; Follow-Up Studies; Lactic Acid; Maxilla; Parietal Bone; Pilot Projects; Polyesters; Polymers; Prospective Studies; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate; Tissue Preservation; Transplantation, Homologous; Wound Healing

Erdheim-Chester disease usually involves the diaphyseal and metaphyseal regions of tubular bones and various visceral organs. A 56-year-old woman presented with the histologically confirmed diagnosis of Erdheim-Chester disease. A Tc-99m MDP bone scan revealed the entire extent of the skeletal disease and showed unusual involvement of the epiphyses and axial skeleton. In addition to MRI, a Ga-67 citrate scan including SPECT showed extensive soft-tissue infiltration of different organs. Both Tc-99m MDP and Ga-67 scintigraphy are useful tools in determining the distribution of this rare disease.

Topics: Biopsy; Bone Diseases; Brain Diseases; Diaphyses; Epiphyses; Female; Foam Cells; Gallium Radioisotopes; Humans; Joint Diseases; Middle Aged; Orbital Diseases; Parotid Diseases; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Xanthomatosis

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

This study was aimed at determining whether the ordered-subset expectation maximum (OSEM) is more effective than filtered backprojection (FBP) for bone SPECT in the routine clinical context.. Fifty-seven consecutive bone SPECT studies were analyzed. They included pelvic and lumbar spine, thoracolumbar spine, head and neck, feet and shoulders. A 64-projection SPECT study was acquired over 360 degrees by single-head cameras 2-3 h after the injection of 750 MBq 99mTc-methylene diphosphonate. Three observers compared the OSEM and FBP reconstructed images.. Streak artifacts, always present with FBP, were rarely generated with the OSEM. When present (n = 24), artifacts associated with negative values near hyperactivities in FBP were not generated with the OSEM in 67% of the cases (n = 16), permitting a satisfactory interpretation of these regions. In half of the other cases (17%, n = 4/24), interpretation was precluded. In only one case did the three observers agree that more hyperactivities were seen with the OSEM. Ninety-six percent of the OSEM pictures were superior or equal to FBP for anatomic resolution and were clearly better in 12% of the cases. The extent of the lesion with the OSEM seemed better or equally defined in 96% and clearly better in 14% of the cases. The low-activity regions were better or equally visualized in all cases and were clearly better seen in 23% of the cases. The quality of the pictures was found to be better or superior with the OSEM in 98% of the cases and definitely better in 65% of the cases.. Replacement of FBP by the OSEM in bone SPECT would be beneficial to clinical practice.

Topics: Artifacts; Bone and Bones; Bone Diseases; Humans; Image Processing, Computer-Assisted; Likelihood Functions; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Our aim was to assess the value of quantitative bone scintigraphy for evaluating long-bone growth and to establish the normal uptake patterns of the growth plate in children. Subjects (180 girls, 154 boys) of normal weight and height, aged 2-20 years, were investigated using skeletal scintigraphy. Regions of interest were outlined over posterior images of the distal femoral growth plate and femoral diaphysis. The average number of counts per fixel in each region of interest was determined. The ratio of uptake in the distal femoral growth plate to that in the femoral diaphysis (GP:D ratio) was calculated for all subjects, and its relationship with age was determined. Peak GP:D ratios in girls and boys were reached at ages 11 and 13 years, respectively (8.26 in girls and 8.18 in boys), corresponding to the periods of most rapid growth. Our findings suggest that determining the scintigraphic GP:D ratio may be useful for evaluating growth and development in children if normal standard GP:D ratios are established.

Topics: Adolescent; Adult; Bone Development; Bone Diseases; Child; Child, Preschool; Female; Growth; Growth Plate; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sex Characteristics; Technetium Tc 99m Medronate

Topics: Blood Vessel Prosthesis; Bone Diseases; Humans; Joint Diseases; Radionuclide Imaging; Radiopharmaceuticals; Surgical Wound Infection; Technetium Tc 99m Medronate

We evaluated the frequency, distribution and appearance of benign lesions in 18F-PET scans.. Between March 1996 and May 1997, 18F-PET scans were performed in 59 patients in addition to conventional planar bone scintigraphy. Eleven patients were subjected to additional SPECT imaging. The main indication was searching for bone metastases (58 pat.). The diagnosis was confirmed radiologically.. With 18F-PET in 39 patients (66.1%) 152 benign lesions, mostly located in the spine were detected. 99mTc bone scans revealed 45 lesions in 10 patients. Osteoarthritis of the intervertebral articulations (69%) or of the acromioclavicular joint (15%) were the most common reasons for degenerative lesions detected with 18F-PET. Osteophytes appeared as hot lesions located at two adjacent vertebral endplates. Osteoarthritis of the intervertebral articulations showed an enhanced tracer uptake at these localizations, whereas endplate fractures of the vertebral bodies appeared very typical; solitary fractures of the ribs could not be differentiated from metastases. Rare benign lesions were not studied.. Most of the degenerative lesions (84%) detected with 18F-PET had a very typical appearance and could be detected with the improved spatial resolution and advantages of a tomographic technique. 18F-PET had an increased accuracy in detecting degenerative bone lesions.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Fluorine Radioisotopes; Humans; Middle Aged; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole-Body Counting

The authors present a prospective analysis of Tc-99m MDP and Tc-99m citrate scintigraphy in 108 patients with known malignant or degenerative benign bone disease. Of 108 patients, 59 (group A) had malignant bone disease. The other 49 patients (group B) had degenerative benign bone disease for which the results of Tc-99m MDP scans were positive. In both groups the Tc-99m citrate scan was performed 1 week after the Tc-99m MDP scan. The Tc-99m citrate/Tc-99m MDP lesion-to-background radioisotope uptake ratio (RUR) was calculated for each lesion 3 hours after radionuclide administration. The mean RUR for the malignant lesions was 1.0 +/- 0.484; for the benign lesions, the RUR was 0.29 +/- 0.250. Static imaging was also done for 10 lesions each from the malignant and benign groups at 1, 3, and 24 hours to study the kinetics of Tc-99m citrate. Time-activity curves for malignant lesions showed that the RUR remained high for 24 hours, whereas benign lesions showed a drastic decrease at 3 and 24 hours compared with the 1-hour images. The ratio of Tc-99m citrate to Tc-99m MDP is a promising parameter to differentiate malignant from benign degenerative lesions seen as areas of increased activity on Tc-99m MDP bone scans. The sensitivity and specificity of this technique were 97.8% and 95%, respectively.

Topics: Adult; Bone Diseases; Bone Neoplasms; Case-Control Studies; Citrates; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

Topics: Bone Diseases; Diagnosis, Differential; Drug Hypersensitivity; Female; Humans; Hypersensitivity; Hypersensitivity, Delayed; Injections, Intravenous; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To define the nature, incidence and consequence of a possible interaction between etidronate (for the treatment of hypercalcemia) and methylene diphosphonate labelled with technetium-99m (99mTc-MDP) (for bone scanning).. The authors reviewed hospital pharmacy records for a period of 2 years and identified 18 patients who had received etidronate. Of this group, 6 patients (4 men and 2 women, ranging in age from 56 to 76 years) had undergone bone scanning with 99mTc-MDP while receiving etidronate. Five of the patients had hypercalcemia associated with metastatic disease, and the sixth had hyperparathyroidism.. All bone scans demonstrated poor uptake of tracer by bone accompanied by high soft-tissue background. There was loss of bone definition below the mid-thigh, and in 5 of the 6 patients there was indistinguishable rib uptake. In 1 of the patients, there was absence of uptake in 2 previously defined metastatic lesions.. Recent oral or intravenous administration of etidronate is a contraindication to bone scintigraphy, as it markedly decreases sensitivity for bone disease. Bone scintigraphy should be timed so that it is performed before etidronate treatment or, if that is not possible, more than 2 to 4 weeks after the therapy has been completed.

Topics: Administration, Oral; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Contraindications; Drug Interactions; Etidronic Acid; Female; Femur; Humans; Hypercalcemia; Hyperparathyroidism; Incidence; Injections, Intravenous; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Ribs; Technetium Tc 99m Medronate

An unusual case of multiple brown tumors due to parathyroid carcinoma is reported. The patient presented with lower leg pain. Plain radiographs demonstrated multiple lytic lesions of the lower legs and a Tc-99m MDP bone scan depicted multiple areas of increased uptake suggesting skeletal metastases. Tc-99m sestamibi tumor scintigraphy showed multiple sites of tumor uptake in bones and a large area of increased uptake with a cystic component in the right lower pole of the thyroid gland. An open biopsy from the right tibial lesion revealed a brown tumor. A large parathyroid carcinoma with a necrotic cyst was removed. After parathyroidectomy and right thyroid lobectomy, the patient became free of bone pain and serum PTH levels normalized. A 9-month follow-up Tc-99m MDP bone scan demonstrated less intense uptake in the pelvis, tibia, and fibulae. Nine-month follow-up tumor imaging with Tc-99m MIBI revealed disappearance of the preoperative uptake of multiple brown tumor.

