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

To evaluate the diagnostic performance of whole-body (WB) integrated single photon emission tomography (SPECT)/computed tomography (CT) in detecting bone metastasis (BM) and to investigate whether WB-SPECT/CT offered any additional benefit value compared to planar bone scintigraphy (PBS) with. Medline, EMBASE, SCOPUS, Web of Science, and CINAHL were searched systematically up to 28 August 2019. All studies using histopathological analysis and/or follow-up imaging and clinical data as the reference standard were eligible for inclusion.. Eleven studies (1,611 patients) were analysed. Based on patient analysis, the sensitivity, specificity, and area under the curve (AUC) of WB-SPECT/CT were 92% (92% confidence interval [CI], 89-95%), 95% (95% CI, 94-96%), and 0.9835, respectively, in the case of negative equivocal findings for BM, and 94% (95% CI, 91-96%), 94% (95% CI, 92-95%), and 0.9790, respectively, when regarded positive. On a lesion basis, these parameters were 91% (95% CI, 89-94%), 96% (95% CI, 94-97%), and 0.9906, respectively, in the case negative equivocal findings, and 92% (95% CI, 89-94%), 95% (95% CI, 94-97%), and 0.9898, respectively, when regarded positive. Comparing 1,265 patients from eight studies, higher sensitivity (92% versus 74%, p=0.04) and specificity for WB-SPECT/CT against PBS (93% versus 80%, p=0.01) in the case of positive equivocal findings; however, when regarded negative, WB-SPECT/CT demonstrated higher sensitivity (91% versus 70%, p=0.01), but no significant difference was apparent in specificity (94% versus 89%, p=0.07).. Compared to PBS, WB-SPECT/CT had superior diagnostic accuracy in BM detection and exhibited a more reliable performance with less equivocal results.

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

Topics: Acquired Hyperostosis Syndrome; Bone Neoplasms; Face; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Hyperplasia; Infections; Mandibular Condyle; Maxilla; Osteitis Deformans; Periodontitis; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sjogren's Syndrome; Technetium Tc 99m Medronate; Technology, Dental; Temporomandibular Joint Disorders; Tomography, X-Ray Computed

The current standard of chemotherapy response evaluation holds the most important prognostic factor to be the histological assessment of the tumor necrosis of the excised lesion, but the major challenge is to find an early prognostic factor that will allow the adjuvant treatment regimen to be adjusted. The objective of this systematic review is to provide an up-to-date and unprecedented summary of the value of Technetium-methylene diphosphate or -hydroxymethylene diphosphate (Tc-MDP/HMDP) scintigraphy for the preoperative evaluation of osteosarcoma response to chemotherapy.. Studies evaluating the alteration ratio (percentage change of the Tc-99m -MDP/HMDP uptake between before and after neoadjuvant chemotherapy) to predict the histological response of osteosarcoma to chemotherapy were searched for in MEDLINE, EMBASE, and Web of Science. A meta-analysis of individual patient data (IPD) was performed to determine the optimal cut-off point from the receiver operating characteristic (ROC) curve. Additionally, aggregate data (AD) meta-analysis was performed to compare the value of Tc-MDP/HMDP scintigraphy with that of other quantitative modalities, such as dynamic magnetic resonance imaging (MRI), Tl scintigraphy, and F-FDG PET-CT.. Seven studies with 154 patients were included for the IPD meta-analysis. The optimal cut-off point of the alteration ratio was 31.0%. Five studies with 123 patients were considered for the AD meta-analysis. The pooled sensitivity and specificity were 0.76 (95% CI, 0.63-0.86) and 0.89 (95% CI, 0.79-0.95), respectively. There was a significant difference between the good and poor responders in terms of the diagnostic odds ratio. The summary ROC curve demonstrated that the area under curve (AUC) was 0.892, indicating excellent diagnostic accuracy.. Our findings have suggested that conventional Tc-MDP/HMDP scintigraphy remains as useful as recent quantitative modalities to predict the histological response of osteosarcoma to neoadjuvant chemotherapy.

Topics: Bone Neoplasms; Humans; Neoadjuvant Therapy; Osteosarcoma; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

There is growing evidence that molecular imaging of bone metastases with positron-emission tomography (PET) can improve diagnosis and treatment response assessment over current conventional standard imaging methods, although cost-effectiveness has not been assessed. In most cancer types, 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG)-PET is an accurate method for detecting bone metastases. For example, in breast cancer, combined (18)F-FDG-PET and computed tomography (CT) is more sensitive at detecting bone metastases than (99m)technetium (Tc)-labelled diphosphonate planar bone scintigraphy (BS) and there is increasing evidence to support the use of serial (18)F-FDG-PET for the assessment of osseous response to treatment. Preliminary data suggest improved diagnostic accuracy of (18)F-FDG-PET-CT in a number of other malignancies including lung, thyroid, head and neck, gastro-oesophageal cancers, and osteosarcoma. As a bone-specific tracer, there is accumulating evidence to support the use of sodium (18)F-fluoride ((18)F-NaF) PET-CT in the diagnosis of skeletal metastases in breast and prostate cancer, although relatively little data are available to support its use for assessment of treatment response. In prostate cancer, (11)C-choline and (18)F-choline PET-CT have better specificities than (18)F-NaF-PET-CT, but equivalent sensitivities in the detection of bone metastases. We review the current literature for staging and response assessment of bone metastases in different cancers.

Topics: Bone Neoplasms; Choline; Contrast Media; Evidence-Based Medicine; Fluorodeoxyglucose F18; Humans; Image Enhancement; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Osteosarcoma is a cancer characterized by formation of bone by malignant cells. Routine bone scan imaging with Tc-99m-MDP is done at diagnosis to evaluate primary tumor uptake and check for bone metastases. At time of relapse the Tc-99m-MDP bone scan also provides a specific means to assess formation of bone by malignant osteosarcoma cells and the potential for bone-seeking radiopharmaceuticals to deliver radioactivity directly into osteoblastic osteosarcoma lesions. This chapter will review and compare a bone-seeking radiopharmaceutical that emits beta-particles, samarium-153-EDTMP, with an alpha-particle emitter, radium-223. The charged alpha particles from radium-223 have far more mass and energy than beta particles (electrons) from Sm-153-EDTMP. Because radium-223 has less marrow toxicity and more radiobiological effectiveness, especially if inside the bone forming cancer cell than samarium-153-EDTMP, radium-223 may have greater potential to become widely used against osteosarcoma as a targeted therapy. Radium-223 also has more potential to be used with chemotherapy against osteosarcoma and bone metastases. Because osteosarcoma makes bone and radium-223 acts like calcium, this radiopharmaceutical could possibly become a new targeted means to achieve safe and effective reduction of tumor burden as well as facilitate better surgery and/or radiotherapy for difficult to resect large, or metastatic tumors.

Topics: Antineoplastic Agents; Bone Neoplasms; Humans; Lung Neoplasms; Molecular Targeted Therapy; Organometallic Compounds; Organophosphorus Compounds; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Radium; Technetium Tc 99m Medronate

This literature review details the history, pharmacokinetics, and utility of (18)F-sodium fluoride (Na(18)F) PET/CT in detecting osseous metastases compared with the current standard of care, technetium-99m methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy. Additional discussion highlights solutions to impediments for broader implementation of this modality and insight into the complementary roles of (18)F-FDG PET/CT and Na(18)F PET/CT in oncology imaging, including preliminary data for combined Na(18)F and FDG PET/CT.. Na(18)F PET/CT is the most comprehensive imaging modality for the evaluation of osseous metastatic disease. Although further data acquisition is necessary to expand cost-benefit analyses of this imaging agent, emerging data reinforce its diagnostic advantage, suggest methods to mitigate impediments to broader utilization of Na(18)F PET/CT, and introduce a potentially viable technique for single-session combined Na(18)F and FDG PET/CT staging of soft-tissue and osseous disease.

Topics: Bone Neoplasms; Fluorine Radioisotopes; Humans; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate

According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases. The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0. 87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

(99m)Tc-hydroxymethylene diphosphonate is not directly to Calcium of the bone matrix, but is binding to hydroxyapatite within the bone matrix. Strontium-89 is a member of family II A of the periodic table, same as Calcium, and is incorporated into bone matrix directly. It is very important that the the regions of the pain from bone metastases are present in the site of the abnormal uptake by bone metastases.

Topics: Bone Matrix; Bone Neoplasms; Humans; Nuclear Medicine; Radiopharmaceuticals; Strontium Radioisotopes; Technetium Tc 99m Medronate

Super scan pattern on technetium-99m methyldiphosphonate (Tc-99m MDP) bone scintigraphy is a special condition of extremely high bone uptake relative to soft tissue with absent or faint renal radioactivity visualization, which is usually seen in diffuse bone metastases or discrete endocrine entities. Here, two cases with super bone scan are presented. One was a young man diagnosed with gastric cancer. The other was a middle-aged woman with a history of breast cancer with recent recurrence. Both cases had 18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) diagnosis simultaneously. Based on imaging of (18)F-FDG PET/CT, diffusely incremental (18)F-FDG avidity in spine/pelvis on PET and subtle erosion of cortical bone on CT were seen. The cytological results of bone marrow biopsy showed evidence of malignant metastasis. However, there were several focal discrepant findings between the (18)F-FDG PET/CT and Tc-99m MDP bone scan. According to integration of both imaging findings and the result of bone marrow biopsy, we believe that the disseminated malignant spread in bone marrow is a primitive alternation in the super bone scan and that it is also as a result of neoplasm-related endocrine factors.

Topics: Adult; Bone Marrow Neoplasms; Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasms, Unknown Primary; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

Bone metastases are responsible for most of the morbidity and mortality associated with solid malignant tumors, occurring in about 65-70% of the patients with advanced breast or prostate cancer. The pathophysiology of skeletal metastasis is a complex process that involves several biologic process leading to cellular invasion, adhesions and stimulation of osteoclasts and osteoblasts with the mediation of several factors including cytokines, serine proteases and tumor-derived factors. The clinical management of pain from bone metastasis, which is mostly due to indirect stimulation of sensory nerve endings by cytokines and other biologically-active compounds released locally in response to the presence of tumor cells in the bone marrow, includes several options that can be used either alone or in varying combinations, such as analgesic drugs, chemo- or hormonal therapy, bisphosponates, external beam radiation therapy, and surgery. Bone-seeking radiopharmaceuticals play an important role in the treatment of pain caused by multiple blastic or mixed-type skeletal lesions; they have in general a favorable toxicity profile and a high rate of overall clinical benefit, although they may differ in terms of duration of pain palliation and suitability for repeat treatments. The palliative effect can be attributed to the radiation targeted to the bone marrow space, and the overall average response ranges between about 45-80%, with complete response in 10-30% of the cases. In selected clinical conditions, radionuclide therapy can also constitute an effective systemic treatment beyond bone pain palliation, and a synergistic anti-tumour effect can be expected by the combination with other agents, such as chemotherapy or bisphosphonates. This review summarizes the current experience with bone-seeking radiopharmaceuticals used for bone pain palliation, focusing on indications, patients' selection, efficacy and toxicity. Finally, the available data on combination therapies showing encouraging results as to potential anti-tumor efficacy are also reviewed.

Topics: Bone Neoplasms; Combined Modality Therapy; Diphosphonates; Drug Therapy, Combination; Etidronic Acid; Humans; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Patient Selection; Radioimmunotherapy; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome

Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.

Topics: Adolescent; Angiography; Biopsy; Biopsy, Needle; Bone Neoplasms; Child; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Multimodal Imaging; Neoplasm Grading; Neoplasm Seeding; Neoplasm Staging; Positron-Emission Tomography; Radionuclide Imaging; Sarcoma; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In recent years tomographic hybrid scanners have been quickly introduced in nuclear medicine: single-photon emission computed tomography (SPECT)-CT and positron emission tomography (PET)-CT.- Both SPECT-CT and PET-CT techniques provide a higher diagnostic accuracy than conventional (non-tomographic, non-hybrid) bone scintigraphy (bone scan).- Differences between 99mTc hydroxymethylene diphosphonate (HDP) SPECT-CT or 99mTc methylene diphosphonate (MDP) SPECT-CT and 18F-fluoride PET-CT bone scanning relate to image quality, technique, availability, quantification possibilities, radiation dosimetry and financial cost.- Indications for these techniques will especially lie in the field of more accurate detection of skeletal metastases than with bone scans, patients with unexplained musculoskeletal pain, the diagnostic stage after conventional X-ray and/or MRI, and quantification of bone metabolism.

Topics: Bone Density; Bone Neoplasms; Costs and Cost Analysis; Fluorine Radioisotopes; Humans; Multimodal Imaging; Neoplasm Metastasis; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

This review explores in depth the most common malignant process involving the bone, namely metastatic disease, as well as some of the more common proliferative forms of hematopoietic disease of bone marrow. These are commonly encountered pathologic processes that often have vague nonspecific symptoms. Imaging findings are frequently subtle on initial radiographs; however, advanced imaging techniques, including CT, MR, and positron emission tomography, allow for accurate diagnosis, staging, and follow-up in most cases.

Topics: Bone Neoplasms; Fluorodeoxyglucose F18; Hematologic Neoplasms; Histiocytosis, Langerhans-Cell; Humans; Leukemia; Lymphoma; Magnetic Resonance Imaging; Multiple Myeloma; Neoplasms, Second Primary; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed; Whole Body Imaging

Scintigraphy of the skeletal system is performed mainly with the use of 99mTc-MDP. There are other radiopharmaceuticals showing affinity to bone lesions: 99mTc-MIBG, 201Tl, 131I (in the case of papillary or follicular thyroid cancers), and 99mTc (V) DMSA (in the case of medullary cancer). Currently, positron emitted radioisotopes are also used in clinical practice. It seems that 18F-NaF/PET is a highly sensitive and specific modality for detection of metastases and other bone lesions. Certain data concerning the role of 18F-FDG, 18F-choline, or 68Ga-DOTATATE can be found. The aim of this article is to review the role of 18F-NaF and 18F-FDG in diagnosis of bone metastases.

Topics: Bone Neoplasms; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Although (18)F-labeled NaF was the first widely used agent for skeletal scintigraphy, it quickly fell into disuse after the introduction of (99m)Tc-labeled bone-imaging agents. Recent comparative studies have demonstrated that (18)F-fluoride PET is more accurate than (99m)Tc-diphosphonate SPECT for identifying both malignant and benign lesions of the skeleton. Combining (18)F-fluoride PET with other imaging, such as CT, can improve the specificity and overall accuracy of skeletal (18)F-fluoride PET and probably will become the routine clinical practice for (18)F-fluoride PET. Although (18)F-labeled NaF and (99m)Tc-diphosphonate have a similar patient dosimetry, (18)F-fluoride PET offers shorter study times (typically less than 1 h), resulting in a more efficient workflow, improved patient convenience, and faster turnarounds of reports to the referring physicians. With the widespread availability of PET scanners and the improved logistics for the delivery of (18)F radiopharmaceuticals, prior limitations to the routine use of (18)F-fluoride bone imaging have largely been overcome. The favorable imaging performance and the clinical utility of (18)F-fluoride PET, compared with (99m)Tc-diphosphonate scintigraphy, support the reconsideration of (18)F-fluoride as a routine bone-imaging agent.

Topics: Bone and Bones; Bone Neoplasms; Fluorine Radioisotopes; Humans; Positron-Emission Tomography; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Osteolytic lesions are frequently encountered in clinical practice. Radionuclide bone scans with technetium-99m-labeled diphosphonates are often performed in the evaluation of both solitary and multiple osteolytic lesions. In this pictorial review, we critically evaluate the current role of bone scan in common osteolytic tumors including aneurysmal bone cyst, simple bone cyst, fibrous dysplasia, nonossifying fibroma, giant cell tumor, eosinophilic granuloma, enchondroma, chondrosarcoma, osteosarcoma, Ewing sarcoma, myeloma, and metastases. The merits and limitations of bone scanning are emphasized.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Child; Female; Humans; Male; Middle Aged; Osteolysis; Positron-Emission Tomography; Practice Guidelines as Topic; Practice Patterns, Physicians'; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

Radioisotope bone scanning is frequently employed in staging malignancies. However, false positive results are common, and biopsy is usually required. In the absence of plain radiographic abnormalities or local symptoms, localization of the area of abnormal tracer activity at the time of open rib or sternum biopsy may be difficult. It often requires resection of a large portion of one or more ribs or other bones to assure that the target area was biopsied, and still the area in question is commonly missed. In this setting, the newly-developed, small gamma probe is now used as a tool to allow precise intraoperative localization of increased tracer activity in the target bone. The use of gamma counting is an easy, highly accurate aid (100% sensitivity) to localize areas of abnormal radioisotope uptake in suspected asymptomatic osseous metastases, usually for open biopsy of a rib. The use of this technique obviates the need to obtain intraoperative localizing radiographs to confirm accurate rib identification, thereby substantially decreasing operative time.

Topics: Biopsy; Bone and Bones; Bone Neoplasms; Humans; Intraoperative Care; Methylene Blue; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Sensitivity and Specificity; Technetium Tc 99m Medronate

Skeletal metastases are one of the major clinical problems for the oncologist. Over the last several decades bone scintigraphy has been used extensively in detecting bone involvement since it can provide information about disease location, prognosis and the effectiveness of treatment. Bone scan offers the advantage of total body examination, and images bone lesions earlier than other techniques. In this paper the main clinical problems related to the most common applications of bone scan in breast, prostate, lung cancer and other tumours are discussed. The experience carried out at the National Cancer Institute of Milan by using bone SPECT to detect single bone metastases is reported. One hundred and eighteen patients with bone metastases (from different tumour types: breast, lung, prostate, lymphomas, etc.) were studied by planar scintigraphy, SPECT and other radiological modalities (CT, MRI or X-rays). The overall performances of bone SPECT were sensitivity: 90.5% (19/21), specificity 92.8% (90/97), positive predictive value 73% (19/26), negative predictive value 97.8% (90/92), accuracy 92.4% (109/118). Considering breast cancer, the most frequent pathology in our series, and the lumbar spinal tract, the most common skeletal segment involved, the figures of merit of SPECT were: sensitivity 100% (4/4), specificity 95.3% (41/43), positive predictive value 66.7% (4/6), negative predictive value 100% (41/41), accuracy 95.7% (45/47). In conclusion bone SPECT showed very good performances, in particular improving the predictive value of planar scan in the diagnosis of vertebral metastases.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Predictive Value of Tests; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Nuclear medicine techniques play an important role in (re)staging and treatment of prostate carcinoma patients. These techniques are reviewed in this paper. For many years, bone scanning has been a valuable tool for the evaluation of bone metastases. Although utilized in a more refined way since the introduction of serum prostate-specific antigen (PSA) measurement, it is still the procedure of choice in patients with higher-grade or higher-stage tumors and elevated or rising PSA levels. Labeled monoclonal antibodies have been found to have some utility in the clinic for the evaluation of disseminated malignant prostate disease and position emission tomography holds promise for the metabolic characterization of prostate cancer. Several agents are available for radionuclide therapy for bone pain palliation in patients with metastasis, improving pain with minimal side effects or discomfort to the patient. Nuclear medicine techniques in prostate carcinoma are far from obsolete. On the contrary, they are evolving and offer unique opportunities for the management of these patients. The bone scan remains useful in well-defined stages of disease, and palliative therapeutic options are evolving. At present, monoclonal antibodies and PET are not very useful in daily clinical practice.

Topics: Antibodies, Monoclonal; Bone Neoplasms; Humans; Male; Nuclear Medicine; Prostatic Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Ascites; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Follow-Up Studies; Humans; Middle Aged; Radionuclide Imaging; Tarsal Bones; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

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

Topics: Aged; Bone and Bones; Bone Neoplasms; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate; Thyroid Gland; Thyroid Nodule; Urinary Bladder Neoplasms

Bone metastases are extremely rare in patients with classical Wilms' tumor (WT). We describe the clinical and radiologic features, treatment and outcome of three patients with WT (one with favorable histology and two with anaplasia) in whom bone metastases were detected at diagnosis or relapse. Bone metastases were documented by skeletal radiographs, computed tomography and/or bone scintigraphy. The patient with favorable histology WT had no evidence of pulmonary metastases and is now free of disease following aggressive chemotherapy and radiotherapy.

Topics: Biopsy, Needle; Bone Neoplasms; Child; Child, Preschool; Humans; Infant; Kidney Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Wilms Tumor

Bone scintigraphy with 99mtechnetium-labelled polyphosphonates is the most sensitive test for early detection of skeletal metastases. Bone metastases are a major factor in prognosis and have a considerable influence on the therapy selected. In patients with prostate cancer, we recommend routine bone scintigraphy in the initial staging. Follow-up bone scans are indicated whenever a patient develops pain, an elevated level of acid phosphatase, or a rise in prostate specific antigen (PSA). Routine bone scans are not necessary for the initial staging of patients with renal cell carcinomas, bladder carcinomas and testicular tumours. Scans should be routinely performed, however, in patients with bone pain or elevated alkaline phosphatase or when radiological findings are inconclusive. Bone scanning is necessary in patients with neuroblastoma, both for the initial diagnosis and during follow-up in all cases with known skeletal involvement. In addition, bone scintigraphy should be performed in cases of recurrent or suspected malignant phaeochromocytoma as a complement to scintigraphy with iodine-123- or iodine-131-MIBG, respectively. Even though skeletal scintigraphy is a very sensitive test, it lacks specificity. This can be compensated, however, by careful interpretation of the scan in the light of the patient's history and the clinical findings. As a positive side-effect, bone scanning--especially in the form of multiphase scintigraphy--may detect renal abnormalities, concurrent diseases or complications in the upper or lower urinary tract. If scintigraphic findings are doubtful, plain film radiographs are required or, in selected cases, bone biopsy must be performed.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Urogenital Neoplasms

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

Topics: Aged; Bone Neoplasms; Diphosphonates; Female; Histiocytoma, Benign Fibrous; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Retroperitoneal Neoplasms; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Fractures, Bone; Humans; Lung Neoplasms; Male; Osteomyelitis; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

This prospective cross-section clinical trial (ChiCTR1800020304) enrolled a total of 385 patients with ESCC diagnosed at thoracic surgery clinic from October 2018 to September 2020. All patients were diagnosed with stage cT. Out of the 385 patients, only two (0.5%) changed their treatment regimen because of BM. The rate of positive BS findings was 1%, while two patients (0.5%) had false-positive or false-negative results. The BS diagnostic performance for BM was sensitivity 50%, specificity 99.5%, positive predictive value 50%, negative predictive value 99.5%, and accuracy 99.0%. There was no significant difference in BM in relation to age, sex, tumor location or clinical stage.. Our data demonstrated that

Topics: Bone Neoplasms; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Humans; Positron-Emission Tomography; Prospective Studies; Technetium Tc 99m Medronate

To evaluate efficacy of oral antioxidant treatment given to patients before radiologic procedures in reducing x-ray-induced DNA damage.. There was a significantly higher number of gamma-H2AX foci/cell after ionization radiation in the control group compared with the antioxidant group (P = .009). There was no statistically significant difference in number of gamma-H2AX foci/cell before or after exposure in the antioxidant group; the number of gamma-H2AX foci/cell was statistically significantly higher (P = .009) in the control group after exposure to. In patients undergoing

Topics: Acetylcysteine; Administration, Oral; Adult; Aged; Aged, 80 and over; Antioxidants; Ascorbic Acid; beta Carotene; Biomarkers; Bone Neoplasms; DNA Breaks, Double-Stranded; Drug Combinations; Histones; Humans; Leukocytes, Mononuclear; Male; Middle Aged; Neoplasm Staging; Ontario; Oxidative Stress; Predictive Value of Tests; Prospective Studies; Radiation Injuries; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thioctic Acid; Time Factors; Treatment Outcome

(153)Sm-ethylene diamine tetramethylene phosphonic acid ((153)Sm-EDTMP) is widely used to palliate pain from bone metastases, and is being studied for combination therapy beyond palliation. Conceptually, red marrow (RM) dosimetry allows myelotoxicity to be predicted, but the correlation is poor due to dosimetric uncertainty, individual sensitivity and biological effects from previous treatments. According to EANM guidelines, basic dosimetric procedures have been studied to improve the correlation between dosimetry and myelotoxicity in (153)Sm-EDTMP therapy.. RM dosimetry for 33 treatments of bone metastases from breast, prostate and lung tumours was performed prospectively (with (99m)Tc-MDP) and retrospectively, acquiring whole-body scans early and late after injection. The (153)Sm-EDTMP activity was calculated by prospective dosimetry based on measured skeletal uptake and full physical retention, with the RM absorbed dose not exceeding 3.8 Gy. Patient-specific RM mass was evaluated by scaling in terms of body weight (BW), lean body mass (LBM) and trabecular volume (TV) estimated from CT scans of the L2–L4 vertebrae. Correlations with toxicity were determined in a selected subgroup of 27 patients, in which a better correlation between dosimetry and myelotoxicity was expected.. Skeletal uptakes of (99m)Tc and (153)Sm (Tc% and Sm%) were well correlated. The median Sm% was higher in prostate cancer (75.3 %) than in lung (60.5%, p = 0.005) or breast (60.8%, p = 0.008). PLT and WBC nadirs were not correlated with administered activity, but were weakly correlated with uncorrected RM absorbed doses, and the correlation improved after rescaling in terms of BW, LBM and TV. Most patients showed transient toxicity (grade 1–3), which completely and spontaneously recovered over a few days. Using TV, RM absorbed dose was in the range 2–5 Gy, with a median of 312 cGy for PLT in patients with toxicity and 247 cGy in those with no toxicity (p = 0.019), and 312 cGy for WBC in those with toxicity and 232 cGy in those with no toxicity (p = 0.019). ROC curves confirmed the correlations, yielding toxicity absorbed dose thresholds of 265 cGy for PLT and 232 cGy for WBC.. The best predictor of myelotoxicity and blood cells nadir was obtained scaling the RM absorbed dose in terms of the estimated TV. It seems clear that the increase in skeletal uptake due to the presence of bone metastases and the assumption of full physical retention cause an overestimation of the RM absorbed dose. Nevertheless, an improvement of the dose–toxicity correlation is easily achievable by simple methods, also leading to possible improvement in multifactorial analyses of myelotoxicity.

Topics: Bone Marrow; Bone Neoplasms; Female; Humans; Male; Multimodal Imaging; Organometallic Compounds; Organophosphorus Compounds; Positron-Emission Tomography; Radiation Dosage; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To investigate the value of diffusion-weighted (DW), perfusion-sensitive, and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) techniques in assessing the response of bone metastases from breast cancer to radiotherapy, with particular emphasis on the role of intravoxel incoherent motion (IVIM)-DW parameters as a potential valuable imaging marker of tumor response.. Fifteen women having breast cancer and bone metastases underwent MRI before and after radiotherapy (3 weeks [time 1], 2 months [time 2], and 4 months [time 3]), consisting of DW, perfusion-sensitive (IVIM), and DCE acquisitions. MR-based DW and perfusion parameters, including water diffusivity (D), perfusion fraction (f), pseudodiffusion (D*), total apparent diffusion coefficient (ADC-total), fractionated ADCs (ADC-high and ADC-low), and initial area under the gadolinium concentration curve after the first 60 seconds (IAUGC60), were determined. The morphologic MRI findings were also recorded. A one-way repeated measures analysis of variance was used to compare the value of MR-based parameters at the different time points.. A significant variation between pretreatment (time 0) and post-treatment (times 1, 2, and 3) was found for ADC-total and D parameters (P < .001). A statistically significant reduction was also found for IAUGC60 values between times 0 and 3 (P < .001). A significant change across the different time points was observed for D* and IAUGC60 parameters (P < .001). On the contrary, there was no statistically significant change over time for parameters ADC-total, D, f, and IAUGC60 comparing response between each metastasis, that is, the response to therapy was similar for each metastasis.. DW, IVIM, and DCE-MRI techniques show effectiveness in assessing the response to radiotherapy in bone metastases from breast cancer.

Topics: Aged; Aged, 80 and over; Algorithms; Artifacts; Bone Neoplasms; Breast Neoplasms; Contrast Media; Diffusion Magnetic Resonance Imaging; Female; Humans; Image Enhancement; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Motion; Outcome Assessment, Health Care; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

Understanding the mechanisms driving disease progression is fundamental to identifying new therapeutic targets for the treatment of men with metastatic castration-resistant prostate cancer (mCRPC). Owing to the prevalence of bone metastases in mCRPC, obtaining sufficient tumor tissue for analysis has historically been a challenge. In this exploratory analysis, we evaluated imaging, procedural and clinical variables associated with tumor yield on image-guided bone biopsy in men with mCRPC.. Clinical data were collected prospectively from men with mCRPC enrolled on a phase II trial with serial metastasis biopsies performed according to standard clinical protocol. Imaging was retrospectively reviewed. We evaluated the percent positive biopsy cores (PPC), calculated as the number of positive cores divided by the total number of cores collected per biopsy.. Twenty-nine men had 39 bone biopsies. Seventy-seven percent of bone biopsies had at least one positive biopsy core. We determined that lesion size and distance from the skin to the lesion edge correlated with tumor yield on biopsy (median PPC 75% versus 42% for lesions >8.8 cm(3) versus ⩽ 8.8 cm(3), respectively, P=0.05; median PPC 33% versus 71% for distance ⩾ 6.1 versus <6.1 cm, respectively, P = 0.02). There was a trend towards increased tumor yield in patients with increased uptake on radionuclide bone scan, higher calcium levels and shorter duration of osteoclast-targeting therapy, although this was not statistically significant. Ten men had 14 soft tissue biopsies. All soft tissue biopsies had at least one positive biopsy core.. This exploratory analysis suggests that there are imaging, procedural and clinical variables that have an impact on image-guided bone biopsy yield. In order to maximize harvest of prostate cancer tissue, we have incorporated a prospective analysis of the metrics described here as part of a multi-institutional project aiming to use the molecular characterization of mCRPC tumors to direct individual therapy.

Topics: Aged; Androgen Antagonists; Androstenes; Antineoplastic Agents, Hormonal; Antineoplastic Combined Chemotherapy Protocols; Azasteroids; Biopsy; Bone Neoplasms; Drug Resistance, Neoplasm; Dutasteride; Humans; Male; Middle Aged; Prostatic Neoplasms, Castration-Resistant; Radiography, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Surgery, Computer-Assisted; Technetium Tc 99m Medronate

The aim of this study was to compare 99mTc-MDP bone scanning, 18F NaF PET/CT, 18F FDG PET/CT, and whole-body MRI (WBMRI) for detection of known osseous metastases.. This prospective pilot trial (September 2007-April 2009) enrolled 10 participants (5 men, 5 women, 47-81 years old) diagnosed with cancer and known osseous metastases. 18F NaF PET/CT, 18F FDG PET/CT, and WBMRI were performed within 1 month for each participant.. The image quality and evaluation of extent of disease were superior by 18F NaF PET/CT compared to 99mTc-MDP scintigraphy in all patients with skeletal lesions and compared to 18F FDG PET/CT in 3 of the patients with skeletal metastases. 18F NaF PET/CT showed osseous metastases where 18F FDG PET/CT was negative in another 3 participants. Extraskeletal metastases were identified by 18F FDG PET/CT in 6 participants. WBMRI with the combination of iterative decomposition of water and fat with echo asymmetry and least-squares estimation, short tau inversion recovery, and diffusion-weighted imaging pulse sequences showed fewer lesions than 18F NaF PET/CT in 5 patients, same number of lesions in 2 patients, and more lesions in 1 patient. WBMRI showed fewer lesions than 18F FDG in 3 patients and same lesions in 6 patients.. Our pilot phase prospective trial demonstrated superior image quality and evaluation of skeletal disease extent with 18F NaF PET/CT compared to 99mTc-MDP scintigraphy and 18F FDG PET/CT, as well as the feasibility of multisequence WBMRI. In addition, 18F FDG PET/CT provided valuable soft-tissue information that can change disease management. Further evaluation of these findings using the recently introduced PET/MRI scanners is warranted.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Pilot Projects; Positron-Emission Tomography; Prospective Studies; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. (18)F sodium fluoride ((18)F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are few prospective studies comparing these three methods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial.. This is a prospective study (Sep 2007-Dec 2010) of 52 patients with proven malignancy referred for evaluation of skeletal metastases. There were 37 men and 15 women, 19-84 years old (average, 55.6 ± 15.9). Technetium-99m ((99m)Tc) MDP bone scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CT were subsequently performed within 1 month.. Skeletal lesions were detected by (99m)Tc MDP bone scintigraphy in 22 of 52 patients, by (18)F NaF PET/CT in 24 of 52 patients, and by (18)F FDG PET/CT in 16 of 52 patients. The image quality and evaluation of extent of disease were superior by (18)F NaF PET/CT over (99m)Tc MDP scintigraphy in all 22 patients with skeletal lesions on both scans and over (18)F FDG PET/CT in 11 of 16 patients with skeletal metastases on (18)F FDG PET/CT. In two patients, (18)F NaF PET/CT showed skeletal metastases not seen on either of the other two scans. Extraskeletal lesions were identified by (18)F FDG PET/CT in 28 of 52 subjects.. Our prospective pilot-phase trial demonstrates superior image quality and evaluation of skeletal disease extent with (18)F NaF PET/CT over (99m)Tc MDP scintigraphy and (18)F FDG PET/CT. At the same time, (18)F FDG PET detects extraskeletal disease that can significantly change disease management. As such, a combination of (18)F FDG PET/CT and (18)F NaF PET/CT may be necessary for cancer detection. Additional evaluation with larger cohorts is required to confirm these preliminary findings.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole-Body Irradiation; Young Adult

Lutetium-177-labeled ethylenediamine-N,N,N',N'-tetrakis (methylene phosphonic acid) (¹⁷⁷Lu-EDTMP), a beta-emitting bone-seeking therapeutic radiopharmaceutical being assessed as an agent for palliation of bone pain, can emit suitable gamma-photons for scintigraphy. This investigation sought to characterize its optimal conditions for whole-body gamma camera imaging in patients.. Eleven patients with bone metastases underwent whole-body bone scanning using both ⁹⁹mTc-methyl-diphosphonate (⁹⁹mTc-MDP) and ¹⁷⁷Lu-EDTMP (29.4 ± 12.5 MBq/kg BW) utilizing a dual-head camera. For lutetium-177 imaging, two types of collimators, low-energy high-resolution (LEHR) and medium-energy general-purpose (MEGP), and two different peak energies of 113 and 208 keV were used.. The femur-to-muscle uptake ratio (F/M) of ⁹⁹mTc-MDP was 2.69 ± 1.06. For ¹⁷⁷Lu-EDTMP, the significantly highest F/Ms were found at 24 h (12.59 ± 5.73) and 48 h (12.54 ± 5.23) by applying MEGP collimators and collecting the 208 keV photons. In all the combinations of collimator and peak energy, the F/Ms at 24 and 48 h are significantly higher than those at 1 h, except the combination of LEHR collimator and 208 keV peak energy. Lesion-to-normal bone uptake ratios of the ⁹⁹mTc-MDP bone scan and images at the 24 and the 48-h phases of Lu-EDTMP were analyzed. MEGP and 208 keV had significantly higher values in lesion-to-normal bone uptake ratios. The combination of LEHR and 208 keV provided the poorest images.. ¹⁷⁷Lu-EDTMP can provide fine whole-body images with the best results when applying medium-energy collimation and collecting the 208 keV energy photons and alternatively by collecting both 208 and 113 keV photons for higher count statistics. The most appropriate time point for imaging is around 24 h after injection.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Gamma Cameras; Humans; Male; Middle Aged; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Time Factors; Whole Body Imaging

One of the central unanswered questions in prostate cancer research is the significance of tyrosine kinase inhibitor (TKI)-induced improvements in (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) bone scans. Multitargeted tyrosine kinase inhibition has recently shown promise in the management of castration-resistant prostate cancer. In some cases, TKI inhibition has produced unprecedented improvements in bone metastases as detected by (99m)Tc-MDP bone scans. The significance of these improvements is not known. In order to gain insight about the effects of TKIs on bone scans in prostate cancer, we systematically evaluated images from a phase II study of sunitinib, a multitargeted TKI.. We analyzed images and data from a previously reported open-label phase II study that enrolled 34 men with advanced castration-resistant prostate cancer. Participants received sunitinib in 6-wk cycles (50 mg daily; 4 wk on, 2 wk off). We examined baseline and 12-wk bone scan images. Partial response was defined as an improvement of at least 50% in previous metastatic lesions subjectively or a change from prior diffuse skeletal metastases (superscan) to recognizable individual metastatic lesions. Our primary objective was to define the incidence of at least partial bone scan response. We also examined concomitant changes in CT and prostate-specific antigen (PSA) evidence of disease.. Analysis at 12 wk revealed 1 partial response by the response evaluation criteria in solid tumors (RECIST) and 2 confirmed PSA responses. There were 25 subjects who underwent bone scans at both time points (baseline and week 12) and who had bone metastases detectable at baseline. Within that group of 25, we found 5 bone scan partial responses and 1 complete response. None of those 6 subjects exhibited a PSA response (≥50% decline from baseline) or RECIST response.. We found a relatively high rate of (99m)Tc-MDP bone scan response to sunitinib among men with metastatic prostate cancer. Further, we found that none of the subjects exhibiting bone scan responses experienced concordant improvements in PSA or CT evidence of disease by accepted criteria. This discordance argues that osteoblastic assessment provides an incomplete assessment of treatment-induced changes. Rational development of multitargeted TKIs for prostate cancer requires improved understanding of treatment-induced bone scan changes. Optimal imaging strategies may include evaluation of perfusion or direct tumor activity.

Topics: Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Humans; Indoles; Male; Molecular Targeted Therapy; Orchiectomy; Prostate-Specific Antigen; Prostatic Neoplasms; Protein Kinase Inhibitors; Protein-Tyrosine Kinases; Pyrroles; Radionuclide Imaging; Sunitinib; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Failure

To evaluate the accuracy of ¹⁸F-fluoride PET/computed tomography (CT) to detect bone metastases (BMs) in a breast and prostate cancer population, using magnetic resonance imaging (MRI) or thin-slice CT as a gold standard.. We have prospectively included 34 patients with breast (N=24) or prostate cancer (N=10) at high risk of BMs. Whole-body PET/CT (low-dose CT) and bone scintigraphy (BS) with single photon emission CT were obtained for all 34 patients and the results compared with a radiological gold standard.. Out of the 386 foci detected by PET/CT, 219 (56.7%) could be verified by CT or MRI. Eighty-six additional foci were detected by BS (n=46) or seen only by CT (n=9), MRI (n=23), or both CT and MRI (n=8). The total number of verified lesions was therefore 274 (58.1%), including 119 (43.4%) benign and 155 (56.6%) BM. The sensitivity, specificity, and accuracy of ¹⁸F-fluoride PET/CT were 76, 84.2, and 80%, respectively. For BS, they were 44.8, 79.2, and 60%, respectively. Sensitivity significantly decreased for the lytic lesions. The accuracy of PET/CT was significantly superior to BS for pelvic and lumbar lesions. PET/CT provided a correct diagnosis (M+/M0) in 32 of 33 patients (one false positive) compared with 28 of 33 with BS (four false positive, one false positive).. ¹⁸F-fluoride PET/CT is significantly more accurate than BS for detecting BMs from breast and prostate cancers.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Reference Standards; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Theoretically, the bisphosphonates used to treat metastatic bone disease could influence the results of nuclear bone scans which use the structurally similar technetium 99m methylene diphosphonate (99mTc MDP). A prospective clinical study was designed to explore this hypothesis.. Patients with metastatic breast cancer receiving intravenous bisphosphonate (IVBP) therapy who had > or =3 osseous lesions on nuclear bone scan were eligible. A baseline bone scan (number 1) was performed as clinically indicated and IVBP with zoledronic acid was administered within 72 hours. A second bone scan (number 2) was performed within 72 hours of zoledronic acid dosing. Both bone scans were reviewed in a blinded fashion and assessed for changes in the number and intensity of osseous lesions. Ten patients were planned to yield at least 30 lesions.. Ten patients were enrolled. One patient withdrew consent and 1 was excluded due to protocol deviation. Among the 8 patients were 163 assessable osseous lesions. The median time from bone scan number 1 to IVBP was 1 day (range, 1-2 days). The median time from IVBP to bone scan number 2 was 2 days (range, 1-3 days). The paired imaging showed no changes in the total number of bone metastases. One hundred sixty-one lesions were identical in both scans; in 1 patient there were 2 lesions that were discordant, one more intense, the other less intense.. These data do not support the hypothesis that IVBP therapy interferes with bone scan results.

Topics: Adult; Aged; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Infusions, Intravenous; Jaw Diseases; Middle Aged; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Zoledronic Acid

The aim of this prospective study is to evaluate the diagnostic and prognostic usefulness of F-18 sodium fluoride (NaF) positron emission tomography-computed tomography (PET-CT) relative to Tc-99m methylene diphosphonate (MDP) planar bone scintigraphy with no CT (BS) for hepatocellular carcinoma (HCC) patients with suspicious bone metastasis.. Both Tc-99m MDP BS and F-18 NaF PET-CT were performed for 34 consecutive Taiwanese HCC patients (five female and 29 male; mean age, 61.0+/-12.0 years) within a time span of 1 month (mean: 11.3+/-10.4 days). The accuracies of BS and PET-CT were determined by comparing their results with the finalized clinical data in a lesion-by-lesion manner.. According to the pathological and/or follow-up results, the accuracy for detecting metastatic bone lesions by Tc-99m MDP BS is 75.4% and that by F-18 NaF PET-CT is 95.7%, respectively. F-18 NaF PET-CT is significantly more accurate than Tc-99m MDP BS (P=0.0001). Furthermore, there is a significant correlation between the presence of F-18 NaF PET-CT-positive bone lesions and the survival time of HCC patients. On the other hand, the diagnostic results from BS are not correlated with the survival time of these HCC patients.. F-18 NaF using PET-CT system has significantly better sensitivity and specificity than conventional Tc-99m MDP BS in detecting metastatic HCC bone lesions that are predominantly osteolytic. The diagnostic result of PET-CT also serves as a more effective prognostic indictor for HCC patients.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Hepatocellular; Female; Fluorine Radioisotopes; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Positron-Emission Tomography; Prognosis; Prospective Studies; Sodium Fluoride; Survival Analysis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To compare the diagnostic and prognostic value of [(18)F] fluorodeoxyglucose positron emission tomography (FDG-PET) and bone scans (BS) in the assessment of osseous lesions in patients with progressing prostate cancer.. In a prospective imaging trial, 43 patients underwent FDG-PET and BS prior to experimental therapies. Bone scan index (BSI) and standardized uptake value (SUV) on FDG-PET were recorded. Patients were followed until death (n = 36) or at least 5 years (n = 7). Imaging findings were correlated with survival.. Osseous lesions were detected in 39 patients on BS and 32 on FDG-PET (P = 0.01). Follow-up was available for 105 FDG-positive lesions, and 84 (80%) became positive on subsequent BS. Prognosis correlated inversely with SUV (median survival 14.4 versus 32.8 months if SUVmax > 6.10 versus ≤ 6.10; P = 0.002) and BSI (14.7 versus 28.2 months if BSI > 1.27 versus < 1.27; P = 0.004). Only SUV was an independent factor in multivariate analysis.. This study of progressive prostate cancer confirms earlier work that BSI is a strong prognostic factor. Most FDG-only lesions at baseline become detectable on follow-up BS, suggesting their strong clinical relevance. FDG SUV is an independent prognostic factor and provides complementary prognostic information.