Topics: Adult; Bone Diseases; Bone Neoplasms; Carcinoma; Female; Follow-Up Studies; Granuloma, Giant Cell; Humans; Hyperparathyroidism; Leg; Osteitis Fibrosa Cystica; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroidectomy; Whole-Body Counting

Sarcoidosis is rarely recognized as an osseous manifestations alone. Patients with osseous involvement usually have a chronic multivisceral form of the disease. The authors report a case of osseous sarcoidosis without other visceral involvement. A bone scan was requested to evaluate the extent of the bone involvement and explore buttocks pain.

Topics: Arthralgia; Bone Diseases; Buttocks; Chronic Disease; Foot Diseases; Hand; Humans; Male; Middle Aged; Pain; Radionuclide Imaging; Sacroiliac Joint; Sarcoidosis; Technetium Tc 99m Medronate

Our purpose was to assess the role of MRI in evaluating the musculoskeletal system in athletes with chronic pain laterally in the groin of unknown etiology. Magnetic resonance imaging (MRI) of the pubic ring was performed in 11 young athletes (soccer players) with long-standing groin pain. MR findings were compared with plain films and isotope examination (bone scan Tc 99M). Abnormal MRI findings included a broadened and irregular symphysis with a characteristic pattern of low signal intensity on T1W and high signal intensity on T2W images localized in the superior pubic ramus at a distance from the symphysis. Positive findings were also observed on plain films and on nuclear medicine studies. However, the imaging findings in the superior public ramus of the symphysis was located considerably more laterally on MRI. MRI is a valuable method for evaluating discrete and ambiguous pelvic pain in athletes, particularly for identifying concomitant changes in the superior ramus, which may give rise to long-standing pain localized laterally in the groin.

Topics: Adolescent; Adult; Bone Diseases; Chronic Disease; Humans; Inguinal Canal; Joint Diseases; Ligaments; Magnetic Resonance Imaging; Male; Pain; Pelvic Bones; Pubic Bone; Pubic Symphysis; Radiography; Radionuclide Imaging; Soccer; Technetium Tc 99m Medronate

A series of plain radiographs, bone scans, bone marrow scans, and MRIs is reported in a patient with Gaucher disease type I, in whom two episodes of acute bone crisis developed during a 6-year period of follow-up. Acute bone crisis and global indolent bone marrow displacement could both be assessed by bone marrow scintigraphy, whereas MRI could better clarify the corti-comedullary alteration after bone infarction. Thus, MRI and bone marrow scintigraphy could be used as complementary imaging methods in the management of patients with Gaucher disease.

Topics: Acute Disease; Adult; Biopsy; Bone and Bones; Bone Diseases; Bone Marrow; Diagnostic Imaging; Follow-Up Studies; Gaucher Disease; Humans; Infarction; Magnetic Resonance Imaging; Male; Pain; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Neurofibromatosis type 1 or von Recklinghausen's disease is one of the most common autosomal dominant genetic disorders. Between 29% and 77% of patients may suffer from a wide range of skeletal abnormalities and, thus, patients with neurofibromatosis frequently undergo skeletal scintigraphy, at which time the common peripheral nerve soft-tissue tumors that occur in this syndrome (neurofibromas, plexiform neuromas and neurofibrosarcomas) may be demonstrated.. Single or multiphase 99mTc methylenediphosphonate (MDP) bone scans were performed in five patients with neurofibromatosis as part of their clinical evaluation.. We imaged neurofibrosarcomas in three patients, cutaneous neurofibromas in one patient and a plexiform neuroma in one patient.. Single- or multiphasic bone scans may localize common soft-tissue tumors in neurofibromatosis.

Topics: Adult; Bone and Bones; Bone Diseases; Female; Humans; Infant; Male; Middle Aged; Neurofibroma; Neurofibroma, Plexiform; Neurofibromatosis 1; Neurofibrosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

The aims of this study were to determine the incidence of hypertrophic pulmonary osteoarthropathy (HPO) in nasopharyngeal carcinoma (NPC) and assess its clinical significance. Altogether, 407 NPC patients were reviewed retrospectively. HPO was identified by 99Tcm-methylene diphosphonate bone scans and related clinical and radiographic evidence. Pulmonary metastases, bony metastases and titre of anti-Epstein Barr virus (EBV) immunoglobulin were assessed in patients with and without HPO. The patients had a mean (+/- S.D.) age of 50.4 +/- 12.4 (range 17-73) years. HPO was found in 27 of the 407 (6.6%) NPC patients, among whom 13 (48%) had pulmonary metastases. HPO preceded lung metastases by 7-22 months (14.4 +/- 6 months) in 7 (52%) patients. Six patients had overt lung metastases at the time of the bone scan. No significant difference was found in anti-EBV immunoglobulins between the patients with or without HPO, nor in the incidence of bony metastases between these two groups of patients. HPO should be regarded as an early sign of pulmonary metastases.

Topics: Adolescent; Adult; Aged; Antibodies, Viral; Bone Diseases; Bone Neoplasms; Child; Herpesvirus 4, Human; Humans; Hypertrophy; Lung Diseases; Lung Neoplasms; Middle Aged; Nasopharyngeal Neoplasms; Osteoarthropathy, Secondary Hypertrophic; Radionuclide Imaging; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate

Benign myocardial uptake of technetium-99m labelled phosphates, not related to cardiac or metabolic disorders, has been documented except in the case of 99mTc-methylene diphosphonate (MDP). The aim of this study was to assess the frequency of myocardial uptake and its possible association with malignant tumours in general and prostatic carcinoma in particular. We reviewed bone scintigrams performed with either 99mTc-hydroxydiphosphonate (HDP) or 99mTc-MDP over a period of more than 2 years for all patients with prostatic carcinoma and a matching group of patients suffering from other malignant and non-malignant disorders. A total of 965 scintigrams of 812 patients (males = 559, females = 253; age range 50-91 years, average age 69.2 years) were reviewed. Increased myocardial uptake was detected in 19 scintigrams (MDP = 13, HDP = 6) of 18 patients (17 males, one female). Most of the male patients with increased myocardial uptake had prostatic carcinoma (13/17) and were over 80 years of age (12/17). All patients were free of any cardiac or noncardiac disorder that might account for such uptake. When scintigraphy was repeated in the same patient, the uptake of 99mTc-HDP was more diffuse and of higher grade than that of 99mTc-MDP. "Benign" myocardial uptake of 99mTc-MDP is more common than previously thought. Although uptake of radiophosphates is attributed to asymptomatic atherosclerotic changes associated with old age, a strong association with prostatic carcinoma exists which may indicate variations in the bone: soft tissue affinity of different MDP complexes.

Topics: Aged; Aged, 80 and over; Bone and Bones; Bone Diseases; Case-Control Studies; Female; Heart; Humans; Male; Muscular Diseases; Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

We present a case of painful osseous sarcoid involving the tibiae bilaterally. Lesions were initially found on plain radiographs and on a 99mTc-MDP bone scan. The patient was also found to have CNS involvement of sarcoidosis in the form of diabetes insipidus and panhypopituitarism. CNS lesions were demonstrated on CT and MR images.

Topics: Bone Diseases; Brain; Brain Diseases; Female; Humans; Knee Joint; Middle Aged; Radionuclide Imaging; Sarcoidosis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Eighty-nine Technetium-99m-MDP scans performed between January 1987 and June 1990 at the Leicester Royal Infirmary were reviewed with regard to the indication, patient outcome and value of the scans in the patients' management. The significant finding was the value of a normal scan in the management of children with chronic pain.