Topics: Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Carcinoma; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Male; Middle Aged; Positron-Emission Tomography; Predictive Value of Tests; Prognosis; Prostatic Neoplasms; Survival Analysis; Technetium Tc 99m Medronate

On the basis of the encouraging results achieved in several clinical trials and its proven therapeutic efficacy, (153)Sm-ethylene diamine tetramethylene phosphonic acid (EDTMP) has become widely used to palliate pain from bone metastases. The results reported in the literature have led the product suppliers (QUADRAMET, Schering) to suggest administering a fixed activity per kilogram (37 MBq/kg). However, considering the observed extreme inter-patient variability of skeletal uptake of (153)Sm-EDTMP, a real therapy optimization would require the individualization of the activity to be administered on a dosimetric basis. This should be planned taking into account the generally accepted 2-Gy dose constraint to the haematopoietic red marrow, the critical organ in palliative treatments with beta-emitting, bone-seeking radiopharmaceuticals.. Seven to 14 days before treatment with (153)Sm-EDTMP, 44 patients underwent (99m)Tc-methylene diphosphonate (MDP) total-body bone scan with two scans (the first within 10 min of injection, the second after 6 h). The percentage bone uptake (Tc(%)) was evaluated as the ratio between total counts at 6 h, adjusted for decay, and total counts at the first scan. Tc(%) was then compared to Sm(%) similarly derived from 10-min and 24-h whole-body scans. Tc(%) and Sm(%) were compared both with and without Brenner's method for soft tissue uptake.. The correlation between Tc(%) and Sm(%) was R (2) = 0.81 and R (2) = 0.88 with and without soft tissue correction, respectively. The difference between their average values was statistically significant (Sm(%) = 64.3 +/- 15.2, Tc(%) = 56.2 +/- 16.0; p = 0.017) with soft tissue correction, while was not statistically significant (Sm(%) = 68.2 +/- 15.5, Tc(%) = 66.9 +/- 14.0; p = 0.670) without soft tissue correction.. The rate of retention of (99m)Tc-MDP in bone provides a reliable estimate of the (153)Sm-EDTMP rate of retention. The proposed method can be usefully adopted for prospective dosimetry seeing its extreme simplicity, and it requires no special investment in terms of human or instrumental resources. This allows an optimization of administered (153)Sm-EDTMP activity.

Topics: Analgesics, Non-Narcotic; Bone Neoplasms; Female; Humans; Leukocyte Count; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Radiometry; Technetium Tc 99m Medronate; Time Factors; Whole Body Imaging

The purpose of this study was to compare the diagnostic accuracy of whole-body MRI (WB-MRI) and bone scintigraphy (BS) for the screening of bone metastases for the first time in a large and homogeneous patient collective with breast cancer in a systematic and controlled study.. 213 breast cancer patients were evaluated for bone metastases under randomized, double-blinded and prospective conditions at two hospitals. All participants were examined by WB-MRI and BS over an average period of four days. The examinations were performed separately at two different locations. The WB-MRI protocol included T 1-TSE and STIR sequences. WB-MRI and BS were reviewed independently by experienced radiologists and nuclear medicine specialists in a consensus reading.. In 66 % of cases bone metastases were excluded by both procedures, and bone metastases were detected concordantly in 2 % of cases. In 7 % of cases there were discrepant results: in 7 cases BS was false-positive when WB-MRI was negative. In 5 / 7 cases BS was negative when WB-MRI identified bone metastases. In 89 % of cases BS was uncertain when WB-MRI was true-negative. In 17 % of cases WB-MRI showed important (non-) tumor-associated findings. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for WB-MRI were 90 %, 94 %, 82 %, 98 % and 99 % and for BS those were 40 %, 81 %, 36 %, 91 % and 93 %.. It could be demonstrated that WB-MRI is superior to BS for detecting bone metastases in breast cancer patients. These results should be considered for the next version of the S 3 guideline "Diagnosis, Therapy and Follow-Up of Breast Cancer".

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Double-Blind Method; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging

The purpose of this study was to investigate the pitfalls of using 2-[18F]-fluoro-2-deoxy-D: -glucose positron emission tomography (FDG-PET) for the evaluation of osteoblastic bone metastases in patients with breast cancer by comparing it with (99m)Tc-hydroxymethylene diphosphonate bone scintigraphy.. Among the 89 breast cancer patients (mean age 59+/-15 years) who had undergone both FDG-PET and bone scintigraphy within 1 month between September 2003 and December 2004, 55 with bone metastases were studied. The bone metastases were visually classified by multi-slice CT into four types according to their degree of osteosclerosis and osteolysis-osteoblastic, osteolytic, mixed and invisible-and compared in terms of tracer uptake on FDG-PET or bone scintigraphy and SUV(mean) on FDG-PET. Differences in the rate of detection on bone scintigraphy and FDG-PET were analysed for significance by the McNemar test.. The sensitivity, specificity and accuracy of bone scintigraphy were 78.2%, 82.4% and 79.8% respectively, and those of FDG-PET were 80.0%, 88.2% and 83.1%, respectively, revealing no significant differences. According to the CT image type, the visualisation rate of bone scintigraphy/FDG-PET was 100%/55.6% for the blastic type, 70.0%/100.0% for the lytic type, 84.2%/94.7% for the mixed type and 25.0%/87.5% for the invisible type. The visualisation rates of bone scintigraphy for the blastic type and FDG-PET for the invisible type were significantly higher. The SUV(mean) of the blastic, lytic, mixed and invisible types were 1.72+/-0.28, 4.14+/-2.20, 2.97+/-1.98 and 2.25+/-0.80, respectively, showing that the SUV(mean) tended to be higher for the lytic type than for the blastic type.. FDG-PET showed a low visualisation rate in respect of osteoblastic bone metastases. Although FDG-PET is useful for detection of bone metastases from breast cancer, it is apparent that it suffers from some limitations in depicting metastases of the osteoblastic type.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Osteoblasts; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients.. Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards.. On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%).. This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

The aim of this study was evaluation of the clinical usefulness of bone scintigraphy and of serum bone turnover marker levels in the assessment of skeletal metastases.. We investigated 60 patients with suspected skeletal metastases. Serum level of bone-formation marker: amino-terminal propeptide of type I procollagen (PINP) and a bone-degradation marker: carboxy-terminal telopeptide of type I collagen (ICTP) were assessed with radioimmunoassays. Bone MDP-99m-Tc scans were performed as well.. Hot spots were showed in 72% of patients. According to bone scintigraphy the patients were divided in to 3 groups: Group I - without hot spots (n=16; 26%), Group II up to 10 hot spots (n=25; 42%) and Group III more that 10 hot spots (n=19; 32%). Mean serum level of ICTP was significantly higher in Group II than in Group I (p< 0.05), as well as in Group III compared to Group II (p< 0.001) and in Group III compared to Group I (p< 0.001). There is only one significant relationship in PINP levels - between Groups II and III.. The levels of bone pathological degradation (ICTP) and bone formation reflect the metastatic disease extent in bone. Serum ICTP level is more useful in staging metastasis. Significantly higher PINP reflects only a much disseminated process.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Collagen Type I; Female; Humans; Male; Middle Aged; Peptide Fragments; Peptides; Procollagen; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Technetium Tc 99m Medronate

The purpose of this study was to evaluate the usefulness of 201Tl scintigraphy in comparison with three-phase bone scintigraphy in the differentiation of residual/recurrent tumors from post-therapeutic changes, in patients previously treated for bone and soft-tissue tumors.. Thirty-five 201Tl and three-phase bone scintigraphy scans were obtained for 30 patients with a history of bone or soft-tissue tumor who had undergone chemotherapy, radiation therapy, tumor resection, or a combination of these treatments. The planar 201Tl images were acquired 10 mins (early) and 2 hrs (delayed) after the intravenous injection of 111 MBq 201Tl-chloride. Three-phase bone scintigraphy was performed using 740 MBq 99mTc-HMDP at the same lesion site as for 201Tl imaging. The blood flow images were obtained every 10 sec for 2 mins and were immediately followed by the blood pool image after 5 mins. Three to 4 hrs later, bone images were obtained. 201Tl and three-phase bone scintigraphies were correlated with the histopathologic findings and/or clinical follow-up of more than 3 months.. Of the 35 cases, 15 were free of disease and 20 had residual or recurrent tumors. Of the 20 residual or recurrent cases, all had true-positive 201Tl early and delayed scans, while bone scintigraphy was true-positive on the blood flow, blood pool and bone images in 16, 18 and 12 cases, respectively. 201Tl early and delayed images and 99mTc-HMDP blood flow and blood pool images were false-positive in one patient. The histology of this false-positive case showed the presence of lymph proliferative tissue.. Although 201Tl uptake after treatment does not always indicate recurrence, 201Tl scintigraphy may still be more useful than three-phase bone scintigraphy in the follow-up of patients with bone and soft-tissue tumors following therapy.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium; Treatment Outcome

The purpose of this study was to determine the potential role of Tc depreotide scintigraphy for the evaluation of bone metastases compared with Tc methylenediphosphonate (MDP) bone scintigraphy and for the prediction of treatment response in breast cancer patients in whom first- or second-line hormonal therapy was to be initiated.. Twelve patients with a diagnosis of advanced breast cancer were included. All patients underwent both a bone scan and a depreotide scan and at least one other conventional imaging procedure, including plain film radiography (n=11), computed tomography (n=6) or magnetic resonance imaging (n=5), for confirmation of metastatic disease. The mean time interval between the bone scan and the depreotide scan was 30.6 days. Follow-up data were retrieved from routine clinical evaluation by means of physical examination, imaging and blood analysis.. On a patient basis we found a sensitivity, specificity and accuracy of, respectively 100%, 50% and 83.3% for the bone scan and 62.5%, 100% and 75% for the depreotide scan in the diagnosis of bone metastasis. In eight patients with available follow-up data two with a positive depreotide scan remained stable and five of six patients with a negative depreotide scan had progressive disease.. In this small series of breast cancer patients Tc depreotide scintigraphy proves less sensitive but more specific as compared to Tc-MDP bone scintigraphy in measuring the extent of bone metastasis. On the other hand Tc depreotide scintigraphy elucidates, non-invasively, tumour characteristics and may be indicative for prognosis and response to hormonal treatment.

Topics: Adult; Aged; Antineoplastic Agents, Hormonal; Bone Neoplasms; Breast Neoplasms; Female; Hormones; Humans; Male; Middle Aged; Organotechnetium Compounds; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Somatostatin; Technetium Tc 99m Medronate; Treatment Outcome

Technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI) is a lipophilic agent that has been proposed as a useful tracer for the detection of disease sites in patients with multiple myeloma (MM). We performed a prospective study to determine the potential of 99mTc-MIBI imaging for the evaluation of the extent of primary disease in patients with advanced stage MM, compared with skeletal survey and bone scintigraphy. Twenty patients with advanced stage MM at initial diagnosis underwent whole-body 99mTc-MIBI imaging, together with contemporaneous skeletal survey and bone scintigraphy. The findings of 99mTc-MIBI imaging were correlated with the results of skeletal survey and bone scan. All 99mTc-MIBI scans were positive for the presence of active MM, whereas skeletal surveys were positive in 18 patients (90%) with osteolytic lesions. Bone scintigraphy demonstrated MM in only 15 patients (75%). In two patients with no detectable lesions on skeletal survey, 99mTc-MIBI imaging revealed uptake in the spine, corresponding to the abnormalities seen on magnetic resonance imaging (MRI). With respect to the localization of bone lesions, 99mTc-MIBI imaging was superior to bone scintigraphy in 15 patients (75%) and had concordant results with bone scintigraphy in four (20%). 99mTc-MIBI imaging is a very sensitive imaging modality for the identification of the extent of disease in patients with advanced MM. It is clearly superior to bone scintigraphy and complements the results of skeletal survey by finding additional disease sites. Hence, in active MM patients, 99mTc-MIBI imaging has the potential to detect bone marrow disease that cannot be detected by skeletal survey and bone scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow Neoplasms; Bone Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Neoplasm Staging; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole-Body Counting

Because of the discrepant findings on regional bone mineral density (BMD) in stage IV patients with bone metastases due to prostate cancer, we decided to evaluate BMD of lumbar spines in 30 prostate cancer patients with lumbar spine metastases. These measurements of BMD in lumbar spines were compared with 30 stage IV prostate cancer patients without lumbar spine metastases.. Before BMD measurements, the bone scan with technetium-99m labeled diphosphonate was carried out in all of the men to evaluate lumbar spine metastases. Dual energy x-ray absorptiometry was used to measure BMD in the lumbar spines.. There was no difference of age, height, weight, and body mass index between the two group patients. However, significantly higher BMD of the lumbar spines in the 30 patients of prostate cancers with lumbar spine metastases was found (p value <0.05).. Our results show that patients of prostate cancers with lumbar spine metastases demonstrated by Tc-99m MDP bone scan have increased BMD in the lumbar spines, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by Tc-99m MDP bone scan.

Topics: Absorptiometry, Photon; Aged; Bone Density; Bone Neoplasms; Carcinoma; Humans; Lumbar Vertebrae; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate

Previous reports have indicated a relatively high incidence of distant metastases in patients with nasopharyngeal carcinoma (NPC), one of the most common sites being the skeleton. Although bone scintigraphy offers the advantage of whole-body imaging in patients with cancer by providing useful information about disease spread, its value in patients with NPC is not well defined because of cost-effectiveness considerations. In this study, we assessed the value of follow-up bone scintigraphy for the evaluation of skeletal metastases in patients with different stages of NPC. Between 1994 and 2001, 230 patients with histologically proven NPC were admitted to the Department of Radiation Oncology. Out of 230 patients, 171 were examined for skeletal metastases with bone scintigraphy prior to therapy and at 1 year intervals. Bone scintigraphy detected increased uptake in 29 patients, which was reported as suggestive of metastases or equivocal. Twenty-six of these were true-positive, confirmed by radiography or clinical follow-up. Bone pain was present in 67% of these patients and serum lactate dehydrogenase and alkaline phosphatase were elevated in 35% and 37%, respectively. The incidence of bone metastases correlated with the extent of lymph node involvement, which were detected after a median time of 10.5 months following the diagnosis of the primary disease. No correlation was observed between the metastatic status and local T stage, histological differentiation age or gender of the patient. We can therefore recommend that bone scintigraphy be used in determining the presence of bone metastases, but its utilization should be preserved for those with nodal involvement.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Prevalence; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate

Bone metastases are assumed to be rare in carcinoid disease and to be associated mainly with bronchial primaries. The aim of the present study was to evaluate the occurrence of bone metastases in patients with metastatic carcinoid tumours, and the role of various nuclear medicine modalities (bone scintigraphy, (111)In-pentetreotide and (131)I-MIBG) in its detection and clinical management. Nine (2 women, 7 men, median age 65 years) out of 86 consecutive carcinoid patients treated between 1987 and 1998 developed bone metastases (10%) with a median interval of 37 months between the diagnosis of metastatic carcinoid and bone metastases. Seven of them had non-bronchial primaries. (111)In-pentetreotide scintigraphy failed to detect the bone lesions in 50% of the cases, and (131)I-meta-iodobenzylguanidine(MIBG) scintigraphy in almost 80% of cases. Standard bone scintigraphy, however, was positive in all. Pain relief of bone metastases by means of radiation therapy was obtained in 5 of 6 patients. In another patient palliation of pain symptoms was obtained with Rhenium-186-hydroxyethylidene diphosphonate. Octreotide, Interferon of MIBG were ineffective for this purpose. It is concluded that bone metastases in carcinoid patients may be missed on (131)I-MIBG and (111)In-pentetreotide scintigraphy. Bone scintigraphy is a sensitive imaging technique. Diagnostic nuclear medicine modalities may be helpful in the clinical management of carcinoid disease.

Topics: 3-Iodobenzylguanidine; Aged; Aged, 80 and over; Appendiceal Neoplasms; Bone Neoplasms; Carcinoid Tumor; False Negative Reactions; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasms, Unknown Primary; Octreotide; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Technetium Tc 99m Medronate

Despite advances in morphological imaging, some patients with non-small cell lung cancer (NSCLC) are found to have non-resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using conventional technetium-99m methylene diophosphate (Tc-99m MDP) whole body bone scan (bone scan), which has a high sensitivity but a poor specificity. We have attempted to evaluate the usefulness of whole body positron emission tomography with 18F-2-deoxyglucose (FDG-PET) for the detection of malignant bone metastases of NSCLC, and to compare FDG-PET results with Bone Scan findings. Forty-eight patients with biopsy-proven NSCLC and suspected to have stage IV disease underwent whole body bone scan and FDG-PET to detect bone metastases. The final diagnoses of bone metastases were established by operative, histopathological findings or clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/Tc-99m MDP bone scan findings showing progressively and extensively widespread bone lesions. A total of 138 bone lesions found on either FDG-PET or Tc-99m MDP bone scan were evaluated. Among the 106 metastatic and 32 benign bone lesions, FDG-PET and Tc-99m MDP bone scan could accurately diagnose 99 and 98, as well as 30 and 2 metastatic and benign bone lesions, respectively. Diagnostic sensitivity and accuracy of FDG-PET and Tc-99m MDP bone scan were 93.4% and 92.5%, as well as 93.5% and 72.5%, respectively. In conclusion, our data suggest that FDG-PET with the same sensitivity and a better accuracy than those of Tc-99m MDP bone scan to detect metastatic bone lesions in patients with biopsy-proven NSCLC and suspected to have stage IV disease.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole-Body Irradiation

At present, bone metastases are usually assessed using conventional technetium-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with (18)F-2-deoxyglucose (FDG-PET) can offer superior spatial resolution and improved specificity. We attempted to evaluate the usefulness of FDG-PET for detecting bone metastases in breast cancer and to compare FDG-PET results with bone scan findings.. The study group comprised 48 patients with biopsy-proven breast cancer and suspected of having bone metastases who underwent bone scan and FDG-PET to detect the bone metastases. The final diagnosis of bone metastases was established by operative, histopathological findings or during a clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/bone scan findings showing progressive widespread bone lesions.. A total of 127 bone lesions including 105 metastatic and 22 benign bone lesions found by either FDG-PET or bone scan were evaluated. Using FDG-PET, 100 metastatic and 20 benign bone lesions were accurately diagnosed, and using bone scan 98 metastatic and 2 benign bone lesions were accurately diagnosed. The diagnostic sensitivity and accuracy of FDG-PET were 95.2% and 94.5%, and of bone scan were 93.3% and 78.7%, respectively.. Our findings suggest that FDG-PET shows a similar sensitivity and a better accuracy than bone scan for detecting bone metastases in patients with breast cancer.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate

Testicular tumors do not occur frequently. Primary treatment is surgical, and radiotherapy and chemotherapy can play important roles in cases of metastatic disease. Bone scintigraphy is used largely for early detection of skeletal metastases from several tumors, and conventional radiographic studies are less sensitive than the nuclear technique for such a purpose. The aim of this study was to identify the role of bone scintigraphy in cases of testicular tumors, regardless of the grade.. The authors examined 28 patients (8 to 52 years old) with proved testicular tumors using Tc-99m MDP (750 MBq; 20 mCi) injected intravenously. Whole-body images were obtained 2 hours later, at 500,000 counts per image. Radiographic studies were obtained to investigate abnormal areas noted on scintigraphy.. The results of bone scintigraphy were abnormal in seven cases, consisting of variable but diffuse uptake in the iliac bone on the same side as the affected testicle. MDP uptake was substantial in five of these patients (four seminomas, one nonseminoma; only two radiographic studies were abnormal), and the two other patients had moderate uptake of the radiopharmaceutical (two seminomas; radiographic studies were normal). Metastases were confirmed by biopsy in three cases.. Early metastases from seminomas can occur through the lymphatic drainage toward the iliac lymph node chain. This could explain these findings. The scintigraphic aspects of the affected iliac bones seem characteristic.. Early detection of metastases is very important to ensure the efficacy of radiotherapy and chemotherapy. Bone scintigraphy may play an important role in such cases and seems to be more sensitive than conventional radiography. Testicular tumor metastases should be considered when iliac involvement is observed. Paget's disease should be included in a differential diagnosis.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Seminoma; Technetium Tc 99m Medronate; Testicular Neoplasms

Technetium-99m-sestamibi (99mTc-MIBI) imaging is a well-established modality in oncologic investigations. The current study aimed to investigate whether any relationship could be found between 99mTc-MIBI uptake and local perfusion in malignant bone and soft-tissue tumours. It also aimed to compare 99mTc-MIBI images with those of technetium-99m-methylene diphosphonate (99mTc-MDP) bone scintigraphy with regard to the activity distribution pattern, intensity and lesion extension. The study group included 24 patients with various bone and soft-tissue tumours. Three-phase bone scintigraphy and 99mTc-MIBI studies were performed within the same week before any surgical and therapeutic intervention. Images were evaluated visually and quantitatively using regions of interest (ROIs) over the lesion and adjacent normal tissue. The 99mTc-MIBI study was positive with varying degrees of uptake (range, 1.4-5.3). The mean 99mTc-MIBI uptake and 99mTc-MDP blood-pool and osseous phase activity ratios were 2.5 +/- 0.5, 2.8 +/- 1.0 and 5.5 +/- 4.0, respectively. The correlation between the 99mTc-MIBI uptake and blood-pool ratios was 0.70 (P<0.05). While activity distribution patterns were in agreement in 99mTc-MIBI and blood-pool images in the majority of cases, 99mTc-MIBI better delineated tumour viability and extension in five cases. In conclusion, 99mTc-MIBI accumulation shows a reasonable correlation with blood-pool uptake assuming the presence of multifactorial mechanisms in addition to local hyperaemia. Better delineation of tumour outlines and cellular activity seems to be an advantage of 99mTc-MIBI scintigraphy which may be helpful in the evaluation of musculoskeletal tumours.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Sarcoma; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The aim of this study was to establish the value of 99Tcm(V)-DMSA scintigraphy in the detection of metastatic bone lesions and compare the results to 99Tcm-MDP bone scintigraphy. Thirty-four patients presenting with metastatic bone disease (Group 1) and 12 controls with degenerative skeletal lesions (Group 2) were studied. Conventional bone scanning and 99Tcm(V)-DMSA whole-body scanning were performed on all patients. All scans were interpreted visually. Furthermore, lesion-to-normal bone ratios (L/N) in vertebral metastases on the 4 and 24 h bone scans were obtained in 58 lesions of cancer patients and in 23 benign (degenerative) vertebral lesions of the control group. 99Tcm-MDP L/N ratios at 24 h (3.08 +/- 0.32) were significantly higher than those at 4 h (2.48 +/- 0.24) in the malignant foci (P < 0.001). No significant difference was observed in benign lesions (P > 0.05). In 167 (164 metastatic, 3 traumatic) of 186 99Tcm-MDP positive lesions (90%) of Group 1, 99Tcm(V)-DMSA uptake was observed. The remaining 19 lesions (10%) were 99Tcm(V)-DMSA negative. Fourteen of these 19 sites were diagnosed as benign. The remaining five foci were malignant. In four lung cancer metastases showing no 99Tcm-MDP uptake, 99Tcm(V)-DMSA uptake was observed. There was no 99Tcm(V)-DMSA accumulation in any of the 99Tcm-MDP positive degenerative lesions of Group 2. All quantitatively evaluated (n = 42) vertebral metastatic foci and two compression fractures in Group 1 showed 99Tcm(V)-DMSA accumulation and an increased 99Tcm-MDP L/N ratio at 24 h. A total of 36 degenerative lesions (Groups 1 and 2) and one compression fracture (Group 1) showed neither 99Tcm(V)-DMSA uptake nor an increased 99Tcm-MDP L/N ratio at 24 h. Our results indicate that quantitative 4/24 h analysis of vertebral lesions on 99Tcm-MDP scans has a similar diagnostic value to 99Tcm(V)-DMSA imaging in the detection of bone metastases. However, the accumulation of 99Tcm(V)-DMSA in four lung cancer metastases showing no 99Tcm-MDP uptake is encouraging and justifies further research in patients with proven bone metastases and negative bone scans.

Topics: Bone and Bones; Bone Neoplasms; Humans; Radionuclide Imaging; Radiopharmaceuticals; Spine; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Whole-Body Counting

To calculate radiation doses of rhenium-186 ((186)Re) etidronate in painful bone metastases using quantitative bone single-photon emission computed tomography (SPECT) and to determine the threshold dose for predicting pain relief. We also wanted to determine whether technetium-99m ((99m)Tc) methylene diphosphonate (MDP) concentrations predict radiation doses of (186)Re etidronate in painful lesions.. Forty-eight patients with breast and prostate cancer were evaluated. Patients received therapeutic doses of (186)Re etidronate. The area under the pain over time curve (AUPC) was measured for 8 weeks after treatment. Response was calculated as the percentage of change in AUPC. Quantitative bone SPECT (QBS)-measured concentration of (186)Re etidronate was used for calculating radiation doses. Receiver operating characteristics curve analysis determined the radiation dose threshold that best separated responders from nonresponders. SPECT-measured concentration of (186)Re etidronate in the urinary bladder was correlated with its concentration in the voided urine. Concentration of (99m)Tc MDP was compared with radiation doses to painful metastases.. The radiation dose threshold was 2.10 Gy. For a decrease of 50% in the AUPC, the positive predictive value (PPV) of this value was 75% and the negative predictive value (NPV) was 88%. For a decrease in pain of 33%, the PPV was 84% and the NPV was 81%. In prostate cancer patients only, the PPV was 81% and the NPV was 92%. The correlation between in vivo/in vitro measured urine concentration was 0.90. The correlation between (99m)Tc MDP concentration and radiation doses of (186)Re etidronate was 0.92.. QBS-measured radiation doses of (186)Re etidronate in painful metastases are a good predictor of pain relief. Bone SPECT using (99m)Tc MDP predicts radiation doses delivered by (186)Re etidronate.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Dose-Response Relationship, Radiation; Etidronic Acid; Female; Humans; Male; Middle Aged; Organometallic Compounds; Pain; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radiopharmaceuticals; Radiotherapy Dosage; ROC Curve; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The bone scan patterns of benign and malignant uptake in 432 patients with newly diagnosed prostate carcinoma were reviewed in relation to prostate-specific antigen (PSA) levels determined within 4 months of scintigraphy. Scan results were categorized in terms of likelihood of metastatic disease and anatomical locations of benign and malignant lesions were tabulated. At least one suspect focus was identified in 138 scans (32%), and metastatic bone disease was present in 38 (9%). Metastatic disease prevalence increased from 1% for PSA <20 ng x ml(-1) to 58% for PSA>100 ng x ml(-1). Among patients with PSA>20 ng x ml(-1) (n = 157), 70 (45%) had at least one bone scan finding of concern for metastases and 35 (22%) proved to have metastatic disease. Almost all scans with metastases had either limited disease (< or = 5 suspicious lesions; n = 16; 42%) or extensive metastases (> 20 abnormalities; n = 19; 50%). The majority of patients with limited skeletal metastases had PSA < 100 ng x ml(-1) (11/16; 69%), while almost all patients with extensive skeletal involvement had PSA >100 ng x ml(-1) (17/19; 89%). Among those with limited metastatic disease, most (13/16; 81%) had at least one lesion in the pelvis or sacrum; the next most common sites were in the thoracic and lumbar spine (six each; 38%). In scans with a low to moderate suspicion for bone metastases, the only anatomical site with a significantly higher prevalence of malignant than benign lesions was the pelvis.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To evaluate the prognostic significance of a bone scan index (BSI) based on the weighted proportion of tumor involvement in individual bones, in relation to other factors and to survival in patients with androgen-independent prostate cancer.. Baseline radionuclide bone scans were reviewed in 191 assessable patients with androgen-independent disease who were enrolled onto an open, randomized trial of liarozole versus prednisone. The extent of skeletal involvement was assessed by scoring each scan using the BSI and independently according to the number of metastatic lesions. The relationship of the scored bone involvement to other known prognostic factors was explored in single- and multiple-variable analyses.. In single-variable analyses, the pretreatment factors found to be associated with survival were age (P = .0446), performance status (P = .0005), baseline prostate-specific antigen (P = .0001), hemoglobin (P = .0001), alkaline phosphatase (P = .0002), AST (P = .0021), lactate dehydrogenase (P = .0001), and treatment (P = .0098). The extent of osseous disease was significant using both the BSI (P = .0001) and the number of lesions present (P = .0001). In multiple-variable proportional hazards analyses, only BSI, age, hemoglobin, lactate dehydrogenase, and treatment arm were associated with survival. When the patient population was divided into three equal groups, with BSI values of < 1.4%, 1.4% to 5.1%, and > 5.1%, median survivals of 18.3, 15.5, and 8.1 months, respectively, were observed (P = .0079).. The BSI quantifies the extent of skeletal involvement by tumor. It allows the identification of patients with distinct prognoses for stratification in clinical trials. Further study is needed to assess the utility of serial BSI determinations in monitoring treatment effects. The BSI may be particularly useful in the evaluation of agents for which prostate-specific antigen changes do not reflect clinical outcomes accurately.

Topics: Aged; Aged, 80 and over; Algorithms; Androgens; Bone Neoplasms; Humans; Male; Middle Aged; Prognosis; Proportional Hazards Models; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Survival Analysis; Technetium Tc 99m Medronate

Scintigraphy with somatostatin analogs is a sensitive method for the staging and therapeutic management of patients with endocrine gastroenteropancreatic (GEP) tumors. The aim of this study was to compare prospectively somatostatin receptor scintigraphy (SRS) using 111n-pentetreotide with bone scintigraphy using 99mTc-hydroxymethylene diphosphonate for the detection of bone metastases.. One-hundred-forty-five patients with proven endocrine GEP tumors were investigated. Patients were classified according to the presence of bone metastases as indicated by CT, MRI or histologic data. Group I included 19 patients with confirmed bone metastases, and group II included 126 patients without bone metastases.. In group I, SRS was positive in all 19 patients with bone metastases, and bone scintigraphy was positive in 17 patients. Bone metastases were found to occur predominantly in patients with liver metastases. In group 11, 5 patients had recent bone surgery for fracture or arthritis. SRS showed bone uptake in 4 of these patients, and bone scanning showed abnormal uptake in 5. In 7 of the remaining 121 group II patients, SRS was negative and bone scanning showed abnormal bone uptake suggesting bone metastases. The detection of bone metastases was of major prognostic value, because 42% of group 1 patients died during a 2-y follow-up.. In patients with GEP tumors, the accuracy of SRS appears to be similar to that of bone scintigraphy for the detection of bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoid Tumor; Digestive System Neoplasms; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Octreotide; Pentetic Acid; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Somatostatin; Technetium Tc 99m Medronate; Zollinger-Ellison Syndrome

Radionuclide bone scanning (RNB) is considered to be the most practical screening technique for assessing the entire skeleton for skeletal metastases. However, RNB has been shown to be of lower sensitivity than MRI and CT in detecting osteolytic metastases. A prospective study was designed to evaluate the accuracy of planar RNB versus tomographic bone imaging with 18F-labeled NaF and PET (18F PET) in detecting osteolytic and osteoblastic metastases and its dependency on their anatomic localization.. Forty-four patients with known prostate, lung or thyroid carcinoma were examined with both planar RNB and 18F PET. A panel of reference methods including MRI of the spine, 1311 scintigraphy, conventional radiography and spiral CT was used as the gold standard. RNB and 18F PET were compared by a lesion-by-lesion analysis using a five-point score for receiver operating characteristic (ROC) curve analysis.. 18F PET showed 96 metastases (67 of prostate carcinoma and 29 of lung or thyroid cancer), whereas RNB revealed 46 metastases (33 of prostate carcinoma and 13 of lung or thyroid cancer). All lesions found with RNB were also detected with 18F PET. Compared with 18F PET and the reference methods, RNB had a sensitivity of 82.8% in detecting malignant and benign osseous lesions in the skull, thorax and extremities and a sensitivity of 40% in the spine and pelvis. The area under the ROC curve was 0.99 for 18F PET and 0.64 for RNB.. 18F PET is more sensitive than RNB in detecting osseous lesions. With RNB, sensitivity in detecting osseous metastases is highly dependent on anatomic localization of these lesions, whereas detection rates of osteoblastic and osteolytic metastases are similar. Higher detection rates and more accurate differentiation between benign and malignant lesions with 18F PET suggest the use of 18F PET when possible.

Topics: Bone Neoplasms; False Negative Reactions; Fluorine Radioisotopes; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Following androgen ablation therapy, skeletal metastases from prostate cancer appear in some instances to show an increase in 99Tcm-methylene diphosphonate (99Tcm-MDP) uptake. Such a phenomenon could represent a mechanism to increase delivery of bone-seeking therapeutic agents to skeletal metastatic sites. The aim of this study was to characterize more precisely the potential increase in 99Tcm-MDP in skeletal metastases from prostate cancer following initiation of hormone therapy. Baseline bone scans were performed within 1 week of onset of hormone therapy in patients with stage D2 prostate cancer followed by multiple repeat bone scans for up to 4-6 weeks. The count density within metastatic lesions was divided by the average count density from several areas of normal bone to obtain a lesion to normal bone uptake ratio (L/N) for each lesion in each scan. Altogether, 61 skeletal metastases were identified on bone scans from five subjects. Eighty-four percent (51/61) of these lesions showed an increase in 99Tcm-MDP activity relative to normal bone following initiation of hormone therapy with a mean peak increase of 39%. Thirty-nine of these 51 metastatic lesions showed maximum uptake at 3 weeks post-onset of hormone treatment. From our findings, it appears that approximately 3 weeks following initiation of hormone blockade, most skeletal metastases from prostate cancer will demonstrate significantly enhanced 99Tcm uptake relative to normal bone. Consequently, it may be possible to improve the uptake and effectiveness of therapeutic bone-seeking radiopharmaceuticals by administering these agents following hormone therapy in patients with prostate cancer metastases.

Topics: Aged; Aged, 80 and over; Alkaline Phosphatase; Anilides; Antineoplastic Agents; Bone and Bones; Bone Neoplasms; Gonadotropin-Releasing Hormone; Hormones; Humans; Male; Nitriles; Osteocalcin; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tosyl Compounds

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

201Tl-Chloride scintigraphy (early and delayed images) was performed in 40 patients with suspected metastatic bone lesions. The sensitivity and specificity of 201Tl scanning for detecting metastatic bone lesions were 66.7% and 77.4%, respectively. The uptake ratio of 201Tl per voxel of the lesions to the normal site was significantly different between the metastatic bone lesion and benign lesions. In 20 sites of 15 patients, 201Tl-Chloride scintigraphy was performed before and after radio- or radiothermotherapy. There was a significant difference in the mean uptake ratios in the early and delayed scans between before and after therapy. The mechanism of intracellular uptake of 201Tl is considered to be one of active transport, which might make 201Tl an accurate indicator of the viability of tumor cells and metabolic activity as long as there is sufficient blood flow to prompty transport 201Tl to tumor cells. Thus it would seem that decreased uptake of 201Tl and change in retention index after therapy depends partially on tumor blood flow. In conclusion, 201Tl-Chloride scintigraphy is very useful not only for clinically detecting metastatic bone lesions but also for assessing the therapeutic effects.

Topics: Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Humans; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thallium; Thallium Radioisotopes

We assessed the relationship between 99Tcm-HMDP extraosseous accumulation (EOA), the histopathology of primary lesions and various laboratory findings. In 155 of 4824 patients, 163 EOA were noted. Of these, 33.7% were in the abdomen, 27.6% in the chest, 22.7% in the extremities, 9.8% in the pelvic area and 6.1% in the head and neck area. We found that 72.4% of EOA were due to malignant processes and 27.6% to benign processes. In the abdomen, 36.6% of the EOA were due to hepatocellular carcinoma and intestinal carcinoma. In the chest, 46.7% of EOA were a result of breast carcinoma. In the extremities, 28.7% of the EOA were due to sarcoma. The mean white blood cell count was elevated (8.0 +/- 6.3 x 10(3)) in patients with malignant processes. The mean serum haemoglobin and haematocrit in benign and malignant processes, for both males and females, were below normal values. All other laboratory findings were within normal limits. Significant differences in serum haemoglobin and haematocrit were noted between male and female patients with benign processes (P = 0.04 and P = 0.04, respectively). No other significant differences between benign and malignant processes were noted. Therefore, EOA is more frequently associated with malignant processes of primary lesions and is often accompanied by leukocytosis and anaemia.

Topics: Aged; Aging; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Ultrasonography; Whole-Body Counting

Biokinetics and imaging characteristics of 117mSn(4+)DTPA have been studied in patients with metastatic bone pain.. Seventeen patients with bone pain due to metastasis were given three dose levels: 180 microCi/kg (6.66 MBq/kg), 229 microCi/kg (8.47 MBq/kg) and 285 microCi/kg (10.55 MBq/kg) body weight. Periodic blood and daily urine samples were collected for 14 days to measure percent injected activity retained in blood and that excreted in urine. Simultaneous anterior and posterior view whole-body images were obtained under identical scan settings at 1, 3.5 and 24 hr and on Days 3 and 7 and between 4-6 and 8-10 wk postinjection. The total body retention was calculated using the geometric mean counts.. After intravenous injection, the total body clearance of 117mSn(4+)DTPA shows two components: a soft-tissue component and a bone component. The soft-tissue component accounts for 22.4% of the dose and consists of four subcomponents with an average biologic clearance half-time of 1.45 days (range 0.1-3.2 days). The bone component accounting for the remaining 77.6% of the dose shows no biologic clearance. A mean 22.4% of the dose is excreted in urine in 14 days; 11.4% within 24 hr. The uptake pattern appears similar to that of 99mTc-MDP. Peak uptake is observed in normal bone by 24 hr and metastatic lesions by 3-7 days. Pain palliation was observed with all three doses levels.. Among the four potential bone pain palliation radionuclides, 117mSn(4+)DTPA demonstrates the highest bone uptake and retention. Some biokinetic and radionuclidic features of 117mSn(4+)DTPA are similar to other agents, but many features are different and unique and may make it an ideal bone pain palliation agent. Double-blind comparative studies are needed to determine its exact role in bone pain palliation.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Pain; Palliative Care; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To determine whether bone imaging with 99mTc methylene diphosphonate is a specific method of making the diagnosis of costochondritis in patients with chest pain who rule out for myocardial infarction.. Nonblinded prospective controlled study in 20 patients and 10 control subjects.. Inpatient medical service of a tertiary teaching hospital.. Two hundred consenting patients admitted to the hospital with chest pain and suspected myocardial infarction were examined. Those in whom acute myocardial infarction was ruled out were evaluated for the clinical signs of costochondritis, ie, tenderness over one or more costochondral junctions. Twenty patients who met the clinical criterion gave informed consent and were subjected to bone imaging. Ten control subjects with cancer who did not have clinical signs of costochondritis underwent bone imaging to rule out metastatic disease (normal in all cases).. Bone imaging with I.V. 99mTc methylene diphosphonate.. Bone scans of the investigative patients and the control subjects were read by two independent nuclear medicine specialists.. Sixteen of the 20 patients with clinically diagnosed costochondritis showed increased technetium uptake at all costochondral junctions bilaterally; six of them also had increased uptake elsewhere on the chest wall (sternum, manubrium, or first rib). All 10 of the control patients likewise showed increased technetium uptake at all costochondral junctions bilaterally.. Bone imaging with 99mTc methylene diphosphonate is not a specific method of making the diagnosis of costochondritis.

Topics: Bone and Bones; Bone Neoplasms; Chest Pain; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Observer Variation; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Tietze's Syndrome

Detectability of bone metastases from differentiated thyroid carcinoma by technetium-99m hydroxymethylene diphosphonate ([99m]Tc-HMDP) bone scan is considered to be poor. Thallium-201 (201Tl) is also widely used for detecting metastatic lesions. Our present study was aimed at the evaluation of the combined use of (99m)Tc-HMDP and 201Tl imaging in successful detection of bone metastases from differentiated thyroid carcinoma. Twenty-seven thyroidectomized thyroid cancer patients (19 females, 8 males; 12 papillary type, 15 follicular type) with 77 bone lesions were included in this retrospective study. All of these patients received ablative doses of radioiodine. Thyroidal origin of the lesions was proved by positive iodine-131 (131I) uptake. In 131I-negative lesions, histological proof or absence of tumor markers other than thyroglobulin was considered when computed tomography (CT) and/or magnetic resonance imaging (MRI) suggested metastatic nature of the lesions. Of the 77 lesions, 58 (75.3%) were positive and 19 were negative in the (99m)Tc-HMDP bone scintigraphy, whereas 53 lesions (68.9%) could be detected by 201Tl scintigraphy. However, within the 19 (99m)Tc-HMDP-negative lesions, 14 showed abnormal accumulation of 201Tl, and within the 24 201Tl negative lesions, 19 were positive in (99m)Tc-HMDP scan. This resulted in a combined sensitivity of 93.5%. Our present study concludes that combined (99m)Tc-HMDP and 201Tl imaging is a sensitive and effective method for detecting bone metastases from thyroid carcinoma.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Bone Neoplasms; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thyroid Neoplasms

Bone scintigraphy has been shown to be sensitive in determining bone involvement in patients with malignancy, but it does not allow the assessment of bone marrow lesions in early disease. The aim of this study was to detect bone marrow invasion using 99Tcm-labelled monoclonal antigranulocyte antibody (AgMoAb) in patients with prostate carcinoma. We studied 56 patients whose mean (+/- S.D.) age was 67 +/- 7 years. The mean prostate-specific antigen level was 6.1 ng ml-1 (normal range 0-5 ng ml-1). Twelve patients were in stage A, 16 in stage B, 17 in stage C and 11 in stage D. Six patients had been receiving chemotherapy and four patients radiotherapy before scanning. Bone scans were obtained 2 h after the intravenous injection of 555 MBq 99Tcm-methylene diphosphonate (99Tcm-MDP). Within a week, bone marrow imaging was performed 4 and 24 h after the injection of 555 MBq 99Tcm-AgMoAb. Metastatic bone lesions were detected on the 99Tcm-MDP scans of 14/56 (25%) patients, of whom one was in stage A, two in stage B, four in stage C and seven in stage D. Hypoactive lesions in bone marrow were detected in 25/56 (45%) patients, of whom two were in stage A, five in stage B, seven in stage C and 11 in stage D. Bone marrow metastases were confirmed in six patients by computed tomography (CT) and magnetic resonance imaging (MRI) and in two patients by marrow aspiration biopsy. A false-positive immune scintigram was found in three patients previously receiving radiotherapy or chemotherapy. We suggest that 99Tcm-AgMoAb scintigraphy is a sensitive procedure for the detection of bone marrow lesions. However, the reason for false-positive and false-negative results should be considered and CT, MRI and marrow biopsy should be performed when clinically necessary.

Topics: Aged; Antibodies, Monoclonal; Antibody Specificity; Bone Neoplasms; False Negative Reactions; False Positive Reactions; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prostatic Neoplasms; Radiographic Image Interpretation, Computer-Assisted; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

It is often difficult to assess accurately the nature of a skeletal lesion. Problems include differentiating a malignant from a benign bone tumor, as well as determining the cause of a pathologic fracture. Such fractures may occur through osteoporotic bone as well as through neoplasm-affected bone. Thus, development of an imaging modality capable of distinguishing between such lesions is of importance. During 1996, we ran a prospective study in which results of Tc-99m-methyl-diphosphate (MDP) bone scans were compared with those of sestamibi (MIBI) bone scans and with subsequent biopsy and clinical course. The results of the bone scans were assessed by 2 independent "blinded" observers, and the ratios of counts in lesions to those in normal tissue (L/N ratios) were calculated. In cases of malignant (7) and benign (8) tumors, intensity of uptake in MDP scans were not predictive of degree of aggressiveness. On the other hand, MIBI bone scans demonstrated significant difference in intensity of uptake between benign and malignant bone tumors (L/N ratios 2.05 vs 2.75). In 5 of 8 benign lesions the L/N ratio was 1. In the others, increased uptake was minimal. In 2 patients changes in uptake in MIBI bone scan following chemotherapy appeared to be related to the degree of tumor necrosis achieved. While the MIBI bone scan cannot replace tissue biopsy as a definitive diagnostic modality in bone neoplasms, it does appear to allow better preoperative assessment and prognosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Bone Neoplasms; Diagnosis, Differential; Female; Fractures, Bone; Humans; Male; Middle Aged; Muscle Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Fourteen F-18 fluorodeoxyglucose (FDG) studies were carried out in 13 patients known to have bony metastases from carcinoma of the prostate. One patient was newly diagnosed. The remaining patients had various types of therapy and were considered hormonally resistant. The average age was 67. All patients had extensive bony metastases shown on the conventional Tc99m-MDP bone scans. Only about 18% of bony lesions apparent on the conventional bone scans showed corresponding increase of FDG uptake. Anatomical correlation was performed by using co-registered images of SPECT and PET in the same area. The positive FDG uptake was not related to the duration of illness, level of PSA, previous therapy, and magnitude of disease involvement. It appears that only a small percentage of bony metastases is associated with increased glycolysis. It is possible that other metabolic processes are more important than glycolysis for providing prostate cancer with a source of energy and nutrients.

Topics: Aged; Androgens; Bone Neoplasms; Deoxyglucose; Evaluation Studies as Topic; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Glycolysis; Humans; Male; Middle Aged; Neoplasms, Hormone-Dependent; Prostatic Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed

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

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

To characterize 201Tl uptake in patients with bone and soft-tissue tumor, we studied 49 patients with surgically proven tumors and one patient with a tumor diagnosed arteriographically. In 37 of our 50 patients, the tumor was evaluated with 201Tl and arteriography. Moreover, in 14 of patients with pre-operative chemotherapy, pathologic changes were graded on the basis of percent tumor necrosis as defined histologically. The percent tumor necrosis histologically was compared with changes in the scintigraphic and conventional angiographic studies. Radiologic comparisons demonstrated a high degree of correlation with images of 201Tl and both arterial and blood pool phase of 99mTc-HMDP. Ninety-six percent of 28 malignant tumors had positive 201Tl uptake. None of the patients showed any thallium accumulation in the soft tissues or skeleton adjacent to the lesion. Activity of 201Tl was mainly dependent upon a tumor blood flow and a vascular density. In of 14 cases with the preoperative chemotherapeutic treatment, 201Tl scintigraphic changes showed concordance with % tumor necrosis. Thallium-201 was superior to 99mTc-HMDP in predicting tumor response to chemotherapy. Interestingly, delayed images of 99mTc-HMDP of 5 responders with > 90% tumor necrosis showed decreased uptake in the adjacent bone to the tumor mass lesions. It seems to be quite all right to consider that a major determinant of 201Tl uptake is intratumoral angiogenecity, which is closely connected with tumor viability. Therefore, 201Tl is a sensitive radiopharmaceutical for detection of vascular rich bone and soft-tissue tumors, and appears to be a simple and an accurate test for evaluating the response to specific therapeutic regimens of malignant bone and soft-tissue tumors.

Topics: Adolescent; Adult; Aged; Angiography; Bone Neoplasms; Cell Survival; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes

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

Bone marrow immunoscintigraphy using a 99mTc-labelled anti-NCA-95 monoclonal antibody and conventional bone scintigraphy with 99mTc-methylene-diphosphonate were compared in the diagnosis of skeletal metastases in 58 patients with urogenital tumours. In 13 patients with metastatic disease, bone marrow immunoscintigraphy proved to be superior to bone scintigraphy, detecting 431 metastatic lesions on immunoscans as compared to 261 lesions on bone scans. However, on a patient-by-patient basis bone marrow immunoscintigraphy did not demonstrate a clinical advantage over conventional bone scanning, as in this study no patient was identified with metastatic disease still confined to the marrow space, with bone scintigraphy and bone X-ray being normal.

Topics: Adult; Aged; Aged, 80 and over; Antigens, Neoplasm; Bone and Bones; Bone Marrow; Bone Neoplasms; Carcinoma, Renal Cell; Carcinoma, Transitional Cell; Cell Adhesion Molecules; Humans; Male; Membrane Glycoproteins; Middle Aged; Prospective Studies; Radioimmunodetection; Technetium Tc 99m Medronate; Urogenital Neoplasms

Fifty-two patients were treated with single doses of 153Sm-EDTMP in a Phase I escalating dose protocol for palliation of bone pain from metastatic prostate carcinoma. Samarium-153 (T1/2 46.3 hr), maximum beta-particle energies 810 keV (20%), 710 keV (30%), 640 keV (50%), gamma photon 103 keV (28%), was complexed to the tetraphosphonate chelate, EDTMP. Five groups of patients were treated at doses of 1.0, 1.5, 2.0, 2.5, and 3.0 mCi/kg to evaluate toxicity from treatment. Patients were screened prior to treatment and followed after treatment with 99mTc-MDP bone scans. Biodistribution data on this group of patients were acquired and showed rapid uptake of 153Sm-EDTMP into bone with complete clearance of nonskeletal radiotoxicity by 6-8 hr. Also included are complete sets of dosimetry estimations on an additional seven patients who received 0.5 mCi/kg 153Sm-EDTMP Ca++ as part of a multiple dose therapy trial. Estimated radiation absorbed doses to bone surfaces averaged 25,000 mrad/mCi (6686 Gy/MBq), and urinary bladder doses averaged 3600 mrad/mCi (964 Gy/MBq).

Topics: Bone Neoplasms; Chelating Agents; Humans; Male; Organometallic Compounds; Organophosphorus Compounds; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiotherapy Dosage; Samarium; Technetium Tc 99m Medronate; Tissue Distribution

Rhenium-186 (tin) hydroxyethylidene diphosphonate (HEDP) is a new radiopharmaceutical that simultaneously localizes in multiple skeletal metastases in patients with advanced cancer. A single intravenous administration of 30-35 mCi (1110-1295 MBq) is associated with a prompt, significant relief of osseous pain in about 80% of such patients. The efficacy of this new compound was evaluated further by utilizing a double-blind crossover comparison with 99mTc-methylene diphosphonate (MDP) as a radioactive placebo. The new rhenium compound resulted in a significantly (p less than 0.05) greater decrease in pain than did treatment with the radioactive placebo. Rhenium-186(Sn)HEDP appears to be a useful new compound for the palliation of painful skeletal metastases.

Topics: Aged; Bone Neoplasms; Double-Blind Method; Etidronic Acid; Female; Humans; Male; Organometallic Compounds; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radioisotopes; Rhenium; Technetium Tc 99m Medronate

From 1977 to 1987, 7,604 out of a total of 20,483 Danish breast cancer patients had a bone scintigraphy in order to exclude or localise osseous metastases. The scintigrams were performed and interpreted at 14 local hospitals. In 1979, standardised guidelines for interpretation were agreed upon. Until 1983, the scintigrams were described centrally, based on the local reports. From 1979, the frequency of positive bone scintigrams suggesting bone metastases stabilised at about 5% of the patients compared with 12 and 20% in 1977-78. The local take-over of description did not change the frequency. The frequency was also stable from 1979 when evaluated in age groups. With increasing age the frequency of positive scintigrams increased. The frequency of positive scintigrams was significantly lower in patients entering a protocol than in those not entering a protocol. The conclusion is that on a nation-wide basis it is possible to establish a stable, uniform interpretation of bone scintigrams after a two-year introduction period.

Topics: Adult; Age Factors; Aged; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Diphosphates; Female; Humans; Intraoperative Period; Middle Aged; Multicenter Studies as Topic; Polyphosphates; Radionuclide Imaging; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Time Factors

The response of osteosarcomas to preoperative chemotherapy as measured by quantitative 99mTc-diphosphonate scintigraphy was compared with the amount of tumor cell destruction found histologically in the resected specimens. 3-phase bone scintigraphy, with determination of tumor/non-tumor (T/NT) ratios, allowed accurate prediction of tumor response in 28 of 30 tumors (accuracy = 93%) after completion and in 10 of 12 osteosarcomas (83%) at the half-way stage of preoperative chemotherapy, when only those tumors were evaluated which showed convergent changes of T/NT ratios in the perfusion and the mineral phase. At the half-way stage, however, evaluation of chemotherapy effects was complicated in 12 of 23 osteosarcomas by diverging T/NT ratios. In contrast, quantification and mapping of the tumor plasma volume and 99mTc-diphosphonate clearance on parametric images predicted correctly the histological tumor response to chemotherapy in 10 of 11 tumors (91%) after completion and in all 11 cases (100%) at the half-way stage.

Topics: Adolescent; Adult; Altretamine; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Neoplasms; Child; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Dactinomycin; Doxorubicin; Follow-Up Studies; Humans; Methotrexate; Multicenter Studies as Topic; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

99mTc-Hydroxymethylene diphosphonate (HMDP) was compared to 99mTc-methylene diphosphonate (MDP) with respect to image quality, lesion detectability, and the uptake ratios of normal bone to soft tissue (B/S), metastatic bone to soft tissue (M/S) and bone metastases to normal bone (M/B) at 2 and 3 h after injection in the same subjects. Thirty-three patients with bone metastases were examined in six nuclear-medicine departments, with each center using its usual bone-scanning protocol which was identical for both compounds in the same patient. The uptake of 99mTc-HMDP in normal bone (B/S) was significantly higher than that of MDP at 2 and 3 h, but there were no significant differences between the two compounds with regard to the M/S or M/B ratios. The M/B of HMDP at 2 h was not significantly different from that of MDP at 3 h, the latter showing a significantly higher B/S and M/S ratio. All lesions were detected with both compounds, even at 2 h. The image quality was rated as follows (in decreasing order): HMDP (3 h), MDP (3 h), HMDP (2 h), and MDP (2 h). HMDP was shown to be a useful bone-imaging agent, especially when shorter intervals between injection and recording are required.

Topics: Adult; Aged; Bone Neoplasms; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Random Allocation; Technetium Tc 99m Medronate; Time Factors

To compare the efficacy of Tc-99m HMDP and Tc-99m MDP to define skeletal lesions, 28 adult patients were examined in a double-blind, randomized, crossover study. Each patient was imaged with both agents over a period of 7-14 days. Both quantitative and qualitative evaluations were performed on the resulting images. Both agents detected the same number of skeletal lesions, and the number of lesions detected was the same whether the imaging was performed 2 or 4 hr after injection. Relative uptake of the tracer in the lesion relative to normal bone was also the same for both agents. Lesions were easier to see at 4 hr after injection than at 2 hr, presumably because soft-tissue levels were lower. Retention of tracer in bone compared with soft tissue was greater, and image quality was judged to be better, with Tc-99m HMDP than with Tc-99m MDP.

Topics: Adult; Bone and Bones; Bone Neoplasms; Clinical Trials as Topic; Diphosphonates; Double-Blind Method; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Two hundred and fifty-seven patients were studied with bone-seeking radiopharmaceuticals. They were randomly divided into three groups. Two groups were injected with two different 99mTc-methylene diphosphonates from two manufacturers (MDP 1 and MDP 2) and the third group with 99mTc-dicarboxypropane diphosphonate (DPD). DPD was found to be superior with respect to blood clearance, femur to soft tissue ratio and subjectively assessed image quality. There seemed to be no marked differences between the bone-seeking agents in the visualisation of pathological foci. The image quality seemed to be better in the MDP 2 group than in the MDP 1 group but they were similar in other respects. The femur to soft tissue ratio decreased with increasing age in the DPD group but not in the MDP groups. With all agents worsening of scan quality with increasing age was noted and the image quality was better with men than with women. When short incubation times of radiopharmaceuticals were used before injection, the bone to soft tissue ratio was lower and the scan quality was poorer than with incubation times longer than 20 min.

Topics: Adult; Age Factors; Aged; Bone and Bones; Bone Neoplasms; Connective Tissue; Diphosphonates; Female; Femur; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sex Factors; Technetium; Technetium Tc 99m Medronate

A prospective double-blind comparison of 99mTc-hydroxymethane diphosphonate (HMDP) and 99mTc-methylene diphosphonate (MDP) as bone-seeking agents was performed with 102 patients. Densitometry showed that both cancellous/compact bone and cancellous bone/soft-tissue ratios were greater with HMDP (p less than 0.05); compact bone/soft-tissue and bone lesion/normal bone ratios were the same with both agents. Bone delineation, soft-tissue uptake, and overall image quality were the same with both agents. The HMDP formulation contained 78% fewer stannous ions and had a longer useful life after technetium labeling than MDP.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Double-Blind Method; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tin

Several methods are used to reconstruct bony defects after malignant tumor excision. Tumor-bearing frozen autograft reconstruction is a biological procedure in which tumor-bearing bone is reused after devitalization with liquid nitrogen to kill tumor cells. The viability of frozen autografts has not been fully evaluated over time. We therefore aimed to evaluate the viability of devitalized bone grafts, using 99m Tc-MDP scintigraphy.. Seventy-four patients who underwent frozen autograft reconstruction after the excision of a malignant bone tumor were enrolled. Two hundred forty-two postoperative 99m Tc-MDP scans were reviewed. For a quantitative analysis, the region of interest on the frozen bone segment and a symmetric region of interest on the contralateral normal area were manually set. The radioactive tracer uptake ratio was calculated by dividing the count density of the frozen bone segment by that of the contralateral normal area in each image. An uptake ratio of 0.9 to 1.1 was defined as a normalization of tracer uptake.. Normalization of tracer uptake was achieved in 95% to 97% of the cases by 60 months postoperatively, and earlier in the middle zone and peripheral zone in the pedicle freezing group in comparison to the free freezing group (both P = 0.03). Fracture and nonunion was associated with a low uptake ratio, whereas infection was associated with a high uptake ratio before the occurrence of the event.. The calculation of the uptake ratio using 99m Tc-MDP scans was an objective and accurate evaluation method. The period to normalization of tracer uptake in the pedicle frozen bone was significantly earlier than that in the free frozen bone. The postoperative complications can be also predicted.

Topics: Autografts; Bone Neoplasms; Bone Transplantation; Freezing; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

A 65-year-old man presented with abdominal bloating, pain, and nausea for 5 days. Abdominal CT revealed a heterogeneous mass with a large area of calcification, and rupture of the mass was seen around the capsulafibrosa. According to pathological examination after percutaneous puncture biopsy, the histopahological and immunohistochemical findings were suggestive of metastatic or primary hepatic osteosarcoma. Whole body bone scintigraphy demonstrated elevated 99mTc-MDP activity in hepatic mass, but no skeletal lesions. The diagnosis of primary hepatic osteosarcoma was finally confirmed. PET/CT showed hepatic mass with heterogeneous high-uptake, and multiple metastases in portacaval lymph nodes, lungs and the third thoracic vertebra were considered.

Topics: Aged; Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Osteosarcoma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone is considered as the third most common site of metastases, besides lung and liver. Early detection of skeletal metastases aids in better management of skeletal-related events. In the present study cold kit-based 2,2 ' ,2 '' -(10-(2-((diphosphonomethyl)amino)-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl) triacetic acid (BPAMD) was labeled with 68 Ga. The radiolabeling parameters and clinical evaluation in patients with suspected bone metastases were compared with routinely used 99m Tc-methylenediphosphonate ( 99m Tc-MDP).. The kit components of MDP were incubated with at room temperature for 10 min, followed by radiochemical purity testing using thin-layer chromatography. For radiolabeling of BPAMD, the cold kit components reconstituted in 400 μL of HPLC grade water were transferred and incubated with 68 GaCl 3 in the reactor vessel of the fluidic module at 95°C for 20 min. Radiochemical yield and purity were determined with instant thin-layer chromatography using 0.5 M sodium citrate as mobile phase. For clinical evaluation, patients ( n  = 10) with suspected bone metastases were enrolled. 99m Tc-MDP and 68 Ga-BPAMD scans were performed on two different days in random order. Imaging outcomes were noted and compared.. Radiolabeling of both tracers is facile using cold kit, although BPAMD requires heating. The radiochemical purity was observed to be greater than 99% for all preparations. Both MDP and BPAMD detected skeletal lesions; however, additional lesions were detected in total of seven patients which were not visualized clearly on 99m Tc-MDP scan.. BPAMD can be easily tagged with 68 Ga using cold kits. The radiotracer is suitable and efficient for detection of bone metastases using PET/computed tomography.

Topics: Bone Neoplasms; Diphosphonates; Humans; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Based on the SUV measurements of non-pathological bones, the optimal SUV threshold, which defines abnormal bone SPECT uptake, was determined to be 8. Median LUV was 39 mL (interquartile range 4.0-104.3 mL) in the CRPC subjects with bone metastases. Kaplan-Meier survival analysis showed a significant relation between prostate cancer-specific survival and LUV (cut-off value, 19.95 mL; P = 0.001). Multivariate analysis revealed LUV as an independent prognostic factor for the survival (P = 0.008, hazard ratio 23.424). Global chi-square test showed that LUV had significant incremental prognostic value in addition to prostate-specific antigen and the interval from progression to CRPC until bone SPECT/CT (P = 0.022).. Quantitative assessment of

Topics: Bone Neoplasms; Castration; Humans; Male; Prognosis; Prostatic Neoplasms, Castration-Resistant; Retrospective Studies; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

This study aimed to evaluate the jaw pathologies of patients with bone metastases using a computer program to assess the bone scan index (BSI) for Tc-99m hydroxymethylene diphosphonate (HMDP) with single-photon emission computed tomography/computed tomography (SPECT/CT).. Ninety-seven patients with jaw pathologies (24 with bone metastases and 73 without) were evaluated. High-risk hot spots and BSI in the patients were evaluated using the VSBONE BSI (ver.1.1) analysis software for Tc-99m HMDP that scanned SPECT/CT and automatically defined the data. The two groups were compared using the Pearson chi-square test and Mann-Whitney U test for high-risk hot spots and BSI, respectively. A P value of <0.05 was considered statistically significant.. High-risk hot spot occurrence was significantly correlated to bone metastases [sensitivity, 21/24 (87.5%); specificity, 40/73 (54.8%); accuracy, 61/97 (62.9%);. A computer program that assessed BSI for Tc-99m HMDP may be useful in the evaluation of patients with bone metastases using SPECT/CT.

Topics: Bone Neoplasms; Humans; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

A 62-year-old man presented with a 5-year history of progressive myasthenia, myalgia, and skin changes. Upon laboratory testing, elevated serum creatine kinase and lactate dehydrogenase, as well as monoclonal immunoglobulin Gκ, were observed. A bone scan revealed generalized muscular uptake of 99m Tc-MDP, whereas 18 F-FDG PET/CT demonstrated only mild hypermetabolism of the muscles. A muscle biopsy showed myofibrillary vacuolar degeneration, and a skin biopsy indicated scleromyxedema. Based on these findings, the patient was diagnosed with scleromyxedema-associated myopathy.

Topics: Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Muscular Diseases; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Scleromyxedema; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 60-year-old man with back pain underwent 99m Tc-MDP to evaluate bone metastases from newly esophageal carcinoma. No bone metastasis was found on the whole-body bone scan. Unexpectedly, subcutaneous metastasis revealed increased 99m Tc-MDP activity.

Topics: Bone Neoplasms; Carcinoma; Esophageal Neoplasms; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Osteosarcoma is a frequently occurring primary skeletal malignancy in the adolescent population. It arises from primitive mesenchymal bone forming cells and frequently involves long bones near the metaphyseal growth plate. Multiple imaging modalities are used for complete staging workup at the time of presentation; including magnetic resonance imaging (MRI) for local disease extent, computed tomography (CT) scan to rule out pulmonary metastasis, and bone scan to look for distant osseous metastases. We present the case of a young boy with osteosarcoma of left tibia, showing additional findings on MDP bone scan acquired for initial staging work up.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Osteosarcoma; Radiopharmaceuticals; Technetium; Technetium Tc 99m Medronate

Composite hemangioendothelioma is a rare disease that exhibits biological potency ranging from benign to low-grade malignancy, and hepatic and bone metastases are even rarer. Here, we present the imaging findings of a 65-year-old man with splenic composite hemangioendothelioma and multiple metastases. A bone scan revealed abnormal uptake of 99m Tc-MDP in multiple bones and spleen, whereas enhanced CT demonstrated splenic lesions with low density and mild enhancement. Based on pathological examination, the patient was diagnosed with splenic composite hemangioendothelioma with bone metastasis.

Topics: Aged; Bone Neoplasms; Hemangioendothelioma; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Spleen; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 99mTc-methylene diphosphate (MDP) bone scintigraphy scan was performed to follow up metastatic breast cancer. A circular region of radiotracer uptake in the location of the patient's left breast implant was seen. Review of the same-day chest CT and the prior CT showed that the patient's breast implant had ruptured in the interim. The 99mTc-MDP uptake in the capsule of the breast implant was attributed to rupture, likely secondary to inflammation. This is an example of an unusual presentation of breast implant rupture discovered on a 99mTc-MDP bone scintigraphy scan.

Topics: Bone Neoplasms; Breast Implants; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Acrometastasis is a rare clinical entity, estimated to represent less than 0.3% of all bone metastases. Here, we present a case of esophageal cancer that was treated with esophagectomy, chemotherapy, and radiation therapy and developed oligometastases of the foot after 8 years in remission. The patient developed pain and swelling in his left ankle and foot as the presenting symptom. He underwent radiography and MRI of the affected area, which revealed the lesion. A 99mTc-MDP whole-body bone scan did not reveal any other sites of metastasis.

Topics: Bone Neoplasms; Esophageal Neoplasms; Esophagectomy; Humans; Male; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To evaluate the accuracy of 68Gallium prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) vs. CT combined with bone scan in the clinical staging of high-risk prostate cancer (PCa).. From January 2020 to October 2021, 30 patients underwent clinical staging according to 68Ga-PSMA PET/TC, lung-abdominal CT and Technetium-99m bone scan.. 68Ga-PSMA PET/CT demonstrated a better accuracy in comparison with CT plus bone scan in the diagnosis of node metastases at definitive histology (76.9% vs. 46.1%; p=0.001).. The 68Ga-PSMA PET/CT was more accurate than CT and bone scan in the staging of high-risk PCa, leading to a change in the therapeutic strategy in 10% of the cases.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Middle Aged; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prospective Studies; Prostatic Neoplasms; Radiography, Abdominal; Radiography, Thoracic; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate

The bone scan index (BSI) is widely used as a quantitative indicator of bone metastasis, therapeutic effect assessment, and prognosis prediction in prostate cancer. However, the BONE NAVI, which calculates BSI, only supports bone scintigraphy using Tc-99m-methylene diphosphonate. We developed the VSBONEⓇ BSI, which calculates BSI from bone scintigraphy using Tc-99m-hydroxymethylene diphosphonate (HMDP). The purpose of this study was to demonstrate that the BSI calculated using VSBONEⓇ BSI and hot spots (HS), which indicates the number of abnormal accumulations, are useful prognostic factors for patients with prostate cancer bone metastasis, similar to BONE NAVI.. We analyzed 322 patients who underwent bone scintigraphy for prostate cancer bone metastasis at our hospital. Initial bone scintigraphy was performed using Tc-99m-HMDP. All cases were retrospectively examined for their outcome and time to the final outcome. The results obtained were compared with the BSI and HS calculated using VSBONEⓇ BSI.. When the patients were divided into two groups, HS >2 and HS ≤2, the HS ≤2 group had a significantly longer survival time (p < 0.001). In addition, when divided into two groups, BSI >0.46 and BSI ≤0.46, the survival time of the BSI ≦0.46 group was significantly longer (p < 0.001).. BSI and HS obtained using VSBONEⓇ BSI may be useful as prognostic predictors, similar to those obtained using BONE NAVI.

Topics: Bone and Bones; Bone Neoplasms; Humans; Male; Prognosis; Prostatic Neoplasms; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Accurate staging is crucial to determine the type of treatment for patients with bladder cancer (BCa), especially in high-risk cases. We aimed to assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC).. Forty-five patients with MIBC were referred to our tertiary clinic to perform a technetium 99m-methyl diphosphonate (Tc99m-MDP) bone scan from January 2019 to March 2020. The patients underwent bone scintigraphy with pelvic SPECT/CT before radical cystectomy. Whole-body scanning was performed 4 hours after Tc99m-MDP injection in both anterior and posterior views. Since the most common bone involvement site in these patients is the pelvic bones and the spine, pelvic SPECT/CT was performed in all patients.. Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient's age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant.. Bone scan has higher diagnostic performance than conventional imaging methods for detecting bone metastases. It changed the management plan in 8.8% of our patients, so we conclude that performing a whole-body bone scan in the initial staging of MIBC would be helpful.

Topics: Bone Neoplasms; Carcinoma; Diphosphonates; Female; Humans; Male; Muscles; Neoplasm Staging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Bladder; Urinary Bladder Neoplasms

Desmoplastic fibroma is a very rare benign bone tumor with local aggressiveness. We describe imaging findings in 2 cases with desmoplastic fibroma of the bone. One case had a desmoplastic fibroma in the right distal femur, showing bone destruction with sclerotic margins and inhomogeneous FDG uptake. The other case had a desmoplastic fibroma in the left ninth rib, showing progressive peripheral enhancement and increased 99m Tc-MDP uptake.

Topics: Bone Neoplasms; Fibroma, Desmoplastic; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Technetium Tc 99m Medronate

Tc-99m methylene diphosphonate (MDP) bone scan is an effective tool for the evaluation of benign and malignant skeletal disorders. Hepatic uptake on bone scan is an unexpected finding and whenever present, the cause must be determined as the distinction between technical and pathological causes is important to direct further patient management. Identification of these abnormalities will decrease errors and provide cardinal clinical information. We present the image of a patient with Osteosarcoma of the left femur; who underwent bone scan for metastatic workup which showed diffuse hepatic uptake.

Topics: Bone Neoplasms; Humans; Osteosarcoma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Terminally Ill

A 76-year-old woman with uterine cervical cancer 20 years ago received right total hip replacement 3 months ago for right hip avascular necrosis without specific intraoperative finding. She reported persistent right hip pain after falling from bed. Pelvic x-ray showed right pubic ramus fracture. To evaluate prosthesis loosening, 99mTc-MDP 3-phase bone scan was arranged, showing diffusely and heterogeneously increased vascularity and tracer perfusion over the right hip, with intensely and heterogeneously increased metabolism in the right iliac bone and hip. SPECT/CT showed nearby swelling of calcified muscles. After debridement and synovectomy, the pathologic report showed chondroblastic osteosarcoma.

Topics: Aged; Arthroplasty, Replacement, Hip; Bone Neoplasms; Female; Hip Prosthesis; Humans; Osteosarcoma; Prosthesis Failure; Technetium Tc 99m Medronate

BSI calculated from bone scintigraphy using. We developed a method in collaboration with the Tokyo University of Agriculture and Technology to calculate bone scan index (BSI) employing deep learning algorithms with bone scintigraphy images using. The purpose of this study is to investigate the usefulness of the BSI calculated by CNNapis as bone imaging and bone metabolic biomarkers in patients with bone metastases from prostate cancer.. At our hospital, 121 bone scintigraphy scans using. Patients diagnosed with bone metastases after bone scintigraphy were also diagnosed with bone metastases using CNNapis. BSI corresponding to the range of abnormal RI accumulation was calculated. PSA and BSI (r = 0.2791) and ALP and BSI (r = 0.6814) correlated positively. Significant intergroup differences in PSA between Groups 1 and 2, Groups 1 and 4, Groups 2 and 3, and Groups 3 and 4 and in ALP between Groups 1 and 4, Groups 2 and 4, and Groups 3 and 4 were found.. BSI calculated using CNNapis correlated with ALP and PSA values and is useful as bone imaging and bone metabolic biomarkers, indicative of the activity and spread of bone metastases from prostate cancer.

Topics: Bone Neoplasms; Deep Learning; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

Skeletal metastases of bone sarcomas are indicators of poor prognosis. Various imaging modalities are available for their identification, which include bone scan, positron emission tomography/CT scan, MRI, and bone marrow aspiration/biopsy. However, there is considerable ambiguity regarding the best imaging modality to detect skeletal metastases. To date, we are not sure which of these investigations is best for screening of skeletal metastasis.. Which staging investigation-18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT), whole-body MRI, or 99mTc-MDP skeletal scintigraphy-is best in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in detecting skeletal metastases in patients with osteosarcoma and those with Ewing sarcoma?. A prospective diagnostic study was performed among 54 of a total 66 consecutive osteosarcoma and Ewing sarcoma patients who presented between March 2018 and June 2019. The institutional review board approved the use of all three imaging modalities on each patient recruited for the study. Informed consent was obtained after thoroughly explaining the study to the patient or the patient's parent/guardian. The patients were aged between 4 and 37 years, and their diagnoses were proven by histopathology. All patients underwent 99mTc-MDP skeletal scintigraphy, 18F-FDG PET/CT, and whole-body MRI for the initial staging of skeletal metastases. The number and location of bone and bone marrow lesions diagnosed with each imaging modality were determined and compared with each other. Multidisciplinary team meetings were held to reach a consensus about the total number of metastases present in each patient, and this was considered the gold standard. The sensitivity, specificity, PPV, and NPV of each imaging modality, along with their 95% confidence intervals, were generated by the software Stata SE v 15.1. Six of 24 patients in the osteosarcoma group had skeletal metastases, as did 8 of 30 patients in the Ewing sarcoma group. The median (range) follow-up for the study was 17 months (12 to 27 months). Although seven patients died before completing the minimum follow-up, no patients who survived were lost to follow-up.. With the number of patients available, we found no differences in terms of sensitivity, specificity, PPV, and NPV among the three staging investigations in patients with osteosarcoma and in patients with Ewing sarcoma. Sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 67% (4 of 6 [95% CI 22% to 96%]) and specificities were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 78% (14 of 18 [95% CI 52% to 94%]), respectively, in patients with osteosarcoma. In patients with Ewing sarcoma, sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 88% (7 of 8 [95% CI 47% to 100%]), 88% (7 of 8 [95% CI 47% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and specificities were 100% (22 of 22 [95% CI 85% to 100%]), 95% (21 of 22 [95% CI 77% to 100%]), and 95% (21 of 22 [95% CI 77% to 100%]), respectively. Further, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and the NPVs were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 88% (14 of 16 [95% CI 62% to 98%]), respectively, in patients with osteosarcoma. Similarly, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (7 of 7 [95% CI 59% to 100%]), 88% (7 of 8 [95% CI 50% to 98%]), and 80% (4 of 5 [95% CI 28% to 100%]), and the NPVs were 96% (22 of 23 [95% CI 78% to 100%]), 95% (21 of 22 [95% CI 77% to 99%]), and 84% (21 of 25 [95% CI 64% to 96%]), respectively, in patients with Ewing sarcoma. The confidence intervals around these values overlapped with each other, thus indicating no difference between them.. Based on these results, we could not demonstrate a difference in the sensitivity, specificity, PPV, and NPV between 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy for detecting skeletal metastases in patients with osteosarcoma and Ewing sarcoma. For proper prognostication, a thorough metastatic workup is essential, which should include a highly sensitive investigation tool to detect skeletal metastases. However, our study findings suggest that there is no difference between these three imaging tools. Since this is a small group of patients in whom it is difficult to make broad recommendations, these findings may be confirmed by larger studies in the future.. Level II, diagnostic study.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Staging; Osteosarcoma; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sarcoma, Ewing; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging; Young Adult

The Tc-99m methylene diphosphonate (MDP) whole body bone scan (WBBS) has been widely accepted as a method of choice for the initial diagnosis of bone and joint changes in patients with oncologic diseases. The WBBS has shown high sensitivity but relatively low specificity due to bone variation. This study aims to use the self-developing irregular flux viewer (IFV) system to predict possible bone lesions in planar WBBS. The study uses gradient vector flow (GVF) and self-organizing map (SOM) methods to analyze the blood fluid-dynamics and evaluate hot points. The evaluation includes a selection of 368 patients with bone metastasis from prostate cancer, lung cancer and breast cancer. Finally, we compare IFV values with BONENAVI version data. BONENAVI is a computer-assisted diagnosis system that analyzes bone scintigraphy automatically. The analysis shows that the IFV system achieves sensitivities of 93% for prostate cancer, 91% for breast cancer, and 83% for lung cancer, respectively. On the other hand, our proposed approach achieves a higher sensitivity than the results of BONEVAVI version 2.0.5 for prostate cancer (88%), breast cancer (86%) and lung cancer (82%), respectively. The study results demonstrate that the high sensitivity and specificity of the IFV system can provide assistance for image interpretation and generate prediction values for WBBS.

Topics: Bone and Bones; Bone Neoplasms; Diagnosis, Computer-Assisted; Humans; Male; Prostatic Neoplasms; Sensitivity and Specificity; Technetium Tc 99m Medronate

This prospective study was aimed at assessing the ability of 99mTc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99mTc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement.. Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan.. Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99mTc-PSMA detected 52 of the 55 bone lesions detected on 99mTc-MDP. However, 99mTc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99mTc-MDP and none on 99mTc-PSMA.. 99mTc-PSMA was comparable to 99mTc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99mTc-PSMA may be a better alternative to 99mTc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.

Topics: Aged; Antigens, Surface; Bone Neoplasms; Female; Glutamate Carboxypeptidase II; Humans; Male; Middle Aged; Neoplasm Staging; Prospective Studies; Prostatic Neoplasms; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

To analyse the additional clinical value of protocol-driven and selective use of multidetector single-photon-emission tomography/computed tomography (SPECT/CT) in oncology patients undergoing whole-body bone scintigraphy (BS) and to analyse reporter confidence in diagnosis with and without SPECT/CT.. During a 2-year period, 2,954 whole-body BS examinations were performed in oncology patients, with 444 (15%) undergoing additional protocol-driven SPECT/CT. Retrospective evaluation of planar BS and SPECT/CT images was performed by two experienced dual-trained nuclear medicine radiologists. The BS and SPECT/CT images were graded blindly using a five-point scale designed to evaluate the likelihood of a lesion being benign or malignant. Interpretation was applied on a per-patient basis.. There was a 74.5% increase in definitive diagnostic classification and a 26.6% reduction in equivocal findings with SPECT/CT when compared to BS alone (p<0001). Of cases initially classified as "probably benign" on BS, 5.1% (10/193) were reclassified to "probably malignant" (1%) or "malignant" (4.1%) using the SPECT/CT data. The highest impact in reporter confidence was seen with SPECT/CT in the interpretation of lesions within the pelvis (34%), ribs (23%), lumbar spine (22%), and thoracic spine (21%).. Protocol-driven, selective use of SPECT/CT imaging to augment planar BS reduces equivocal findings and improves reporter confidence whilst minimising the impact on patient and reporting workflows.

Topics: Aged; Algorithms; Bone Neoplasms; Clinical Protocols; Diagnosis, Differential; Female; Humans; Male; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging; Workflow

Topics: Aged, 80 and over; Amyloid Neuropathies, Familial; Bone Neoplasms; Cardiomyopathies; Genetic Predisposition to Disease; Humans; Incidental Findings; Male; Mutation; Prealbumin; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

A 39-year-old man with bone pain underwent Tc-MDP bone scan to assess skeletal lesions, which demonstrated multiple fractures and a focus of subtle extraosseous activity in the left thigh. A Tc-hynic-octreotide imaging was performed due to the suspected diagnosis of tumor-induced osteomalacia, which revealed a hypermetabolic subcutaneous nodule in the left thigh, which exactly corresponded to the same site of MDP activity. Biopsy confirmed the subcutaneous nodule as the culprit tumor of tumor-induced osteomalacia. Bone scan, as a conventional imaging, provided useful information for detecting culprit tumor as shown in our case.

Topics: Adult; Bone and Bones; Bone Neoplasms; Humans; Male; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 61-year-old woman diagnosed with left breast cancer underwent a bone scan for the evaluation of possible bone metastases. Multiple foci of elevated activity were noticed in the spine and pelvis. In addition, a focus of intense activity was observed in the right lung on the SPECT/CT images without corresponding anatomic abnormality.

Topics: Biological Transport; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung; Middle Aged; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

The aim of this study was to compare the diagnostic precision of bone scintigraphy with BONENAVI version 1 and BONENAVI version 2 in bone metastasis of primary breast cancer.. The subjects were 56 consecutive patients (all women, mean age 59 ± 12.7 years) who underwent bone scintigraphy with Tc-MDP and were diagnosed with bone metastasis of primary breast cancer from January 2012 to November 2014. Bone scintigraphy was performed with BONENAVI version 1 and BONENAVI version 2 to calculate artificial neural network (ANN), bone scan index (BSI), and hot-spot values, with ANN ≥ 0.5 considered to reflect bone metastasis for the calculation of sensitivity. Mean ANN, BSI, hot-spot values, and sensitivity were compared between BONENAVI version 1 and BONENAVI version 2, with P < 0.05 considered a significant difference.. With BONENAVI version 1, mean ANN was 0.73 ± 0.29, BSI was 1.47 ± 1.85, the hot-spot value was 12.4 ± 12.5, and sensitivity was 76.8% (43/56). With BONENAVI version 2, the mean ANN was 0.86 ± 0.19, BSI was 1.53 ± 2.09, hot-spot value was 12.9 ± 15.6, and sensitivity was 94.6% (53/56). BONENAVI version 2 yielded significantly better ANN and sensitivity than BONENAVI version 1 (both P < 0.01).. BONENAVI version 2 has improved sensitivity for detecting bone metastasis of primary breast cancer compared to BONENAVI version 1.

Topics: Bone Neoplasms; Breast Neoplasms; Diagnosis, Computer-Assisted; Female; Humans; Image Processing, Computer-Assisted; Middle Aged; Sensitivity and Specificity; Technetium Tc 99m Medronate

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

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

Topics: Bone and Bones; Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Neuroblastoma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Multiple intravascular papillary endothelial hyperplasia involved with bone is rare. In this study, we present the case of a 53-year-old woman having occasional chest pains located in the middle of the sternum and the left chest wall. Multiple intravascular papillary endothelial hyperplasia lesions with high metabolism distributed in the sternum, left ribs, 12th thoracic vertebra, and left ilium on bone scintigraphy as well as PET/CT, which were easily misdiagnosed as bone malignant tumors. Increased awareness of this benign lesion and its high metabolic findings will improve preoperative diagnosis and avoid misinterpretation that may lead to an unnecessary invasive treatment.

Topics: Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Endothelial Cells; Female; Fluorodeoxyglucose F18; Humans; Hyperplasia; Middle Aged; Positron Emission Tomography Computed Tomography; Technetium Tc 99m Medronate

The aim of our study was to compare Tc-99m MDP bone scan and Ga-68 PSMA PET/CT in terms of detection of bone metastasis in prostate cancer patients.. A total of 28 prostate cancer patients with bone scan and PSMA PET/CT performed within 90 days were retrospectively included in our analysis. All bone lesions were scored as negative (score-0), positive (score-1), or suspicious (score-2) for metastasis by two experienced nuclear medicine physicians. Both patient-based and region-based analyses were made for all osseous lesions.. On per-patient analysis; sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 72.7%, 52.9%, 50%, 75%, and 60.7%, respectively, for bone scan and 90.9%, 100%, 100%, 94.4%, and 96.4%, respectively, for PSMA PET/CT. On per-region analysis; sensitivity, specificity, PPV, NPV, and accuracy were 76.2%, 80.9%, 57.1%, 91.1%, and 79.8%, respectively, for bone scan and 85.7%, 100%, 100%, 95.5%, and 95.4%, respectively, for PSMA PET/CT.. Ga-68 PSMA PET/CT has higher sensitivity, specificity, and accuracy compared to bone scan in terms of bone metastasis detection in prostate cancer patients. Therefore, it might be the modality of choice for patients with suspicion for metastatic disease, despite negative bone scan and conventional imaging results

Topics: Aged; Bone and Bones; Bone Neoplasms; Gallium Radioisotopes; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prostatic Neoplasms; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

We presented a 61-year-old man's surprising Tc-MDP whole-body blood pool superscan pattern with early unexpected generalized bone uptake. He complained of weakness and undesired weight loss with anemia and elevated erythrocyte sedimentation rate. As a malignancy workup in a patient without obvious suspicious origin, a whole-body Tc-MDP bone scan was requested. This unusual tracer distribution on blood pool imaging was very similar to the whole-body delayed scan except for visible kidneys.

Topics: Bone Neoplasms; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Neoplasm Metastasis; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Extraosseous Tc-MDP uptake on bone scans is frequently encountered and has a broad differential diagnosis. A small subset of such patients can present with intestinal Tc-MDP uptake. We present the case of a 35-year-old woman with status after right nephrectomy for renal cell carcinoma, being followed with bone scan for osseous metastases. Follow-up imaging revealed new faint Tc-MDP uptake in the right hemiabdomen. Correlation with contrast-enhanced CT localized this uptake to the ascending colon. Enteric Tc-MDP uptake and its association with iodinated contrast should be considered in the differential diagnosis of extraosseous enteric Tc-MDP uptake.