Topics: Acute Disease; Adolescent; Bone and Bones; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Chronic Disease; Humans; Infant; Medical Audit; Osteomyelitis; Pain; Radionuclide Imaging; Sarcoma, Ewing; Synovitis; Technetium Tc 99m Medronate

Twenty cases of normal roentgen variants of bone in the plain film which simulated tumor, inflammatory change or fracture were studied. Plain roentgenography and 99mTc-MDP bone scintigraphy were investigated, and some of the patients had other examinations such as CT, MRI, angiography and biopsy. No abnormal radionuclide accumulation were detected in all regions, and they were finally diagnosed to be normal roentgen variants of bone. When the patient was suspected of having normal roentgen variants of bone, scintigraphy should be done first. 99mTc-MDP bone scintigraphy is very useful and less stress than other procedures to distinguish normal roentgen variant from disease.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

99Tcm-methylene diphosphonate (MDP) global skeletal uptake (4 h GSU) was determined by quantitative measurement of activity on bone scan images 4 h after injection in whole skeleton regions of interest (ROI) in 16 normal subjects, in five patients with hypertrophic pulmonary osteoarthropathy (HPO) and in 12 with Paget's disease. Values were correlated with those of whole body retention (24 h WBR), and serum bone gla protein (BGP), i.e. osteocalcin, alkaline phosphatase (AP) and type 1 procollagen (P1CP). They were 40% higher in HPO than in the normal controls, while in Paget's disease they increased more in polyostotic than in monostotic patients. A statistically significant difference was noted between 4 h GSU and 24 h WBR values in the two groups of patients compared with the controls. Of the bone metabolism markers, serum AP and P1CP were higher in the patients and positively correlated with their enhanced 4 h GSU values, whereas BGP was always within the normal range. This method may thus be regarded as a useful way of simultaneously determining bone 99Tcm-MDP uptake and altered bone turnover sites, especially in patients with systemic bone disease.

Topics: Adult; Aged; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Diseases; Female; Humans; Male; Middle Aged; Osteitis Deformans; Osteoarthropathy, Secondary Hypertrophic; Osteocalcin; Procollagen; Radionuclide Imaging; Technetium Tc 99m Medronate

Endemic skeletal fluorosis is characterized by bone, joint and muscle pain, progressive ankylosis of various joints and crippling deformities. Whole body skeletal scintigraphy with 99Tcm-methylene diphosphonate was performed for 17 symptomatic subjects suffering from this disorder. The fluoride content of drinking water ranged from 4.1 to 12.9 mg l-1 (normal < 1 mg l-1). Urinary and serum fluoride levels were markedly elevated. Serum calcium (total and ionized), inorganic phosphorus, creatinine and albumin were essentially normal while serum alkaline phosphatase was elevated in six subjects (mean +/- S.D. 206 +/- 106; range 22-1072 IU l-1). Skeletal radiology revealed a wide spectrum of bony abnormalities. Skeletal scintigraphy revealed a picture similar to metabolic 'superscan' in all subjects, i.e. increased tracer uptake in axial and appendicular skeleton, reduced soft tissue uptake, poor or absent renal images, prominent costochondral junction and 'tie' sign in sternum. Increased uptake was present in all subjects irrespective of age, water fluoride content, serum alkaline phosphatase level and radiological abnormalities. Our findings suggest the presence of a high bone turnover state in endemic skeletal fluorosis irrespective of other variables.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Child; Female; Fluoride Poisoning; Humans; India; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Water Pollution, Chemical

Differentiating bony metastases from degenerative lesions is of great importance to the oncologist. Routine bone scanning using technetium-99m methylene diphosphonate is the investigation of choice for detecting bony lesions, but its specificity is low. Using the difference in radio-uptake behaviour of metastatic and degenerative lesions as the criterion, a 24/3 h radio-uptake, lesion to non-lesion ratio was used to separate out the two types of lesions. Radio-uptake ratio (RUR) distribution curves of malignant and degenerative lesions were found to be significantly different (P < 0.001). Taking 1.12 as the critical point, RUR of malignant lesions was found to be more than the critical point, and that of degenerative lesions was found to be less than the critical point. Sensitivity, specificity and accuracy were found to be 68%, 80% and 74%, respectively.

Topics: Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

We evaluated the results of reconstruction of a skeletal defect with use of a vascularized bone graft from the iliac crest or fibula in 160 patients who had been managed consecutively between 1979 and 1989. The indications for the procedure were a skeletal defect including non-union, resulting from resection of a tumor; traumatic bone loss; osteomyelitis; or a congenital anomaly. The average duration of follow-up was forty-two months (range, twelve to 112 months). For the entire series, the rate of union after the primary procedure was 61 per cent and the over-all rate at the latest follow-up examination (including the patients who had a secondary procedure) was 81 per cent. In a subgroup of seventy-six patients who had union after the primary procedure and did not have additional treatment, the average interval until union was six months and the average interval until full activity was sixteen months. The results were more favorable for the patients who had had reconstruction for resection of a tumor (of sixty-nine patients, fifty-six had union), for a congenital anomaly (of six patients, five had union), or for a non-union without infection (of twenty-five patients, twenty-three had union). The results were less satisfactory for patients who had had the reconstruction for bone loss due to osteomyelitis (of sixty patients, forty-six had union). Our data suggest that vascularized bone transfer for the reconstruction of large skeletal defects is a valuable procedure in appropriately selected patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Diseases; Bone Neoplasms; Bone Transplantation; Child; Child, Preschool; Female; Fibula; Follow-Up Studies; Humans; Ilium; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Medronate

Congenital generalized lipodystrophy (CGL) is a rare genetic disease characterized by the absence of body fat from birth. Focal bone lesions have also been reported, but their pathophysiology is poorly understood. To characterize skeletal abnormalities further in 3 patients with CGL, we employed whole-body radiographic skeletal surveys, magnetic resonance imaging (MRI, including gadolinium enhancement), and triple phase technetium-99m methylene diphosphonate bone scintigraphy. Radiographs showed numerous focal lesions within the long bones, as described in other reports. MRI showed that the entire marrow space of the long bones was abnormal and was characterized, at least in part, by the absence of marrow fat. Prolonged T1 and T2 times and marked gadolinium enhancement were observed in radiographically normal-appearing long bone. Radiographically lytic lesions occasionally demonstrated fluid-fluid levels on MRI and enhanced peripherally after gadolinium infusion. Bone scintigraphy findings such as periarticular hyperemia were relative subtle. We conclude that the appendicular skeleton of patients with CGL is diffusely abnormal and is predisposed to focal osteolysis and cyst formation.

Topics: Adult; Bone and Bones; Bone Diseases; Contrast Media; Female; Gadolinium; Gadolinium DTPA; Humans; Lipodystrophy; Magnetic Resonance Imaging; Organometallic Compounds; Pentetic Acid; Technetium Tc 99m Medronate

The potential of hexakis (methoxyisobutylisonitrile) technetium (1) (MIBI) for the imaging of various bone pathologies and for assessment of effectiveness of therapy were investigated in a prospective study. MIBI was evaluated in comparison to MDP bone scans in 73 bone lesions (31 benign, 42 malignant). With MIBI, all but six malignant lesions were clearly visualized and the mean lesion/contralateral (L/C) ratio (2.21 +/- 1.17) was significantly higher than that of benign counterparts (1.26 +/- 0.40) (p less than 0.0005). No such significance was detected on corresponding MDP bone scans (4.86 +/- 3.48 versus 3.11 +/- 1.52). Ten cases with malignant tumor underwent both pre- and post-therapy MIBI evaluation and it was demonstrated that radiotherapy and/or chemotherapy significantly inhibited MIBI uptake. Moreover, post-therapeutic MIBI uptake was a good reflection of the effectiveness of therapy as confirmed by histopathological evaluation. Thus, with a strikingly higher uptake in malignant bone lesions MIBI might have good potential for the detection of malignant bone pathologies as well as for assessing tumor response to therapy.

Topics: Adolescent; Adult; Aged; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Adolescent; Adult; Bone and Bones; Bone Diseases; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Small children often cannot describe the location of bone pain for parents or physicians. Bone scans were performed in 56 children under five years of age with lower extremity pain and/or gait abnormalities of unknown etiology. Patients with fever, and those known to have infection, child abuse, malignancy, and/or radiographic abnormalities were excluded. Thirty patients had abnormal bone scans. Abnormalities included evidence of hip synovitis (4), femoral head avascularity (2), various proximal femoral abnormalities (3), knee synovitis (3), toddler's fracture (1), various tibial or fibular abnormalities (4), and various abnormalities of the tarsal bones (16). Tarsal bone abnormalities included four with abnormal calcaneal uptake and nine with abnormal uptake in or adjacent to the cuboid bone. Correlative imaging studies were available for 26 sites, and focal bone findings were noted at only five locations. Tarsal bone abnormalities accounted for over half of the scintigraphic abnormalities in these preschool children with gait abnormalities. Abnormal uptake in/or adjacent to the cuboid bone was common and probably represented stress injury.