Topics: Adult; Bone Neoplasms; Colon; Contrast Media; Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Metastatic calcification relates to abnormal calcification resulting from hypercalcaemia in otherwise normal tissues. Hypercalcaemia can occur secondary to chronic renal failure, hyperparathyroidism, hypervitaminosis D, and metastatic neoplasms. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. We present cases with different patterns of soft tissue calcification on Tc99m MDP bone scan.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Calcinosis; Carcinoma; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thoracic Wall

Malignant transformation of giant cell tumour of the bone is extremely rare. In addition, bone transformation in giant cell tumour may occur in different phases. With conventional X-rays, CT scans or MRIs, it may be challenging to distinguish among different phases of bone transformation, normal bone, soft tissue disease and bone disease (benign vs malignant lesions) and changes in multiple organs such as lung, liver and lymph nodes unless every lesion is biopsied, which is not practical. Molecular imaging with different isotopes (Tc-99m phosphonate, 2-deoxy-2-(

Topics: Adult; Bone Neoplasms; Cell Transformation, Neoplastic; Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Giant Cell Tumor of Bone; Humans; Molecular Imaging; Neoplasm Metastasis; Osteosarcoma; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Rare Diseases; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 34-year-old woman with pancreatic acinar cell carcinoma underwent a Tc-MDP bone scan to rule out potential bone metastasis because of back pain 18 months after radiation therapy. The bone scintigraphy revealed increased uptake over the upper pole of both kidneys corresponding to the portions of the kidneys included within the radiation field, consisting with radiation nephritis.

Topics: Adult; Bone Neoplasms; Carcinoma, Acinar Cell; Diagnosis, Differential; Female; Humans; Nephritis; Pancreatic Neoplasms; Radiation Injuries; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Radionuclide bone scintigraphy with technetium-99m-methylene diphosphonate is the commonest procedure in nuclear medicine. It is an effective diagnostic tool in staging of primary bone tumours since long. It is not only helpful to confirm the radiologic features of malignant bone tumours but also demonstrates skeletal metastasis and soft tissue involvement. Computed tomography (CT) combined with single-photon emission computed tomography (SPECT/CT) give better insight to localize and categorize the lesions. We describe an interesting image of chondrosarcoma showing anatomical extent of primary tumour and multifocal uptake in the chest conforming to underlying widespread partially calcified pulmonary metastases.

Topics: Bone Neoplasms; Chondrosarcoma; Female; Humans; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

To compare the diagnostic performance of Fluciclovine PET/CT and 99mTc-MDP bone scan in detecting bone metastases in patients with metastatic prostate cancer.. Patients with metastatic prostate cancer who had both Fluciclovine PET/CT and bone scan within 3-month interval between October 2017 and October 2018 in our center were retrospectively reviewed. Exclusion criteria included separate concurrent cancer, or prostate-specific antigen were more than two-fold difference with an absolute difference >1 ng/ml between the two image studies. All abnormal bone lesions on either scan were compared. The findings were verified by available pathology and 4-month clinical follow-up.. A total of 106 patients with 106 dual scans were included in this study. 80/106 (75%) had concordant findings, whereas 26/106 (25%) had discordant findings. Of the discordant findings, 13/26 (50%) had false-positive findings on bone scan but negative on Fluciclovine PET/CT, 3/26 (11.5%) had positive lesions on Fluciclovine PET/CT but negative on bone scan, 8/26 (30.8%) had more positive lesions on Fluciclovine PET/CT than bone scan, and 2/26 (7.7%) with false-positive lesions on Fluciclovine PET/CT but negative on bone scan. The sensitivity, specificity, positive predictive value and negative predictive value for bone scan were 79%, 86%, 45% and 96%, respectively; and 100%, 98%, 89% and 100% in Fluciclovine PET/CT, respectively.. Our results demonstrated that Fluciclovine PET/CT detected more bone metastases than bone scan. Importantly, there were no lesions identified by bone scan that was missed by Fluciclovine PET/CT. With the extra capacity of detecting soft tissue metastasis in PET/CT, Fluciclovine PET/CT may render bone scan unnecessary to investigate metastatic prostate cancer.

Topics: Aged; Aged, 80 and over; Biopsy; Bone and Bones; Bone Neoplasms; Carboxylic Acids; Cyclobutanes; False Negative Reactions; False Positive Reactions; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Retrospective Studies; Technetium Tc 99m Medronate

Background Patient acceptance is an important factor when implementing imaging methods in clinical practice in line with availability, diagnostic accuracy, and cost-effectiveness. Purpose To investigate patient experience and acceptance regarding18F-sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT), 11 C-choline-PET/CT, whole-body magnetic resonance imaging (WB-MRI), and 99mTc-hydroxymethane diphosphonate (HDP) single photon emission/computed tomography (SPECT/CT). Material and Methods One hundred and forty-nine patients with prostate cancer filled in a questionnaire regarding their experience of the imaging procedures they had been undergoing as part of a diagnostic accuracy study. Each patient had been undergoing a NaF-PET/CT, a WB-MRI, and either a SPECT/CT (group A) or a choline-PET/CT (group B). Results All four imaging methods received overall experience ratings at the favorable end of a 5-point Likert scale with the two PET/CT scans receiving marginally better average ratings (2.0) compared to SPECT/CT (2.2) and WB-MRI (2.3). The arm positioning above the head was the most uncomfortable part of the three nuclear medicine scans, whereas the acoustic noise was the most unpleasant part of the WB-MRI. The experience of staff instruction was relatively strongly correlated to the overall scanning experience of all four imaging modalities. Overall, the patients were willing to repeat the four imaging methods and NaF-PET/CT was the method most preferred in both groups. Conclusion Four imaging procedures were evaluated from the perspective of a selected group of prostate cancer patients. NaF-PET/CT, choline-PET/CT, WB-MRI, and bone SPECT/CT are well accepted imaging methods, and most patients prefer NaF-PET/CT.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Choline; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Patient Acceptance of Health Care; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Sodium Fluoride; Surveys and Questionnaires; Technetium Tc 99m Medronate; Whole Body Imaging

The classification of thyroid nodules in children is often difficult, especially in pretreated patients with metastatic disease. In osteosarcoma patients, Tc-MDP SPECT/CT is used for primary and follow-up staging. Bone and soft tissue metastases can be revealed because of Tc-MDP imaging of osteoid-producing metastases. We present Tc-MDP SPECT-CT, CT, and ultrasound images of a highly suspicious calcified thyroid lesion in a 17-year-old boy with osteosarcoma. High uptake in Tc-MDP SPECT-CT provides diagnosis of thyroid metastasis of osteosarcoma, which was proven by histopathology.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Neoplasm Staging; Osteosarcoma; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Thyroid Neoplasms; Ultrasonography

We herein report a case of a 43-year-old man with a right 8th-rib bone tumor exhibiting features of malignancy at CT-scan. Considering that a SPECT/CT with Tc-MDP showed solitary intense radio-tracer uptake and the inconclusive results from a fine-needle biopsy, surgical en bloc tumor resection was performed. Pathologic analysis revealed a well-limited benign bone lesion ("fibrous rib dysplasia") composed by a cellular fibrous proliferation. Since benign osseous diseases may present an intense scintigraphic tracer uptake (as in this case), we suggest a certain caution when interpreting the results of SPECT/CT with Tc-MDP in order to avoid misdiagnosis and wrong treatments.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Fibrous Dysplasia of Bone; Humans; Male; Radiopharmaceuticals; Ribs; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

Mirels' scoring system quantifies the risk of sustaining a pathologic fracture in osseous metastases of weight bearing long bones. Conventional Mirels' scoring is based on radiographs. Our pilot study proposes Tc MDP bone SPECT-CT based modified Mirels' scoring system and its comparison with conventional Mirels' scoring. Cortical lysis was noted in 8(24%) by SPECT-CT versus 2 (6.3%) on X-rays. Additional SPECT-CT parameters were; circumferential involvement [1/4 (31%), 1/2 (3%), 3/4 (37.5%), 4/4 (28%)] and extra-osseous soft tissue [3%]. Our pilot study suggests the potential role of SPECT-CT in predicting risk of fracture in osseous metastases.

Topics: Aged; Bone Neoplasms; Fractures, Spontaneous; Humans; Male; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

A 57-year-old man with renal mass underwent Tc-diethylenetriaminepentaacetic acid renal dynamic scintigraphy for evaluation of renal function. The blood flow phase images demonstrated a focus of abnormal increased tracer uptake in the region of the right lower quadrant. On the functional phase images, the activity became unimpressive gradually. This focus corresponded to an osteolytic lesion in the right ilium on the CT and MR images, which was a typical pattern of bone metastasis.

Topics: Bone Neoplasms; Humans; Incidental Findings; Kidney; Kidney Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

The objective was to compare the efficacy of 99mTc-MDP-BS, 18F-FDG-PET/CT and 18F-FCH-PET/CT in detecting bone metastases in prostate cancer patients.. 56 patients diagnosed with prostate cancer underwent 99mTc-methylendiphosphonates bone scintigraphy (99mTc-MDP-BS) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) or fluorine-18-fluorocholine PET/CT (18F-FCH-PET/CT) within six weeks. There were 27 patients examined with 99mTc-MDP-BS + 18F-FDG (mean age 67.96 ± 9.04 years) and 29 patients examined with 99mTc-MDP-BS + 18F-FCH (mean age 73.93 ± 8.75 years). The R factor in scintigraphy and semi- quantitative analysis with Standardized Uptake Value (SUV) in the PET/CT were used using semi - automatic methods of bone lesions' contouring. The R factor was calculated as the total count rate in bone metastasis and the total count rate in contralateral area ratio. For further analysis, the mean pixel and the total surface of lesion product in scintigraphy, the Total Lesion Glycolysis (TLG) in the 18F-FDG-PET/CT and the Total Lesion Activity (TLA)in the 18F-FCH-PET/CT were evaluated.. The average maximal SUV (SUVmax) value was significantly higher in patients who underwent 18F-FCH-PET/CT than in 18F-FDG-PET/CT (5.17 ± 2.24, 3.71 ± 1.56, P < .05). The R factor differences in both groups (patients who underwent BS and 18F-FDG-PET/CT, BS and 18F-FCH-PET/CT) were insignificant (1.92± 0.87, 2.03 ± 0.57, respectively, P > .05). There was no statistically significant correlation (Pearsons' correlationcoefficient - Rp) between the R factor and the SUVmax within examined groups (Rp = .42; P = .31) and between the R factor and the SUVmean (Rp = .43; P = .28). A high Rp between measured total surface in the BS and volume in the PET/CT of the metastatic lesion was found. In patients who underwent BS + 18F-FDG-PET/CT and BS +18F-FCH-PET/CT, Rp equaled .95 and .70.. 99mTc-MDP-BS, 18F-FDG-PET/CT and 18F-FCH-PET/CT occurred as comparable imaging methods in bone metastases detection in the prostate cancer patients and provide complementary clinical conclusions.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Choline; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms; Technetium Tc 99m Medronate

Metachondromatosis (MC) is a very rare genetic disease, which is infrequently reported worldwide, which leads to osteochondroma and enchondromatosis. The disease has been shown to be associated with loss of function of the tumor suppressor gene "protein tyrosine phosphatase, non-receptor type 11" (PTPN11).. A 12-year-old female was admitted to the hospital with pain due to an enlarged mass in her left fifth finger.. Examination of the left hand by computed tomography (CT) revealed an expanding type of round and low-density lesion in the fifth proximal phalanx. The patient then underwent technetium-99m methylene diphosphonate single-photon emission CT/CT (Tc-MDP SPECT/CT) to assess the nature of the lesion. The SPECT/CT image revealed dilated osteopathy and increased activity of the fifth proximal phalanx on the left hand. Unexpectedly, the examination of the right hand revealed slight expanded lesions and increased activities of the third metacarpal and proximal phalange, as well as the fourth proximal phalange and the middle phalanx. On the basis of the patient's symptoms and the results of the above-mentioned examinations, we diagnosed the patient as having MC in her hands.. Considering the pain of the fifth finger of the left hand, the patient underwent debridement of the fifth proximal phalanx of the left hand and internal fixation with bone graft taken from the body.. The patient was discharged after a week of observation. One year later, she was admitted to the hospital again for removal of the bone healing internal fixation after osteoma surgery. Preoperative Tc-MDP SPECT/CT revealed that the left-handed lesions displayed postoperative changes, while the multiple lesions in the right hand increased in volume but remained unchanged in number.. This case revealed the CT and Tc-MDP SPECT/CT imaging features of MC. Specifically, SPECT/CT imaging contributed to the diagnosis of clinically asymptomatic bone lesions, and the 3D SPECT/CT fusion allowed a more comprehensive and intuitive view of the lesion by combining anatomy and function.

Topics: Bone Neoplasms; Child; Chondromatosis; Exostoses, Multiple Hereditary; Female; Finger Phalanges; Humans; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

A 28-year-old woman presented with a mass in her right leg, which, on plain radiograph, appeared as a lytic lesion in the mid-shaft of the tibia with cortical thinning but without periosteal reaction. Tc-MDP 3-phase bone scan demonstrated intense uptake in the periphery of the mass with a photopenic center, the so-called doughnut sign. Histopathology revealed a capillary hemangioma. This case demonstrates that the doughnut sign on bone scan can be caused by capillary hemangioma in addition to other reported bone pathologies, including aneurysmal bone cyst, giant cell tumor, and telangiectatic osteosarcoma.

Topics: Adult; Bone Neoplasms; Female; Hemangioma, Capillary; Humans; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 37-year-old female patient with four months history of paroxysmal pain in the left index finger was referred to our department for 99mTC-MDP scintigraphy. Radiographic studies of the patient showed a lytic tumour in the distal phalanx of the left second finger compatible with a glomus tumour. The scan showed mild decreased activity in the blood pool phase and minimal increased activity on the delayed images. The patient underwent surgery and a glomus tumour was removed. To the extent of our knowledge, this is the first case of bone scan in a glomus tumour of the finger reported in the literature.

Topics: Adult; Bone Neoplasms; Female; Glomus Tumor; Hand Bones; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate

Insufficiency fractures (IFs) are a type of stress fracture caused by the effects of normal or physiological stresses on abnormally weakened bone. Frequently, these fractures are occult, and a portion of these fractures is misdiagnosed as bone metastases on a whole-body bone scan (WBS). The aim of this study was to evaluate a potential benefit of single-photon emission computed tomography/computed tomography (SPECT/CT) with metabolic and morphological imaging to diagnose IF in patients with cervical cancer after radiotherapy.. This article presents a retrospective review of 35 patients with cervical cancer after radiotherapy in patients (females; mean age, 55.94 ± 8.75 years; range, 36-73 years) who were referred to have WBS to determine whether there was any bone metastasis. The criterion standard was based on radiological investigations, clinical information, and follow-up at a minimum of 12 months.. Insufficiency fractures were most frequently observed in the sacrum, accounting for 52.5% (21/40) of lesions. Fracture lines or sclerotic lines were noted in the IF lesion in 19 of 40 lesions on CT, and osteosclerosis was seen in 31 of 40 lesions. On WBS analysis, the sensitivity for detected lesions was 87.5% (42/48) for WBS. Nineteen lesions were interpreted as benign, 6 lesions were malignant, and 21 (43.8%) lesions were equivocal. Based on the criterion standard, WBS had an accuracy of only 47.9% (23/48). On SPECT/CT analysis, all of the lesions were observed on SPECT/CT; only 3 (6.25%) of 48 lesions were equivocal, and the accuracy was 89.6% (43/48).. Single-photon emission computed tomography/computed tomography should be included in the differential diagnoses when lesions show elevated technetium Tc 99m-labeled methylene diphosphonate uptake on WBS. Compared with a WBS alone, a more accurate diagnosis of IF can be obtained using SPECT/CT, which resulted not only in fewer equivocal lesions but also in a higher diagnostic accuracy.

Topics: Adult; Aged; Bone Neoplasms; Female; Fractures, Stress; Humans; Middle Aged; Radiation Injuries; Radiopharmaceuticals; Retrospective Studies; Sacrum; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Uterine Cervical Neoplasms; Whole Body Imaging

Extraskeletal osteosarcomas are uncommon entities in clinical practice, which account for 1% to 2% of all soft tissue sarcomas. We here reported a case of multiple extraskeletal osteosarcomas and nuclear medicine imaging findings of this disease in Tc-MDP bone scan as well as F-FDG PET/CT.

Topics: Bone and Bones; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Osteosarcoma; Positron Emission Tomography Computed Tomography; Technetium Tc 99m Medronate

Three-phase bone scintigraphy is sometimes of great value in the detection of uncharacteristic metastases and assists the management of patients in terms of primary focus detection. While evaluating the skeletal system with whole-body bone scintigraphy, other system pathologies may also be detected incidentally. In this case, we present the extraordinary findings on the 3-phase MDP bone scintigraphy and F-FDG PET/CT imaging of the complicated bone metastases in a patient with thyroid carcinoma.

Topics: Aged; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

We compared the usefulness of Tc-methyl diphosphonate (Tc-MDP) bone scintigraphy and F-fluorodeoxyglucose (FDG) for positron emission tomography/computed tomography (PET/CT) in predicting histologic response in patients with osteosarcoma receiving neoadjuvant chemotherapy (NAC).We retrospectively reviewed 62 patients with high-grade osteosarcoma who had received 2 cycles of NAC and surgery. All patients underwent Tc-MDP bone scintigraphy and F-FDG PET/CT before and after NAC. Tc-MDP uptake in the primary tumor was measured quantitatively as the maximum tumor-to-nontumor ratio (T/NTmax) and F-FDG uptake was measured as the maximum standardized uptake value (SUVmax), before and after NAC. The percent changes of T/NTmax (percent changes of the maximum tumor-to-nontumor ratio [Δ%T/NTmax]) and SUVmax (percent changes of the maximum standardized uptake value [Δ%SUVmax]) after NAC were calculated and the correlations between these parameters were evaluated. After surgery, the effects of NAC were graded histopathologically (good vs poor) and the optimum cut-off values of Δ%T/NTmax and Δ%SUVmax for predicting histologic response were assessed using the receiver operating characteristic (ROC) curve analysis.Δ%T/NTmax and Δ%SUVmax were positively correlated with each other (r = 0.494, P < .01). Based on the ROC curve analysis, both Δ%T/NTmax (area under the curve [AUC] = .772, P < .01) and Δ%SUVmax (AUC = .829, P < .01) predicted good histologic response. However, there was no significant difference between the AUCs of Δ%T/NTmax and Δ%SUVmax (P = .44). The sensitivity and specificity for predicting good histologic response were 83.3% and 75.0%, for the criterion Δ%T/NTmax <-12.5%, and 80.0% and 81.3% for the criterion Δ%SUVmax <-49.0%, respectively.The Tc-MDP bone scan and F-FDG PET scan are non-inferior to each other in predicting the histologic response of osteosarcoma treatments. The Tc-MDP bone scan and F-FDG PET scan showed respective advantages with differing features. Therefore, physicians should consider which scan is appropriate for their own institute based on the advantages of each scan and the circumstances of the institute.

Topics: Adolescent; Adult; Area Under Curve; Bone Neoplasms; Chemotherapy, Adjuvant; Female; Fluorodeoxyglucose F18; Humans; Male; Neoadjuvant Therapy; Osteosarcoma; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome; Young Adult

Accurate staging of neuroblastoma requires multiple imaging examinations. The purpose of this study was to determine the relative contribution of. A medical record search by the identified patients with neuroblastoma from 1993 to 2012 who underwent both MIBG and bone scan for disease staging. Cross-sectional imaging was used to corroborate the scintigraphy results. Clinical records were used to correlate imaging findings with clinical staging and patient management.. One hundred thirty-two patients underwent both MIBG and bone scan for diagnosis. All stage 1 (n = 12), 2 (n = 8), and 4S (n = 4) patients had a normal bone scan with no skeletal MIBG uptake. Six of 30 stage 3 patients had false (+) bone scans. In the 78 stage 4 patients, 58/78 (74%) were both skeletal MIBG(+)/bone scan (+). In 56 of the 58 cases, skeletal involvement detected with MIBG was equal to or greater than that detected by bone scan. Only 3/78 had (-) skeletal MIBG uptake and (+) bone scans; all 3 had other sites of metastatic disease. Five of 78 had (+) skeletal MIBG with a (-) bone scan, while 12/78 had no skeletal involvement by either MIBG or bone scan. In no case did a positive bone scan alone determine a stage 4 designation.. In the staging of neuroblastoma,

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Cohort Studies; Contrast Media; Cross-Sectional Studies; Follow-Up Studies; Humans; Iodine Radioisotopes; Neoplasm Staging; Neuroblastoma; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To determine when a bone scintigraphy investigation is appropriate in patients with newly diagnosed prostate cancer (PCa).. We retrospectively reviewed 703 newly diagnosed PCa patients who were referred for bone scintigraphy. The association between age, prostate specific antigen (PSA), Gleason score (GS) and bone scintigraphy result were investigated by series of crude or stratified analysis.. Overall, 15.08% (106/703) patients had bone metastases. PSA and GS between positive bone scan group and negative bone scan group were significantly different, while age was not. The incidence of bone metastasis in patient with PSA < 20 ng/ml or GS < 8 was less than 10%, but increased dramatically with rising PSA and upgrading GS. In multivariate analysis, PSA ≥ 20 ng/ml (OR = 5.10, 95%CI (2.12-12.27)) and GS ≥ 8 (OR = 3.61, 95%CI (1.55-8.41)) were independently predictive of positive bone scan.. Patients with PSA ≥ 20 ng/ml or GS ≥ 8 were in higher risk of bone metastasis, bone scintigraphy was recommended. But a bone scintigraphy is of limited value in PCa patients with PSA ≤ 20 ng/ml and GS ≤ 7.

Topics: Aged; Bone Neoplasms; Cohort Studies; Follow-Up Studies; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

The bone scan index (BSI) is calculated from a whole-body bone scan image; it shows the tumor burden in bone as a percentage of total skeletal mass. It has been used to determine the prognosis and to assess treatment effects; however, little has been reported on whether the BSI calculated using a two-dimensional image can accurately evaluate the three-dimensional spread in tumor volume. We investigated the relationship between tumor volume and BSI using Monte Carlo simulation (MCS). We simulated a gamma camera and constructed a voxel phantom based on an anthropomorphic phantom computed tomography (CT) image and gamma rays emitted from each part according to technetium-99m-labeled methylene diphosphonate (

Topics: Bone Neoplasms; Humans; Image Processing, Computer-Assisted; Monte Carlo Method; Phantoms, Imaging; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Tumor Burden; Whole Body Imaging

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

Despite increasing reliance on CT, MRI, and FDG PET/CT for oncological imaging, whole-body skeletal scintigraphy remains a frontline modality for staging and surveillance of osseous metastatic disease. We present a 54-year-old woman with metastatic breast cancer who received palliative external-beam radiation to the left ilium. Serial follow-up Tc-MDP bone scans demonstrated progressive soft-tissue uptake in her left lower extremity, extending from thigh to leg, with associated enlargement and skin thickening, consistent with lymphedema related to radiation-induced fibrosis. Correlative abdominopelvic CT scans confirmed fibrotic changes in the left thigh.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fibrosis; Fluorodeoxyglucose F18; Humans; Lymphedema; Magnetic Resonance Imaging; Middle Aged; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Radiotherapy; Technetium Tc 99m Medronate

An otherwise healthy 33-year-old man presents with new pain involving the right leg. Radiographs of the femur showed scattered lucent lesions. An MRI of the knee demonstrated nonspecific cortical-based lesions. Biopsy confirmed pseudomyogenic hemangioendothelioma. MDP bone scan and F-FDG PET/CT were obtained to evaluate for extent of disease demonstrating disease limited to the bone of the right leg. Interestingly, the FDG and MDP uptake and CT appearance of the disease were not entirely concordant, with some lesions being lytic on CT and associated with FDG and MDP uptake, other lesions being CT silent and either MDP or FDG avid.

Topics: Adult; Bone Neoplasms; Femur; Fluorodeoxyglucose F18; Hemangioendothelioma; Humans; Magnetic Resonance Imaging; Male; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is commonly performed for cancer staging, as it can detect metastatic disease in multiple organ systems. However, there has been some controversy in the scientific literature when comparing FDG PET/CT and technetium-99 m-bone scintigraphy (bone scan) for the detection of skeletal metastases.. To compare the accuracy of FDG PET/CT with bone scan for the detection of skeletal metastases.. The study group comprised 202 adult cancer patients who underwent both FDG PET/CT and bone scan within 31 days for staging. Bone scans and FDG PET/CT were evaluated by two musculoskeletal radiologists for the presence and location of skeletal metastatic disease. Confirmation of the final diagnosis was based on the CT or magnetic resonance imaging (MRI) appearance, follow-up imaging, or histology.. The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of bone scan were 83%, 98%, and 93%, respectively. The lesions that bone scan most commonly missed were located in the pelvis, spine, and sacrum. FDG PET/CT missed mostly lesions that were outside of the field of view, but in all of these cases the patient had additional sites of skeletal metastatic disease. Bone scan falsely identified six metastatic lesions and FDG PET/CT falsely identified three metastatic lesions.. FDG PET/CT is an accurate technique for detection of skeletal metastases, and is superior to bone scan, especially in the spine and pelvis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A reproducible and quantitative imaging biomarker is needed to standardize the evaluation of changes in bone scans of prostate cancer patients with skeletal metastasis. We performed a series of analytic validation studies to evaluate the performance of the automated bone scan index (BSI) as an imaging biomarker in patients with metastatic prostate cancer.. Three separate analytic studies were performed to evaluate the accuracy, precision, and reproducibility of the automated BSI. Simulation study: bone scan simulations with predefined tumor burdens were created to assess accuracy and precision. Fifty bone scans were simulated with a tumor burden ranging from low to high disease confluence (0.10-13.0 BSI). A second group of 50 scans was divided into 5 subgroups, each containing 10 simulated bone scans, corresponding to BSI values of 0.5, 1.0, 3.0, 5.0, and 10.0. Repeat bone scan study: to assess the reproducibility in a routine clinical setting, 2 repeat bone scans were obtained from metastatic prostate cancer patients after a single 600-MBq (99m)Tc-methylene diphosphonate injection. Follow-up bone scan study: 2 follow-up bone scans of metastatic prostate cancer patients were analyzed to determine the interobserver variability between the automated BSIs and the visual interpretations in assessing changes. The automated BSI was generated using the upgraded EXINI bone(BSI) software (version 2). The results were evaluated using linear regression, Pearson correlation, Cohen κ measurement, coefficient of variation, and SD.. Linearity of the automated BSI interpretations in the range of 0.10-13.0 was confirmed, and Pearson correlation was observed at 0.995 (n = 50; 95% confidence interval, 0.99-0.99; P < 0.0001). The mean coefficient of variation was less than 20%. The mean BSI difference between the 2 repeat bone scans of 35 patients was 0.05 (SD = 0.15), with an upper confidence limit of 0.30. The interobserver agreement in the automated BSI interpretations was more consistent (κ = 0.96, P < 0.0001) than the qualitative visual assessment of the changes (κ = 0.70, P < 0.0001) was in the bone scans of 173 patients.. The automated BSI provides a consistent imaging biomarker capable of standardizing quantitative changes in the bone scans of patients with metastatic prostate cancer.

Topics: Bone and Bones; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Reference Standards; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

The aim of this study was to evaluate, using international urology and oncology guidelines, the criteria for performing bone scintigraphy (BS) in patients with newly diagnosed prostate cancer in a prospective setting with 2 years of follow-up after prostatectomy.. In a prospective setting, criteria from European and US urology and oncology guidelines were evaluated in 220 unselected patients with BS performed as a routine investigation before radical prostatectomy. A prostate-specific antigen level of 0.1 ng/ml or lower after surgery was considered successful and was used as a measure of true-negative BS.. Overall, 200 out of 220 patients (91%) experienced successful radical prostatectomy at 6 months, with a 2 year success rate of 83%. The proportion of redundant BS ranged from 56% to 89% among the guidelines, whereas the outcome after radical prostatectomy was 93% within 6 months after surgery and 86-89% after 2 years of follow-up, without significant differences among guideline recommendations.. The guidelines from the American Urological Association and the criteria recently published by the present group proposed the largest proportion of redundant BS without compromising patient-related outcome.

Topics: Aged; Bone and Bones; Bone Neoplasms; Cohort Studies; Denmark; Humans; Kallikreins; Male; Middle Aged; Neoplasm Staging; Practice Guidelines as Topic; Prospective Studies; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate

Hemangiolymphangioma is a very rare, congenital malformation of both lymphatic and blood vessels. In the present study, we report a case of vertebral hemangiolymphangioma that was misdiagnosed as bone metastasis on 99mTc-MDP SPECT/CT.

Topics: Adult; Bone Neoplasms; False Positive Reactions; Hemangioma; Humans; Lymphangioma; Male; Multimodal Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Bone is the third most common site of metastasis from hepatocellular carcinoma (HCC), the first two being the lung and lymph nodes, respectively. Metastatic HCC has been reported in the vertebrae, ribs, pelvis, and femur, which are more common sites of bone metastases. We present a case of HCC with metastasis to the distal tibia, fibula, and small bones of the feet as the only sites of bone metastasis, along with a brief literature review.

Topics: Ankle; Bone Neoplasms; Carcinoma, Hepatocellular; Foot; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 15-year-old girl experienced an alveolar soft part sarcoma in the right thigh 3 years ago, which was resected. Postsurgical recovery was uneventful until approximately 1 year ago when she began to feel mild local tenderness and gradual swelling around the surgical scars. The patient underwent Tc-MDP bone scintigraphy to evaluate osseous metastases. Although no lesion in the bone was identified, the images showed abnormally increased activity in the region of known focal lesion.

Topics: Adolescent; Bone Neoplasms; Female; Humans; Neoplasm Recurrence, Local; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma, Alveolar Soft Part; Technetium Tc 99m Medronate; Thigh

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

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

Topics: Antigens, Surface; Bone Neoplasms; Glutamate Carboxypeptidase II; Humans; Lysine; Male; Middle Aged; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Tissue Distribution; Tomography, X-Ray Computed; Urea; Whole Body Imaging

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

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Incidental Findings; Injections, Intravenous; Iodine; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The aim of this study was to evaluate the efficacy of fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) compared with bone scan in detecting bone metastases in patients with head and neck cancer.. A total of 319 patients with head and neck cancer were identified in our database who had undergone F-FDG PET/CT, from January 2006 until June 2007. Of them 156 patients (age range 15-100 years) met our inclusion criteria - namely, biopsy-proven head and neck cancer, and bone scan and F-FDG PET/CT within 30 days. Comparison was made on a lesion-by-lesion analysis. MRI, multidetector CT, and the clinical course of the patients were our references.. F-FDG PET/CT identified (n=213) bone lesions in 18 patients, in addition to distant metastases in solid organs such as the liver and lung, lymphadenopathy above and below the diaphragm, and adrenal glands in 12 patients. However, bone scan identified (n=198) 16 patients. Bone scan missed two patients with confirmed bone metastases by means of biopsy in one patient and radiologically in the second. F-FDG PET/CT showed true-positive results in 18 patients, whereas bone scan showed true-positive results in 16 patients. F-FDG PET/CT showed true-negative results in 138 patients, whereas bone scan showed true-negative results in 134 patients. F-FDG PET/CT showed no false-positive or false-negative results. However, bone scan had two false-positive and two false-negative results. The overall sensitivity, specificity, and accuracy was 100% for F-FDG PET/CT and 88, 98, and 96%, respectively, for bone scan.. F-FDG PET/CT is superior to Tc-methylene diphosphonate bone scan in detecting bone metastases in head and neck cancer.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Image Enhancement; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Young Adult

A 6-year-old castrated Goldendoodle dog was presented for left-sided lameness of 3 weeks' duration. Focal, moderate to marked increased

Topics: Animals; Bone Neoplasms; Dog Diseases; Dogs; Fatal Outcome; Femur; Hair Diseases; Lameness, Animal; Lung Neoplasms; Male; Pilomatrixoma; Radionuclide Imaging; Scapula; Skin Neoplasms; Technetium Tc 99m Medronate

A 75-year-old man with castrate-resistant prostate cancer and increasing prostate-specific antigen (PSA) level developed severe bone marrow depression during Ra radionuclide therapy. Because of this, he was treated with Lu-PSMA in compassionate use for this not-yet-approved therapy. At the beginning of Lu-PSMA therapy, repeated blood transfusions (BT) were necessary. Six months after the last BT, after 3 cycles of Lu-PSMA, his blood count stabilized. He required no further BTs and his PSA level remained lowered.

Topics: Aged; Anemia; Antineoplastic Agents; Bone Marrow Diseases; Bone Neoplasms; Compassionate Use Trials; Dipeptides; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Heterocyclic Compounds, 1-Ring; Humans; Lutetium; Male; Oligopeptides; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms, Castration-Resistant; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Radium; Technetium Tc 99m Medronate

The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients.. After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis.. The patient mean age was 71.9 ± 8.6 years (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were 260.2 ± 1107.8 ng/mL and 7.4 ± 1.5, respectively. The body mass index (BMI) for the series was 24.5 ± 3.4 kg/m2. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI (23.3 ± 3.5 vs. 24.8 ± 3.3; p=0.003), a higher Gleason score (8.5 ± 1.1 vs. 7.1 ± 1.5; p < 0.001), and a higher PSA level (1071.3 ± 2337.1 vs. 69.4 ± 235.5; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ≥7, clinical stage ≥T3, BMI ≤22 kg/m2, and an initial PSA level of ≥20 ng/mL were all independent predictors of bone metastasis.. A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasm Grading; Predictive Value of Tests; Prognosis; Prostatic Neoplasms; Radiopharmaceuticals; Risk Factors; Survival Rate; Technetium Tc 99m Medronate; Tissue Distribution

Myopericytoma is a rare type of unusual soft tissue tumor with perivascular myoid differentiation. A 53-year-old man with the diagnosis of colon cancer was referred to Tc-MDP bone scan and F-FDG PET/CT for staging. A subcutaneous mass located in right lower back with heterogeneous FDG uptake was detected on PET/CT. There was increased osteoblastic activity on MDP bone scan in the same region. Mass was resected and subsequently confirmed as myopericytoma by histopathology.

Topics: Bone Neoplasms; Colonic Neoplasms; Fluorodeoxyglucose F18; Humans; Incidental Findings; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Torso

A 23-year-old man, with no relevant medical history, presented with inflammatory peripheral and axial polyarthritis, wrist pain, and persistent low-grade fever for the past 4 months. A bone scintigraphy showed intense periosteal early and delayed uptake in long bones, with normal uptake in the spine, pelvis, and rib cage, and no clear focus of hypermetabolism. CT scan revealed a mediastinal mass. A biopsy of the mass demonstrated Hodgkin lymphoma with bulky disease. This paraneoplastic syndrome as the first sign of intrathoracic Hodgkin's disease is rare.

Topics: Bone Neoplasms; Hodgkin Disease; Humans; Male; Paraneoplastic Syndromes; Radiopharmaceuticals; Technetium Tc 99m Medronate; Young Adult

The superiority of sodium F-fluoride PET (F-PET)/computed tomography (CT) over planar and single field-of-view single-photon emission computed tomography (SPECT) bone scintigraphy with Tc-methylene diphosphonate in bone metastases detection has been established. The present study prospectively compares whole-body Tc-methylene diphosphonate SPECT (WB-SPECT) and F-PET performance indices for the detection of bone metastases in breast cancer.. A total of 41 pairs of studies in female breast cancer patients (average age 58 years, range 30-75) were included. Half-time WB-SPECT and F-PET/CT were performed at a 4-day average interval (range 0-36 days), with subsequent fusion of CT to WB-SPECT. Two readers independently interpreted the studies, with differences resolved by consensus. Composite gold standard included the CT component of the F-PET/CT study with follow-up CT, MRI, F-fluoro-deoxyglucose-PET/CT, and bone scans.. On patient-based analysis, metastases were diagnosed in 21 patients, with 19 patients detected by WB-SPECT and 21 with F-PET, the latter being the only modality to detect a single metastasis in two patients. The sensitivity of WB-SPECT and F-PET was 90 and 100% (P=NS), and the specificity were 95 and 85%, respectively (P=NS). On lesion-based analysis, 284 total sites of increased uptake were found. WB-SPECT detected 171/284 (60%) and F-PET 268/284 (94%) lesions, with good interobserver agreement for WB-SPECT (κ=0.679) and excellent agreement for F-PET (κ=0.798). The final analysis classified 204 lesions as benign and 80 as metastases. WB-SPECT identified 121 benign and 50 malignant sites compared with 192 and 76, respectively, for F-PET. WB-SPECT and F-PET had a sensitivity of 63 vs. 95%, P-value of less than 0.001, and a specificity of 97 vs. 96% (P=NS), respectively, on lesion-based analysis.. F-PET had higher sensitivity for the diagnosis of bone metastases from breast cancer compared with WB-SPECT, showing a statistically significant 32% increase on lesion-based analysis.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorine Radioisotopes; Humans; Middle Aged; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Dual-energy computed tomography (DECT) images may be underutilized for the evaluation of skeletal metastasis. Spectral parametric segmentation of DECT can produce bone-iodine separated images, which have the potential to detect bone metastases.. To evaluate the potential of bone-iodine separation in the detection of bone metastasis with spectral parametric segmentation of DECT images which are acquired at clinical follow-up for patients with prior malignancy.. The institutional review board approved the protocol of this retrospective review. Chest DECT scans using fast kV-switching between 80 and 140 kVp were included in this study. Bone-iodine separated reformatted images were produced by spectral parametric segmentation of synthesized monochromatic images. All chest CT images of 702 metastatic lesions from 54 patients were retrospectively evaluated in terms of visualization of metastatic lesions compared with (99m)Tc-MDP (methylene diphosphonate) whole-body bone scintigraphy (WBBS) as reference standard of diagnosis.. Spectral parametric segmentation images of DECT visualized metastatic lesions in 92.3% (n = 648/702). Osteoblastic metastases were delineated as subtle enhancing lesions on DECT in comparison to WBBS.. Spectral parametric segmentation of iodine from cortical and medullary bone allowed visualization of bone metastasis. DECT might be utilized for the screening or detection of bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Contrast Media; Feasibility Studies; Female; Humans; Iopamidol; Male; Middle Aged; Radiographic Image Enhancement; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

The aim of this study is to modify and validate a novel screening tool to determine the necessity of bone scans in Chinese PCa patients at the time of diagnosis.. Five-hundred-and-one patients diagnosed with PCa between 2010 and 2013 at Zhongshan Hospital, Fudan University, were included in the study. All received bone scans using technetium 99m methylene diphosphonate (99mTc-​MDP) at the initial staging. Age, prostate-specific antigen (PSA) and alkaline phosphatase (ALP) at diagnosis, disease stage, and biopsy Gleason score were collected from all patients. Multivariate logistic regression analysis and discrimination analysis were performed. A validation analysis of this screening tool was performed by Shanghai Cancer Center, Fudan University.. Among the 501 patients, 84 (16.7%) of them had BM. The area under the ROC curve was 0.9006 (95% CI, 0.87-0.93). The sensitivity of the cut-off point was 94.1%, and the specificity was 58.3%. The validation analysis demonstrated an area under the ROC curve of 0.846 (95% CI, 0.805-0.887).. Study results demonstrated that a baseline bone scan can be safely omitted for cT1-T3 PCa patients who have a PSA ≤39 ng/ml and an ALP ≤88 IU/l. This novel screening tool may help determine the necessity of including a bone scan at the time of initial diagnosis of PCa.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Bone and Bones; Bone Neoplasms; China; Humans; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate

Fluorine-18 deoxyglucose positron emission tomography computed tomography (18F-FDG-PET/ CT) and bone scintigraphy (BS) are widely used for the detection of bone involvement. The optimal imaging modality for the detection of bone metastases in hormone receptor positive (+) and negative (-) groups of breast cancer remains ambiguous.. Sixty-two patients with breast cancer, who had undergone both 18F-FDG-PET/CT and BS, being eventually diagnosed as having bone metastases, were enrolled in this study.. 18F-FDG-PET/CT had higher sensitivity and specificity than BS. Our data showed that 18F-FDG- PET/CT had a sensitivity of 93.4% and a specificity of 99.4%, whiel for BS they were 84.5%, and 89.6% in the diagnosis of bone metastases. κ statistics were calculated for 18F-FDGPET/CT and BS. The κ-value was 0.65 between 18F-FDG-PET/CT and BS in all patients. On the other hand, the κ-values were 0.70 in the hormone receptor (+) group, and 0.51 in hormone receptor (-) group. The κ-values suggested excellent agreement between all patient and hormone receptor (+) groups, while the κ-values suggested good agreement in the hormone receptor (-) group.. The sensitivity and specificity for 18F-FDG-PET/CT were higher than BS in the screening of metastatic bone lesions in all patients. Similarly 18F-FDG-PET/CT had higher sensitivity and specificity in hormone receptor (+) and (-) groups.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Three-phase bone scintigraphy using technetium-99m-methylene diphosphonate is used to diagnose skeletal lesions, whereas single-photon emission computed tomography/computed tomography (SPECT/CT) improves the diagnostic accuracy of bone disease. We investigated the usefulness of SPECT/CT combined with three-phase bone scintigraphy over three-phase bone scintigraphy alone in assessing suspected bone tumors in patients with no malignant history.. Forty-eight patients (30 men and 18 women; mean age, 43.3 ± 20.1 years; age range, 11-82 years) with suspected bone tumors who underwent technetium-99m-methylene diphosphonate three-phase bone scintigraphy and SPECT/CT between July 2008 and August 2013 were retrospectively reviewed. The lesion from each patient was resected or biopsied for pathological confirmation of the diagnosis within 3 weeks of the bone scan. All images were interpreted by two experienced nuclear medicine physicians who had not been involved in the selection of data for the present study. The reviewers were aware of the patient's sex, age, and the lesion's site but were unaware of the results of other imaging modalities, such as radiography, MRI, and laboratory tests. In cases of discrepancy regarding the interpretations, a consensus was reached after mutual discussion. The diagnostic ability of three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy was compared with pathological results using the χ(2)-(test, with P-values less than 0.05 indicating significant differences. Agreement between three-phase bone scintigraphy alone or SPECT/CT combined with three-phase bone scintigraphy with pathological results was evaluated using κ scores.. Pathological results from the 48 lesions of all patients revealed 32 malignant bone tumors and 16 benign lesions. On using three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy for the differential diagnosis of bone lesions, we found sensitivities to be 96.9 and 100%, specificities to be 31.2 and 81.3%, positive predictive values to be 73.8 and 91.4%, and negative predictive values to be 83.3 and 100%, respectively. The diagnostic accuracies of three-phase bone scintigraphy alone and SPECT/CT combined with three-phase bone scintigraphy were 75.0 and 93.8%, respectively (χ(2) = 5.057; P = 0.025). κ Scores for the agreement of three-phase bone scintigraphy and SPECT/CT combined with three-phase bone scintigraphy with pathological results were 0.333 (P = 0.005) and 0.850 (P < 0.0001), respectively.. Compared with three-phase bone scintigraphy, the diagnostic accuracy of SPECT/CT combined with three-phase bone scintigraphy was higher. SPECT/CT combined with three-phase bone scintigraphy is beneficial over three-phase bone scintigraphy for the differential diagnosis of suspected bone tumors in patients with no malignant history.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Multimodal Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, Spiral Computed; Young Adult

The objective of this study was to evaluate the feasibility and diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and (99m)Tc-methylenediphosphonate (MDP) whole-body bone scanning (BS) for the detection of osteolytic bone metastases.. Thirty-four patients with pathologically confirmed malignancies and suspected osteolytic bone metastases underwent 18F-FDG PET/CT and (99m)Tc-MDP whole-body BS within 30 days. The sensitivity, specificity, and accuracy with respect to the diagnosis of osteolytic bone metastases and bone lesions were compared between the two imaging methods.. The sensitivity, specificity, and accuracy of 18F-FDG PET/CT for the diagnosis of osteolytic bone metastases were 94.3% (95% confidence interval [CI], 91.6-96.2%), 83.3% (95% CI, 43.6-96.9%), and 94.2% (95% CI, 91.5-96.1%), respectively. It was found that (99m)Tc-MDP whole-body BS could discriminate between patients with 50.2% (95% CI, 45.4-55.1%) sensitivity, 50.0% (95% CI, 18.8-81.2%) specificity, and 50.2% (95% CI, 45.5-55.1%) accuracy. 18F-FDG PET/CT achieved higher sensitivity, specificity, and accuracy in detecting osteolytic bone metastases than 99mTc-MDP whole-body BS (p<0.001).. F-FDG PET/CT has a higher diagnostic value than (99m)Tc-MDP whole-body BS in the detection of osteolytic bone metastases, especially in the vertebra.

Topics: Adult; Aged; Bone Neoplasms; Feasibility Studies; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Osteolysis; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Bone scan abnormalities, especially rib lesions, are often confusing for physicians due to a high number of false-positive lesions. This study investigated risk factors that are associated with bone metastasis in 613 breast cancer patients with bone scan abnormalities. Significantly increased rates of bone metastasis were observed in patients with multiple lesions, large tumor sizes, and lymph node involvement. In addition, patients with concurrent lesions of rib and other sites exhibited a significant higher rate of metastatic disease compared to those with other site lesions (P = 0.009). In the subset of 324 patients with rib abnormalities, the rate of metastasis was extremely low in patients with pure rib lesions (1.2%; 95% CI: 0.1%-4.1%). Concurrent lesions of rib and other sites were more likely to be rib metastasis compared to pure rib lesions (P < 0.001). Moreover, multiple rib lesions and lesions located on bilateral ribs were more likely to be rib metastasis (P < 0.001). Our data suggest that patients with pure rib abnormalities could be recommended for follow-up only. However, if concurrent lesions of rib and other sites were detected on bone scans, additional radiological examinations should be performed to patients.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; China; Comorbidity; Female; Humans; Incidence; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Ribs; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The detection of occult bone metastases is a key factor in determining the management of patients with renal cell carcinoma (RCC), especially when curative surgery is considered. This prospective study assessed the sensitivity of (18)F-labelled sodium fluoride in conjunction with positron emission tomography/computed tomography ((18)F-NaF PET/CT) for detecting RCC bone metastases, compared with conventional imaging by bone scintigraphy or CT.. An adaptive two-stage trial design was utilized, which was stopped after the first stage due to statistical efficacy. Ten patients with stage IV RCC and bone metastases were imaged with (18)F-NaF PET/CT and (99m)Tc-labelled methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy including pelvic single photon emission computed tomography (SPECT). Images were reported independently by experienced radiologists and nuclear medicine physicians using a 5-point scoring system.. Seventy-seven lesions were diagnosed as malignant: 100% were identified by (18)F-NaF PET/CT, 46% by CT and 29% by bone scintigraphy/SPECT. Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by (18)F-NaF PET/CT. On an individual patient basis, (18)F-NaF PET/CT detected more RCC metastases than (99m)Tc-MDP bone scintigraphy/SPECT or CT alone (P = 0.007). The metabolic volumes, mean and maximum standardized uptake values (SUV mean and SUV max) of the malignant lesions were significantly greater than those of the benign lesions (P < 0.001).. (18)F-NaF PET/CT is significantly more sensitive at detecting RCC skeletal metastases than conventional bone scintigraphy or CT. The detection of occult bone metastases could greatly alter patient management, particularly in the context when standard-of-care imaging is negative for skeletal metastases.

Topics: Aged; Bone Neoplasms; Carcinoma, Papillary; Carcinoma, Renal Cell; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Kidney Neoplasms; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Prognosis; Prospective Studies; Radionuclide Imaging; Research Design; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Kidney Neoplasms; Male; Multimodal Imaging; Radionuclide Imaging; Research Design; Technetium Tc 99m Medronate

Bone pain resulting from cancer metastases reduces a patient's quality of life. Magnetic Resonance-guided High Intensity Focused Ultrasound (MR-HIFU) is a promising alternative palliative thermal treatment technique for bone metastases that has been tested in a few clinical studies. Here, we describe a comprehensive pre-clinical study to investigate the effects, and efficacy of MR-HIFU ablation for the palliative treatment of osteoblastic bone metastases in rats.. Prostate cancer cells (MATLyLu) were injected intra-osseously in Copenhagen rats. Upon detection of pain, as determined with a dynamic weight bearing (DWB) system, a MR-HIFU system was used to thermally ablate the bone region with tumor. Treatment effect and efficacy were assessed using magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) with technetium-99m medronate ((99m)Tc-MDP), micro-computed tomography (μCT) and histology.. DWB analysis demonstrated that MR-HIFU-treated animals retained 58.6 ± 20.4% of limb usage as compared to 2.6 ± 6.3% in untreated animals (P=0.003). MR-HIFU delayed tumor specific growth rates (SGR) from 29 ± 6 to 13 ± 5%/day (P<0.001). Untreated animals (316.5 ± 78.9 mm(3)) had a greater accumulation of (99m)Tc-MDP than HIFU-treated animals (127.0 ± 42.7 mm(3), P=0.004). The total bone volume increase for untreated and HIFU-treated animals was 15.6 ± 9.6% and 3.0 ± 4.1% (P=0.004), respectively. Histological analysis showed ablation of nerve fibers, tumor, inflammatory and bone cells.. Our study provides a detailed characterization of the effects of MR-HIFU treatment on bone metastases, and provides fundamental data, which may motivate and advance its use in the clinical treatment of painful bone metastases with MR-HIFU.

Topics: Animals; Bone Neoplasms; Bone Remodeling; Cell Line, Tumor; High-Intensity Focused Ultrasound Ablation; Humans; Magnetic Resonance Imaging; Male; Neoplasms, Experimental; Pain Management; Palliative Care; Radiopharmaceuticals; Rats; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; X-Ray Microtomography

A 55-year-old man was a hepatocellular carcinoma patient, diagnosed by sonography and a biopsy. Because of his musculoskeletal tenderness, a bone scan was performed to exclude skeletal metastasis. A subsequent F-FDG PET/CT scan revealed that the unilateral abnormal uptake seen on the bone scan was actually a mineralized tendon. A mineralized tendon is easily detectable using Tc-MDP; therefore, it is imperative to differentiate between bone lesions and mineralized tendons. In addition, few studies have reported F-FDG uptake in a calcified tendon.

Topics: Bone Neoplasms; Calcinosis; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tendons; Tomography, X-Ray Computed

Strontium-89 chloride ((89)Sr) bremsstrahlung single photon emission computed tomography (SPECT) imaging was evaluated for detecting more detailed whole body (89)Sr distribution.. (89)Sr bremsstrahlung whole body planar and merged SPECT images were acquired using two-detector SPECT system. Energy window A (100 keV ± 50 %) for planar imaging and energy window A plus adjacent energy window B (300 keV ± 50 %) for SPECT imaging were set on the continuous spectrum. Thirteen patients with multiple bone metastases were evaluated. Bone metastases can be detected with (99m)Tc-HMDP whole body planar and merged SPECT images and compared with (89)Sr bremsstrahlung whole body planar and merged SPECT images. Based on the location of metastatic lesions seen as hot spots on (99m)Tc-HMDP images as a reference, the hot spots on (89)Sr bremsstrahlung images were divided into the same bone parts as (99m)Tc-HMDP images (a total of 35 parts in the whole body), and the number of hot spots were counted. We also evaluated the incidence of extra-osseous uptakes in the intestine on (89)Sr bremsstrahlung whole body planar images.. A total of 195 bone metastatic lesions were detected in both (99m)Tc-HMDP whole body planar and merged SPECT images. Detection of hot spot lesions in (89)Sr merged SPECT images (127 of 195; 66 %) was more frequent than in (89)Sr whole body planar images (108 of 195; 56 %), based on metastatic bone lesions in (99m)Tc-HMDP whole body planar and merged SPECT images. A large intestinal (89)Sr accumulation was detected in 5 of the 13 patients (38 %).. (89)Sr bremsstrahlung-merged SPECT imaging could be more useful for detailed detection of whole body (89)Sr distribution than planar imaging. Intestinal (89)Sr accumulation due to (89)Sr physiologic excretion was detected in feces for 4 days after tracer injection.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Gamma Cameras; Humans; Intestines; Male; Middle Aged; Radiopharmaceuticals; Strontium; Strontium Radioisotopes; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 39-year-old man presented with left shoulder and interscapular pain. 99mTc-MDP bone scan demonstrated multiple active bone lesions including scapula, spines, ribs, and pelvis. Chest X-ray showed no active lung lesion, and MRI demonstrated infiltrative enhancing lesions in the T-spines and ribs, indicating skeletal metastasis. 18F-FDG PET/CT performed to search for hidden malignancy revealed multiple osteolytic lesions with intense FDG uptake, supporting metastasis. Tissue obtained from the T1 lesion showed no malignant cells but was positive for Mycobacterium tuberculosis. After 18 months of antituberculosis medication, follow-up 18F-FDG PET/CT showed complete normalization of FDG uptake in the skeletal lesions.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Multimodal Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tuberculosis, Osteoarticular

To establish a Chinese esophageal squamous cell carcinoma (ESCC) cell line with high bone metastasis potency using (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) micro-pinhole scintigraphy, X ray and micro-positron emission tomography/computed tomography (PET/CT) for exploring the mechanism of occurrence and development in esophageal cancer.. The cells came from a BALB/c nu/nu immunodeficient mouse, and oncogenic tumor tissue was from a surgical specimen from a 61-year-old male patient with ESCC. The cell growth curve was mapped and analysis of chromosome karyotype was performed. Approximately 1 × 10⁶ oncogenic cells were injected into the left cardiac ventricle of immunodeficient mice. The bone metastatic lesions of tumor-bearing mice were detected by (99m)Tc-MDP scintigraphy, micro-PET/CT and X-ray, and were resected from the mice under deep anesthesia. The bone metastatic cells in the lesions were used for culture and for repeated intracardiac inoculation. This in vivo/in vitro experimental metastasis study was repeated for four cycles. All of the suspicious bone sites were confirmed by pathology. Real-time polymerase chain reaction was used to compare the gene expression in the parental cells and in the bone metastatic clone.. The surgical specimen was implanted subcutaneously in immunodeficient mice and the tumorigenesis rate was 100%. First-passage oncogenic cells were named CEK-Sq-1. The chromosome karyotype analysis of the cell line was hypotriploid. The bone metastasis rate went from 20% with the first-passage oncogenic cells via intracardiac inoculation to 90% after four cycles. The established bone metastasis clone named CEK-Sq-1BM had a high potential to metastasize in bone, including mandible, humerus, thoracic and lumbar vertebrae, scapula and femur. The bone metastasis lesions were successfully detected by micro-pinhole bone scintigraphy, micro-PET/CT, and X-ray. The sensitivity, specificity and accuracy of the micro-pinhole scintigraphy, X-ray, and micro-PET/CT imaging examinations were: 89.66%/32%/80%, 88.2%/100%/89.2%, and 88.75%/77.5%/87.5%, respectively. Some gene expression difference was found between parental and bone metastasis cells.. This newly established Chinese ESCC cell line and animal model may provide a useful tool for the study of the pathogenesis and development of esophageal carcinoma.

Topics: Animals; Bone Neoplasms; Carcinoma, Squamous Cell; Cell Line, Tumor; Chromosomes, Human; Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Gene Expression Regulation, Neoplastic; Heterografts; Humans; Karyotyping; Male; Mice; Mice, Inbred BALB C; Mice, Nude; Middle Aged; Multimodal Imaging; Neoplasm Transplantation; Positron-Emission Tomography; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Medronate; X-Ray Microtomography

Metastatic breast cancer often metastasizes to bone. The purposes of the study were (1) to evaluate the use of (99m)Tc-MDP bone scintigraphy for detection of metastatic bone lesions, and (2) to determine the efficacy of zoledronic acid in mice with breast cancer bone metastasis. All tumor-bearing mice were analyzed with radionuclide bone scintigraphy, X-ray, and histological analysis. The metastatic bone tissue was also harvested and analyzed by western blotting and real-time qPCR. Interestingly, zoledronic acid significantly decreased both the tumor burden and the incidence of bone metastasis in mice. In addition, histomorphometric, stereological, and molecular biology analyses demonstrated that zoledronic acid may function to inhibit breast cancer cell growth in the bone microenvironment and regulate the function of osteoblasts and osteoclasts in tumor-bearing mice. Finally, the attenuation of breast cancer bone metastasis using zoledronic acid can be accurately characterized by (99m)Tc bone scintigraphy in mice.

Topics: Animals; Biomarkers, Tumor; Blotting, Western; Bone Density Conservation Agents; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Mice; Mice, Inbred BALB C; Mice, Nude; Radionuclide Imaging; Radiopharmaceuticals; Real-Time Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Technetium Tc 99m Medronate; Tumor Cells, Cultured; Xenograft Model Antitumor Assays; Zoledronic Acid

Bone metastasis occurs frequently in nasopharyngeal carcinoma (NPC) patients. The aim of this study was to compare the clinical value of 18F-FDG PET/CT with that of 99mTc-MDP planar bone scintigraphy (PBS) for detecting bone metastasis in NPC patients.. Thirty-five histologically proven NPC patients were enrolled in this retrospective study. They underwent both 18F-FDG PET/CT and PBS within 7 days in our department. In a lesion-based analysis, the skeletal system, excluding the head, was divided into four regions: the spine, the pelvis, the thorax, and the appendix. Bone metastasis was considered to be present by either biopsy or clinical follow-up for at least 6 months. PET/CT and PBS were compared by McNemar's paired-sample test.. A total of 50 lesions were confirmed to be malignant (spine 27, thorax 11, pelvis 8 and appendix 4). Although PET/CT was found to be more sensitive on lesion level than PBS (sensitivity 70.0 versus 42.0%; P=0.044), there were still 14 metastatic (28.0%) lesions that could be detected by PBS while negative in PET/CT imaging. In a patient-based analysis, fifteen (42.9%) of 35 eligible patients were found to have bone metastasis. The sensitivity, specificity and accuracy of PET/CT was 60.0% (9/15), 100% (20/20) and 82.9% (29/35); as for PBS, it was 66.7% (10/15), 85.0% (17/20) and 77.1% (27/35), respectively. There was no statistical difference between PET/CT and PBS (P>0.05).. PBS, as a conventional imaging, should be used as an important complement for detecting bone metastasis in NPC patients.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma; Female; Fluorodeoxyglucose F18; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Multimodal Imaging; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Positron-Emission Tomography; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Young Adult

Prostate cancer is incurable once it has metastasized to the bone. Appropriate preclinical models are lacking. The therapeutic efficacy of the multikinase inhibitor cabozantinib was assessed in an orthotopic xenograft model of castration-resistant prostate cancer (CRPC) bone metastasis using noninvasive, multimodality functional imaging.. NOD/SCID mice were injected intratibially with luciferase-expressing ERG (v-ets avian erythroblastosis virus E26 oncogene homolog) rearranged VCaP human prostate carcinoma cells. The response of VCaP xenografts (n = 7 per group) to cabozantinib was investigated using bioluminescence imaging and anatomical and diffusion weighted magnetic resonance imaging. This enabled quantitation of tumor volume and apparent diffusion coefficient (ADC). Bone uptake of technetium-methylene diphosphonate ((99m)Tc-MDP) was assessed by single-photon emission computed tomography. Ex vivo micro computed tomography was used to quantify bone volume and correlated with appropriate histopathology. Statistical significance was determined using the two-sided Mann-Whitney test or Wilcoxon signed rank test.. VCaP xenografts were predominantly osteosclerotic with some osteolytic activity. Fluorescent in situ hybridization analysis confirmed retention of ERG oncogene rearrangements. Cabozantinib induced a statistically significant 52% reduction in tumor luminance (P = .02) and stasis in tumor volume after 15 days of treatment. Tumor ADC statistically significantly increased with cabozantinib and was associated with extensive necrosis (after 10 days, mean tumor ADC ± SD = 556±43×10(-6) mm(2)/s vs pretreatment ADC = 485±43×10(-6) mm(2)/s; P = .02 ). Tumor-associated uptake of (99m)Tc-MDP was statistically significantly reduced after 3 days of treatment (P = .02), sustained over 15 days treatment, and associated with a statistically significant (P = .048) reduction in bone growth on the tibial cortex, yet a highly statistically significant (P = .001) increase in trabecular bone volume.. The intratibial VCaP model faithfully emulates clinical disease. Cabozantinib exerts potent effects on both tumor and tumor-induced bone matrix remodeling, and quantitation of ADC provides a clinically translatable imaging biomarker for early, sensitive assessment of treatment response in CRPC bone metastasis.

Topics: Aged; Anilides; Animals; Antineoplastic Agents; Biomarkers, Tumor; Bone Neoplasms; Bone Remodeling; Diffusion Magnetic Resonance Imaging; Humans; Luminescent Measurements; Male; Mice; Mice, Inbred NOD; Mice, Nude; Middle Aged; Osteolysis; Osteosclerosis; Prostatic Neoplasms, Castration-Resistant; Pyridines; Radiopharmaceuticals; Receptor Protein-Tyrosine Kinases; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tumor Burden; Xenograft Model Antitumor Assays

The aim of this study was to evaluate the utility of Tc-methylene diphosphonate (Tc-MDP) single-photon emission tomography (SPECT)/computed tomography (CT) for the diagnosis of osteoid osteoma and compare the same with three-phase planar bone scintigraphy (BS) and CT alone.. Data of 31 patients (age: 20.6±13.2 years; male: 80.6%) who had undergone Tc-MDP BS with SPECT/CT for clinically and/or radiographically suspected osteoid osteoma were retrospectively evaluated. Planar BS images were analyzed by an experienced nuclear medicine physician. CT images were evaluated by an experienced radiologist. SPECT/CT images were evaluated by the nuclear medicine physician and radiologist in consensus. On the basis of the diagnostic confidence the interpreters used a scoring scale of 1-3, in which 1 is negative for osteoid osteoma, 2 is equivocal, and 3 is positive for osteoid osteoma. For the calculation of sensitivity, specificity, and predictive values for planar BS, CT, and SPECT/CT an interpretive score of 2 or higher was taken as positive for osteoid osteoma. Receiver operating characteristic curve analysis was performed and the area under the curve was calculated and compared. Histopathology and microbiology/clinical imaging follow-up was used as the reference standard.. There were nine equivocal lesions on planar BS and five equivocal lesions on CT, but none on SPECT/CT. The sensitivity, specificity, and accuracy of SPECT/CT were all 100%; those of CT were 77.8, 92.3, and 83.8% and those of planar BS were 100, 38.4, and 74.1%, respectively. On comparison, the area under the curve of SPECT/CT was significantly larger than that of planar BS (1.00 vs. 0.761; P=0.005) and CT (1.00 vs. 0.872; P=0.044). However, no significant difference was seen between planar BS and CT (0.761 vs. 0.872; P=0.236).. Tc-MDP SPECT/CT shows excellent diagnostic accuracy for osteoid osteoma and can be used as a one-stop imaging modality for the same. It is superior to planar BS and CT alone for the diagnosis of suspected osteoid osteoma.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Humans; Male; Middle Aged; Multimodal Imaging; Osteoma, Osteoid; Radionuclide Imaging; Retrospective Studies; ROC Curve; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Young Adult

It is well established that irregular bursae can form adjacent to an osteochondroma (bursa exostotica) as a result of mechanical irritation and that these bursae can be complicated by inflammation, hemorrhage, or infection. Bursal chondromatosis is a rare complication, with only seven published cases in the literature according to our searches. We present the case of a 53-year-old female who presented with slowly progressive left hip/thigh pain and was found to have an osteochondroma arising from the lesser trochanter with numerous ossified bodies in the adjacent soft tissues. MRI demonstrated osteochondral bodies in a fluid-filled bursa adjacent to the osteochondroma, with several of the bodies noted to be fairly displaced from the osteochondroma cartilaginous cap. At surgery, the osteochondroma was removed and numerous bodies of varying sizes were excised, some of which were noted to be adherent to the bursal lining and others that were separated/distant from the cartilage cap. The question arises as to whether this process represents bursal chondromatosis resulting from benign neoplasia of cells lining the abnormal bursa, "cartilage shedding" from the osteochondromatous cap, or both. The purpose in presenting this case is to introduce a rare complication of an osteochondroma, demonstrate that soft tissue calcification and osteochondral densities displaced from an underlying osteochondroma are not always the result of sarcomatous degeneration, and provide support for the theory that cells lining a bursa in a nonphysiologic location can undergo benign neoplasia with subsequent formation of osteochondral bodies.

Topics: Bone Neoplasms; Bursa, Synovial; Chondromatosis, Synovial; Contrast Media; Female; Hip Joint; Humans; Image Enhancement; Magnetic Resonance Imaging; Middle Aged; Osteochondroma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

The aim of this study was to compare bone scintigraphy (BS) and positron emission tomography/computed tomography (PET/CT) for the detection of bone metastases from breast cancer.. Twenty patients with breast cancer and bone pain were submitted to both bone scintigraphy and 18-F-fluorodeoxyglucose PET/CT imaging between July 2012 and June 2013. Scintigraphy was performed following an intravenous injection of technetium-99m-methylene diphosphonate (99mTc-MDP) around 10 days before the PET/CT scan, performed using an intravenous injection of 18-F-fluorodeoxyglucose followed by whole-body computed tomography (CT) to characterize metastases by both methods. Student's t-test for paired samples was used in the comparative data analysis, with significance at p<0.05.. CT identified 429 metastatic implants in the 20 patients, with scintigraphy showing 244 of these lesions (57%) and PET/CT showing 307 (72%); however, there was no statistically significant difference between the mean number of lesions detected per patient with the two imaging modalities (p=0.367).. In the present study, no difference was found between PET/CT and bone scintigraphy in the detection of bone metastases from breast cancer.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

99mTc-3PRGD2, a promising tracer targeting integrin receptor, may serve as a novel tumor-specific agent for single photon emission computed tomography (SPECT). A multi-center study was prospectively designed to evaluate the diagnostic accuracy of 99mTc-3PRGD2 imaging for bone metastasis in patients with lung cancer in comparison with the conventional 99mTc-MDP bone scan.. The patients underwent whole-body scan and chest tomography successively at both 1 h and 4 h after intravenous injection of 11.1 MBq/Kg 99mTc-3PRGD2. 99mTc-MDP whole-body bone scan was routinely performed within 1 week for comparison. Three experienced nuclear medicine physicians blindly read the 99mTc-3PRGD2 and 99mTc-MDP images. The final diagnosis was established based on the comprehensive assessment of all available data.. A total of 44 patients (29 male, 59±10 years old) with suspected lung cancer were recruited from 4 centers. Eighty-nine bone lesions in 18 patients were diagnosed as metastases and 23 bone lesions in 9 patients were benign. In a lesion-based analysis, 99mTc-3PRGD2 imaging demonstrated a sensitivity, specificity, and accuracy of 92.1%, 91.3%, and 92.0%, respectively. The corresponding diagnostic values for 99mTc-MDP bone scan were 87.6%, 60.9%, and 82.1%, respectively in the same patients. 99mTc-MDP bone scan had better contrast in most lesions, whereas the 99mTc-3PRGD2 imaging seemed to be more effective to exclude pseudo-positive lesions and detect bone metastases without osteogenesis.. 99mTc-3PRGD2 is a novel tumor-specific agent based on SPECT technology with a promising value in diagnosis of bone metastasis in patients with lung cancer.. ClinicalTrials.gov NCT01737112.

Topics: Aged; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Peptides, Cyclic; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Classical appearance of "Lincoln's sign" on 99mTc-MDP bone scintigraphy has been described in literature in case of monostotic Paget disease of mandible showing increased radiotracer uptake in the body of mandible. This pattern has also been described as "black beard" sign. The monostotic presentation of Paget disease is rare, and involving the mandible, however, is very unusual. We present a case of carcinoma of the tongue with contiguous spread to the mandible presented in the similar fashion as the earlier reported Lincoln's sign or black beard sign on 99mTc-MDP bone scintigraphy. This appearance was confirmed with SPECT/CT, and the lytic sclerotic lesion of the mandible was confirmed.

Topics: Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Tongue Neoplasms

Prostate cancer (PCa) is increasingly being diagnosed in China. Early detection of bone metastases (BM) is critical in the management of patients with high-risk PCa. The aim of this study is to establish a screening model to determine if bone scan should be performed for BM in Chinese patients at the time when PCa is diagnosed.. The study included 488 patients who were diagnosed with PCa between 2009 and 2011 at a single center. All patients received bone scans using technetium (99m)Tc methylene diphosphonate at the initial staging. If the bone scan finding was equivocal, computed tomography or magnetic resonance imaging was performed to confirm the diagnosis. Age, prostate-specific antigen (PSA) at diagnosis, clinical stage assigned according to the TNM 2002 staging system and biopsy Gleason score were collected in all patients. Multivariate logistic regression analysis was performed to identify statistically significant covariates and then receiver operating characteristic (ROC) curves were generated to identify optimal cut-off values. Using these cut-off values, a formula was devised to calculate an index value for BM screening at diagnosis. The model was cross-validated using the leave-one-out method.. Of the 488 patients, 65 patients (13.3%) had BM. The area under the ROC curve was 0.87 (95% confidence interval 0.83-0.94). The sensitivity of the cut-off point was 87.7% and the specificity was 73.1%. Bone scan is needed for all cT4 PCa patients, however, it is also advisable for cT1-T3 PCa patients who have a biopsy Gleason score ≤3 + 4 and a PSA >132.1, and for cT1-T3 patients having a Gleason score of ≥4 + 3 and PSA >44.5.. The regression model may help determine if bone scan is needed to detect BM from PCa at the time of diagnosis. The model was generated upon a single center experience. Further validation is needed in future studies.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Bone and Bones; Bone Neoplasms; China; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Neoplasm Metastasis; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Regression Analysis; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this study was to compare (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma.. In this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35-80 years) underwent (99m)Tc-MDP planar and SPECT/CT bone scan (BS) followed by (18)F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation.. (18)F-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of (99m)Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of (99m)Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of (18)F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between (99m)Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and (18)F-fluoride PET/CT (κ = 0.74) were found.. ( 18)F-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional (99m)Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Fluorides; Fluorine Radioisotopes; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Bladder Neoplasms

Bone extraction and division can enhance the accuracy of diagnoses based on whole-body bone SPECT data. This study developed a method for using conventional SPECT for automatic recognition of the vertebral column. A novel feature of the proposed approach is a novel "bone graph" image description method that represents the connectivity between these image regions to facilitate manipulation of morphological relationships in the skeleton before surgery. By tracking the paths shown on the bone graph, skeletal structures can be identified by performing morphological operations. The performance of the method was evaluated quantitatively and qualitatively by two experienced nuclear medicine physicians. Datasets for whole-body bone SPECT scans in 46 lung cancer patients with bone metastasis were obtained with Tc-99m MDP. The algorithm successfully segmented vertebrae in the thoracolumbar spine. The quantitative assessment shows that the segmentation method achieved an average TP, FP, and FN rates of 95.1%, 9.1%, and 4.9%. The qualitative evaluation shows an average acceptance rate of 83%, where the data for the acceptable and unacceptable groups had a Cronbach's alpha value of 0.718, which indicated reasonable internal consistency and reliability.

Topics: Algorithms; Bone and Bones; Bone Neoplasms; Computational Biology; Humans; Lung Neoplasms; Radiographic Image Interpretation, Computer-Assisted; Radiopharmaceuticals; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Topics: Bone Neoplasms; Diffusion Magnetic Resonance Imaging; Humans; Lymph Nodes; Male; Prostatic Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole Body Imaging

We compared the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and (99 m)Tc-methylene diphosphonate bone scintigraphy (BS) for the detection of bone metastasis in osteosarcoma.. We retrospectively reviewed 206 patients with stage II-IV osteosarcoma treated with surgery and chemotherapy as well as at least one paired PET/CT and BS scan (defined as an examination). PET/CT and BS images were interpreted separately. When analyzing the diagnostic yield of a combination of PET/CT and BS (PET/CT+BS), an examination was considered positive if either PET/CT or BS scored positive. The final diagnosis was obtained from histological findings or clinical follow-up with imaging studies for at least 6 months. Diagnostic performances of PET/CT, BS, and their combinations were calculated.. Out of 833 examinations in 206 patients, 55 with 101 lesions in 38 patients were confirmed as bone metastases. The sensitivity, specificity, and diagnostic accuracy were 95, 98, and 98%, respectively, for PET/CT; 76, 97, and 96%, respectively, for BS; and 100, 96, and 97%, respectively, for PET/CT+BS in an examination-based analysis. Lesion-based analysis demonstrated that the sensitivity of PET/CT+BS (100%) was significantly higher than that of PET/CT (92%) or BS (74%) alone. BS detected significantly less bone metastases in the growth plate region than outside the growth plate region (22 vs. 77%).. PET/CT is more sensitive and accurate than BS for diagnosing bone metastases in osteosarcoma. The combined use of PET/CT and BS improves sensitivity.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Osteosarcoma; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Reducing the radiation dose and scanning time of diagnostic tests is often desirable. One method uses image enhancement software such as Pixon, which processes lower-count scans and aims to produce high-quality images. However, it is essential that diagnostic accuracy is not compromised. We compared the level of agreement between clinicians using standard scans, with half-count and Pixon-enhanced half-count scans. Bone scans from 150 patients referred to diagnose metastatic disease were degraded by a process of Poisson-preserving binomial resampling to generate equivalent half-count scans and then processed by Pixon software to recreate 'original' high-quality scans. Two experienced clinicians reported the scans in a randomized, blinded manner for metastatic disease (yes/no) and assigned a confidence level to this diagnosis. Levels of agreement between clinicians were calculated for the full-count, half-count, and Pixon-enhanced half-count scans and between scanning methods for each clinician. Agreement between clinicians for standard full-count scans was 92% (±4%, κ=0.80), compared with 92% (±4%, κ=0.79) for half-count scans and 87% (±5%, κ=0.70) for Pixon-processed half-count scans. Agreement for a single clinician viewing full-count versus half-count scans was 95% (±2%, κ=0.88), similar to the agreement for a single clinician viewing full-count versus Pixon-processed half-count scans (95%, ±2%, κ=0.88). With respect to confidence in diagnosis, 127 full-count scans were scored in the highest category, compared with 98 half-count and 88 Pixon-processed half-count scans. Switching to half-count scanning does not introduce more diagnostic disagreement than is already present between clinicians. However, clinicians feel less confident reporting half-count scans. The Pixon enhancement step improved neither objective diagnostic agreement nor clinician confidence.

Topics: Bone and Bones; Bone Neoplasms; Humans; Image Enhancement; Radionuclide Imaging; Retrospective Studies; Software; Technetium Tc 99m Medronate

By analyzing bone scans we aimed to determine whether the assessment of the central skeleton is sufficient for osseous staging in breast cancer patients. This might be of interest for future staging modalities, especially positron emission tomography/computed tomography, usually sparing the peripheral extremities, as well as the skull.. In this retrospective study, a total of 837 bone scans for initial staging or restaging of breast cancer were included. A total of 291 bone scans in 172 patients were positive for bone metastases. The localization and distribution of the metastases were re-evaluated by two readers in consensus. The extent of the central skeleton involvement was correlated to the incidence of peripheral metastases.. In all 172 patients bone metastases were seen in the central skeleton (including the proximal third of humerus and femur). In 34 patients (19.8 %) peripheral metastases of the extremities (distally of the proximal third of humerus and femur) could be detected. Sixty-four patients (37.2 %) showed metastases of the skull. Summarizing the metastases of the distal extremities and skull, 79 patients (45.9 %) had peripheral metastases. None of the patients showed peripheral metastases without any affliction of the central skeleton. The incidence of peripheral metastases significantly correlated with the extent of central skeleton involvement (p<0.001).. Regarding bone scans, an isolated metastatic spread to the peripheral skeleton without any manifestation in the central skeleton seems to be the exception. Thus, the assessment of the central skeleton should be sufficient in osseous breast cancer staging and restaging. However, in case of central metastases, additional imaging of the periphery should be considered for staging and restaging.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Comorbidity; Female; Germany; Humans; Middle Aged; Neoplasm Staging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Many children with sarcomas undergo whole body 2-deoxy-2-((18)F)fluoro-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and technetium methylene diphosphonate ((99)Tc-MDP) studies. It is unknown whether the combination of both tests results in more accurate detection of bone lesions than (18)F-FDG- PET/CT alone.. (99)Tc-MDP bone and (18)F-FDG PET/CT scans were each read by 2 "blinded" observers and then reviewed side-by-side by 3 readers. Bone lesions were graded qualitatively on a 5-point scale (from benign to malignant). Clinical and imaging follow-up (n = 21) and bone biopsy results (n = 8) served as reference standard.. A total of 39 paired (99)Tc-MDP and (18)F-FDG-PET/CT studies (cases) performed at a mean interval 4 ± 7 days, were performed on 29 patients (mean age 12 ± 5 y). Of these, 21 patients (72%) had bone sarcoma, whereas 8 patients (28%) had soft tissue sarcoma. By patient and case-based analysis, (18)F-FDG PET/CT had an accuracy of 100%. Tc-MDP had accuracies of 90% and 82% by patient and case-based analysis. The combined interpretation had an accuracy of 97%.. In this study, (99)Tc-MDP bone imaging does not provide an added diagnostic value for bone involvement over (18)F-FDG-PET/CT.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; Diagnostic Imaging; Female; Fluorodeoxyglucose F18; Humans; Image Interpretation, Computer-Assisted; Male; Multimodal Imaging; Positron-Emission Tomography; Radionuclide Imaging; Retrospective Studies; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To evaluate the incremental value of single-photon emission computed tomography-computed tomography (SPECT-CT) over planar scintigraphy and SPECT alone for equivocal bone scintigraphy lesions in patients with breast cancer and to assess its impact on patient management.. A total of 102 patients with 115 equivocal lesions on planar scintigraphy underwent SPECT and SPECT-CT of selected volume. Images were evaluated in separate sessions to minimize recall bias. A scoring scale of 1-5 was used, where 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign, and 5 is definitely benign. With receiver operating characteristic analysis, area under the curves was constructed for each modality. Clinical/imaging follow-up and/or histopathology were taken as the reference standard.. There were 52 indeterminate lesions on planar scintigraphy, 15 on SPECT, and three on SPECT-CT. Area under the curve for SPECT-CT was significantly larger compared with planar scintigraphy (P<0.001) and SPECT (P=0.033). This improvement was mostly for lytic lesions (P<0.0001). In patients (n=67) in whom the lesions under evaluation were the only lesions and hence whose management was decided, SPECT-CT was superior to SPECT (P=0.045) and planar scintigraphy (P <0.001).. SPECT-CT is better than planar scintigraphy and SPECT alone for characterizing equivocal bone scintigraphy lesions in patients with breast cancer and can have a significant impact on patient management.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Osteosarcoma (OS) management requires a better understanding of tumor/bone interactions in vivo during disease progression. Using [(18)F]-FDG and [(99m)Tc]-HMDP imaging, we assessed a methodology for an in vivo quantitative characterization of an orthotopic model of osteolytic OS on the basis of (1) tumor proliferation, (2) tumor and bone metabolic activities, and (3) bone remodeling.. POS-1 tumor bearing mice were monitored in vivo over a 26-day period, with tumor and bone metabolic volumes (TMV and BMV, respectively) being determined from [(18)F]-FDG, bone remodeling from [(99m)Tc]-HMDP, and tumoral volume from micro- computed tomography scans.. From day 10, [(18)F]-FDG strongly accumulated within POS-1 tumor, with a tumor/muscle ratio of 3.7 ± 0.8. TMV and BMV increased as pathology progressed: TMV increased at early stage of pathology (from 56%) whereas BMV strongly increased (from 113%) during late stage. From [(99m)Tc]-HMDP imaging, bone remodeling features were evidenced within the distal region of tibia bearing the tumor, with a mean scintigraphic ratio of 1.36 ± 0.11 at day 12, that reached value of 2.53 ± 0.19 at day 26.. Our results validated the POS-1 orthotopic model as "OS imaging model," that could serve for evaluating in vivo therapies targeting tumor proliferation and/or bone remodeling in OS.

Topics: Animals; Bone Neoplasms; Bone Remodeling; Cell Growth Processes; Fluorodeoxyglucose F18; Male; Mice; Mice, Inbred C3H; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this study was to explore the distribution features of metastatic bony lesions in prostate cancer.. Bone scans with 99mTc-methylene diphosphonate were performed in 144 patients with pathologically proven prostate cancer, and distribution regularity of metastatic bony lesions was analyzed retrospectively.. A total of 2000 lesions of bone metastasis were detected in 102 patients, 28.9% of which were distributed in the ribs, 14.8% in thoracic vertebrae, 13.8% in the ilium, and 8.0% in the lumbar vertebrae. The distribution of metastatic bony lesions was correlated with the total number of lesions. The proportion of metastatic lesions of vertebrae and pelvis was up to 84.5% (49/58) in fewer bone metastases. The proportion gradually decreased with an increase in the total number of lesions, but the proportion of the bony lesions, except for the vertebrae and pelvis, gradually increased with an increase in the total number of lesions. Ninety-nine percent (903/912) of metastatic bony lesions, except for the vertebrae and pelvis, coexisted with metastasis of vertebrae or pelvis, whereas only 1.0% (9/912) of those were detected in no metastasis of the vertebrae and pelvis; their difference was significant (χ2=876.4, P=0.000). About 98.8% (571/578) of metastatic costal lesions coexisted with vertebrae metastasis, but only 1.2% (7/578) of these were detected in no metastasis of vertebrae; their difference was significant (χ2=550.3, P=0.000). The difference between left body and right body was not significant (χ=1.3, P=0.249).. Metastatic bony lesions of prostate cancer are located mainly in the vertebrae and pelvis in the early stage. The distribution of metastatic bony lesions is not only characterized by spreading to left body and right body randomly, but also presents the tendency of developing with orderliness to a certain extent in the whole body.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Humans; Ilium; Lumbar Vertebrae; Male; Middle Aged; Prostatic Neoplasms; Radiopharmaceuticals; Retrospective Studies; Ribs; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

There is little consensus on a standard approach to analysing bone scan images. The Bone Scan Index (BSI) is predictive of survival in patients with progressive prostate cancer (PCa), but the popularity of this metric is hampered by the tedium of the manual calculation.. Develop a fully automated method of quantifying the BSI and determining the clinical value of automated BSI measurements beyond conventional clinical and pathologic features.. We conditioned a computer-assisted diagnosis system identifying metastatic lesions on a bone scan to automatically compute BSI measurements. A training group of 795 bone scans was used in the conditioning process. Independent validation of the method used bone scans obtained ≤3 mo from diagnosis of 384 PCa cases in two large population-based cohorts. An experienced analyser (blinded to case identity, prior BSI, and outcome) scored the BSI measurements twice. We measured prediction of outcome using pretreatment Gleason score, clinical stage, and prostate-specific antigen with models that also incorporated either manual or automated BSI measurements.. The agreement between methods was evaluated using Pearson's correlation coefficient. Discrimination between prognostic models was assessed using the concordance index (C-index).. Manual and automated BSI measurements were strongly correlated (ρ=0.80), correlated more closely (ρ=0.93) when excluding cases with BSI scores≥10 (1.8%), and were independently associated with PCa death (p<0.0001 for each) when added to the prediction model. Predictive accuracy of the base model (C-index: 0.768; 95% confidence interval [CI], 0.702-0.837) increased to 0.794 (95% CI, 0.727-0.860) by adding manual BSI scoring, and increased to 0.825 (95% CI, 0.754-0.881) by adding automated BSI scoring to the base model.. Automated BSI scoring, with its 100% reproducibility, reduces turnaround time, eliminates operator-dependent subjectivity, and provides important clinical information comparable to that of manual BSI scoring.