Topics: Bone Diseases; Child, Preschool; Female; Hip Joint; Humans; Infant; Knee; Leg; Male; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

94 patients diagnosed as having sarcoidosis were studied in Galicia in order to evaluate the frequency of bone manifestations, as well as to analyse the clinical and radiological features. Bone lesions were found in 10 patients (10.6%) with a median age of 47.4 years, the predominant sex being female in this group (70%). The lesions were of two types: a) osteolytic on metacarpal (4 cases), nasal bones (1 case), sacrum (1 case), femur (1 case); b) osteosclerosis on femur and fibula (1 case), acrosclerosis (3 cases), metacarpal (1 case). The first lesions were associated to chronic types of sarcoidosis with skin and lung involvements. The second lesions were associated to a sub-acute type of Löfgren. We highlight the behaviour of both types of bone lesions and comment on the physiopathology of the sclerotic lesions.

Topics: Age Factors; Biopsy; Bone and Bones; Bone Diseases; Humans; Incidence; Osteolysis; Osteosclerosis; Radiography; Radionuclide Imaging; Sarcoidosis; Sex Factors; Spain; Technetium Tc 99m Medronate

Glucose phosphate (GP) labelled with 99mTc was used to obtain scintigraphic images of bone lesions in one group of patients (n = 28) and of lung tumors in another (n = 35). All bone lesions detected by 99mTc-MDP were also demonstrated by 99mTc-GP; all lung tumors except 4 were detected by 99mTc-GP, the failure rate being about the same as that for 67Ga. The use of 99mTc-GP is preferable to that of 99mTc-MDP because the former does not accumulate in normal bone; the advantage of 99mTc-GP over 67Ga lies in its better physical characteristics and in the fact that the result of the study is available within a few hours rather than three days.

Topics: Adolescent; Adult; Aged; Bone Cysts; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Female; Glucosephosphates; Humans; Hyperparathyroidism; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Osteitis Deformans; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Biopsy, Needle; Bone Diseases; Echinococcosis; Female; Humans; Magnetic Resonance Imaging; Pelvic Bones; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this work was to establish when, in the investigation of local musculoskeletal symptoms, dynamic isotope bone imaging yields useful information not available from static isotope bone imaging, using 99mTc methylene diphosphonate. One hundred and forty-two dynamic bone scans were reviewed, with particular reference to the site being imaged, the suspected underlying pathology, and the contribution of the dynamic phases to diagnosis, management, and eventual outcome. All were performed as part of the investigation of adult patients complaining of localized musculoskeletal symptoms. The dynamic phases influenced diagnosis, management, and eventual outcome most positively in suspected infection, particularly at a previous fracture site or around a prosthesis. They did not alter management significantly in suspected fracture, avascular necrosis, in most patients with pain of unknown cause, and were rarely helpful in imaging the axial skeleton. We suggest that, in the context of routine bone imaging, dynamic bone scanning should be reserved for cases of suspected infection. In the investigation of most other local bone pathologies, the static phase of the bone scan provides all the diagnostic information which is required for management decisions.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Diseases; Bone Neoplasms; Child; Diagnosis, Differential; Hand; Humans; Knee Joint; Middle Aged; Muscular Diseases; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Of thirty-four occurrences of bone pain in seventeen children and young adults who had type-I Gaucher disease, twenty-five were finally diagnosed as bone crises. On the basis of a bone scan with technetium-99m methylene diphosphonate, a correct diagnosis of bone crisis was made for twenty-three occurrences, with a sensitivity of 0.92. At the onset of a crisis, the bone scan typically showed decreased uptake of radionuclide at the involved site. After six weeks, a repeat bone scan of the long bones showed a ring of increased uptake surrounding an area of decreased uptake. At six months, the appearance of the bones on the radionuclide scan was normal.

Topics: Adolescent; Adult; Bone Diseases; Child; Female; Femur; Gaucher Disease; Humans; Humerus; Male; Pain; Predictive Value of Tests; Prospective Studies; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tibia

An animal model was developed to determine the ratio of uptake of different bone seeking radiotracers in skeletal lesions relative to normal bone in rats by dual tracer quantitative autoradiography (QARG). The lesion to normal bone uptake ratios (L/NB ratios) of 99mTc-MDP, 99mTc-HDP and 99mTc-DMAD were compared using 153Sm-EDTMP as an internal standard. The results from these studies demonstrated that the L/NB ratio of 99mTc-DMAD was an average of 54 and 71% higher than 99mTc-MDP and 99mTc-HDP, respectively and 79% higher than measured for 153Sm-EDTMP.

Topics: Animals; Autoradiography; Bone and Bones; Bone Diseases; Diphosphonates; Organometallic Compounds; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium Tc 99m Medronate

Topics: Adolescent; Bone and Bones; Bone Diseases; Bone Neoplasms; Brucellosis; Female; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate

The utility of 99Tcm-HMPAO leucocytes has been studied in combination with 99Tcm-MDP bone scanning in the diagnosis of bone infection in a series of 50 patients with a clinical suspicion of bone infection. Thirty-three patients were referred to our Service from the Department of Orthopaedic Surgery (Group A) and seventeen from the Infectious Disease Unit (Group B). A total of 52 lesion sites were studied. The leucocyte and bone studies were performed within four days. The leucocyte scan was obtained at 30-60 min and 4-6 h after i.v. injection of 370 +/- 74 MBq of 99Tcm-HMPAO leucocytes. After confirming the scintigraphic findings, the results obtained were: Group A, 12 true positive, 21 true negative and 2 false positive; and in Group B, 5 true positive, 9 true negative and 4 false negative. The overall sensitivity was 80.9% with a specificity of 93.7%. Although the high bone marrow activity seen with 99Tcm-HMPAO leucocytes may reduce sensitivity, very good results were obtained in bone infection. The use of 99Tcm means great progress in the radiolabelling of white blood cells in terms of availability and better image quality. The combination of 99Tcm-HMPAO leucocytes and 99Tcm-MDP can be recommended as one of the most suitable methods for use in the diagnosis of bone infection, especially in patients with previous bone disease.

Topics: Adolescent; Adult; Aged; Bone Diseases; Female; Humans; Infections; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Oximes; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

We evaluated the monoclonal antibody MAb, BW 250/183, which is easy to label with Tc-99m, with respect to its clinical application for the detection of inflammatory processes in bone and joint diseases. This monoclonal antibody is a murine immunoglobulin (IgG1 isotype), directed against NCA 95 (nonspecific cross-reacting antigen), which is also present on the surface of neutrophil granulocytes. We investigated patients with acute (n = 9) and chronic (n = 3) osteomyelitis, with coxitis (n = 3) and coxarthrosis (n = 2), with septic hip prosthesis (n = 8) and loosening hip prosthesis (n = 14), with low back pain (n = 4), with spondylitis (n = 5) and with postoperative spondylodiscitis (n = 9). With reference to the total number of patients examined in this study we found 29 true positive results, 22 true negative results, 4 false negative results and 2 false positive results. This gives a sensitivity of 88% and a specificity of 92%. The lesions were already visualized within 4 to 6 hours, but 24 hour pictures are desirable. SPECT pictures are mandatory in patients with diseases of the hip or of the spine because sensitivity is considerably improved thereby.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal; Arthritis, Infectious; Bone Diseases; Discitis; Female; Humans; Inflammation; Joint Diseases; Male; Middle Aged; Osteoarthritis, Hip; Osteomyelitis; Prosthesis Failure; Radionuclide Imaging; Spondylitis; Technetium Tc 99m Medronate

Neuroblastoma is a potentially curable childhood malignancy with survival rates of 20% reported even in advanced disease. Technetium-labelled methylene diphosphonate (Tc99m-MDP) scanning is well established as a method of assessing bone disease. We report four patients, with advanced neuroblastoma in complete or partial remission, in whom new abnormalities on bone scintigraphy were due to benign lesions. Correct management depends on the precise diagnosis of such lesions.

Topics: Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

For the evaluation of bony metastases in cancer patients, bone scanning has become an important tool, but some limitations exist. One of these is the differential diagnosis of benign and malignant bony lesions, in which bone scanning shows one or more lesions in the spine. To help solve this, bone scintigraphy was performed 4 and 24 hours after intravenous injection of Tc-99m MDP; the ratio of radiouptake in the lesion and normal spine was measured as 24-hr/4-hr (T/F) ratio. Fifty-four patients with an average age of 56 years were studied and divided into two groups. Group A included 34 patients (17 women and 17 men) with bony metastases. Group B included 20 patients (8 women and 12 men) with radiographically proven benign bony lesions and no evidence of cancer. An LFOV Elscint Apex 400 digital gamma camera and an Informatek Simis 5 nuclear minicomputer were used. The results showed that the T/F ratio of Group A was 1.3 +/- 0.15 (mean +/- SD) and that of Group B was 1.0 +/- 0.12 (mean +/- SD). The P value was less than 0.001. We conclude that the ratio of radiouptake of lesions and normal spine at 24 and 4 hours may be a reliable method of differentiating benign bony lesions from malignant lesions.