Topics: Aged; Bone and Bones; Bone Neoplasms; Cohort Studies; Humans; Image Interpretation, Computer-Assisted; Male; Neoplasm Grading; Prognosis; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Technetium Tc 99m bone scintigraphy (BS) and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) of the pelvis and abdomen are universally recommended for detecting prostate cancer (PCa) metastases in cancer of all stages. However, this two-step approach has limited sensitivity and specificity.. Evaluate the diagnostic accuracy of whole-body MRI (WBMRI) as a one-step screening test for PCa metastases.. One hundred consecutive PCa patients at high risk for metastases prospectively underwent WBMRI, CT, and BS completed with targeted x-rays (BS/TXR) in case of equivocal BS. Four independent reviewers reviewed the images.. This study compares the diagnostic performance of WBMRI, CT, BS, and BS/TXR in detecting PCa metastases using area under the curve (AUC) receiver operator characteristics. A best valuable comparator (BVC) approach was used to adjudicate final metastatic status in the absence of pathologic evaluation.. Based on the BVC, 68 patients had metastases. The sensitivity of BS/TXR and WBMRI for detecting bone metastases was 86% and 98-100%, respectively (p<0.04), and specificity was 98% and 98-100%, respectively. The first and second WBMRI readers respectively identified bone metastases in 7 and 8 of 55 patients with negative BS/TXR. The sensitivity of CT and WBMRI for detecting enlarged lymph nodes was similar, at 77-82% for both; specificity was 95-96% and 96-98%, respectively. The sensitivity of the combination of BS/TXR plus CT and WBMRI for detecting bone metastases and/or enlarged lymph nodes was 84% and 91-94%, respectively (p=0.03-0.10); specificities were 94-97% and 91-96%, respectively. The 95% confidence interval of the difference between the AUC of the worst WBMRI reading and the AUC of any of the BS/TXR plus CT lay within the noninferiority margin of ±10% AUC.. WBMRI outperforms BS/TXR in detecting bone metastases and performs as well as CT for enlarged lymph node evaluation. WBMRI can replace the current multimodality metastatic work-up for the concurrent evaluation of bones and lymph nodes in high-risk PCa patients.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Diffusion Magnetic Resonance Imaging; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Prospective Studies; Prostatic Neoplasms; Risk; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole Body Imaging

The development and evaluation of a computer-aided bone scan analysis technique to quantify changes in tumor burden and assess treatment effects in prostate cancer clinical trials.. We have developed and report on a commercial fully automated computer-aided detection (CAD) system. Using this system, scan images were intensity normalized, and then lesions were identified and segmented by anatomic region-specific intensity thresholding. Detected lesions were compared against expert markings to assess the accuracy of the CAD system. The metrics Bone Scan Lesion Area, Bone Scan Lesion Intensity, and Bone Scan Lesion Count were calculated from identified lesions, and their utility in assessing treatment effects was evaluated by analyzing before and after scans from metastatic castration-resistant prostate cancer patients: 10 treated and 10 untreated. In this study, patients were treated with cabozantinib, a MET/vascular endothelial growth factor inhibitor resulting in high rates of resolution of bone scan abnormalities.. Our automated CAD system identified bone lesion pixels with 94% sensitivity, 89% specificity, and 89% accuracy. Significant differences in changes from baseline were found between treated and untreated groups in all assessed measurements derived by our system. The most significant measure, Bone Scan Lesion Area, showed a median (interquartile range) change from baseline at week 6 of 7.13% (27.61) in the untreated group compared with -73.76% (45.38) in the cabozantinib-treated group (P=0.0003).. Our system accurately and objectively identified and quantified metastases in bone scans, allowing for interpatient and intrapatient comparison. It demonstrates potential as an objective measurement of treatment effects, laying the foundation for validation against other clinically relevant outcome measures.

Topics: Anilides; Bone Neoplasms; Humans; Image Processing, Computer-Assisted; Male; Prostatic Neoplasms; Pyridines; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome; Tumor Burden; Whole Body Imaging

Topics: Bone and Bones; Bone Neoplasms; Humans; Image Interpretation, Computer-Assisted; Male; Prostatic Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging

Technetium-99m methylene diphosphonate (Tc-99m MDP) whole-body bone scintigraphy (BS) has been widely used for detecting bone metastases. The aim of this study is to investigate the diagnostic accuracy of BS in detecting skeletal metastases for hepatocellular carcinoma (HCC) patients. In addition, the anatomic distribution of the metastatic bone lesions and the prognoses of the HCC patients are also analyzed.. We retrospectively reviewed BS results of 179 consecutive HCC patients from January 2005 to December 2006 in our institution. The false negative (FN) rate, sensitivity, and specificity of BS were evaluated by patient-based and region-based analyses.. A total of 59 patients (33.0%) were confirmed of bone metastases. A total of 25 of these 59 patients (46.3%) had at least one lesion categorized as BS FN, and the bone metastatic status for 10 patients (17.0%) was underestimated by BS. The most observed metastatic site was spine while the most observed sites with FN of BS were the lower extremity. In total, there were 122 metastatic regions and 33 regions (27.0%) were FN of BS. Patients without any metastases survived significantly longer than any of other groups with metastases.. High FN rate of Tc-99m MDP BS in detecting metastatic bone lesions for HCC patients was observed. In our opinion, careful history taking, meticulous examination, and a high index of suspicion are important for HCC patients with unexplained progressive pain in the musculoskeletal system. Even with negative results from Tc-99m MDP BS, the possibility of skeletal metastases cannot be indiscriminately excluded.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Hepatocellular; False Negative Reactions; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Diffusion Magnetic Resonance Imaging; Humans; Lymph Nodes; Male; Prostatic Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole Body Imaging

Bone scintigraphy using (99m)TC MDP (technetium-99m methylene diphosphonate) is a routine procedure for evaluation of osteoblastic metastases; however, its sensitivity compared with FDG PET/CT in a variety of malignancies remains to be established. We report a case of multiple osseous metastases revealed by FDG PET/CT in an 8-year-old girl with pleomorphic liposarcoma. Many of these osseous lesions were not visualized on the MDP planar bone scintigraphy performed 24 hours after PET/CT scan, becoming evident only on repeat bone scan performed 3 months later. The case suggests that FDG PET/CT has higher sensitivity in detecting osteoblastic metastases in pleomorphic liposarcoma.

Topics: Bone and Bones; Bone Neoplasms; Child; Early Detection of Cancer; Female; Fluorodeoxyglucose F18; Humans; Liposarcoma; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

The aim of this work was to report an unusual case of multiple soft tissue metastases of osteosarcoma detected using bone scan and confirmed by CT scan.. A 15-year-old patient with a history of osteogenic sarcoma presented with fatigue and loss of appetite in addition to a painless swelling of the distal left lower extremity. Bone scan and chest CT scan were performed for restaging purposes. The bone scan revealed multiple bone metastases and suspected tumor recurrence in the left lower extremity in addition to multiple extraosseous hot spots. The latter findings were assessed as ossified soft tissue metastases after considering the performed CT scan.. This case showed the double role of bone scan in osteosarcoma in simultaneously assessing the bone status and tumor spread in soft tissue. The benefit of a comparison of bone scan findings with other modalities was also demonstrated.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Osteosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

The aim of this study was to compare the diagnostic ability of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) with that of (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) bone scan for bone metastasis in staging patients with small cell lung cancer (SCLC).. Ninety-five patients with SCLC who underwent both (18)F-FDG PET/CT and (99m)Tc-MDP bone scan for initial staging work-up were retrospectively enrolled. All (18)F-FDG PET/CT and bone scan images were visually assessed. Bone metastasis was confirmed by histopathological results and all available clinical information.. Of 95 patients with SCLC, metastatic bone lesions were found in 30 patients, and 84 metastatic lesions were evaluated on a lesion-basis analysis. The sensitivity of (18)F-FDG PET/CT was 100 % on a per-patient basis and 87 % on a per-lesion basis, and there was no false-positive lesion on PET/CT images. In contrast, the sensitivity of the bone scan was 37 % on a per-patient basis and 29 % on a per-lesion basis. The bone scan showed 11 false-positive lesions. The bone scan detected two metastatic lesions that were not detected by PET/CT, which were outside the region scanned by PET/CT. On follow-up bone scan, 21 lesions that were not detected by the initial bone scan but were detected by PET/CT were newly detected.. In patients with SCLC, (18)F-FDG PET/CT showed higher detection rate of bone metastasis than (99m)Tc-MDP bone scan. Thus, (18)F-FDG PET/CT can replace bone scan in staging patients with SCLC.

Topics: Aged; Bone and Bones; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Multimodal Imaging; Neoplasm Staging; Positron-Emission Tomography; Retrospective Studies; Sensitivity and Specificity; Small Cell Lung Carcinoma; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Osteosarcoma metastases frequently occur in the lungs or the skeleton. Bone scans play an important role in disease staging by identifying other skip areas of skeletal involvement as well as extraosseous metastases. We report a case of aggressive osteosarcoma, with bone metastases and extraosseous areas of involvement in the lungs, distant lymph nodes, and peritoneal and subcutaneous metastasis seen in a preoperative Tc-99m methylene diphosphonate bone scan. These findings were confirmed with histology and correlative cross-sectional imaging.

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Knee; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Young Adult

Topics: Bone Neoplasms; Carcinoma, Renal Cell; Fluorodeoxyglucose F18; Humans; Kidney Neoplasms; Middle Aged; Molecular Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Biopsy; Bone Density Conservation Agents; Bone Neoplasms; Calcinosis; Calcium; Diagnosis, Differential; Diphosphonates; Drug Therapy, Combination; Edema; Humans; Humerus; Imidazoles; Male; Middle Aged; Multimodal Imaging; Osteolysis, Essential; Positron-Emission Tomography; Radiopharmaceuticals; Sarcoma, Synovial; Scapula; Shoulder Joint; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Vitamin D; Zoledronic Acid

The aim of this study was to compare the diagnostic and prognostic values of (99m)Tc-MDP-planar bone scintigraphy ((99m)Tc-MDP-BS), (131)I single-photon emission computed tomography/computed tomography ((131)I-SPECT/CT) and (18)F-fluorodeoxyglucose ((18)F-FDG)-PET/CT for the detection of bone metastases from differentiated thyroid cancer (DTC).. Eighty patients with DTC with suspected bone metastases from DTC were retrospectively analysed. All patients were examined with (99m)(99m)Tc-MDP-BS, (131)I-SPECT/CT and (18)F-FDG-PET/CT, with a maximum interval of 2 months between scans. The diagnostic performances of (99m)Tc-MDP-BS, (131)I-SPECT/CT and (99m)F-FDG-PET/CT were investigated and compared. Univariate and multivariate analyses were carried out to evaluate the effects of variables on the survival of patients.. Out of the 80 patients with 148 foci, 43 with 106 foci were diagnosed as being true positive for bone metastases from DTC. In patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of (99m)Tc-MDP-BS were 79.07, 83.78, 85.00, 77.50 and 81.25%, respectively; those of (131)I-SPECT/CT were 93.02, 97.30, 97.56, 92.31 and 95.00%, and those of (18)F-FDG-PET/CT were 86.05, 94.59, 94.87, 85.36 and 87.80%, respectively. In lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of (99m)Tc-MDP-BS were 72.64, 73.81, 87.50, 51.67 and 72.97%, respectively; those of (131)I-SPECT/CT were 92.45, 97.62, 98.99, 83.67 and 93.92%, and those of (18)F-FDG-PET/CT were 85.85, 88.10, 94.50, 71.15 and 86.49%, respectively. Comparing the receiver-operating characteristic area using the McNemar test, both (131)I-SPECT/CT and (18)F-FDG-PET/CT were found to be superior to (99m)Tc-MDP-BS for the detection of bone metastases from DTC in patient-based and lesion-based analyses (P<0.05). Patient-based analysis showed that there were no significant differences between (131)I-SPECT/CT and (18)F-FDG-PET/CT (P=0.087) but lesion-based analysis revealed that (131)I-SPECT/CT was superior to (18)F-FDG-PET/CT (P=0.002). For the association between these image patterns and the prognosis of DTC patients, (18)F-FDG positivity was the factor predicting a poor prognosis.. (131)I-SPECT/CT and (18)F-FDG-PET/CT demonstrated high diagnostic performance in detecting bone metastases from DTC. (99m)Tc-MDP-BS might be completely replaced by (131)I-SPECT/CT in combination with ((131)F-FDG-PET/CT in the management of DTC patients with bone metastases. (18)F-FDG-PET/CT positivity was an independent factor associated with poor prognosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prognosis; Retrospective Studies; Sensitivity and Specificity; Survival Analysis; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, X-Ray Computed; Young Adult

Extraosseous accumulation of bone-seeking agents is rare, but has been previously reported in pediatric sarcomas and neuroblastomas. We present an unusual case of a 5-month-old male with an abdominal mass observed clinically by his parents and referring pediatrician. Contrast abdominal computerized tomography confirmed the presence of a large pelvic mass that was diagnosed pathologically as embryonal rhabdomyosarcoma. A bone scintigraphy that was performed for staging of the disease revealed accumulation of the radiopharmaceutical in the tumor. There was no evidence for skeletal metastatic disease. This case further demonstrates the nonspecificity of soft-tissue tumor uptake on bone scintigraphy.

Topics: Bone Neoplasms; False Positive Reactions; Humans; Infant; Male; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyosarcoma, Embryonal; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tissue Distribution

Whole-body bone scan is one of the most frequent diagnostic procedures in nuclear medicine. Especially, it plays a significant role in important procedures such as the diagnosis of osseous metastasis and evaluation of osseous tumor response to chemotherapy and radiation therapy. It can also be used to monitor the possibility of any recurrence of the tumor. However, it is a very time-consuming effort for radiologists to quantify subtle interval changes between successive whole-body bone scans because of many variations such as intensity, geometry, and morphology. In this paper, we present the most effective method of image enhancement based on histograms, which may assist radiologists in interpreting successive whole-body bone scans effectively. Forty-eight successive whole-body bone scans from 10 patients were obtained and evaluated using six methods of image enhancement based on histograms: histogram equalization, brightness-preserving bi-histogram equalization, contrast-limited adaptive histogram equalization, end-in search, histogram matching, and exact histogram matching (EHM). Comparison of the results of the different methods was made using three similarity measures peak signal-to-noise ratio, histogram intersection, and structural similarity. Image enhancement of successive bone scans using EHM showed the best results out of the six methods measured for all similarity measures. EHM is the best method of image enhancement based on histograms for diagnosing successive whole-body bone scans. The method for successive whole-body bone scans has the potential to greatly assist radiologists quantify interval changes more accurately and quickly by compensating for the variable nature of intensity information. Consequently, it can improve radiologists' diagnostic accuracy as well as reduce reading time for detecting interval changes.

Topics: Algorithms; Bone and Bones; Bone Neoplasms; Humans; Image Enhancement; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Medronate; Whole Body Imaging

In order to aid radiologists' routine work for interpreting bone scan images, we developed a computerized method for temporal subtraction (TS) images which can highlight interval changes between successive whole-body bone scans, and we performed a prospective clinical study for evaluating the clinical utility of the TS images. We developed a TS image server which includes an automated image-retrieval system, an automated image-conversion system, an automated TS image-producing system, a computer interface for displaying and evaluating TS images with five subjective scales, and an automated data-archiving system. In this study, the radiologist could revise his/her report after reviewing the TS images if the findings on the TS image were confirmed retrospectively on our clinical picture archiving and communication system. We had 256 consenting patients of whom 143 had two or more whole-body bone scans available for TS images. In total, we obtained TS images successfully in 292 (96.1%) pairs and failed to produce TS images in 12 pairs. Among the 292 TS studies used for diagnosis, TS images were considered as "extremely beneficial" or "somewhat beneficial" in 247 (84.6%) pairs, as "no utility" in 44 pairs, and as "somewhat detrimental" in only one pair. There was no TS image for any pairs that was considered "extremely detrimental." In addition, the radiologists changed their initial reported impression in 18 pairs (6.2%). The benefit to the radiologist of using TS images in the routine interpretation of successive whole-body bone scans was significant, with negligible detrimental effects.

Topics: Aged; Algorithms; Bone and Bones; Bone Neoplasms; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Male; Middle Aged; Pattern Recognition, Automated; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Medronate; Whole Body Imaging

The etiology of osteonecrosis of the jaw is poorly understood, but preferential mandibular uptake of intravenous bisphosphonates (IVBPs) has been implicated. We examined this association within a prospective study assessing the effect of IVBPs on radionuclide bone scanning.. Women with at least 3 osseous breast metastases on bone scanning and previous IVBP use within 8 weeks were eligible for the present study. After the first clinically indicated bone scan, the patients received zoledronic acid within 72 hours and underwent a second bone scan within another 72 hours. The regions of interest on the bone scan were read in triplicate, and the mean count per pixel was calculated for the mandible (C(M)), left femur (C(FL)), right femur (C(FR)), and thigh (C(B)). The mandibular bone turnover (MBT) was quantified as the ratio of (C(M) - C(B))/(C(F) - C(B)), where C(F) = (C(FL) + C(FR)/2). The MBT was compared before and after IVBP use.. A total of 10 patients were enrolled (median age 51 years, range 40 to 71); none had known osteonecrosis of the jaw. Of the 10 patients, 8 had paired bone scans available for analysis. The previous zoledronic acid exposure was 48.6 mg (range 24 to 148) for a median of 13 months (range 6 to 35). The baseline mean MBT ratio was 2.33 (range 0.88 to 4.22). After IVBP administration, the mean MBT ratio was statistically unchanged at 2.23 (range 1.05 to 3.09). The MBT had declined in 4 patients and increased in 4. Only 1 patient had had an MBT of less than 1.0 before IVBP use, and no patient had an MBT ratio of less than 1.0 after IVBP use.. The mandibular region appears to be a site of increased uptake of technetium-99m bound to methylene diphosphonate-technetium. Acute changes in bisphosphonate binding in the mandible were not observed in our patients receiving chronic IVBP therapy.

Topics: Adult; Aged; Bone Density Conservation Agents; Bone Neoplasms; Diphosphonates; Female; Femur; Humans; Imidazoles; Infusions, Intravenous; Mandible; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Single-Blind Method; Technetium Tc 99m Medronate; Thigh; Time Factors; Zoledronic Acid

The aim of this study was to examine the relation between pain and bone metastases in a group of patients with prostate or breast cancer that had been referred for bone scintigraphy. Whole-body bone scans, anterior and posterior views obtained with a dual detector gamma camera were studied from 101 consecutive patients who had undergone scintigraphy (600 MBq Tc-99m MDP) because of suspected bone metastatic disease. At the time of the examination, all patients were asked whether they felt any pain or had recently a trauma. This information was correlated with the classifications regarding the presence or absence of bone metastases made by a group of three experienced physicians. In patients with prostate cancer, we found metastases in 47% (18/38) of the patients with pain, but only in 12% (2/17) of the patients without pain (p = 0.01). In patients with breast cancer, on the other hand, metastases were more common in patients without pain (71%; 10/14) than in patients with pain (34%; 11/32) (p = 0.02). In conclusion, a significant relation between pain and skeletal metastases could be found in patients with prostate cancer and a reverse relation in patients with breast cancer.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Middle Aged; Pain; Pain Measurement; Predictive Value of Tests; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Surveys and Questionnaires; Sweden; Technetium Tc 99m Medronate

New or worsening bone lesions in patients responding to treatment, known as the flare phenomenon is well described on (99m)Tc-MDP bone scintigraphy, but to our knowledge has not previously been described on CT. The appearance of new or worsening bone sclerosis on CT in patients with prostate cancer may therefore be erroneously classified as disease progression.. To assess the incidence of osteoblastic healing flare response at 3-month CT assessment in patients with castrate-resistant prostate cancer and to identify associated features that enable differentiation from progressive metastatic bone disease at 3 months.. CT scans of 67 patients with castrate-resistant prostate cancer undergoing treatment were reviewed by a radiologist blinded to clinical outcome. Changes in number, size, and density of metastatic bone lesions were documented and Response Evaluation Criteria in Solid Tumours (RECIST) in soft tissue lesions, alkaline phosphatase, prostate specific antigen, and (99m)Tc-MDP bone scans were used for correlation.. Of the 39 patients who had 3- and 6-month follow-up, eight patients (21%) demonstrated an increase in number, size, or density of sclerotic lesions on the 3-month CT scan despite improvement in PSA and soft tissue lesions. Three out of eight patients (8%) maintained partial response/remained stable at follow-up and were defined as showing a flare response: in this group bone metastases evident on CT showed a qualitative and quantitative increase in density and no lesions faded at 3 months. In contrast, in all patients who progressed at 3 months by PSA/RECIST criteria (n = 8) bone lesions showed a mixed pattern with some lesions increasing and others decreasing in density.. The incidence of flare response of metastatic bone disease evident at 3-month post-treatment CT in patients with prostate cancer undergoing systemic treatment is 8%. In patients with falling PSA and stable/responding soft tissue disease at 3 months an increase in bone sclerosis in the absence of fading bone metastases can be interpreted as flare and is likely to represent a response.

Topics: Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers, Tumor; Bone Neoplasms; Contrast Media; Diagnosis, Differential; Disease Progression; Humans; Iohexol; Male; Middle Aged; Osteoblasts; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Statistics, Nonparametric; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In a previous study using a rodent osteosarcoma-grafted rat model, in which cell-dependent mineralization was previously demonstrated to proportionally increase with growth, we performed a quantitative analysis of mineral deposit formation using (99m)Tc-HMDP and found some weaknesses, such as longer acquisition time and narrower dynamic ranges (i.e. images easily saturated). The recently developed near-infrared (NIR) optical imaging technique is expected to non-invasively evaluate changes in living small animals in a quantitative manner.. To test the feasibility of NIR imaging with a dual-channel system as a better alternative for bone scintigraphy by quantitatively evaluating mineralization along with the growth of osteosarcoma lesions in a mouse-xenograft model.. The gross volume and mineralization of osteosarcoma lesions were evaluated in living mice simultaneously with dual-channels by NIR dye-labeled probes, 2-deoxyglucose (DG) and pamidronate (OS), respectively. To verify these quantitative data, retrieved osteosarcoma lesions were then subjected to ex-vivo imaging, weighing under wet conditions, microfocus-computed tomography (μCT) analysis, and histopathological examination.. Because of less scattering and no anatomical overlapping, as generally shown, specific fluorescence signals targeted to the osteosarcoma lesions could be determined clearly by ex-vivo imaging. These data were well positively correlated with the in-vivo imaging data (r > 0.8, P < 0.02). Other good to excellent correlations (r > 0.8, P < 0.02) were observed between DG accumulation and tumor gross volume and between OS accumulation and mineralization volume.. This in-vivo NIR imaging technique using DG and OS is sensitive to the level to simultaneously detect and quantitatively evaluate the growth and mineralization occuring in this type of osteosarcoma lesions of living mice without either invasion or sacrifice. By possible mutual complementation, this dual imaging system might be useful for accurate diagnosis even in the presence of overlapping tissues.

Topics: Animals; Bone Neoplasms; Calcification, Physiologic; Diphosphonates; Feasibility Studies; Inositol; Mice; Mice, Hairless; Osteosarcoma; Pamidronate; Radiopharmaceuticals; Spectroscopy, Near-Infrared; Technetium Tc 99m Medronate; Transplantation, Heterologous

Topics: Aged; Antigens, CD34; Biomarkers, Tumor; Bone Neoplasms; Humans; Male; Osteolysis; Solitary Fibrous Tumors; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Parosteal osteosarcoma (POS) is the most common form of surface osteosarcoma. Its symptoms are insidious and its duration prior to diagnosis is considerably longer than that of other types of osteosarcoma. We report a case of POS with a growing mass but no evidence of metastasis. This tumor, which was diagnosed as calcified hematoma with benign characteristics, was incompletely resected in our hospital 21 years before the diagnosis of recurrence. The patient underwent a wide en bloc resection in our hospital and was free of symptoms, with no signs of tumor recurrence or metastasis during a 53-month follow-up.

Topics: Adult; Bone Neoplasms; Diagnostic Errors; Follow-Up Studies; Humans; Humerus; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Osteosarcoma, Juxtacortical; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

In planning diagnostic or follow-up investigational strategies, neuroblastoma (NB) metastatic deposits in bone and/or bone marrow (BM) should be detected as early as possible. Therefore, all investigational detection tools should be conducted simultaneously for precise staging. However, because of the financial conditions in our developing countries and in view of the cost/benefit relationship, the question is, can one detection tool only become satisfactory and replacing others? The purpose of our study is to compare simultaneous results of bone and metaiodobenzylguanidine (MIBG) scans versus BM biopsies with immunohistochemical (IHC) staining; in detecting bone and/or BM metastatic deposits in NB patients.. This study included 138 NB patients; 46 were de novo and 92 were under follow-up. They were subjected to bilateral BM biopsies, IHC staining (using NSE McAb) and Tc-99m methylene diphosphonate (Tc-99m MDP) bone scan (BS). Only 57/138 patients were, in addition, subjected to I-131 MIBG scan.. Matched results between IHC-stained BM sections and bone scans (BSs) 107/138 (77.5%) were higher than the un-matched ones 31/138 (22.5%). There was a moderate agreement between the two methods in all studied cases (Kappa=0.538) and it was higher among de novo (Kappa=0.603) than follow-up group (Kappa=0.511). Among the 31 un-matched results, the most frequent (17/31) were due to the presence of minute amount of infiltrating NB cells that could be detected by IHC-stained BM sections and not by BSs. The less frequent (12/31) were due to the presence of metastatic deposits outside pelvic bones that could be detected by BSs and not by IHC-stained BM sections mainly in the follow-up cases (11/12) rather than de novo cases (1/12). The matched results between IHC-stained BM sections and MIBG scans 54/57 (94.7%) were higher than the un-matched ones 3/57 (5.3%). The agreement between the two methods was higher among de novo (Kappa=1.000) than follow-up group (Kappa=0.847). The agreement between IHC-stained BM sections and MIBG scans was substantial (Kappa=0.890) while that between IHC-stained BM sections and BSs was moderate (Kappa=0.538).. We suggest a step-wise strategy to be applied, at least in developing countries, in approaching de novo and follow-up NB cases for detecting bone and/or BM metastatic deposits. This strategy might be beneficial if it is considered during application of NB guide-lines for diagnosis and follow-up.

Topics: Adolescent; Bone Marrow; Bone Marrow Neoplasms; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Immunohistochemistry; Infant; Male; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. The objective of our study was to compare the sensibility of the 2-deoxy-2-[18F] fluoro-d-glucose positron emission tomography/computed tomography (F-18 FDG PET/CT) for the detection of bone metastasis in patients with non-small-cell lung cancer (NSCLC) whose technetium 99m methylenediphosphonate (Tc-99m MDP) bone scans were absolutely normal.. This study based on the retrospective analysis of 95 consecutive patients with histologically proven NSCLC who underwent F-18 FDG PET/CT and Tc-99m MDP bone scan at the Eskişehir Osmangazi University School of Medicine, Department of Nuclear Medicine between November 2006 and October 2008. Nineteen patients (19 of 95, 20%) with absolutely normal Tc-99m bone scan versus multiple high-grade F-18 FDG avid bony metastases on F-18 FDG PET/CT were selected for the review. Their ages ranged from 46 to 73 years (15 males and four females; mean: 57.2 years).. Nine patients had squamous cell carcinoma, six had adenocarcinoma, three had large cell carcinoma and one had adenosquamous cell carcinoma. Tc-99m MDP bone scan that did not reveal bony abnormalities or radiotracer uptake was characteristic of benign disease (defined as absolutely normal) in these patients. Whereas, F-18 FDG PET/CT not only showed extremely disseminated heterogeneous nest-like high-grade FDG avid metastatic foci within the marrow cavity of the upper and lower thoracic spine, lumbar spine, pelvis, rib cages and bilateral proximal long bones, but also showed disseminated osteolytic bony metastases in these areas.. Discordant findings of skeletal metastasis between Tc-99m MDP bone scans and F-18 FDG PET/CT imaging may be seen in 20% of the patients with NSCLC. F-18 FDG PET/CT could detect metastatic bone involvement more accurately than bone scintigraphy. Bone scans are insensitive to early bone marrow neoplastic infiltration. Assessment of glucose metabolism with FDG PET/CT can represent a more powerful tool to detect early bone metastases in lung cancer than with traditional bone scans.

Topics: Aged; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; False Negative Reactions; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Several guidelines have indicated that in patients with well-differentiated or moderately well-differentiated prostate cancer (PCa), a staging bone scan may be omitted. However, the guidelines recommendations have not yet been externally validated.. The aim of the study was to externally validate the available guidelines regarding the need for a staging bone scan in patients with newly diagnosed PCa. Moreover, we developed a novel risk stratification tool aimed at improving the accuracy of these guidelines.. The study included 853 consecutive patients diagnosed with PCa between January 2003 and June 2008 at a single centre. All patients underwent bone scan using technetium Tc 99m methylene diphosphonate at diagnosis.. The area under the curve (AUC) of the criteria suggested by the guidelines (European Association of Urology, American Urological Association, National Comprehensive Cancer Network, and American Joint Committee on Cancer) to perform a baseline bone scan was assessed and compared with the accuracy of a classification and regression tree (CART) including prostate-specific antigen (PSA), clinical stage, and biopsy Gleason sum as covariates.. The AUC of the guidelines ranged between 79.7% and 82.6%. However, the novel CART model, which stratified patients into low risk (biopsy Gleason ≤7, cT1-T3, and PSA <10 ng/ml), intermediate risk (biopsy Gleason ≤7, cT2/T3, and PSA >10 ng/ml), and high risk (biopsy Gleason >7) was significantly more accurate (AUC: 88.0%) than all the guidelines (all p≤0.002). The limitation of this study resides in its retrospective design. Moreover, the proposed risk stratification tool can be considered only for patients who are candidates for radical prostatectomy until validated in other clinical settings.. This is the first study aimed at externally validating the available guidelines addressing the need for staging baseline bone scans in PCa patients. All guidelines showed high accuracy. However, their accuracy was significantly lower compared with the accuracy of the novel risk stratification tool. According to this tool, staging bone scans might be considered only for patients with a biopsy Gleason score >7 or with a PSA >10 ng/ml and palpable disease (cT2/T3) prior to treatment. However, before recommending its use in clinical practice, our model needs to be externally validated.

Topics: Adult; Aged; Aged, 80 and over; Algorithms; Area Under Curve; Biopsy; Bone Neoplasms; Decision Support Techniques; Humans; Italy; Least-Squares Analysis; Logistic Models; Male; Middle Aged; Neoplasm Staging; Odds Ratio; Patient Selection; Practice Guidelines as Topic; Predictive Value of Tests; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Technetium Tc 99m Medronate; Time Factors

Topics: Algorithms; Biopsy; Bone Neoplasms; Decision Support Techniques; Humans; Male; Neoplasm Staging; Nomograms; Patient Selection; Practice Guidelines as Topic; Predictive Value of Tests; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Reproducibility of Results; Risk Assessment; Risk Factors; Technetium Tc 99m Medronate; Time Factors

Topics: Aged; Biological Transport; Bone Neoplasms; Female; Humans; Leg Bones; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate

We tried to assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) ((18)F-FDG-PET/CT) scan in detecting bone metastases in cancer patients and to compare the results with bone scan (BS) findings.. Seventy patients with a variety of neoplastic diseases, who had undergone both (18)F-FDG-PET/CT and BS and were eventually diagnosed as having metastatic bone disease, were enrolled in this study. The confirmation of the final diagnosis of bone metastasis was made by histopathological findings or clinical follow-up for 11 months, on average, including magnetic resonance imaging, (18)F-FDG-PET/CT or BS findings, showing progression of the lesions or their disappearance after therapy.. (18)F-FDG-PET/CT imaging detected bone involvement in 68 out of 70 patients with a sensitivity of 97.1%. In contrast, BS showed the presence of metastases in 60 patients (85.7%). PET/CT detected 666 out of 721 metastatic lesions correctly (92.3%), whereas BS detected 506 lesions totally (70.1%). PET/CT revealed organ metastases in 24 patients and in seven patients with unknown primary; PET/CT also depicted primary tumor.. (18)F-FDG-PET/CT is more sensitive than BS in detecting bone metastasis in patients with neoplastic diseases. (18)F-FDG-PET/CT has the advantage of detecting unknown primary cancers and visceral metastases besides bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Positron-Emission Tomography; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

This investigation was undertaken to evaluate the significance of solitary bony abnormalities on bone scintigrams of children with known or suspected malignancy. A total of 215 bone scans were performed in 183 children in order to look for possible metastasis over a 10-year period. Forty-nine scans (22.8%) were found to have single lesions, of which 18 were due to uptake at the primary site and were excluded from further consideration. Of the remaining 31 lesions, 13 (41.9%) were confirmed as metastases, 17 lesions were proved to be benign, and 1 indeterminate. Solitary hot spots in children with known or suspected malignancy are common and therefore have to be taken seriously due to their higher malignant potential.

Topics: Adolescent; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Humans; Infant; Infant, Newborn; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Aged, 80 and over; Biological Transport; Bone and Bones; Bone Neoplasms; False Positive Reactions; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Trachea

Favorable vertebroplasty outcomes reflect accurate preoperative identification of vertebral fracture targets, operator proficiency, and assiduous fracture aftercare. Conventional teaching is that nuclear bone scintigraphy is not helpful in the management of osteolytic myeloma bone disease. Nuclear bone scintigraphy in two patients with multiple myeloma and vertebral fracture pain convincingly identified the fracturing vertebral level and provided confidence that synchronous vertebral fractures were not missed, whereas neither had been appreciated by either radiography or magnetic resonance imaging.

Topics: Aged; Bone Neoplasms; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Positron-Emission Tomography; Predictive Value of Tests; Preoperative Care; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae; Vertebroplasty

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

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

We recently experienced a case of cerebral infarction incidentally found by whole body bone scintigraphy for the detection of bone metastasis from renal cell carcinoma. Additional bone SPECT and brain MR fusion images clearly demonstrated the wedge-shaped uptake of tracer corresponded to the abnormal intensity reflecting subacute cerebral infarction. Follow-up bone scan and fused images with MRI showed complete resolution of the abnormal uptake in chronic phase. A breakdown in the normal blood-brain barrier results in abnormal ionic calcium flux into the cells following altered cell membrane integrity leading to precipitation of calcium salts which eventually binds to bone imaging tracer such as (99m)Tc-methylene diphosphonate. That is, increased accumulation of bone seeking agents represents lethal cell death. The recent development of software and hardware has enabled the fusion of functional and anatomic images. Image fusion between SPECT with various tracers and MRI is expected to provide clues as to the underlying cause of diseases and to decide our treatment planning in the near future.

Topics: Bone Neoplasms; Carcinoma, Renal Cell; Cerebral Infarction; Endocarditis; Humans; Image Processing, Computer-Assisted; Incidental Findings; Magnetic Resonance Imaging; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

This study aims to compare the sensitivity of whole-body MRI with bone scintigraphy in the detection of bone metastases in patients with renal cancer. A prospective study was carried out in 47 patients with renal cancer (mean age 62 years, range 29-79 years). All patients had assessment of the skeleton with whole-body bone scintigraphy (with technetium-99m methylene diphosphonate) and whole-body MRI (coronal T(1) weighted and short tau inversion recovery sequences). The number and sites of bony metastases were assessed on each imaging investigation independently. Sites of extra-osseous metastasis on MRI were also noted. The imaging findings were correlated with other imaging modalities and follow-up. 15 patients (32%) had bone metastases at 34 different sites. Both scintigraphy and MRI were highly specific (94% and 97%, respectively), but the sensitivity of MRI (94%) was superior (p = 0.007) to that of scintigraphy (62%). MRI identified more metastases in the spine and appendicular skeleton, whereas scintigraphy showed more lesions in the skull/facial and thoracic bones. MRI identified extra-osseous metastases in 33 patients (70%), these were mainly lung and retroperitoneal in site. Whole-body MRI is a more sensitive method for detection of bone metastases in renal cancer than bone scintigraphy, and also allows the assessment of soft-tissue disease.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Renal Cell; Female; Humans; Kidney Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

The aim of this multicenter study was to investigate whether a computer-assisted diagnosis (CAD) system could improve performance and reduce interobserver variation in bone-scan interpretations of the presence or absence of bone metastases.. The whole-body bone scans (anterior and posterior views) of 59 patients with breast or prostate cancer who had undergone scintigraphy for suspected bone metastatic disease were studied. The patients were selected to reflect the spectrum of pathology found in everyday clinical work. Thirty-five physicians working at 18 of the 30 nuclear medicine departments in Sweden agreed to participate. The physicians were asked to classify each case for the presence or absence of bone metastasis, without (baseline) and with the aid of the CAD system (1 y later), using a 4-point scale. The final clinical assessments, based on follow-up scans and other clinical data including the results of laboratory tests and available diagnostic images (such as MRI, CT, and radiographs from a mean follow-up period of 4.8 y), were used as the gold standard. Each physician's classification was pairwise compared with the classifications made by all the other physicians, resulting in 595 pairs of comparisons, both at baseline and after using the CAD system.. The physicians increased their sensitivity from 78% without to 88% with the aid of the CAD system (P < 0.001). The specificity did not change significantly with CAD. Percentage agreement and kappa-values between paired physicians on average increased from 64% to 70% and from 0.48 to 0.55, respectively, with the CAD system.. A CAD system improved physicians' sensitivity in detecting metastases and reduced interobserver variation in planar whole-body bone scans. The CAD system appears to have significant potential in assisting physicians in their clinical routine.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Diagnosis, Computer-Assisted; Female; Humans; Male; Middle Aged; Observer Variation; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

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

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

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.

Topics: Aged; Alkaline Phosphatase; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Medical Records; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

The aim of the study was to compare the diagnostic accuracy of (18)F-fluorodeoxyglucose (FDG) PET/CT versus standard planar bone scintigraphy (BS) and (18)F-labelled NaF ((18)F) PET for the detection of bone metastases (BM) in non-small cell lung cancer (NSCLC).. (18)F-FDG PET/CT was performed in 126 patients with NSCLC. Within 7 days BS (n = 58) or (18)F PET (n = 68) was performed. (18)F-FDG PET/CT, BS and (18)F PET were evaluated by two experienced readers. Lesions were graded on a scale from 1 (definite BM) to 5 (degenerative lesion), and equivocal lesions were determined as indifferent (grade 3).. A total of 92 patients showed degenerative lesions (grade 4/5) on PET/CT, BS or (18)F PET. In 34 patients (27%) BM lesions were diagnosed (grades 1 and 2). In 13 of 18 patients BM were concordantly diagnosed with PET/CT and (18)F PET. PET/CT showed more BM compared to (18)F PET (53 vs 40). In one patient one osteolytic BM was false-negative on (18)F PET. However, (18)F PET identified four patients with BM compared to negative findings on PET/CT. Of 16 patients, 11 had concordant findings of BM on PET/CT and BS. In three patients BS was false-negative and in two patients BM were diagnosed as indifferent.. Integrated (18)F-FDG PET/CT is superior to BS in the detection of osteolytic BM in NSCLC. Thus, PET/CT may obviate the need to perform additional BS or (18)F PET in the staging of NSCLC, which significantly reduces costs.

Topics: Bone and Bones; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Fluorides; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Positron-Emission Tomography; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Diagnosis, Differential; Female; Humans; Indium Radioisotopes; Meningioma; Middle Aged; Osteoblasts; Radionuclide Imaging; Sphenoid Bone; 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

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

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

Osteoid osteoma is a benign tumor commonly found in young patients. The most interesting feature of the tumor is its peculiar obvious pain. The intensity of pain produced by osteoid osteoma is unproportionate to its nature and size. Much has been written about the mechanism of this symptom of the tumor and the specific characteristics of the pain that can be misleading when appearing as radicular pain especially when some subtle neurologic signs and symptoms accompany the pain. In this article, 12 patients who were referred to our clinic with radicular pain and neurological signs and symptoms months after initiation of symptoms between 2000 and 2008 are presented. Of these 12 patients, most were first thought to have root compression disease before being referred to our hospital. Precise history taking and special attention to physical examinations led to a suspicion of osteoid osteoma. Plain radiographs, computed tomography, and bone scans indicated osteoid osteoma, and excisional biopsy confirmed its diagnosis. Osteoid osteoma should always be considered in young patients with radicular pain, even with subtle neurological signs and symptoms.

Topics: Adolescent; Algorithms; Bone Neoplasms; Child; Diagnosis, Differential; Female; Humans; Male; Nerve Compression Syndromes; Osteoma, Osteoid; Pain Measurement; Radiculopathy; Retrospective Studies; Technetium Tc 99m Medronate; Young Adult

A rare case of osteogenic sarcoma (OGS) of the left humerus metastasizing to the right breast is presented. This lesion was detected by serendipitous observation on (99m)Tc-MDP skeletal scintigraphy that demonstrated a rounded focus just outside the skeletal outline of the right chest. The focus remained at a similar location on repeat postwash view. Clinical examination revealed a breast mass corresponding to the site of uptake, and a biopsy of this mass revealed it to be a metastasis of osteogenic sarcoma. The present case demonstrates a rare site of metastasis from OGS of the left humerus to the contralateral breast and hence is reported here as an unusual case vignette.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Humerus; Incidental Findings; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Female; Gated Blood-Pool Imaging; Humans; Incidental Findings; Lung Neoplasms; Middle Aged; Pulmonary Circulation; Radiopharmaceuticals; Small Cell Lung Carcinoma; Technetium Tc 99m Medronate

Incidental extraosseous uptake seen on Tc-99m methylene diphosphonate (MDP) bone scan is not unusual. We discuss here an incidental thyroid uptake in a 55-year-old female patient affected by breast cancer treated by total mastectomy, who underwent total body bone scintigraphy as a staging study. In the positron emission tomography era, traditional nuclear medicine imaging still has an important role in the diagnostic field, and incidental findings may be very useful in patient management, revealing unknown diseases and allowing correct therapeutic decisions.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Goiter, Nodular; Humans; Incidental Findings; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Gland

Local bone tumor excision followed by pasteurization and reimplantation is a unique technique of reconstruction for sarcoma patients. The long-term scintigraphic findings of pasteurized bone grafts in relation to clinical patients' data were reviewed retrospectively.. Twenty-two sarcoma patients (mean age, 24 years) done between April 2000 and January 2004 constituted the material of this study. One hundred and fifty-two 99 m TC-methylene diphosphonate (MDP) whole-body scans were reviewed. Initially, all autografts appeared as photon deficient areas. Diffusely increased bone uptake was present at the osteotomy sites within 4-6 months after surgery, the uptake of the grafted pasteurized bone was detected in 17 patients from about 6 months after surgery.. Of 22 patients, 11 (50%) showed higher uptake than the normal bone, 6 (27%) had uptake similar to the normal bone, while 5 (23%) had less uptake than the normal bone. Radiologically, 15 patients (68%) showed complete incorporation of graft and 5 patients (23%) had partial incorporation. Oncologically, 16 patients are disease free, while 6 died of disease. No local recurrence was detected at a mean of 59 months, while fracture (13.6%) eventually healed with bone grafting and revision of internal fixation, graft collapse (9%) (needed revision arthroplasty) and infection (9%), one cured and one converted to rotationplasty, were the major complications encountered. Significantly more mechanical complications were seen when tracer uptake suggestive of revascularization occurred; thus, revascularization and partial bone ingrowth are not sufficient conditions for lower mechanical complication rate.. The method of pasteurization of bone is a useful option for reconstruction after resection of malignant bone tumors.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Bone Transplantation; Child; Follow-Up Studies; Humans; Humerus; Middle Aged; Osteosarcoma; Plastic Surgery Procedures; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sarcoma; Sarcoma, Ewing; Technetium Tc 99m Medronate; Transplantation, Autologous; Young Adult

In this article, we present a rare case of B-cell bone lymphoma in a child with multifocal asymptomatic lesions detected by bone scintigraphy and a chronic clinical history characterized by limping and fever episodes for over a year. Initially, multifocal osteomyelitis was suspected and antibiotic therapy was administered with no clinical improvement. The biopsy of the main lesion in the left distal femur along with bone marrow cytology established the final diagnosis. This rare case illustrates the utility of routinely low cost-effective nuclear medicine studies like whole body bone scan and 99mTc hexamethylpropyleneamine oxime-labeled leukocytes to orientate similar cases to a correct diagnosis.