Topics: Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

A collimated whole-body counter was used to measure the retention and distribution of radioactivity along the longitudinal axis of the body at several times during the 24 hours after the intravenous injection of 50 microCi of Tc-99m-diphosphonates. Whole-body retention (WBR) was measured together with regional uptakes in the following four areas: head, chest, bladder, and legs using two structurally related Tc-99m-diphosphonate skeletal imaging agents: 1-hydroxyethylidene diphosphonate (HEDP) and methylene diphosphonate (MDP). The average 24 hour WBR values in young males, reflecting skeletal uptake of these tracers, were 17.7 +/- 2.2% (n = 20) and 31.0 +/- 2.4% (n = 3), respectively. A model of skeletal clearance was developed using the sum of two exponentials. In normal volunteers the initial rapid clearance phase of both tracers had a half-time of about 1 hour, whereas the slower second phase clearance had a half-time of 22 hours with HEDP and 44 hours with MDP. The WBR is usually calculated for the entire body only at 24 hours, but with the improved spatial resolution of a collimated whole-body counter, regional measurements could potentially be done over shorter periods (6-8 hours) in order to simplify the procedure.

Topics: Bone and Bones; Bone Diseases; Etidronic Acid; Humans; Kidney Diseases; Male; Organotechnetium Compounds; Technetium; Technetium Tc 99m Medronate; Whole-Body Counting

Sixteen patients with primary fibromyalgia syndrome were assessed blindly by multiphase skeletal scintigraphy to detect possible subclinical synovitis and uptake abnormalities at tender point sites. Results were normal in 14 of the 16 patients. Mild and localized abnormalities were found in 2 patients and were possibly due to the trauma of overuse. Our multiphase skeletal scintigraphy study showed that synovitis, other evidence of arthritis, or abnormalities at tender point sites were not increased above normal expectation among our sample of patients studied with fibromyalgia.

Topics: Adolescent; Adult; Bone Diseases; Child; Connective Tissue Diseases; Female; Fibromyalgia; Humans; Male; Radionuclide Imaging; Single-Blind Method; Sodium Pertechnetate Tc 99m; Synovitis; Technetium Tc 99m Medronate

Brucellosis is an endemic disease in the Middle East. Its incidence in Kuwait has increased during the last 5 years. Bone and joint involvement causes major symptoms and disabilities. Radionuclide bone scans are more sensitive than radiographs in detecting these lesions. The aim of this study is to describe the abnormal patterns detected on bone imaging in acute and chronic brucellosis. Tc-99m MDP bone scans of 56 patients with established diagnosis of brucellosis (19 acute and 37 chronic) were retrospectively analyzed. Bone scans were positive in 8 of 19 patients (42%) with acute brucellosis and in 28 of 37 patients (76%) with chronic brucellosis. Six patterns were observed: involvement of an entire body of one or more vertebrae, especially at the lumbar region (50%); sacroiliitis (41%); focal high uptake at the junction of the upper and lateral margins of the vertebra "Caries sign" (27%); multiple costovertebral joints and costochondral junction involvement (19%); involvement of large joints similar to degenerative osteoarthritis (25%); and focal involvement of long bone (11%).

Topics: Acute Disease; Adult; Back Pain; Bone Diseases; Brucellosis; Chronic Disease; Female; Humans; Joint Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Intense Tc-99m MDP uptake in both clavicles was noted in a patient with fulminant acne. X-ray examination and biopsy performed later showed hyperostosis.

Topics: Acne Vulgaris; Adolescent; Bone Diseases; Clavicle; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone Diseases; Female; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Twenty-six cases of lipid (cholesterol) granulomatosis, Erdheim-Chester Disease (ECD), have been described in the literature to date. A new case of ECD in a 33-year-old man with an unusual presentation of exudative ascites following a four year history of abdominal pain is reported. The radiographic and bone scan findings in this disease have been established and Ga-67 scan findings are reported. The Tc-99m sulphur colloid bone marrow and In-111 chloride scan findings are presented.

Topics: Adult; Bone Diseases; Cholesterol; Humans; Indium Radioisotopes; Male; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Xanthomatosis

Topics: Bone Diseases; Humans; Mastocytosis; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Using a rotating gamma camera the normal single photon emission computed tomography (SPECT) anatomy of the skull was defined in eight subjects. The value of SPECT as compared with planar scintigraphy was assessed in 34 patients with known or suspected disease of the skull. Seven patients had normal planar scintigraphy and SPECT. In 12 of 27 patients with bone involvement SPECT and planar scintigraphy showed essentially the same findings. In 15 patients SPECT was superior to planar scintigraphy. In three of these patients SPECT detected lesions while planar scan was normal. In the other 12 patients SPECT showed better anatomic localization and defined the full extent of the lesion. This was most obvious in patients with involvement of sphenoid, petrous, clivus, maxilla, and zygomatic bones. Our findings confirm the potential of SPECT to detect lesions in deep bones that are overlapped by superficial bony structures that cannot be visualized clearly with planar scintigraphy.

Topics: Bone Diseases; Cadaver; Evaluation Studies as Topic; Humans; Skull; Skull Fractures; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Aged; Biopsy; Bone Diseases; Bone Neoplasms; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Eosinophilia; Follow-Up Studies; Histiocytoma, Benign Fibrous; Humans; Osteoma, Osteoid; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

A new system for classification of stress fractures identified by bone scintigraphy was developed and divided into four grades according to lesion dimension, bone extension, and tracer accumulation. The scintigraphic findings were evaluated for severity of lesions by extent of the visualized bone response, ranging from ill-defined cortical lesions with slightly increased activity (I) to well-defined intramedullary transcortical lesions with intensely increased activity (IV). Bone scintigraphies using [99mTc]MDP were obtained in 310 military recruits suspected of having stress fractures. In 235 patients, 391 stress fractures were diagnosed. Forty percent of the lesions were asymptomatic. Most of the lesions were in the tibiae (72%), and 87% of the patients had one or two lesions, while 13% had three to five lesions. Eighty-five percent of the lesions were classified as mild and showed early and more complete resolution on follow-up studies after treatment as compared to the severe grades. Furthermore, specific scintigraphic patterns have been introduced for distinguishing inflammatory shin-splints from stress fractures, allowing for their appropriate early treatment. Thus, early recognition of mild stress fracture scintigraphic patterns representing the beginning of pathologic bone response to stress enabled a prompt and effective treatment to prevent progression of lesions, protracted disability, and complications.

Topics: Adult; Bone Diseases; Diagnosis, Differential; Femoral Fractures; Follow-Up Studies; Fractures, Bone; Humans; Male; Military Personnel; Physical Exertion; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

Clinical, radiographic and scintigraphic abnormalities in primary oxalosis of a 52 years old female are demonstrated. Severe oxalosis-nephropathy and oxalosis-arthropathy/enthesiopathy are shown. For the first time an intense myocardial uptake of 99 m Tc-HDP and 99 m Tc-MDP is described in connection with oxalosis. It is suggested that in the appropriate clinical setting this pattern may be suggestive of oxalosis-cardiomyopathy. Review of literature.

Topics: Arthritis; Bone Diseases; Cardiomyopathies; Diphosphonates; Female; Humans; Hyperoxaluria; Kidney Calculi; Middle Aged; Oxalates; Technetium; Technetium Tc 99m Medronate

99mTc-sodium pertechnetate was reduced and complexed with 1,2-dihydroxy-1,2-bis(dihydroxyphosphinyl)ethane (DHPE) with a yield higher than 95%. When administered to rats, 99mTc-DHPE demonstrated very good skeletal uptake, a high clearance from blood to the bones a low concentration in muscles and other organs, satisfactory biological stability and a clearance mainly through the kidneys. The biodistribution of 99mTc-DHPE in rats compared to that of 99mTc-methylenediphosphonate (99mTc-MDP) at 2 and 24 h post injection, showed higher skeletal uptake, substantially higher blood clearance, but also higher concentration in muscles which, however, caused no significant degradation in image quality. These characteristics suggest that 99mTc-DHPE is a promising new skeletal imaging agent.

Topics: Animals; Bone and Bones; Bone Diseases; Diphosphonates; Female; Organometallic Compounds; Organotechnetium Compounds; Radiation Dosage; Radiochemistry; Radionuclide Imaging; Rats; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone and Bones; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Sternocostoclavicular hyperostosis is a rare syndrome that is characterized by hyperostosis and soft tissue ossification between the clavicles and the anterior part of the upper ribs. This syndrome frequently is found in the case of palmoplantar pustulosis (PPP), especially in Japan. There have been few published reports, however, of Tc-99m MDP bone imaging findings in PPP. Eleven patients with PPP who were suspected to have sternocostoclavicular hyperostosis were studied with Tc-99m MDP whole body bone imaging. Bone images were abnormal in 11 patients. Abnormal radionuclide concentrations were observed in the sternoclavicular, sternocostal, and manubriosternal joints, in the ribs, and in the sternum. Whole body imaging revealed radionuclide accumulations unexpectedly in other bones such as the vertebrae, femur, tibia, or sacroiliac joints in five of 11 cases. Radiographs were available in nine patients. Three chest radiographs were negative, and six showed various degrees of hyperostosis or sclerotic changes in sternoclavicular, sternocostal, or manubriosternal joints, or in the sternum or anterior upper ribs. These bone lesions usually were more prominent and more easily recognized with bone scintigraphy. Bone scintigraphy should be used as a routine procedure in patients with PPP who are suspected to have sternocostoclavicular hyperostosis.

Topics: Adult; Bone Diseases; Clavicle; Female; Humans; Keratoderma, Palmoplantar; Male; Middle Aged; Radionuclide Imaging; Ribs; Sternum; Syndrome; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone and Bones; Bone Diseases; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole-Body Counting

The effectiveness of CT and technetium-99m sulfur colloid (99mTc SC) bone-marrow scans in determining the extent and severity of skeletal involvement in 23 patients with type 1 Gaucher's disease was compared with the effectiveness of conventional radiographic techniques and technetium-99m methylene diphosphonate (99mTc MDP) bone scintigrams. Density measurements obtained by CT proved sensitive in differentiating normal marrow (-50 to -120 H). Scintigrams with the sulfur colloid nuclide demonstrated three distinct patterns of uptake: peripheral expansion of normal marrow (profile B), greater marrow expansion with patchy areas lacking uptake (profile C), and greater loss of uptake with retention of the nuclide in other reticuloendothelial organs and circulation (profile D). CT scans provided greater sensitivity in resolving the extent of marrow involvement in affected areas, while the 99mTc SC scintigrams were more effective in overall assessment of the severity of bone-marrow involvement. Both conventional radiographic techniques and 99mTc MDP bone scans were useful primarily as screening procedures or for evaluating specific involved areas. 99mTc MDP scans were useful in evaluating regional defects (i.e., ischemic necrosis) in certain cases, but no consistent patterns were observed. CT and 99mTc SC scans are useful for determining the extent and severity of Gaucher's disease involvement of bone marrow.

Topics: Bone Diseases; Female; Gaucher Disease; Humans; Male; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Imaging features of a case of sternoclavicular hyperostosis are described, and the pathologic and clinical features of this uncommon entity are discussed.

Topics: Bone Diseases; Clavicle; Gallium Radioisotopes; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Ribs; Sternum; Syndrome; Technetium Tc 99m Medronate

Topics: Bone Diseases; Bone Neoplasms; Diagnosis, Differential; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Arthritis, Rheumatoid; Bone Diseases; Bone Neoplasms; Calcinosis; Female; Humans; Male; Middle Aged; Osteonecrosis; Pain; Radionuclide Imaging; Technetium Tc 99m Medronate

Gaucher's disease involves the liver, the spleen, and the bone. Liver-spleen and bone scintigraphy were used during an 8-yr period to evaluate changes caused by this disease. Patients were investigated with a liver-spleen scan for abdominal pain, mechanical discomfort, enlarged liver or spleen on physical examination, abdominal mass, abnormal liver function tests, and symptoms of hypersplenism. Fourteen liver-spleen scans were performed in nine patients. Liver scintigraphy showed various degrees of enlargement and inhomogeneous uptake. In two patients focal defects were detected. In one, focal defects were due to liver involvement with Gaucher's disease, but in the other they were caused by metastatic pancreatic carcinoma. The study was also useful in detecting splenic infarction and in following enlargement of the spleen after partial splenectomy. The main indication for bone scintigraphy in six patients was bone pain. This was found to be caused by either aseptic necrosis of the head of the femur, bone infarction, pathological fractures, or osteomyelitis. Loosening after total hip replacement was ruled out in three patients and missed in one patient. Scintigraphy appears to be a simple, sensitive test for evaluation of the liver, spleen, and bony skeleton in patients with symptomatic Gaucher's disease.

Topics: Bone Diseases; Femur Head Necrosis; Gaucher Disease; Hepatomegaly; Humans; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Splenomegaly; Technetium; Technetium Tc 99m Medronate

The performance of Tc-99m MDP vs Tc-99m dicarboxypropane diphosphonate (DPD) was evaluated in 20 patients with various skeletal bone diseases. Each patient was investigated twice, with an interval of three days between studies and using the same protocol, hence each case served as its own control. The results were: In a subjective interpretation by five independent and experienced investigators, the difference between agents was small, yet in favor of MDP. Region of interest (ROI) analysis of the pooled results in 74.4% of all cases shows a higher bone lesion to normal bone ratio (BL/NB), and in 79.3% of all cases, a better bone lesion to soft tissue ratio (BL/ST) with Tc-99m MDP. When considering pathology types separately, the BL/NB ratio of Tc-99m MDP was 17.7% higher than the one of Tc-99m DPD in metastases, 9.5% higher in rheumatoid arthritis, 2.8% higher in metabolic diseases, and 24% higher in bone fractures. Student's paired t test on the pooled BL/NB ratios shows a difference of 15.5% for Tc-99m MDP, significant at P = 0.00155. The overall results of our study favor Tc-99m MDP.

Topics: Adult; Aged; Bone and Bones; Bone Diseases; Diphosphonates; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Four patients with sternocostoclavicular hyperostosis showing characteristic abnormal uptake on bone imaging are described. Bone imaging was useful in the diagnosis of sternocostoclavicular hyperostosis.

Topics: Adult; Bone Diseases; Clavicle; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Ribs; Sternum; Technetium Tc 99m Medronate

A 64-year-old man was found to have isolated focal rib lesion(s) by radiographs and radionuclide bone scan. A biopsy of one of the lesions located by imaging was done. The histologic diagnosis was sclerosing (ossifying) xanthoma. A literature search disclosed that xanthomatous lesions of bone are only one of the manifestations in hyperlipidemic patients. These benign lesions should be included among the causes of discrete hot rib abnormalities visualized on bone scan.

Topics: Biopsy; Bone Diseases; Diagnosis, Differential; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate; Xanthomatosis

A 30-yr-old diver experienced pain in the area of the sacroiliac joint during the descent phase of air diving to less than 10 ATA. Computed tomography of the pelvis demonstrated two gas-filled cysts within the ilium. The mechanism by which this lesion causes pain is discussed and reports of gas within bone are reviewed.

Topics: Adult; Bone Diseases; Cysts; Decompression Sickness; Diving; Gases; Humans; Male; Pain; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone scans and skeletal x-rays of eight patients with systemic mastocytosis were reviewed. Mast cell infiltration of bone marrow had been proven histologically in every patient. Bone scan and roentgenographic findings are not specific for the disease and do not correlate well in some patients. A generalized increase of uptake was noted in two patients, a generalized decrease of skeletal activity with poor delineation of bony structures was observed in others. A circumscribed increase of activity was observed in some patients, only one patient had a normal bone scan. Roentgenographic examination revealed diffuse sclerosis of trabecular bone in three patients, osteoporosis with collapse of multiple vertebral bodies in three patients, and no abnormalities in two patients.

Topics: Adult; Aged; Bone Diseases; Diphosphonates; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Urticaria Pigmentosa

The usefulness of indium-111 white blood cell scintigraphy in the diagnosis of subacute or chronic bone infection was examined in 21 orthopedic patients. In-111 WBC imaging was compared with gallium-67 and technetium-99m methylene diphosphonate skeletal scintigraphy and bone radiography, all studies being performed within 1 week. In-111 WBC scintigraphy showed no definite advantage over Ga-67 scintigraphy in the identification of chronic bone infection. The two tests had the same sensitivity (80%) and similar specificity (In-111 WBC 75%, Ga-67 83%; difference not significant). Bone radiography had a sensitivity of 60% and a specificity of 67%. A negative Tc-99m MDP bone scintigram ruled out infection (sensitivity 100%), but because of low specificity (25%), final evaluation required performance of Ga-67 or In-111 WBC scintigraphy.