Topics: Antineoplastic Agents; Bone Neoplasms; Child, Preschool; Diagnosis, Differential; Gait; Humans; Leukocytes; Lymphoma, B-Cell; Male; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Exametazime; Technetium Tc 99m Medronate

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

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

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

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

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Osteoarthropathy, Secondary Hypertrophic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Chronic pain is one of the most frequent and distressing symptoms in patients suffering from bone metastases due to malignant disease. Besides pharmacological therapy using analgesics according to the WHO scheme and local surgical or radiotherapeutic treatment options, systemic radionuclide therapy is available, particularly for patients with multilocular metastatic disease. This palliative pain treatment is almost free of severe side effects and is thus indicated as a complementary therapy as part of an interdisciplinary approach in pain treatment. Moreover, preliminary data indicate a favorable cost:utility ratio. Positive clinical effects with marked reduction of pain are described in 70-80% of patients with breast or prostate cancer. However, complete analgesia is uncommon and, thus, most patients require analgesic treatment during the further course of their disease.

Topics: Aged; Bone Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Neoplasms; Pain; Prostatic Neoplasms; Radiography; Radioisotopes; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Carbon Radioisotopes; Cell Proliferation; Choline; Diagnosis, Differential; Femur; Humans; Inflammation; Lumbar Vertebrae; Lymphatic Metastasis; Male; Osteitis Deformans; Pelvic Bones; Positron-Emission Tomography; Prostatectomy; Prostatic Neoplasms; Reference Values; Sacrum; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tibia; Tomography, X-Ray Computed; Whole Body Imaging

Topics: Aged, 80 and over; Athletic Injuries; Bone Neoplasms; Exercise; Humans; Male; Muscles; Prostatic Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To determine when a bone scan investigation is appropriate in asymptomatic men diagnosed with prostate cancer.. Between November 2005 and July 2006, 317 men with prostate cancer underwent a bone scan study; 176 men fulfilled the inclusion criteria. Prostate-specific antigen (PSA) cut-offs as well as univariate and multivariate logistic regression analyses using digital rectal examination finding, biopsy Gleason scores and age were performed to determine when a bone scan study is likely to be of value.. Only 1/61 men (1.6%) with a serum PSA 20 ng/mL had a positive bone scan. However, 2/38 men (4.7%) with a serum PSA 20.1-40.0 ng/mL, 3/20 men (15%) with a serum PSA 40.1-60.0 ng/mL, 7/19 men (36.8%) with a serum PSA 60.1-100.0 ng/mL and 19/38 men (50%) with a serum PSA > 100.0 ng/mL had positive bone scans. Univariate and multivariate logistic regression analyses were uninformative in these groups.. Based on our findings, a bone scan is of limited value in asymptomatic prostate cancer patients presenting PSA =or< 20 ng/mL. Therefore, this investigation can be eliminated unless a curative treatment is contemplated. Furthermore, digital rectal examination finding, biopsy Gleason score and age are unhelpful in predicting those who might harbor bone metastasis.

Topics: Aged; Aged, 80 and over; Analysis of Variance; Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

The purpose of this study was to develop a computer-assisted diagnosis (CAD) system based on image-processing techniques and artificial neural networks for the interpretation of bone scans performed to determine the presence or absence of metastases.. A training group of 810 consecutive patients who had undergone bone scintigraphy due to suspected metastatic disease were included in the study. Whole-body images, anterior and posterior views, were obtained after an injection of (99m)Tc-methylene diphosphonate. The image-processing techniques included algorithms for automatic segmentation of the skeleton and automatic detection and feature extraction of hot spots. Two sets of artificial neural networks were used to classify the images, 1 classifying each hot spot separately and the other classifying the whole bone scan. A test group of 59 patients with breast or prostate cancer was used to evaluate the CAD system. The patients in the test group were selected to reflect the spectrum of pathology found in everyday clinical work. As the gold standard for the test group, we used the final clinical assessment of each case. This assessment was based on follow-up scans and other clinical data, including the results of laboratory tests, and available diagnostic images, such as from MRI, CT, and radiography, from a mean follow-up period of 4.8 y.. The CAD system correctly identified 19 of the 21 patients with metastases in the test group, showing a sensitivity of 90%. False-positive classification of metastases was made in 4 of the 38 patients not classified as having metastases by the gold standard, resulting in a specificity of 89%.. A completely automated CAD system can be used to detect metastases in bone scans. Application of the method as a clinical decision support tool appears to have significant potential.

Topics: Aged; Aged, 80 and over; Algorithms; Bone Neoplasms; Female; Humans; Image Enhancement; Image Interpretation, Computer-Assisted; Male; Middle Aged; Neural Networks, Computer; Pattern Recognition, Automated; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

The aim of the study was to evaluate the value of the single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging in the diagnosis of benign and malignant lesions in bones.. One hundred and forty one bone lesions of 125 cancer patients, for whom the natures of the lesions were not able to be determined by the 99Tc(m)-MDP whole-body bone scan, were examined by the SPECT, CT and SPECT/CT fusion imaging simultaneously. All of the images were blindly interpreted independently by two experienced nuclear medicine physicians. The natures of the lesions were eventually confirmed by MRI, pathology or follow-up diagnosis six months later.. The diagnostic sensitivity of SPECT, SPECT+CT and SPECT/CT for the 141 bone lesions was 82.5%, 93.7%, and 98.4% respectively. The specificity was 66.7%, 80.8%, and 93.6% respectively. The accuracy was 73.8%, 86.5%, and 95.7% respectively. The specificity and accuracy of SPECT/CT for diagnosing bone lesions were significantly higher than those of SPECT and SPECT+CT (P<0.05).. SPECT/CT can effectively differentiate benign and malignant bone lesions.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The role of 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in identifying bone metastases in patients with head and neck cancer is not clear. We compared the ability of FDG-PET and bone scintigraphy (BS) to detect bone metastases in patients with upper aerodigestive tract (UADT) malignancies. Patients with histologically confirmed malignancies in the UADT underwent both FDG-PET and BS at initial staging or follow-up. The two methods were compared in patients and in seven skeletal regions. Maximum standard uptake value (SUVmax) on PET was calculated in each lesion and compared between true- and false-positive lesions. This study included 564 eligible patients, of whom 17 had bone metastases. The spine was the most frequently involved site, followed by the lungs and liver. Both FDG-PET and BS had high specificity, accuracy, and negative predictive values for detecting bone metastases (>95% each), and the two methods did not differ in sensitivity, specificity, and predictive values (P>0.05). Both FDG-PET (n=15) and BS (n=14) yielded a significant number of false-positive results, which could be corrected by further work-ups and follow-up imaging. Compared with true-positive lesions, the false-positive lesions on FDG-PET were usually single (86.7% vs. 12.5%, P<0.001) and had lower mean SUVmax (2.4 vs. 5.6, P<0.001). FDG-PET is not more accurate than BS for detecting bone metastasis in patients with UADT cancer. Positive findings on FDG-PET or BS require further confirmation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Cohort Studies; Female; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity; Statistics, Nonparametric; Technetium Tc 99m Medronate; Whole Body Imaging; Whole-Body Counting

Topics: Adolescent; Bone Cysts, Aneurysmal; Bone Neoplasms; Bone Transplantation; Chondroblastoma; Diagnosis, Differential; Femur; Hip; Humans; Magnetic Resonance Imaging; Male; Pain; Radiopharmaceuticals; Synovitis, Pigmented Villonodular; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome; Whole Body Imaging

Topics: Adolescent; Biopsy; Bone Neoplasms; Chronic Disease; Diagnosis, Differential; Genetic Testing; Humans; In Situ Hybridization, Fluorescence; Joint Diseases; Knee Joint; Male; Pain, Intractable; Positron-Emission Tomography; Sarcoma, Ewing; Technetium Tc 99m Medronate; Thigh; Tomography, X-Ray Computed

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Osteoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporal Bone

A number of studies have demonstrated the value of performing spinal SPECT in addition to planar scintigraphy for the diagnosis of bone metastases. This has not been demonstrated in an African population, however, where patients typically present with more advanced disease.. To investigate the contribution of bone SPECT to the diagnosis of bone metastases in an African population.. In a retrospective survey the studies of all patients with known primary tumours who underwent skeletal scintigraphy for the diagnosis of bone metastases during one calendar year were reviewed. The studies of patients who underwent both planar imaging and SPECT were reinterpreted. Blinded to the SPECT study, the planar studies were graded for probability of metastatic disease using a four-point scale, and the number of spinal lesions was noted. This was repeated with the planar and SPECT studies reviewed together. The interpretation using the planar images alone was compared with that obtained after the addition of SPECT using non-parametric tests. Of a total of 576 patients, 119 (45 men and 74 women) underwent planar and SPECT imaging.. The addition of SPECT resulted in a significant change in the interpretation of these studies (P<0.05), and a significantly lower proportion of patients had equivocal gradings (P<0.01). However, the actual numbers of patients affected was relatively small, varying from six to 21, representing about 5-18% of the 119 patients who underwent an additional SPECT. Furthermore, of the total population of 576 patients with known malignancies undergoing bone scintigraphy for bone metastases, the availability of SPECT only resulted in an altered classification in 1-4%. Equivocal planar gradings were far more likely to be altered following the addition of SPECT. The addition of SPECT also resulted in the detection of significantly more spinal lesions (P<0.01).. In a setting where SPECT is not easily available, planar imaging alone is still adequate in the vast majority of cases.

Topics: Aged; Bone Neoplasms; Female; Humans; Male; Middle Aged; Prevalence; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; South Africa; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to investigate, in a nationwide study, the inter-observer variation and performance in interpretations of bone scans regarding the presence or absence of bone metastases.. Bone scan images from 59 patients with breast or prostate cancer, who had undergone scintigraphy due to suspected bone metastatic disease, were studied. The patients were selected to reflect the spectrum of pathology found in everyday clinical work. Whole body images, anterior and posterior views, were sent to all 30 hospitals in Sweden that perform bone scans. Thirty-seven observers from 18 hospitals agreed to participate in the study. They were asked to classify each of the patient studies regarding the presence of bone metastasis, using a four-point scale. Each observer's classifications were pairwise compared with the classifications made by all the other observers, resulting in 666 pairs of comparisons. The interpretations of the 37 observers were also compared with the final clinical assessment, which was based on follow-up scans and other clinical data.. On average, two observers agreed on 64% of the bone scan classifications. Kappa values ranged between 0.16 and 0.82, with a mean of 0.48. Sensitivity and specificity for the observers compared with the final clinical assessment were 77% and 96%, respectively, for detecting bone metastases in planar whole-body bone scanning.. Moderate inter-observer agreement was found when observers were compared pairwise. False-negative errors seem to be the major problem in the interpretations of bone scan images, whilst the specificities for the observers were high.

Topics: Bone Neoplasms; Data Collection; Female; Humans; Male; Observer Variation; Professional Competence; Quality Assurance, Health Care; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Sweden; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Esophageal Neoplasms; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Staging; Patient Satisfaction; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed; Whole Body Imaging

Topics: Bone Neoplasms; Humans; Incidental Findings; Infarction, Middle Cerebral Artery; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Non-Hodgkin lymphoma (NHL) is rare in infancy, and we present a case of aggressive NHL of T-cell lineage in an infant with multifocal bone, cardiac, mediastinal nodal, paranasal sinus, calvarial, and soft-tissue deposits on presentation that were detected on whole-body MRI.

Topics: Bone Neoplasms; Heart Neoplasms; Humans; Infant; Lymph Nodes; Lymphoma, T-Cell; Magnetic Resonance Imaging; Male; Mediastinal Neoplasms; Paranasal Sinus Neoplasms; Radiopharmaceuticals; Skull Base Neoplasms; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Topics: Bone Neoplasms; Brain Neoplasms; Glioma; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Metatarsal Bones; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To assess the value of (99m)Tc-MDP bone scintigraphy in the staging of primary bone lymphoma.. Thirteen staging scintigrams of patients with biopsy proven primary bone lymphoma were reviewed. The number and location of involved sites of disease were documented in each case.. Seven out of 13 scintigrams (54%) demonstrated a single site of bone involvement. Six cases (46%) showed multifocal disease, including clinically silent weight-bearing sites.. Bone scintigraphy is a valuable tool in the staging of primary bone lymphoma. It detects multifocal involvement which alters prognosis and possibly treatment. Clinically silent involvement of weight-bearing sites may be detected allowing prophylactic treatment if required.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Humans; Image Enhancement; Lymphoma; Male; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To determine if a correlation exists between the semiquantitative bone scintigraphy index (SQBSI) and serum tartrateresistant acid phosphatase 5b (TRACP5b) activity, a novel osteoclast marker that has been shown to be useful for monitoring bone metastasis in breast cancer (BC) patients.. Among patients enrolled in 2 prospective studies conducted at Tri-Service General Hospital, Taipei, Taiwan, between December 2000 and July 2002, we identified post hoc 52 patients with both BC and bone metastasis who had detailed records of clinical condition, bone scintigraphy, and concordant serum TRACP5b levels. Between January 1, 2003, and December 31, 2005, we performed bone scintigraphy and serum TRACP5b activity assays to monitor these patients, while they were treated according to clinical need. To assess clinical condition, we obtained information from patient records, such as performance status and visual analogue pain score, as well as from selected laboratory tests for tumor markers and serum TRACP5b activity. Those patients with BC and bone metastasis who had undergone whole-body bone scintigraphy and serum TRACP5b activity determination before any therapeutic intervention were designated the pretreated group (n=30). We developed our own formula for calculating SQBSI on the basis of bone scintigraphy findings.. A significant correlation was observed between SQBSI and serum TRACP5b activity in pretreated BC patients with bone metastasis, but the strength of the correlation lessened after treatment. No significant correlation was noted between the change in serum TRACP5b activity and the change in SQBSI in treated patients. Compared with the change in SQBSI, the change in TRACP5b activity had higher sensitivity, specificity, and positive predictive value as well as a greater likelihood ratio for reflecting the clinical scenarios of bone morbidity over time.. As monitors of the response of bone metastasis in BC to treatment, serial determinations of serum TRACP5b activity and SQBSI were both shown to be useful by our preliminary findings. However, serum TRACP5b activity proved the better monitoring tool. If follow-up studies were conducted within 6 months, the combined use of SQBSI and TRACP5b would allow distinction of genuine disease progression from the "flare" phenomenon, in which bone metastasis can appear to progress in bone scintigraphic images although clinical symptoms improve. Larger prospective studies are needed to confirm these findings.

Topics: Acid Phosphatase; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Disease Progression; Female; Follow-Up Studies; Humans; Isoenzymes; Middle Aged; Osteoclasts; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Remission Induction; Sensitivity and Specificity; Tartrate-Resistant Acid Phosphatase; Technetium Tc 99m Medronate; Whole Body Imaging

Metastases from bladder cancer to the bones of the hands or feet are rare and usually present after the diagnosis of the primary lesion has been made. This case report describes a 76-year-old man presenting with initial signs of infection of the right foot. Subsequent bone scan revealed multiple bony metastases and hydronephrosis raising the possibility of a primary bladder tumour that was later confirmed by urine cytology and fine needle aspiration of the foot.

Topics: Aged; Bone Neoplasms; Carcinoma, Transitional Cell; Foot; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urinary Bladder Neoplasms

Inguinoscrotal herniation of the bladder is a rare clinical entity. The condition is often diagnosed incidentally or during the course of surgical repair of inguinal hernias. In a smaller number of cases, bladder hernia can be seen during nuclear medicine studies. We report a rare case of massive inguinoscrotal bladder herniation with ureter, causing urinary stasis on bone scintigraphy.

Topics: Bone Neoplasms; Hernia, Inguinal; Humans; Incidental Findings; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ureteral Diseases; Urinary Bladder Diseases

Topics: Abnormalities, Multiple; Bone and Bones; Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Neoplasms

The aim of this study was to assess the value of Tc-99m-hexakis-2-methoxyisobutylisonitrile (MIBI) scintigraphy diagnosing the malignant and benign bone lesions in comparison with a conventional bone tracer 99Tm-methylene-diphosphonate (MDP).. 99Tc(m)-MDP three-phase bone scintigraphy and 99Tc(m)-MIBI dynamic and quiet states scintigraphy were obtained from 39 patients with proved malignant diseases or suspected bone metastases after bolus injected intravenously radiopharmaceuticals, respectively. The results were compared with using film reading and regions of interesting (ROI) technique.. 139 bone metastases were confirmed in 169 lesions. The sensitivity of 99Tc(m)-MDP or 99Tc(m)-MIBI scintigraphy was 90.3% or 68.4% (P < 0.05), respectively; the specificity was 33.3% or 96.7% (P < 0.05), respectively;the false positive rate was 6.71% or 1.04%. No statistical difference was appeared in both malignant tumors and benign lesions with 99Tc(m)-MDP scintigraphy. However, while with 99Tc(m)-MIBI scintigraphy, there were significant statistical difference (P < 0.05) both in malignant tumors and benign lesions. 99Tc(m)-MIBI scintigraphy could early detect 17 bone metastases and proved 11 lesions to be benign bone foci and 2 to be pathologic bone fractures.. Although 99Tc(m)-MIBI scintigraphy has lower general sensitivity than 99Tc(m)-MDP scintigraphy, it has higher specificity, lower false positive rate and can detect lesions early and judge the quality, which may be helpful in the evaluation and strategy of clinical therapy for bone metastases.

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

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

We present a case of thymic carcinoid, in which primary and metastatic lesions of lymph nodes and bones could be detected by [(18)F]fluoro-2-deoxy-D-glucose (FDG)-PET, but not by (123)I-meta-iodobenzylguanidine ((123)I-MIBG) SPECT, or by (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy. FDG-PET may be a useful tool for managing thymic carcinoids in patients with negative results on (123)I-MIBG SPECT or (99m)Tc-MDP imaging.

Topics: 3-Iodobenzylguanidine; Aged; Bone Neoplasms; Carcinoid Tumor; Fluorodeoxyglucose F18; Humans; Iodine Radioisotopes; Lymphatic Metastasis; Male; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thymus Neoplasms

Traditionally, Tc 99m methyl diphosphate (MDP) bone scintigraphy provides high-sensitivity detection of skeletal metastasis from breast and lung cancers in regular follow-up. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), based on the glucose metabolism of malignant cells, plays a role in describing tumor growth, proliferation of neoplasm and the extent of metastasis. In general, concordant findings of skeletal metastasis are seen on both types of image, especially in cases of breast and lung cancer. However, there were extremely discordant findings of skeletal metastasis between bone scans and F 18 FDG PET/CT imaging in two cases among 300 consecutive F 18 FDG PET/CT follow-up exams of patients with malignancies, during the past year, in our center. Both cases, one of breast cancer and one of lung cancer, had negative bone scintigraphic findings, but a diffusely high grade of F 18 FDG avid marrow infiltration in the axial spine, leading to the diagnosis of stage IV disease in both cases. Owing to variant genetic aberrance of malignance, F 18 FDG PET/CT reveals direct evidence of diffuse, rapid neoplasm metabolism in the bone marrow of the spine, but not of secondary osteoblastic reactions in vivo . F 18 FDG PET/CT should always be employed in the follow-up of patients with malignancies.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq (99m)Tc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of +/-20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within +/-19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Esophageal Neoplasms; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Staging; Patient Satisfaction; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed; Whole Body Imaging

The literature is replete with cases of Tc-99m bone imaging agent uptake in pleural effusions. Far rarer is the report of photopenia in a pleural effusion. In this case of malignant mesothelioma, we describe a unique case of unilateral hemithoracic photopenia from a pleural effusion with concomitant uptake in the contralateral lung resulting from calcified pleural plaques. Although initially perplexing clinically, this case can be readily explained with an understanding of basic physiological principles.

Topics: Aged, 80 and over; Bone Neoplasms; Diagnosis, Differential; False Positive Reactions; Humans; Male; Mesothelioma; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone metastases are of the most frequent in prostate cancer. Serum prostate specific antigen--PSA has been suggested as an accurate means of monitoring prostate cancer. Whole body scintigraphy are currently the most widely used diagnostic procedures for metastases to the bone, the most common site of distant tumor spread. Aim of the study was to determinate relation between PSA level, number of metastases and 99mTc- MDP (methyl-diphosponate) uptake in patients with previous prostatectomy for prostate cancer.. Study enrolled 15 patients after previous prostatectomy for prostate cancer (histologically proven). Standard whole body scintigraphy (WBS) was performed 3 hours after intravenous application of 740 MBq 99mTc-MDP. Total PSA was measured by MEIA-Microparticle Enzyme Immunoassay.. Group 1: 12/15 (80%) patients were with WBS detected metastases. Correlation of PSA level and number of detected bone metastases was good (r=0.79). Correlation of PSA level and uptake intensity of 99mTc-MDP (score 3) was positive and significant (r=0.706).. PSA values were highly predictive for WBS results. PSA values correlated well with number of metastases. We propose no WBS in patients with normal PSA level. WBS is a sensitive diagnostic tool for detecting prostate cancer metastases to bone. PSA levels is good and simpler marker for disease progression, but that neither technique in isolation gives complete accuracy.

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

The aim of this study was to compare the detection of bone metastases by 99mTc-methylene diphosphonate (99mTc-MDP) planar bone scintigraphy (BS), SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT in patients with high-risk prostate cancer.. In a prospective study, BS and 18F-Fluoride PET/CT were performed on the same day in 44 patients with high-risk prostate cancer. In 20 of the latter patients planar BS was followed by single field-of-view (FOV) SPECT and in 24 patients by multi-FOV SPECT of the axial skeleton. Lesions were interpreted separately on each of the 4 modalities as normal, benign, equivocal, or malignant.. In patient-based analysis, 23 patients had skeletal metastatic spread (52%) and 21 did not. Categorizing equivocal and malignant interpretation as suggestive for malignancy, the sensitivity, specificity, positive predictive value, and negative predictive value of planar BS were 70%, 57%, 64%, and 55%, respectively, of multi-FOV SPECT were 92%, 82%, 86%, and 90%, of (18)F-Fluoride PET were 100%, 62%, 74%, and 100%, and of 18F-Fluoride PET/CT were 100% for all parameters. Using the McNemar test, 18F-Fluoride PET/CT was statistically more sensitive and more specific than planar or SPECT BS (P < 0.05) and more specific than 18F-Fluoride PET (P < 0.001). SPECT was statistically more sensitive and more specific than planar BS (P < 0.05) but was less sensitive than 18F-Fluoride PET (P < 0.05). In lesion-based analysis, 156 lesions with increased uptake of 18F-Fluoride were assessed. Based on the corresponding appearance on CT, lesions were categorized by PET/CT as benign (n = 99), osteoblastic metastasis (n = 46), or equivocal when CT was normal (n = 11). Of the 156 18F-Fluoride lesions, 81 lesions (52%), including 34 metastases, were overlooked with normal appearance on planar BS. SPECT identified 62% of the lesions overlooked by planar BS. 18F-Fluoride PET/CT was more sensitive and more specific than BS (P < 0.001) and more specific than PET alone (P < 0.001).. 18F-Fluoride PET/CT is a highly sensitive and specific modality for detection of bone metastases in patients with high-risk prostate cancer. It is more specific than 18F-Fluoride PET alone and more sensitive and specific than planar and SPECT BS. Detection of bone metastases is improved by SPECT compared with planar BS and by 18F-Fluoride PET compared with SPECT. This added value of 18F-Fluoride PET/CT may beneficially impact the clinical management of patients with high-risk prostate cancer.

Topics: Aged; Bone Neoplasms; Fluorine Radioisotopes; Humans; Imaging, Three-Dimensional; Male; Positron-Emission Tomography; Prostatic Neoplasms; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To develop a completely automated method, based on image processing techniques and artificial neural networks, for the interpretation of bone scans regarding the presence or absence of metastases.. A total of 200 patients, all of whom had the diagnosis of breast or prostate cancer and had undergone bone scintigraphy, were studied retrospectively. Whole-body images, anterior and posterior, were obtained after injection of 99mTc-methylene diphosphonate. The study material was randomly divided into a training group and a test group, with 100 patients in each group. The training group was used in the process of developing the image analysis techniques and to train the artificial neural networks. The test group was used to evaluate the automated method. The image processing techniques included algorithms for segmentation of the head, chest, spine, pelvis and bladder, automatic thresholding and detection of hot spots. Fourteen features from each examination were used as input to artificial neural networks trained to classify the images. The interpretations by an experienced physician were used as the 'gold standard'.. The automated method correctly identified 28 of the 31 patients with metastases in the test group, i.e., a sensitivity of 90%. A false positive classification of metastases was made in 18 of the 69 patients not classified as having metastases by the experienced physician, resulting in a specificity of 74%.. A completely automated method can be used to detect metastases in bone scans. Future developments in this field may lead to clinically valuable decision-support tools.

Topics: Adult; Aged; Aged, 80 and over; Artificial Intelligence; Bone Neoplasms; Decision Support Techniques; Humans; Image Interpretation, Computer-Assisted; Middle Aged; Pattern Recognition, Automated; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Sensitivity and Specificity; Sweden; Technetium Tc 99m Medronate; Whole Body Imaging

The aim of this study was to evaluate the value of bone scintigraphy for the assessment of graft viability following vascularized bone grafts in patients with mandibular reconstruction.. We investigated 16 patients with vascularized grafts from the fibula (13 patients) and iliac crest (3 patients) in the last 8 years. For the follow up of all these patients, Tc-99m MDP bone scintigraphy was performed between 2-10 days postoperatively. SPECT study was included in 5 patients. For the evaluation of the grafts, a six-grade scoring system was used. The grading system was based on a comparison of tracer uptake between graft and the cranium. The uptake was defined as increasing from grade 6 to grade 1.. Thirteen of the 16 grafts had an uncomplicated clinical course. Complications in the graft occurred in three patients. In the analysis of planar scintigrams, patients with uncomplicated healing showed increased uptake in 12 of the 13 grafts (grade 1-3) and 1 showed the same level tracer uptake compared to cranium (grade 4). In the failed 3 grafts, decreased uptake was observed (grade 5 and 6). In 5 patients, SPECT was performed in addition to planar imaging. In these patients, 4 of the 5 grafts had an uncomplicated clinical course and 1 had a complicated one. In the analysis of SPECT images, while all the grafts with an uncomplicated clinical course exhibited increased uptake (grade 1-3), the failed graft showed decreased uptake (grade 6).. Three-phase bone scintigraphy performed within 10 days after the mandibular reconstruction is a useful tool to monitor the viability and early complications of vascularized mandibular bone grafts. SPECT is also recommended. It may contribute to interpretation of the bone scans and to precise assessment of graft viability.

Topics: Adult; Aged; Bone Neoplasms; Bone Transplantation; Female; Fibula; Graft Rejection; Humans; Ilium; Male; Mandible; Middle Aged; Plastic Surgery Procedures; Postoperative Care; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Surgical Wound Infection; Technetium Tc 99m Medronate; Treatment Outcome; Wound Healing

Diaphyseal medullary stenosis (DMS) is an extremely rare hereditary bone dysplasia, which was first described by Arnold in 1973. DMS has a high incidence of pleomorphic malignant fibrous histiocytoma (MFH). In this paper, we report the imaging findings of DMS with pleomorphic MFH of the bone, mainly describing 99mTc hydroxymethylenediphosphonate (HMDP) and thallium-201 (201Tl) chloride scintigraphy findings. On 99mTc HMDP scintigraphy, focal increased uptake area of the right femur corresponded to the area of bone marrow invasion of the tumor and bone infarction. The mechanism of the uptake of 99mTc HMDP to the extraosseous lesion was not clear. On 201Tl chloride scintigraphy, the increased uptake of the periphery of the mass seemed to reflect the aggressiveness of invasion and the cellularity.

Topics: Adult; Bone Neoplasms; Camurati-Engelmann Syndrome; Histiocytoma, Malignant Fibrous; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Osteolysis; Osteosarcoma; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate

It is important to recognize osteonecrosis of the jaws in patients treated with bisphosphonates because an early diagnosis can make a significant difference to the outcome of the disease. The aim of this study is to describe the radiological features of bisphosphonate osteonecrosis (BON) in order to aid its prompt recognition.. A conventional radiograph, a computed tomograph (CT), a magnetic resonance image (MRI) and a 99Tc(m)-MDP 3-phase bone scan were carried out for 11 patients with BON. The main imaging findings of osteonecrosis are described.. Conventional radiography and CT displayed osteolytic lesions with the involvement of cortical bone. MRI demonstrated the characteristic features of osteonecrosis and the oedema of soft tissues. Both CT and MRI were very useful in defining the extent of the lesions. 99Tc(m)-MDP three-phase bone scan was the most sensitive tool to detect the osteonecrosis at an early stage.. 99Tc(m)-MDP three-phase bone scans who could be used as a screening test to detect subclinical osteonecrosis in patients who have received bisphosphonates. CT scans and MRI are useful in defining the features and extent of osteolytic lesions.

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Bone Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Jaw Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Osteonecrosis; Radiography, Panoramic; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Zoledronic Acid

Initial staging of lung cancer is essential to determine the appropriate therapeutic strategy. 18F-FDG PET is currently considered to be the gold standard. 99mTc bisphonate bone scintigraphy has long been indicated to search for bone metastases but it is not know whether this exploration adds further information after an 18F-FDG PET scan. In order to answer this question, two observers unaware of the clinical situation reread PET scans and bone scintigraphies and results compared with other imaging findings. Between February 2001 and March 2004, 39 patients (13F, 26M, 62 +/- 11 yr) underwent 18FFDG PET and bone scintigraphy (mean interval 17 +/- 17 d). When the two explorations agreed for the diagnosis of bone extension, we considered that bone scintigraphy added nothing. When the two explorations were in disagreement, the other imaging examinations, the clinical features and laboratory results during the five-month minimal follow-up were used to establish the reference diagnosis. 18F-FDG PET and bone scintigraphy were in agreement in 29 patients (74%) with positive results in 12 (31%) and negative results in 17 (43%). The two explorations were in disagreement in 10 patients (26%). Among the five disagreement cases with positive bone scintigraphy and no bone anomaly on the 18F-FDG PET, the anomalies were benign and explained by clinical features (3 patients) or were not confirmed by the clinical course and laboratory results (2 patients). Among the 5 cases with a bone anomaly on the 18F FDG PET, no metastasis could be identified during clinical follow-up. Bone scintigraphy does not enable identification of any bone metastases which were not recognized on the PET scan and therefore should not be performed systematically. Using a computed tomography scan with the 18F-FDG PET could further limit the contribution of bone scintigraphy by providing more precision concerning foci identified on the PET scan.

Topics: Aged; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Observer Variation; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Technium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) are useful imaging modalities to detect skeletal metastases. Several other conditions such as infection, fractures, and arthritis can cause false-positive results with either modality. However, PET is felt to be more specific than bone scintigraphy for malignancy. Our objective was to investigate the value of PET scan compared with bone scintigraphy for directing biopsies in patients with suspected metastatic bone lesions.. Retrospective case series of subjects with undergoing skeletal biopsy of suspected metastases detected by 99mTc-MDP scintigraphy or 18F-FDG PET scan. Reference standards were pathologic reports and follow-up for 6 months. The diagnostic test performance measures of true positive (TP), false positive (FP), and positive predictive value (PPV) were calculated for each group. The PPV with 95% confidence intervals (CI) was compared using the Fisher exact test.. There were a total of 68 subjects. PET-directed skeletal biopsies (n = 39) showed 35 TP, 4 FP, and an 89.7% PPV (95% CI: 75.7-97.1%). Bone scintigraphy directed biopsies (n = 29) had 21 TP, 8 FP, and 72.4 % PPV (95% CI: 52.7-82.7%). The PPV was not significantly different between the groups (P = .10).. This study supports that PET can be used to effectively direct bone biopsies to confirm metastatic neoplasm and suggests that PET may provide incremental improvement to diagnostic yield over bone scintigraphy. The role of PET compared with bone scintigraphy for directing skeletal biopsies warrants further verification.

Topics: Biopsy; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed

To investigate the clinical and pathologic characteristics of patients with bone metastases identified at the time of newly diagnosed prostate carcinoma at biopsy.. From November 2002 to May 2004, 1587 consecutive patients had a pathologic diagnosis of prostate cancer and underwent conventional technetium-99m methylene diphosphonate scintigraphy of the entire body. The clinical and pathologic features of those patients with positive bone scan findings (group 1) were compared with those of a subcohort of 372 patients with negative bone scan findings performed at the same nuclear medicine department (group 2).. A retrospective complete data collection was available for 1242 of 1587 patients. Bone metastases were found in 31 patients (2.5%). As expected, patients with skeletal metastases had a significantly greater mean serum total prostate-specific antigen level, and a Gleason sum of 8 or 9 was significantly more frequent in the pathologic findings of these subjects. Group 1 patients had a significantly greater prevalence of previous nonprostate primary neoplasms (chi-square 12.74, df = 1, P = 0.0004) and reported a greater prevalence of current use of H2 blockers for the treatment and prevention of gastroesophageal reflux disorders (chi-square 37.52, df = 1, P < 0.0001) than did group 2 patients.. Our data have confirmed that bone metastases are more frequent in patients with high prostate-specific antigen levels and poorly differentiated tumors at biopsy regardless of the patient's age. A history of previous nonprostate primary neoplasms and the use of H2 blockers seemed to be more prevalent in those patients with bone metastases at diagnosis.

Topics: Aged; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has become widely available and an important oncological technique. To evaluate the influence of PET on detection of bone metastasis, we compared the diagnostic accuracy of PET and conventional bone scintigraphy (BS) in a variety of cancer patients.. Consecutive ninety-five patients with various cancers, who received both PET and BS within one month, were retrospectively analyzed. A whole-body PET (from face to upper thigh) and a standard whole body BS were performed and these images were interpreted by two experienced nuclear medicine physicians with and without patient information using monitor diagnosis. Each image interpretation was performed according to 8 separate areas (skull, vertebra, upper limbs, sternum and clavicles, scapula, ribs, pelvis, and lower limbs) using a 5-point-scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4: definitely positive for bone metastasis).. Twenty-one of 95 patients (22.1%) with 43 of 760 areas (5.7%) of bone metastases were finally confirmed. In untreated patients, 12 of 14 bone metastasis positive patients were detected by PET, while 9 of 14 were detected by BS. Three cases showed true positive in PET and false negative in BS due to osteolytic type bone metastases. In untreated cases, PET with and without clinical information showed better sensitivity than BS in patient-based diagnosis. For the purpose of treatment effect evaluation, PET showed better results because of its ability in the evaluation of rapid response of tumor cells to chemotherapy. Out of 10 cases of multiple-area metastases, 9 cases included vertebrae. There was only one solitary lesion located outside of FOV of PET scan in the femur, but with clinical information that was no problem for PET diagnosis.. Diagnostic accuracy of bone metastasis was comparable in PET and BS in the present study. In a usual clinical condition, limited FOV (from face to upper thigh) of PET scan may not be a major drawback in the detection of bone metastases because of the relatively low risk of solitary bone metastasis in skull bone and lower limbs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Adult; Bone Neoplasms; False Negative Reactions; Humans; Male; Osteoblastoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole Body Imaging

The aim of the study was to determine the value of radioisotope bone scans in the preoperative staging of patients with hepatopancreatobiliary (HPB) cancer.. Bone scanning was performed as part of a routine staging protocol in 402 consecutive patients with HPB cancer over a period of 5 years. Patients with positive bone scans underwent coned radiography, computed tomography with review on bone windows, or a bone biopsy. Bone scans were reviewed along with staging investigations, surgical and histological findings. Patients were followed for a minimum of 6 months.. There were 171 patients with colorectal liver metastases, 106 with suspected pancreatic cancer, 47 with hepatocellular cancer, 52 with gallbladder cancer or cholangiocarcinoma, and 26 with other types of HPB cancer. Bone scans were negative in 377 patients (93.8 per cent) and positive in 25 patients (6.2 per cent). Of the 25 positive scans, 16 were falsely positive as a result of degenerative bone disease. Of nine patients with a true-positive bone scan, four had locally irresectable disease and four distant metastases. In only one patient did the bone scan result alone influence the decision to resect the HPB cancer. Overall sensitivity was 100 per cent, specificity 95.9 per cent, positive predictive value 36.0 per cent and negative predictive value 100 per cent.. Bone scanning should not be included in the routine staging protocol for HPB cancer.

Topics: Aged; Biopsy, Needle; Bone Neoplasms; Cholangiocarcinoma; Colorectal Neoplasms; Female; Gallbladder Neoplasms; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Pancreatic Neoplasms; Preoperative Care; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Spiral Computed

Topics: Adult; Arm; Bone Neoplasms; Diagnosis, Differential; Erythrocytes; Hemangioma; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal; Female; Humans; Incidental Findings; Meningeal Neoplasms; Meningioma; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Solitary Pulmonary Nodule; Somatostatin; Technetium Tc 99m Medronate; Whole-Body Counting

Patients with benign solitary enchondromas of the proximal humerus frequently present to the diagnosing physician with shoulder pain. Once the lesion is considered benign, emphasis can be placed on identifying the etiology for the pain. We reviewed our experience with these patients to identify the cause of the presenting pain. A retrospective review of clinical records and radiographic studies (radiographs, magnetic resonance images, and bone scans) was done for all patients presenting to an orthopaedic oncology unit with solitary enchondroma of the proximal humerus. Attention was focused on diagnostic evidence of additional disease in the shoulder. Fifty-seven patients (mean age, 53.6 years) met the criteria of the study and were included for evaluation. Of patients presenting with pain, 82% (47 of 57 patients) had findings seen on magnetic resonance imaging scans that correlated with the initial clinical diagnostic impression, suggesting that other disease was present that could explain the pain. Solitary enchondromas of the proximal humerus often are found incidentally during the initial evaluation of patients with shoulder pain. This study showed that additional treatable disease usually is present in patients with enchondromas of the proximal humerus.

Topics: Acromioclavicular Joint; Algorithms; Biopsy; Bone Neoplasms; Chondroma; Comorbidity; Female; Humans; Humerus; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Rotator Cuff; Shoulder Impingement Syndrome; Shoulder Pain; Technetium Tc 99m Medronate; Tendinopathy

Topics: Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; False Negative Reactions; Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Subtraction Technique; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this retrospective study was to determine the predictors of a positive bone scan in female patients with breast carcinoma. The participants were 126 females with newly diagnosed breast carcinoma and a baseline bone scan. Patients who had started treatment before their bone scan were excluded. Bone scans were assessed as "no metastases" or "definite skeletal metastases" without knowledge of the patient's predictor variables. Those with "possible metastases" were correlated with other available imaging and clinical information, and recategorized as "no metastases" or "definite skeletal metastases". Results were compared with predictor variables. Significant predictors were increasing age, a higher histopathological grading and positive progesterone receptor status following a forward-stepwise logistic regression analysis. Axillary nodal status, tumour size and oestrogen receptor status did not correlate with a positive bone scan. Not every patient needs a staging bone scan. This study is important because it predicts the need for baseline scintigraphy for specific patients in whom skeletal metastases are more likely to be present or to develop. The findings are particularly valuable in times of worldwide resource scarcity and evolving surgical practice.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Chi-Square Distribution; Female; Humans; Logistic Models; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Risk Factors; Statistics, Nonparametric; Technetium Tc 99m Medronate

A 74-year-old man underwent low anterior resection for rectal cancer. Technetium-99m methylene diphosphonate (MDP) bone scanning was performed as part of the patient's postoperative follow-up study. Scans revealed an area of increased tracer uptake in the left hemipelvis. Coronal single-photon emission computed tomography and caudal images clearly separated the lesion from the skeletal structures. Transverse magnetic resonance images showed a large diverticulum originating from the left lateral wall of the bladder. The pelvic findings on the bone scan were the result of tracer retained within this diverticulum.

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Diverticulum; Humans; Incidental Findings; Male; Pelvis; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Severity of Illness Index; Technetium Tc 99m Medronate; Urinary Bladder Diseases; Whole-Body Counting

The aim of this study is to clarify the period of extraosseous accumulation of (99m)Tc-hydroxymethylenediphosphonate (HMDP) to radiation nephropathy mimicking recurrent or remnant neuroblastoma in the pararenal region.. We reviewed five neuroblastoma and one ganglioneuroblastoma patients (2 boys and 4 girls aged 1-9 years) who underwent (99m)Tc-HMDP bone scintigraphies periodically before and after radiation therapy.. Increased renal uptake coincident with the radiation port appeared in 5 of 6 patients from 0 to 3 months (mean 1.7 months), and persisted up to 7 months after the completion of radiotherapy. Renal uptake of (99m)Tc-HMDP was gradually decreased, and eventually became accumulation defects in 5 of 6 patients from 6 to 17 months (mean 8.9 months) after radiotherapy.. When extraosseous accumulation is found after radiation therapy in neuroblastoma patients, radiation nephropathy would be a candidate in the differential diagnosis besides recurrent or remnant tumor.

Topics: Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Infant; Kidney; Kidney Diseases; Male; Neoplasm Recurrence, Local; Neuroblastoma; Radiation Injuries; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy; Technetium Tc 99m Medronate

Extraskeletal osteosarcoma is an extremely rare high-grade malignant soft tissue tumor, which accounts for approximately 4% of osteosarcomas and less than 1% of all soft tissue sarcomas. There have been reports describing the scintigraphic findings of this tumor, especially with Tl-201. We report a biopsy-proven case of extraskeletal osteosarcoma in which the bone and thallium scans were found to be useful in monitoring chemotherapy response. The Tc-99m HMDP bone scan revealed increased extraskeletal uptake in the tumor.

Topics: Bone Neoplasms; Humans; Male; Middle Aged; Muscle Neoplasms; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium; Thigh

It is an evaluation of radionuclide bone scanning in detecting bone metastasis in the patients with nasopharyngeal carcinoma after radiotherapy.. The bone scanning was performed in 78 patients with nasopharyngeal carcinoma after radiotherapy.. Bone metastasis were detected in 47 patients out of 78, including 46 squamous cell carcinoma and 1 undifferentiated carcinoma.. Radionuclide bone imaging is useful for diagnosing, treating and prognosing of nasopharyngeal carcinoma.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Radiography; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

Patients with skeletal metastases from hormone-refractory prostate cancer have shown variable responses to high-activity therapy with (186)Re-HEDP and peripheral stem cell support. In this paper, we report on the use of a novel technique to compare sequential planar images acquired post-(186)Re-HEDP therapy administration with pretherapy diagnostic (99m)Tc-MDP scans, to evaluate the turnover of the radiopharmaceutical in normal and abnormal bone. It was found that the activity in normal (i.e., disease-free) segments of the spine demonstrates a faster effective decay than that of the metastases, with the latter showing only physical decay. This study showed, for the first time, a detailed correlation in the behavior of the (99m)Tc-MDP and (186)Re-HEDP images, encouraging the possibility of using the pretherapy 99mTc-MDP scan for estimations of absorbed doses to be delivered by prescribed activities of (186)Re-HEDP.