Topics: Adult; Aged; Bone Diseases; Chronic Disease; Diphosphonates; Gallium Radioisotopes; Humans; Indium; Infections; Leukocytes; Middle Aged; Radiography; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The application of radioisotope scanning to osseous involvement from systemic sarcoidosis has been infrequently described in the scientific literature. Most commonly, the small bones of the hands and feet are affected if sarcoidosis involves the skeleton. Nonetheless, there are also occasional manifestations of sarcoid in the skull, long bones, and vertebral bodies. This paper describes a case of sarcoid involving the lung parenchyma with multiple lesions in the skull and ribs demonstrated by bone scanning with Tc-99m MDP. Following treatment with steroids, the bone scan showed complete resolution of the rib lesions and almost complete resolution of the lesions in the calvarium.

Topics: Bone Diseases; Diphosphonates; Female; Humans; Lung Diseases; Middle Aged; Pentetic Acid; Radionuclide Imaging; Sarcoidosis; Skull; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pentetate

Quantitative evaluation of whole-body bone scans is valuable for the description of metabolic activity in systemic bone disease and provides parameters of whole-body activity retention up to 24 h after injection of the radiopharmacon, of bone to soft tissue relation and of the activity in the epiphysis and diaphysis. A combination of whole-body imaging by a gamma-camera with pinhole collimator and a series of single pictures evaluated by the ROI technique is able to record these parameters with sufficient precision. This is demonstrated by measuring phantoms, and patients with and without bone disease. In 34 patients with systemic bone disease the quantitative parameters are altered partially, the changes however are insufficient for their differential diagnosis.

Topics: Bone and Bones; Bone Diseases; Diphosphonates; Humans; Models, Structural; Organotechnetium Compounds; Radionuclide Imaging; Reference Values; Technetium; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

A simultaneous dual isotope technique incorporating computer subtraction for the diagnosis of bone, joint, or soft-tissue infection using [67Ga]citrate and [99mTc]MDP or sulfur colloid is described. Comparison of this technique with visual congruence or noncongruence of the two radionuclide images in 41 patients shows that the two techniques have identical sensitivity (93%) and specificity (92%) but the computer technique gave additional information in 17% of all cases (44% of abnormals) concerning the anatomic location of the infective focus which aided in the subsequent surgical management of the patient.

Topics: Adolescent; Adult; Aged; Bone Diseases; Child; Child, Preschool; Computers; Connective Tissue Diseases; Diphosphonates; Female; Gallium Radioisotopes; Humans; Infections; Male; Middle Aged; Radionuclide Imaging; Subtraction Technique; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Four patients undergoing routine bone imaging with a Tc-99m bone imaging agent were observed to have multiple focal areas of increased uptake in the lungs. Delayed or repeat examination demonstrated resolution of the areas. The authors conclude that this was an isolated and bizarre case of aggregate formation.

Topics: Bone and Bones; Bone Diseases; Diphosphonates; Humans; Lung; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

We have investigated the possibilities of technetium-99m-(-3-aminohydroxypropylidene)-1-1-bisphosphon ate ([99mTc]APD) as a bone scanning agent in 14 normal subjects and 28 patients. Similar studies in the same normal subjects and patients were carried out with 99mTc-methylene-bisphosphonate ([99mTc]MDP). The compounds were labeled with 99mTc by means of an electrolytical method; the free pertechnetate content was always under 1%. The [99mTc]APD T1/2 of the third component of the disappearance plasma curve in six normal subjects was 152 +/- 46 min (mean +/- s.d.), while the 24-hr whole-body retention (WBR) was 17.6% +/- 4.6. The [99mTc]MDP value of the 24-hr WBR was 28.6% +/- 3.9 (p less than 0.001). The bone/soft-tissue ratio (B/ST) was investigated in eight control subjects on the eleventh thoracic and the fourth lumbar vertebrae. The B/ST ratios were similar for both APD and MDP studies. In 28 patients with suspected bone metastasis or primary bone disease, bone scintigraphy was carried out; both compounds showed similar findings and the same number of positive results. In five of these patients, the lesion/normal bone ratio was determined with values of 4.6 +/- 2.0 in APD studies and 4.8 +/- 2.3 with MDP. APD was also used in 126 patients; no adverse reactions were observed. The APD dose used i.v. for bone scanning was 200-fold less than those employed by mouth per day, for the treatment of bone disease for long periods. In our experience, APD appears to be an adequate agent for bone scintigraphy.

Topics: Adolescent; Adult; Aged; Bone Diseases; Diphosphonates; Electrolysis; Female; Humans; Isotope Labeling; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

A retrospective review of 2,851 bone scans done at a cancer center over a period of 4 yr revealed 41 patients having a single abnormality in a rib as their first abnormal scintigraphic finding. The scan findings in these cases were correlated with clinical, scintigraphic, and radiographic follow-up to ascertain their etiology and course. Four lesions (9.8%) were due to malignant disease, 16 (39%) were associated with benign fractures demonstrated on x-ray, 11 (27%) were associated with primary or postoperative radiation therapy. The remaining ten patients (24.2%) with normal x-rays and no association with radiation therapy or subsequent development of metastasis were assigned to benign etiology. This experience suggests that solitary rib lesions in cancer patients are uncommon and are most frequently (90%) associated with benign etiology.

Topics: Bone Diseases; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Neoplasm Invasiveness; Neoplasms; Radionuclide Imaging; Radiotherapy; Retrospective Studies; Rib Fractures; Ribs; Technetium Tc 99m Medronate

Scintigraphy with Technetium methylene diphosphate gives a positive result in bone tissue in a state of raised metabolic activity. This can be used in the diagnosis of mechanical stress lesions in bone. The authors present several clinical examples confirming the usefulness of this method.

Topics: Adult; Aged; Bone Diseases; Cartilage Diseases; Female; Femur Head Necrosis; Hip Joint; Hip Prosthesis; Humans; Joint Diseases; Knee Joint; Male; Middle Aged; Radionuclide Imaging; Stress, Physiological; Technetium Tc 99m Medronate

Topics: Adult; Bone Diseases; Carpal Bones; Diphosphonates; Female; Humans; Pain; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography

Topics: Adult; Aluminum; Antacids; Bone Diseases; Deferoxamine; Diphosphonates; Female; Fractures, Spontaneous; Humans; Technetium; Technetium Tc 99m Medronate; Time Factors

Topics: Bone Diseases; Clavicle; Diphosphonates; Female; Humans; Middle Aged; Radionuclide Imaging; Ribs; Sternum; Technetium; Technetium Tc 99m Medronate

The detection of radionuclide activity in the living equine skeleton, using bone seeking radiopharmaceuticals and a hand-held radiation detector, is reported. Pathological changes in bone can be detected and subsequent development monitored. The availability and use of this diagnostic technique in equine practice is discussed.

Topics: Animals; Bone and Bones; Bone Diseases; Diphosphonates; Horse Diseases; Horses; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

In 87 patients with proved diagnosis and a normal or pathologic bone scan (BS) in addition a bone marrow scan (BMS) was performed using a 99mtechnetium-labelled microcolloid. The analysis of scintigraphic findings included those obtained by other investigations shows that in these selected patients a false normal or false positive interpretation would have been resulted in 18% performing the BS only. Both methods BS and BMS were capable of diagnosing the correct stage of disease in all patients. The results indicate an augmentation of diagnostic facilities by the BMS in diseases affecting bone or bone marrow.

Topics: Adult; Bone and Bones; Bone Diseases; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Hodgkin Disease; Humans; Lung Neoplasms; Male; Middle Aged; Myeloproliferative Disorders; Osteomyelitis; Osteosarcoma; Plasmacytoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Scintigraphic findings in ten cases of systemic mastocytosis are described. Four radionuclide bone patterns were noted: normal, unifocal, multifocal, and diffuse. Compared with radiographic surveys, bone images were better able to show the widespread skeletal involvement in patients with diffuse disease, and to detect a greater number of focal lesions. Serum calcium, phosphorus, and bone-derived alkaline phosphatase, as well as urinary calcium, phosphorus, and hydroxyproline levels, were usually within normal limits even when the bone scintigrams were clearly abnormal. Plasma and urinary histamine levels were highest in patients whose bone images detected widespread skeletal involvement. In systemic mastocytosis, not only does scintigraphy document active bone disease more effectively than laboratory studies of bone metabolism and radiographs of bone, but it also appears to reflect the general severity of the disease process.

Topics: Adult; Bone Diseases; Diphosphonates; Female; Histamine; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Urticaria Pigmentosa

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Child; Diagnostic Errors; Diphosphonates; Female; Fractures, Bone; Humans; Indium; Male; Middle Aged; Organophosphorus Compounds; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The osseous lesions of disseminated coccidioidomycosis may be detected by bone but not by gallium scintigraphy or vice versa. This case emphasizes the need for performing both bone and gallium scans to avoid missing potentially serious bone lesions.

Topics: Bone Diseases; Coccidioidomycosis; Diphosphonates; Gallium Radioisotopes; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Bone and Bones; Bone Diseases; Diphosphonates; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The herniation pit of the femoral neck is a common radiographic lesion whose pathogenesis has been described by Pitt et al and reported as negative on bone scanning. This case report demonstrates increased uptake of Tc-99m MDP in a herniation pit of the femoral neck.

Topics: Adult; Bone Diseases; Diphosphonates; Femur Neck; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone Diseases; Coccidioidomycosis; Diphosphonates; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Diseases; Child; Child, Preschool; Diphosphonates; Female; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A computer macro-program was developed for standardized, semiquantitative measurement of radiotracer uptake. The method uses profiles of selectable length, width, and inclination according to the anatomical structures of the pathological and the corresponding healthy region. The ratio of the two curves is calculated automatically and shown as an 'uptake curve'. The essential use of osteoscintimetry is in the follow-up examination if small changes of regional uptake have to be identified. The profile-technique rather than the ROI-technique was selected, because the main benefit of the profile-technique is that the results of follow-up examinations are comparable to previous examinations with a standard deviation of +/-5%.

Topics: Adolescent; Adult; Bone Diseases; Child; Child, Preschool; Computers; Diphosphonates; Humans; Infant; Male; Methods; Osteitis; Osteomyelitis; Radionuclide Imaging; Syndrome; Technetium; Technetium Tc 99m Medronate; Tuberculosis, Osteoarticular

Besides the known joint involvement as seen in the whole-body scan which uses 99m technetium-phosphate-complexes, skeletal scintigraphic investigations in 17 patients with psoriasis have demonstrated circumscribed or diffuse accumulative pathological concentrations of the radionuclide within the skeleton of the skull, the thyroid cartilage, the bony thorax and osseous long bones. These pathological accumulations of radionuclides of TcP-complexes which are distant from joint regions, point to proliferative phenomena in the bone in case of psoriasis especially in alterations of the collagenous metabolism.

Topics: Adult; Aged; Arthritis; Bone Diseases; Diphosphonates; Female; Humans; Male; Middle Aged; Psoriasis; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphonates; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The bone scan is generally recognized to be an extremely powerful investigational tool in the evaluation of patients with skeletal disease. Currently 99mTc-methylene diphosphonate is the most widely used bone scanning agent, but recently several new diphosphonate compounds have been introduced which appear to have relatively higher skeletal affinity, leading to greater absolute uptake of tracer by bone. While the resulting improved contrast between bone and background soft-tissue may provide more pleasing scan images, it is not clear that increased bone uptake of tracer is equally desirable for identification of disease. Nevertheless, to date, no significant difference in lesion detection has been found in any comparative study of diphosphonate compounds. In this review the clinical studies evaluating diphosphonate bone scanning agents are summarized and the properties required of an ideal bone scanning agent in both benign and malignant disease discussed.

Topics: Bone Diseases; Bone Neoplasms; Diphosphonates; Etidronic Acid; Humans; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Diphosphonates; Female; Humans; Male; Middle Aged; Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The radionuclide bone scan is a noninvasive screening procedure which can help in identifying or confirming subtalar coalitions in patients with foot and/or ankle pain of unknown origin in whom routine plain film studies are inconclusive. Five patients (seven symptomatic feet) with clinical and plain film findings suggesting a subtalar coalition are presented. The radionuclide bone scans in four patients (six feet) with documented subtalar coalitions demonstrated augmented uptake in the subtalar joint in all six feet and a secondary area of augmented concentration in the superior aspect of the talus or talonavicular joint in five feet. The radionuclide bone scan was normal in the one patient who was later proved not to have a coalition. The scans of 100 patients with foot pain of other etiologies were reviewed, and in no instance did the scan demonstrate the combination of subtalar and talus or talonavicular uptake observed in the patients with coalitions.

Topics: Adolescent; Adult; Aged; Bone Diseases; Diagnosis, Differential; Diphosphonates; Foot Diseases; Humans; Male; Radionuclide Imaging; Talus; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Bone Diseases; Diphosphonates; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Vibration

Bone scans of patients with diabetic osteoarthropathy of the ankle and foot were characterized by a combination of diffuse and focal increased uptake, similar to that seen with hyperemia and reactive new bone formation. Scintigraphy showed more extensive abnormalities than radiography, with the scan abnormalities sometimes preceding the radiographic changes. The clinical and scintigraphic appearance of osteoarthropathy may improve following strict diabetic control and non-weight-bearing.

Topics: Adult; Aged; Ankle; Bone Diseases; Diabetic Neuropathies; Diphosphonates; Female; Foot; Humans; Joint Diseases; Male; Middle Aged; Radiography; Technetium; Technetium Tc 99m Medronate

Radiographs were compared with 99mTc scans of the bones and bone marrow as well as 67Ga-citrate scans to evaluate their sensitivity in identifying skeletal lesions in 21 children with histiocytosis X. Seven of 20 bone scans were completely normal in patients with extensive radiographic evidence of skeletal disease. In only one patient were bone scan changes demonstrated prior to radiographic abnormalities. None of the lesions was "cold" on the bone scans. 99mTc-sulfur colloid bone marrow scans and 67Ga-citrate whole-body scans were not valuable. Radiographic survey of the skeleton should be the primary diagnostic test employed in patients with histiocytosis X who have suspected skeletal lesions. Bone scans should be obtained only when the radiographs are normal or equivocal.

Topics: Bone and Bones; Bone Diseases; Bone Marrow; Child; Child, Preschool; Diphosphonates; Etidronic Acid; False Negative Reactions; Female; Gallium Radioisotopes; Histiocytosis, Langerhans-Cell; Humans; Infant; Male; Organotechnetium Compounds; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

A new method for measurement of 24-hr whole-body retention (WBR) of 99mTc-MDP, using a thyroid uptake probe was established and its clinical significance was evaluated in various bone diseases. (1) Reproducibility of 24-hr WBR in 9 patients was very good. Correlation coefficient was 0.997 and coefficient of variability was only 1.83%. (2) Radiochemical purity of 99mTc-MDP was 97.8 +/- 0.7% (n = 5), indicating no significant inter-lot variations. (3) 24-hr WBR of normal adult males (n = 5) was 30.0 +/- 4.9%, which was significantly elevated compared to the reported 99mTc-HEDP WBR of 19.2 +/- 1.7%. Whole-body retentions of chronic renal failure, metastatic bone disease and hyperthyroidism groups were significantly elevated compared to that of the normal group. However, WBR of steroid-induced osteoporotic group was significantly decreased. Based on these results, this thyroid uptake probe method was simple, reproducible and accurate to measure 24-hr WBR of 99mTc-MDP. Quantification of WBR of 99mTc-MDP was of great clinical value to diagnose metabolic bone disease and to follow-up metabolic and metastatic bone diseases.

Topics: Adult; Aged; Bone Diseases; Diphosphonates; Drug Stability; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Thyroid Function Tests; Whole-Body Counting

Topics: Bone and Bones; Bone Diseases; Diphosphonates; Humans; Kinetics; Technetium; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Diseases; Diphosphonates; Etidronic Acid; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Twenty-four patients with increased skeletal:renal uptake ratios of 99mTc-methylene diphosphonate were studied. Increased uptake was central in metastatic prostate carcinoma, peripheral in hematologic disorders, and heterogeneous in Paget disease and fibrous dysplasia. There was no discernible redistribution of skeletal uptake in patients with renal failure. Absence of both renal and bladder activity was not observed in patients with normal renal function. An increased ratio was always abnormal and frequently indicated diffuse bone disease.

Topics: Adolescent; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphonates; Female; Hematologic Diseases; Humans; Kidney; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Urinary Bladder Neoplasms

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphonates; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Kinetics; Liver Cirrhosis; Middle Aged; Osteitis Deformans; Osteomalacia; Osteoporosis; Technetium; Technetium Tc 99m Medronate

The biologic and imaging characteristics of Tc-99m MDP and Tc-99m HEDP were compared in ten patients: Tc-99m MDP exhibited lower blood activity, lower 4-hr urinary excretion, and higher normal bone-to-background ratio. Assessment of overall image quality also favored Tc-99m MDP, indicating that the normal skeleton is better visualized with this agent. The total number of lesions seen (18) was not large enough to allow critical comparison of relative lesion-detecting efficacy. However, discrepancies between the two agents were observed, suggesting additional evaluation of the relative lesion-detecting efficacy of these two bone agents.

Topics: Adult; Aged; Bone Diseases; Bone Neoplasms; Diphosphonates; Etidronic Acid; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Reagent Kits, Diagnostic; Technetium; Technetium Tc 99m Medronate