Topics: Bone and Bones; Bone Neoplasms; Etidronic Acid; Humans; Image Processing, Computer-Assisted; Male; Neoplasm Metastasis; Organometallic Compounds; Prostatic Neoplasms; Radioimmunodetection; Radioisotopes; Radiopharmaceuticals; Software; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

Topics: Adult; Aged; Bone Neoplasms; Choristoma; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Kidney; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adrenal Gland Neoplasms; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Humans; Incidental Findings; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Choristoma; Diagnosis, Differential; Female; Gallbladder; Humans; Incidental Findings; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Osteoblasts; Positron-Emission Tomography; Practice Guidelines as Topic; Practice Patterns, Physicians'; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Positron-Emission Tomography; Prognosis; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

A case in which radiotherapy was requested for bone metastases from prostate carcinoma after hormonal and radiation therapy and diagnosed as insufficiency fracture of the sacrum on bone scan was reported. A 78-year-old man underwent endocrine therapy with luteinizing hormone releasing hormone agonists and radical radiotherapy toward pelvis for prostate cancer. The onset of buttock pain started from the nine-month after the beginning of radiotherapy, and was diagnosed as sacrum metastasis by MRI, and radiotherapy was requested again for pain control. However, on bone scan, butterfly-like changed accumulation was noted, therefore sacrum insufficiency fracture was suspected. Addition of CT inspection and reconfirmation of MRI were performed, and bone metastases became negative, and serial observation was performed of the painkilling effect after that. No tumor marker rise was seen after five months without sigh of new bone metastases and the final diagnosis became insufficient fracture. In order to avoid unnecessary treatment, we think that the view of bone scintigram for diagnosis of sacrum insufficient fracture should be known.

Topics: Aged; Bone Neoplasms; Fractures, Bone; Gonadotropin-Releasing Hormone; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiotherapy; Sacrum; Technetium Tc 99m Medronate

The aim of this study was presentation of a whole-body MRI technique with a moving table as a screening tool for bone metastases in patients with breast cancer. Twenty-two patients with breast carcinoma underwent both a planar whole-body bone scintigraphy and whole-body MRI at 1.5 T. The MRI images were acquired with a moving table at six different anatomical positions within a measurement time of 20 min. Coronal images were acquired using a short-tau inversion recovery sequence, accomplished by an axial T2-weighted turbo-spin-echo sequence through the head, and a T1-weighted opposed-phase sagittal 2D fast low-angle shot sequence covering the whole spine. The MRI findings indicating bone metastases were compared with findings from bone scintigraphy. Metastatic lesions were confirmed by follow-up examinations over 1 year. Twelve patients showed bone metastases. Whole-body MRI was superior to bone scintigraphy in predicting lesion origin with a sensitivity of 92% (bone scintigraphy 83%), a specificity of 90% (scintigraphy 80%) and an accuracy of 91% (scintigraphy 82%). The MRI showed additional findings such as metastases of the lung and liver. Whole-body MRI with moving table technique may be an effective method of total body screening for bone in selected patients with breast carcinoma and a high risk of distant metastases, although with the higher costs of MRI bone scintigraphy must still be considered as the first method for screening patients with breast cancer.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Cohort Studies; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Radiographic Image Enhancement; Radionuclide Imaging; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate

Osteolytic lesions seen on plain radiographs can be caused by various disorders of the bones such as simple bone cyst, aneurysmal bone cyst, plasmacytoma, giant cell tumor, eosinophilic granuloma and tuberculosis. We studied prospectively Tc-99m-methylene diphosphonate bone scan findings in osteolytic lesions seen radiologically and followed them to histopathology. Interestingly, the scans in these patients helped to show if the lesions were monoostotic or polyostotic and, in some cases, ruled out malignant or infective etiology.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Osteitis Deformans; Osteolysis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tuberculosis, Osteoarticular

Topics: Adolescent; Bone Neoplasms; Diagnosis, Differential; Female; Foot; Foot Deformities, Congenital; Humans; Lymphatic Abnormalities; Magnetic Resonance Imaging; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma; Diagnosis, Differential; Dyspnea; Humans; Incidental Findings; Lung Neoplasms; Male; Middle Aged; Pulmonary Atelectasis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Humans; Ossification, Heterotopic; Osteosarcoma, Juxtacortical; Palpation; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

Mixed medullary-follicular thyroid carcinoma (MMFTC) is a rare tumor with a metastatic behavior that has not been fully appreciated. Scintigraphy and radioiodine entrapment propensity of its metastases remains largely undescribed. The authors present a case of MMFTC with widespread bone and soft-tissue metastases, where every known site of metastases concentrated radioiodine intensely. The patient responded well to radioiodine therapy. The report suggests that the tumor may have a propensity to metastasize to the skeleton, and the metastases retain the ability to accumulate radioiodine.

Topics: Adenocarcinoma, Follicular; Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms

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

Topics: Bicycling; Bone Neoplasms; Buttocks; Carcinoma, Hepatocellular; Cumulative Trauma Disorders; Humans; Incidental Findings; Liver Neoplasms; Male; Middle Aged; Occupational Diseases; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Injuries; Technetium Tc 99m Medronate

Breast metastasis from a primary ovarian neoplasm is very rare. We report a case of breast metastasis along with involvement of the liver, spleen, and pelvis from ovarian carcinoma in a 54-year-old woman demonstrated by whole-body bone scanning. Ovarian metastatic deposits frequently show calcification, and a Tc-99m MDP bone scan could be useful in determining the extent of calcified soft tissue metastatic spread in these patients. A review of the literature of breast metastases form ovarian carcinoma is discussed.

Topics: Antineoplastic Agents; Bone Neoplasms; Breast Neoplasms; Carcinoma, Papillary; Female; Humans; Incidental Findings; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Bone Neoplasms; Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Middle Aged; Ovarian Neoplasms; Pelvic Bones; Pelvic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Retrieving diagnostic tissue from a rib lesion can be challenging. Using a hand-held intraoperative gamma probe to target and biopsy the areas of increased radioisotope uptake has been limited largely to use by thoracic surgeons and interventional radiologists. Such techniques also have been used by orthopaedic oncologists in localizing osteoid osteomas. We pursued a similar technique in localizing the rib lesion. During the 10 months, two patients with a history of cancer and recent bone scans indicative of possible rib metastasis required biopsies for definitive tissue diagnosis. Both patients had gamma-probe localization of their rib lesions intraoperatively using minimally invasive techniques. The operation of the probe was simple with a short learning curve. Both patients had biopsies that yielded diagnoses verifying the abnormality on the staging bone scan. Localization was sensitive and accurate with histologic confirmation in both patients. The length and extent of surgery were markedly reduced with no complications. These results match those reported in the literature by thoracic surgeons and radiologists. The hand-held gamma probe assisted biopsy of suspicious rib abnormalities can be an effective surgical technique that the orthopaedic surgeon should consider. Additional experience with the technique will allow an assessment of the sensitivity and specificity.

Topics: Aged; Biopsy, Needle; Bone Neoplasms; Breast Neoplasms; Equipment Design; Female; Gamma Cameras; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Accurate staging of cancer has a critical role in optimal patient management. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastases in patients with non-small cell lung cancer. Although Tc-99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X-rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans.

Topics: Bone Neoplasms; Fatal Outcome; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed

The study was performed to compare whole-body short time inversion recovery (STIR) MR imaging and (99m)Tc-methylene diphosphonate planar scintigraphy in the examination of children with suspected multifocal skeletal malignant lesions. Sixteen patients with known or suspected malignant skeletal disease underwent both whole-body STIR MR imaging and bone scintigraphy. The lesions were described and numbered according to scintigraphic evaluation criteria. Thus, 16 regions were analyzed in each patient for the comparison between the two modalities. Histology was proven in the primary malignant regions. Follow-up MRIs were registered. Scintigraphy and MRI follow-up were evaluated as gold standard. A total of 139 different lesions was observed by both modalities. Baseline whole-body MRI revealed 119 bone lesions in 256 possible sites (46.5%); scintigraphy revealed only 58 lesions (22.6%). Congruence was observed in only four patients (25%). According to the location of the lesion, correlation was observed in 39/139 lesions (28%). In all, 57.5% of the lesions were detected only by MRI and 14.5% of the lesions were detected only by scintigraphy. Whole-body MRI was more sensitive (P<0.001). Of all lesions numbered which could be separated in the initial MRI, whole-body MRI detected 178 lesions in the patients. The results suggest that whole-body MRI using a STIR sequence is an effective radiation free method for examination of children with suspected multifocal bone lesions. MRI showed more lesions than conventional (99m)Tc-methylene diphosphonate scintigraphy. Therefore, whole-body MRI may be feasible as a screening modality for metastatic and skip lesions in osteosarcoma, PNET, Ewing sarcoma and Langerhans cell histiocytosis in children.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Extrarenal uptake of Tc-99m DMSA is not seen very often. It has previously been described in metastatic disease and was mainly attributed to the presence of V-DMSA in the injected solution. We report a clinical case of incidental visualization of metastatic bone disease of the colon in a patient with renal failure. This could be the result of not only the presence of V-DMSA, but also the renal failure and the atypia of the lesions.

Topics: Aged; Bone Neoplasms; Colorectal Neoplasms; Humans; Incidental Findings; Kidney; Male; Radionuclide Imaging; Radiopharmaceuticals; Renal Insufficiency; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

In the search for a cure for metastatic bone cancer, 117mSn with its conversion electrons and low energy photons both of discrete energies shows little bone marrow toxicity, providing the opportunity to increase the administered dose. Selective accumulation in lesions would capitalise on this advantage. The 10-30 kDa fraction of the water-soluble polymer polyethyleneimine, functionalised with methyl phosphonate groups (PEI-MP) and labelled with 99mTc, has shown selective uptake into bone tumours. Furthermore using speciation calculations it was predicted that the Sn(II)-PEI-MP complex would remain intact in the blood plasma. Because of this positive indication animal experiments were carried out to test this prediction. This paper relates the labelling, biodistribution and pharmacokinetics of various fractions of 117mSn-(II) PEI-MP in the normal primate model, and points to promising therapeutic possibilities.

Topics: Animals; Bone and Bones; Bone Neoplasms; Molecular Weight; Organotin Compounds; Papio; Polyethyleneimine; Radionuclide Imaging; Radiopharmaceuticals; Structure-Activity Relationship; Technetium Tc 99m Medronate; Tin Radioisotopes; Tissue Distribution

Topics: Bone Neoplasms; Chordoma; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sacrum; Technetium Tc 99m Medronate

The case of a 12-year-old girl with Jaffé-Lichtenstein-Uehlinger syndrome is presented. A bone scan pattern exhibits clinical symptoms, X ray images and histological findings are described in a case of polyostotic form of the fibrous dysplasia. A biopsy with histology was performed in consideration of bone scan findings and a confirmed final diagnosis.

Topics: Bone and Bones; Bone Neoplasms; Child; Female; Fibrous Dysplasia of Bone; Humans; Radionuclide Imaging; Radiopharmaceuticals; Syndrome; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Artifacts; Bone Neoplasms; Diagnostic Errors; Extravasation of Diagnostic and Therapeutic Materials; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Skin; Technetium Tc 99m Medronate; Ulnar Nerve

Topics: Aged; Bone Neoplasms; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ureteral Neoplasms

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma, Renal Cell; Choristoma; Humans; Kidney; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this study is to specify the precise role of bone scintigraphy and serum CEA and CA 15-3 assays in the monitoring of breast cancers in order to optimize their use and to determine whether it is possible to guide the prescription of bone scan by the use of CEA and CA 15-3 assays in the monitoring of breast cancer.. For this purpose, from November 1997 to May 2002, 98 consecutive female breast cancer patients (median age, 52 years; range 35-77 years) underwent bone scintigraphy during follow-up. In these patients values of tumor markers were compared with the results of bone scintigraphy. Some of the patients with bone metastasis were checked repeatedly at intervals of 6 to 12 months, resulting in 49 patients with bone metastasis and 74 patients without bone metastasis being included in the study.. In patients with bone metastasis, serum CEA levels were abnormal in 23/49 cases and CA 15-3 serum concentrations were elevated above the cut-off in 33/49 cases. Among patients without bone metastasis, CEA and CA 15-3 serum concentrations were normal in 50/74 and 55/74 cases respectively. The combination of the two markers improved the diagnostic sensitivity.. Although serial tumor marker measurements are an efficient and cost effective method of monitoring disease progression, it does not allow prediction of the bone scan results; so it is not justifiable to reject a bone scintigraphy on the basis of these markers.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Breast Neoplasms; Carcinoembryonic Antigen; Carcinoma; Female; Humans; Middle Aged; Mucin-1; Radionuclide Imaging; Radiopharmaceuticals; Statistics as Topic; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Osteopoikilosis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The potential targeting of therapeutic bisphosphonate conjugates to bone metastatic lesions was evaluated in vivo in mice. A bisphosphonate conjugate with 5-fluorouracil was synthesized as a potential chemotherapy agent, and a bisphosphonate conjugate with diethylenetriaminepentaacetic acid (DTPA) was prepared as a potential carrier of cytotoxic radionuclides. The compounds are hypothesized to be able to deliver either high doses of radiation or a high concentration of chemotherapy agents at sites of increased osteoclastic activity in patients with bony metastases while exhibiting minimal toxicity to normal tissues. Tissue distribution studies with the 99mTc-labeled bisphosphonate conjugates with DTPA and 5-fluorouracil showed rapid blood clearance and excretion of unbound activity, clearance from most tissues, and substantial retention of the bisphosphonates in bone. For the DTPA conjugate, activity in the bone represents 13.6% of the total injected dose at 8 hours following injection, representing 54.3% of the total whole-body activity at this time period. Under the same conditions, the 5-fluorouracil conjugate showed a 17.1% bone uptake at 60.2% of the whole-body activity. This normal bone uptake predicts that high concentrations of conjugates are expected to be achieved at sites of bone metastatic disease. Chemotherapy and radiotherapy studies with these compounds in animal models of metastatic bone cancer are underway.

Topics: Animals; Antimetabolites, Antineoplastic; Bone Neoplasms; Diphosphonates; Female; Fluorouracil; Humans; Mice; Mice, Inbred BALB C; Models, Chemical; Neoplasm Metastasis; Neoplasm Transplantation; Neoplasms, Experimental; Pentetic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Pentetate; Time Factors; Tissue Distribution

Topics: Animals; Bone Neoplasms; Dog Diseases; Dogs; Female; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

In-111 pentetreotide (Octreotide) is highly sensitive for detecting gastroenteropancreatic neuroendocrine tumors and their metastases. However, a lack of landmarks makes it difficult to localize them anatomically. To overcome this difficulty, the authors simultaneously obtained Octreotide and bone tomoscintigrams, in addition to standard planar images. They used a bicolor scale to display pairs of scintigrams to easily identify the distribution of both tracers.. Twenty-one hours after Octreotide injection, Tc-99m MDP was also administered to the patients. Three hours later, dual-energy planar and tomographic data were acquired simultaneously. The latter were reconstructed using a filtered back-projection algorithm using a Metz filter. Both sets of data were displayed simultaneously using a bicolor scale, such that Octreotide data appear in green and bone data in red.. Planar, tomographic, and three-dimensional data were obtained. With this approach, foci of abnormal uptake are localized more precisely. Hard data can be transmitted easily to referring physicians, who appreciate this compact and efficient means to locate foci of abnormal uptake, especially during surgery planning. However, this method is not well suited to the visualization of small lesions with low Octreotide uptake because the intensity range is drastically reduced. Such lesions are better seen on Octreotide planar images and standard tomoscintigrams.. This approach, which involves only standard image processing, provides landmarks to easily localize significant Octreotide uptake. It can be implemented readily in most nuclear medicine workstations. It complements but does not replace the usual method to display Octreotide data.

Topics: Aged; Bone and Bones; Bone Neoplasms; Gastrointestinal Neoplasms; Humans; Image Processing, Computer-Assisted; Indium Radioisotopes; Neuroendocrine Tumors; Pancreatic Neoplasms; Radiopharmaceuticals; Somatostatin; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Arachnoid Cysts; Bone Neoplasms; Breast Neoplasms; Craniocerebral Trauma; Female; Humans; Incidental Findings; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; 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

The uptake of (99m)Tc-methylene diphosphonate (MDP) in malignant pleural effusions and, rarely, in nonmalignant pleural effusions has been well documented in the literature. Although the exact mechanism of uptake in these conditions remains unclear, there have been attempts to use the bone scintigraphic features of pleural effusion to predict sensitivity and specificity for malignancy based on pleural fluid cytology. It has been suggested that activity in the chest increases with an increase in effusion volume. We report here, however, a case of malignant pleural effusion, that showed reduced hemithoracic activity in contrast to the expected increased activity. Our experience highlights the need for an open and inquisitive mind to avoid diagnostic pitfalls when confronted with a bone scintigram showing reduced uptake unilaterally or bilaterally in the chest.

Topics: Aged; Bone and Bones; Bone Neoplasms; Humans; Lung Neoplasms; Male; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Abdominal Neoplasms; Bone Neoplasms; Calcinosis; Child; Diagnosis, Differential; Female; Humans; Ovarian Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Teratoma

Topics: Aged; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urinary Bladder Calculi

To assess the predictive value of serial bone scans as a surveillance tool for bone metastasis in men with clinically localized prostate cancer and managed with watchful observation.. A prospective single-arm study was conducted to assess the feasibility of a watchful observation protocol with selective delayed intervention for patients with clinically localized prostate cancer, i.e. T1b-T2bN0M0, a Gleason score of 15 ng/mL the patient underwent bone scintigraphy every year.. In all, 244 eligible patients were enrolled into the study. With a median follow-up of 30 months, 449 bone scans were taken (150 at baseline and 299 in follow-up evaluations); all 299 follow-up scans were negative for bone metastasis. Hence, the true rate of positive follow-up bone scans was estimated to be 0-1.0% (95% confidence). In all, 171 patients had at least one follow-up bone scan; of these, the number (%) of patients who had 1, 2, 3, 4 and >or= 5 follow-up scans was 89 (52), 53 (31), 17 (10), eight (4.7) and four (2.3), respectively. The PSA levels (ng/mL) corresponding to all follow-up bone scans were: 214 scans at PSA < 10, 61 at 10-14.9, 18 at 15-19.9 and six at >or= 20 (range 20.2-24.9). The probability of a negative bone scan was estimated to be 88-100% (95% confidence interval) when a PSA threshold of 15 ng/mL was used.. The probability of positive findings in serial bone scans in untreated, localized, low to intermediate grade prostate cancer was low when the follow-up PSA level remained < 15 ng/mL. Avoiding bone scans in this group of patients would translate into a significant cost saving and reduction in their psychological and physical burden. As for those with a follow-up PSA of> 15 ng/mL, the role of serial bone scintigraphy remains undefined, as a longer follow-up and a larger sample are needed.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Cohort Studies; Disease Progression; Humans; Male; Middle Aged; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Carcinoma, Squamous Cell; Diagnosis, Differential; Fatal Outcome; Humans; Liver Failure; Lung Neoplasms; Male; Necrosis; Neoplasm Recurrence, Local; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Bisphosphonates (BisP) are non-metabolized compounds with high bone affinity used in bone metastasis diagnosis and treatment. Currently, BisP are used to treat hypercalcemia of malignancy as well as to prevent, minimize, or delay skeletal morbidity. These compounds have a long half-life in bone. Thus long-term BisP treatment might saturate bone and interfere with a single-dose scanning agent used for bone scintigraphy when visualizing bone metastases. In an effort to answer this question, this study evaluated the concordance of histology and Technetium99 methylene diophosphonate (Tc99 MDP) bone scintigraphy in the diagnosis of bone metastases in prostate cancer patients. We assessed the concordance of findings between bone scintigraphy and histology using 188 bone biopsies from 11 autopsied patients who died with metastatic prostate cancer, 5 of whom were treated with pamidronate for 2 to 13 months before death. Overall agreement between histology and bone scintigraphy was 84%, 86% in non-pamidronate-treated patients and 82% in pamidronate-treated patients. Scintigraphic bone metastases without histological metastasis (false negatives = 12.7%) were observed in 24 anatomic locations; half of these were in one patient who had been treated with pamidronate and had no histological bone response to the carcinoma. There were only 4 sites where a positive bone scan was not associated with histologic metastasis (false positives = 2.21%). There was no statistical difference between the treated and non-treated group for concordance, specificity, sensitivity, positive and negative predictive values of bone scintigraphy and prevalence of histological abnormality. Long-term pamidronate treatment of prostate cancer bone metastases does not generally affect the ability to detect bone metastases with Tc99 MDP bone scintigraphy.

Topics: Antineoplastic Agents; Autopsy; Bone Neoplasms; Diphosphonates; Humans; Infusions, Intravenous; Male; Pamidronate; Predictive Value of Tests; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

To investigate the usefulness of bone turnover markers as a modality for monitoring bone metastasis in patients with prostate cancer with bone metastasis.. Serial measurements of pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), carboxyterminal pro-peptide of type I procollagen (PICP), prostate-specific antigen (PSA), and the percentage of the positive area on the bone scan were prospectively performed before and after hormonal therapy in 84 patients with prostate cancer with bone metastasis for median follow-up of 29 months.. Serial ICTP and PICP levels in 48 patients without progression of bone metastasis demonstrated a downward trend during treatment and were almost within the normal range by the end of follow-up. The remaining 36 patients, who had PSA failure with progression of bone metastasis, showed an upward trend for serial ICTP and PICP levels before the progression of bone metastasis. The rates of detecting bone progression using bone turnover markers were higher than those using PSA levels on the basis of the percentage of clinical effectiveness and receiver operating characteristic curves.. Serial measurement of bone turnover markers is useful for monitoring the bone activity of prostate cancer and might detect early progression of bone metastasis in patients with PSA failure.

Topics: Aged; Aged, 80 and over; Biomarkers; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Collagen; Collagen Type I; Disease Progression; Humans; Male; Middle Aged; Peptide Fragments; Peptides; Predictive Value of Tests; Procollagen; Prospective Studies; Prostate-Specific Antigen; Prostatic Neoplasms; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

We report an unusual severe systemic reaction that occurred in a woman after a (99m)Tc-methylene diphosphonate bone scan and for which no alternative explanation could be found. The bone scintigram showed diffusely increased uptake in the liver and kidneys accompanied by reversible dysfunction of these organs and dermatologic manifestations. We speculate that an immune-mediated mechanism may have caused this unusual reaction.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Hepatorenal Syndrome; Humans; Kidney; Liver; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Bone scintigraphy performed on a patient during the middle of radiation therapy for an inoperable left lung malignancy showed diffusely increased uptake in the thoracic vertebrae and relatively increased uptake in the ribs of the left thorax. This bone scan finding is apparently a transient phenomenon that occurs in response to irradiation and eventually leads to photon deficiency or photopenia of the vertebrae. However, this transiently increased uptake of the thoracic spine, compared with uptake in the lumbar spine, mimics diffusely decreased uptake or photopenia of the lumbar vertebrae and may be misinterpreted as an effect of irradiation of the abdominal region. In the case of asymmetric uptake between the thoracic and lumbar spine, a carefully taken history of the timing and location of irradiation is necessary to avoid misinterpretation.

Topics: Aged; Artifacts; Bone Neoplasms; Diagnosis, Differential; False Positive Reactions; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Adolescent; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Glucose; Humans; Male; Osteosarcoma; Prognosis; Radiopharmaceuticals; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed

Topics: Bone Neoplasms; Chondrosarcoma; Diagnosis, Differential; Exostoses, Multiple Hereditary; Humans; Lung Neoplasms; Male; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Adolescent; Bone Neoplasms; Humans; Leg; Male; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Whole-Body Counting

Topics: Adenocarcinoma, Papillary; Bone Neoplasms; Clavicle; Female; Humans; Middle Aged; Parathyroid Neoplasms; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Sternum; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium; Whole-Body Counting

Osteoid osteoma is a benign bone tumor that can be removed by marginal excision. Excessive removal of reactive bone may result in significant morbidity. We made use of the highly specific radioactive technetium uptake characteristic of osteoid osteoma for its localization. Radioactive technetium (25 mCi) was injected intravenously 2 hours before surgery to a 21-year-old male patient with an osteoid osteoma over the left distal radius. Tumor tissue was localized intraoperatively by a portable hand-held radioactive gamma counter to detect a focal high intensity of radioactivity. Complete tumor removal was shown by reduction of radioactivity to background level. This was confirmed by bone scintigraphy of the specimen and the forearm immediately after surgery. The defect was packed with cancellous bone graft taken from the ipsilateral distal radius through the same wound. Postoperative recovery was very satisfactory. We found this approach useful in limiting resection margin and surgical site morbidity in resection of osteoid osteoma.

Topics: Adult; Bone Neoplasms; Humans; Intraoperative Care; Male; Osteoma, Osteoid; Radionuclide Imaging; Radiopharmaceuticals; Radius; Scintillation Counting; Technetium Tc 99m Medronate

This study was carried out to evaluate the diagnostic utility of gallium citrate Ga 67 ((67)Ga) and technetium Tc 99m bone scintigraphy as initial screening methods for distant metastasis and synchronous malignancies in patients with oral cancer.. Ga and/or bone scintigraphy was performed for 123 patients with primary squamous cell carcinoma (SCC). Abnormal accumulation sites detected with scintigraphy were reevaluated with radiography or computed tomography. Whether the accumulation sites were metastatic was determined according to the radiographic findings and the later clinical course of the patients.. Ga scintigraphy did not detect distant metastases or 4 synchronous cancers at other sites and provided no useful information on the emergence of delayed pulmonary metastases that developed in 3 cases after a few months. Ga scintigraphy showed an abnormal accumulation in 53% of primary tumors and 25% of metastatic cervical lymph nodes, and the detection of accumulation was closely related to the size of the lesion. Bone scintigraphy showed 1 case (0.9%) with distant metastasis to the vertebra; however, there were numerous false-positive cases that required additional radiographic confirmation.. These results suggested that Ga and bone scintigraphy at the initial examination of patients with primary oral SCC are ineffective for detecting distant metastasis and other malignancies because of the low incidence of these lesions and the diagnostic inaccuracy of scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma, Squamous Cell; Citrates; Female; Follow-Up Studies; Gallium; Gallium Radioisotopes; Humans; Lymphatic Metastasis; Male; Middle Aged; Mouth Neoplasms; Neck; Neoplasm Staging; Neoplasms, Multiple Primary; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

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

A 27-year-old female patient was admitted to our hospital with a history of leg pain and mass. She had a benign osteoblastoma in right tibia. Resection of the tumor without treatment by vitamin D antagonist resulted in rapid cure of the osteomalacia. Bone scintigraphy with Tc-99m MDP revealed multiple hot uptakes in initial scan, and follow up scan showed a clear resolution of the lesions.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Osteoblastoma; Osteomalacia; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

Enchondroma is a common benign cartilaginous tumor arising from the medullary cavity, most commonly in the phalanges and metacarpals of the hand. Enchondroma involving the ulna is very rare. Typically, benign enchondroma shows normal or only slightly increased uptake of a bone-seeking agent on delayed bone scintigraphy. Markedly increased activity of enchondroma with pain is most often associated with pathologic fracture or malignant degeneration. The authors present the 3-phase bone scintigraphic findings of a benign enchondroma associated with pain, which showed focal hyperperfusion, hyperemia, and intense bone uptake in the distal right ulna.

Topics: Adult; Bone Neoplasms; Chondroma; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ulna

Topics: Bone Neoplasms; Calcinosis; Diagnosis, Differential; Gastric Mucosa; Humans; Lung; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Stomach; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Acute Disease; Bone Neoplasms; Brain Neoplasms; Diagnosis, Differential; Humans; Infarction, Middle Cerebral Artery; Middle Cerebral Artery; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The aim of this study was to analyze the levels of serum prostate specific antigen in patients with and without bone metastases detected by means of bone scintigraphy and to determine the highest prostate specific antigen level in patients without bone metastases. The 50 patients consecutively diagnosed of prostate cancer between 1999 and 2001 in our institution made up the study population. Prostate specific antigen plasmatic levels were determined and bone scintigraphy was performed (whole body study after 99mTc-methyl-diphosphonate administration) in all the patients. In patients with positive bone scans (n=23), the mean prostate specific antigen level was 71.4+/-35.2 ng/ml and was significantly (p<0.00005) higher than in 14 patients with negative bone scans (mean prostate specific antigen level was 10.1+/-10.5 ng/ml). Suspicious lesions were found in 13 patients and their mean prostate specific antigen level was 8.5+/-7.7 ng/ml. Regarding prostate specific antigen levels, no statistically significant differences were found between patients with suspicious lessons and normal bone scans. The highest determined prostate specific antigen level in patients without bone metastases was 18 ng/ml. The bone scintigraphy should be performed in all patients with prostate specific antigen level above 18 ng/ml, but it is of limited value in patients with prostate specific antigen level below 18 ng/ml.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Follow-Up Studies; Humans; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Time Factors

A 40-year-old woman presented with a known case of osteogenic sarcoma of the right leg and underwent below-the-knee amputation. The preoperative workup was negative for distant metastases, and the patient was followed regularly. Two years later she developed dyspnea and chest pain. Computed tomography revealed diffuse left lung metastases with pleural involvement and nodular metastases in the right lung. Tc-99m methylene diphosphonate whole-body bone scanning revealed the amputated right leg with a clean stump but with widespread metastases in the right thigh involving soft tissue and bone, and the pelvis, left femur, and skull. In addition, diffuse left lung metastases involving both parietal pleura and lung parenchyma were seen. Tc-99m methylene diphosphonate uptake has been observed in the soft tissue and lungs in patients with osteogenic sarcoma but is rarely observed in practice with this degree of aggressiveness.

Topics: Adult; Bone Neoplasms; Female; Humans; Lung Neoplasms; Osteosarcoma; Pleural Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Bone and Bones; Bone Neoplasms; Europe; Humans; Nuclear Medicine; Patient Care Management; Practice Guidelines as Topic; Practice Patterns, Physicians'; Radiopharmaceuticals; Societies, Medical; Technetium Tc 99m Medronate; Tomography, Emission-Computed

In patients with an osteosarcoma, the prognosis is still poor. The aim of the present study was to investigate whether routinely tested biochemical parameters or additional parameters on bone scintigraphy could be identified which can select prognostic subgroups at the time of diagnosis.. A retrospective study was performed in 115 consecutive patients (70 male, 45 female) (mean age: 25.6 years; range: 3.50-78.0 years) who were referred for bone scintigraphy prior to treatment from March 1986 to September 2000 because of a newly diagnosed osteosarcoma. All bone scans were reassessed for the intensity and pattern of uptake and a bone-scan index. All pre-treatment general, histological, biochemical, and scintigraphic data were correlated with clinical outcome during follow-up.. During follow-up 54 patients died. Tumour volume and GGT showed significance as independent variables for metastases. Patients with metastases demonstrated a significantly lower survival rate (23% 5-year survival) than patients without metastases (98% 5-year survival). Tumours of the humerus and femur had a significantly lower survival rate. With respect to significant biochemical parameters (ALP, GGT, ASAT), it was not possible to determine a cut-off value that could be used to differentiate between high- and low-risk patients. Additional parameters assessed on bone scintigraphy were not important for prognostic stratification.. The strongest predictor of survival in osteosarcoma is the presence or absence of metastasis. Some biochemical parameters have prognostic value, but they cannot be used for the unequivocal identification of subgroups. Additional scintigraphic parameters are irrelevant for prognostic stratification.

Topics: Adolescent; Adult; Aged; Biomarkers; Biopsy; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Osteosarcoma; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Survival Analysis; Technetium Tc 99m Medronate; Time Factors; Treatment Outcome

The purpose of this retrospective analysis was to evaluate the prognostic significance of both initial glucose metabolism as measured by (18)F-FDG PET and osteoblastic activity as measured by (99m)Tc-methylene diphosphonate (MDP) bone scintigraphy in osteosarcoma.. In 29 patients (18 male, 11 female; age range, 5-41 y) with primary osteosarcoma, (18)F-FDG uptake and (99m)Tc-MDP uptake were measured semiquantitatively (average and maximum tumor-to-nontumor ratios [T/NT(av) and T/NT(max), respectively]) using PET and bone scintigraphy at the time of diagnosis. After chemotherapy, the patients underwent surgery for their primary tumor, and the response was determined histologically. Cumulative overall survival and event-free survival were determined by clinical and imaging follow-up of 7-72 mo (median, 28 mo).. Clinical and imaging follow-up revealed that the disease relapsed or failed to achieve complete remission in 9 patients and that 6 patients died of the disease. Both overall and event-free survival were significantly better in patients with a low (18)F-FDG T/NT(max) (less than the median) than in patients with a high (18)F-FDG T/NT(max) (at least the median). The negative relationship of (18)F-FDG T/NT(av), (99m)Tc-MDP T/NT(max), and (99m)Tc-MDP T/NT(av) with overall and event-free survival did not reach a level of significance. (18)F-FDG uptake values correlated moderately and positively with (99m)Tc-MDP uptake values, but a level of significance was reached only between (18)F-FDG T/NT(max) and (99m)Tc-MDP T/NT(av).. The initial glucose metabolism of primary osteosarcoma as measured by (18)F-FDG PET using T/NT(max) provides prognostic information. High (18)F-FDG uptake correlates with poor outcome. Thus, (18)F-FDG uptake may be complementary to other well-known factors in judging the prognosis in osteosarcoma.

Topics: Adolescent; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Glucose; Humans; Male; Osteosarcoma; Prognosis; Radiopharmaceuticals; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed

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

To determine the feasibility of radionuclide-guided surgical rib biopsy in patients in whom a local metastasis is suspected.. Descriptive.. In eight patients (three men and five women) with a known primary carcinoma, radionuclide-guided surgical rib biopsy was performed because a local metastasis was suspected. The skin was marked on the basis of a technetium-99m-(99mTc)-medronate scintigram. During surgery, a gamma probe was used to look for the hot spot in the rib in the vicinity of the skin marking; this hot spot was then minimally excised and submitted for pathological examination.. In all patients, the radionuclide-guided rib biopsy resulted in an unequivocal histopathologic diagnosis: tumour metastasis (n = 2), necrosis (n = 1), old fracture (n = 5).. Radionuclide-guided surgical bone biopsy has been shown to be a specific, simple, minimally invasive technique for obtaining a representative histological specimen with little stress on the patient. This technique can be used in every hospital that is equipped to carry out the sentinal node procedure in case of breast cancer or melanoma.

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

Conventional technetium-99m methylene diphosphate whole body bone scan (bone scan) has a high sensitivity but a poor specificity to detect bone metastases. However, positron emission tomography with 18F-2-deoxyglucose (FDG-PET) can offer superior spatial resolution and improved specificity. We have attempted to evaluate the usefulness of FDG-PET for detecting bone metastases in renal cell carcinomas (RCC) and to compare FDG-PET results with bone scan findings.. Eighteen patients were selected for this study with biopsy-proven RCC. They were suspected of having bone metastases and were undergoing bone scan and FDG-PET to detect bone metastases. The final diagnoses of bone metastases were established by operative, histopathological findings or clinical follow-up longer than 1 year by additional radiographs or following FDG-PET/bone scan findings showing progressive and extensive widespread bone lesions.. A total of 52 bone lesions including 40 metastatic and 12 benign bone lesions found on either FDG-PET or bone scan were evaluated. FDG-PET could accurately diagnose all 40 metastatic and 12 benign bone lesions. Bone scan could accurately diagnose only 31 metastatic bone lesions. Diagnostic sensitivity and accuracy of FDG-PET were 100% and 100%, respectively,and bone scan were 77.5% and 59.6%, respectively.. Our data suggest that FDG-PET has a higher sensitivity and a better accuracy than that of bone scan to detect bone metastases in patients with RCC.

Topics: Aged; Bone Neoplasms; Carcinoma, Renal Cell; Female; Fluorodeoxyglucose F18; Humans; Kidney Neoplasms; Male; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed

We analyzed whether classifying bone prostate cancer metastases correlates with survival in patients treated primarily with androgen deprivation.. We identified 86 patients with bone metastases who were followed between September 1988 and September 1999. Only those treated initially with androgen deprivation as monotherapy were included in this study. Clinical, pathological and radiological information were obtained by patient chart review. The 86 patients were divided into 2 groups according to metastasis grade on bone scan at diagnosis. Group 1 included patients with metastases on the axial skeleton and group 2 included those with bone metastases on the appendicular skeleton. In addition to our classification, we stratified patients according to the Soloway and Crawford et al classifications, and analyzed survival.. There were no statistical differences in the groups with axial versus appendicular metastases in terms of patient age, biopsy Gleason score, serum prostate specific antigen or clinical stage. Median survival was 53 and 29 months in patients with axial and appendicular bone metastases, respectively. Those with axial disease had better survival than those with appendicular bone metastases (p = 0.048). No statistical difference was observed when grading bone scan according to the Soloway and Crawford et al classifications.. Classifying bone scans according to the site of metastases (axial versus appendicular) had many advantages. It is easy to understand and helps urologist better predict the patient prognosis. Axial metastases carries a better prognosis than appendicular metastasis.

Topics: Aged; Aged, 80 and over; Androgen Antagonists; Antineoplastic Agents, Hormonal; Bone Neoplasms; Gonadotropin-Releasing Hormone; Humans; Male; Middle Aged; Neoplasm Staging; Prognosis; Prostatic Neoplasms; Radionuclide Imaging; Survival Rate; Technetium Tc 99m Medronate

Bone scintigraphy (BS) is widely utilized for the assessment of bone metastases (BMs) of neuroblastoma (NB). Since 111In-pentetreotide scintigraphy (PS) has been used to image NB with high sensitivity, we compared the sensitivity and specificity of PS with that of BS for the detection of BMs of NB. Nine patients with NB underwent both PS and BS for staging and/or restaging of their disease. The sensitivity and specificity of both imaging approaches were compared based on the findings of histopathology, other conventional imaging methods and subsequent clinical follow-up. In five of the nine patients, both PS and BS were negative for BMs. Radiographic bone surveys (RBSs) were also negative in these patients, except in one who showed a suspicious tibial lesion, but a computed tomography-guided biopsy failed to show evidence of disease. These patients remained without clinical evidence of BMs after a median duration of more than 15 months (range, 6-19 months). In three of four remaining patients, both PS and BS were positive for BMs, whilst only PS was positive in one patient. Overall, PS showed a greater number of BMs (30 vs. 7) with greater conspicuity compared with BS. The initial experience comparing BS with PS suggests that PS may provide a better assessment of the extent of BMs of NB, and that it may be useful as an adjunct to BS at institutions in which 131I- or 123I-metaiodobenzylguanidine is not available, particularly if BS is negative. In patients with similarly positive BS, PS might still provide unique prognostic information beyond that provided by BS. Further studies are therefore warranted.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Neoplasms; Brain Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Male; Neuroblastoma; Pentetic Acid; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The emergence of MRI has challenged the long-standing primacy of skeletal scintigraphy in pediatric cases of suspected acute hematogenous osteomyelitis (AHO) with nondiagnostic radiographs. This study evaluated a strategy in which skeletal scintigraphy is the primary and MRI a supplemental test.. We reviewed the records of 213 children (age range, 8 mo-18 y; mean age, 67 mo) with musculoskeletal symptoms and nondiagnostic radiographs who were referred for skeletal scintigraphy because of the possibility of AHO. MRI was performed when diagnostic uncertainty persisted after skeletal scintigraphy or when abscess was suspected.. Diagnosis was made using skeletal scintigraphy without referral for MRI in 179 (84%) of the children, including 79 (92%) of 86 with a final diagnosis of AHO. In no instance was the diagnosis of AHO indicated only by MRI. Treatment and diagnosis were accomplished without referral for MRI in 146 (69%) of all cases and 46 (53%) of the AHO cases. Abscesses that required drainage were found in 3 (6%) of 48 cases of major-long-bone AHO. Each of these 3 had exhibited a slow therapeutic response before MRI. Drainable abscesses were found in 5 (20%) of 25 cases affecting the pelvis, which was the other preponderant location of AHO. These were found with pelvic foci both when MRI was performed at diagnosis and when MRI was performed during treatment.. An imaging strategy in which skeletal scintigraphy is the first test used when AHO is suspected but radiographs are negative remains highly effective. This approach can be most strongly advocated when symptoms are poorly localized or are localized to major long bones. MRI should be performed after skeletal scintigraphy shows major-long-bone AHO if treatment response is slow. Skeletal scintigraphy is also an appropriate first test for suspected radiographically occult pelvic AHO. Because of the association of abscesses with pelvic AHO, however, the use of MRI should be strongly considered after pelvic AHO is detected, and MRI might be substituted diagnostically for skeletal scintigraphy when symptoms are well localized to the pelvis.

Topics: Abscess; Acute Disease; Bone and Bones; Bone Neoplasms; Child, Preschool; Connective Tissue Diseases; Fractures, Bone; Humans; Magnetic Resonance Imaging; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child, Preschool; Diagnosis, Differential; False Positive Reactions; Female; Humans; Ilium; Pelvic Neoplasms; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Rhabdomyosarcoma; Sacrum; Technetium Tc 99m Medronate; Urinary Bladder

Topics: Adult; Bone Neoplasms; Humans; Male; Osteoma, Osteoid; Pattern Recognition, Visual; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate

Topics: Arm; Bone and Bones; Bone Neoplasms; Brain Neoplasms; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Venous Thrombosis

Topics: Antibodies, Monoclonal; Antirheumatic Agents; Arthritis; Bone and Bones; Bone Neoplasms; Humans; Infliximab; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Spinal Diseases; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Bone and Bones; Bone Neoplasms; Carcinoma, Squamous Cell; Femoral Neoplasms; Head and Neck Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Osteolysis; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

In this study, we evaluated the potential of (99m)Tc-hexakis-2-methoxyisobutylisonitrile (MIBI) for detecting bone metastases in comparison with a conventional bone tracer.. (99m)Tc-MIBI and (99m)Tc-hydroxymethylene diphosphonate (HMDP) scans were obtained from 99 patients with proven malignant diseases and suspected bone metastases. We compared 373 lesions that showed abnormal uptake on (99m)Tc-MIBI scans or (99m)Tc-HMDP scans (or both).. Bone metastases were confirmed in 334 of 373 lesions. Thirty-nine lesions on (99m)Tc-HMDP scans had false-positive findings, but only 2 of these lesions had false-positive findings on (99m)Tc-MIBI scans. (99m)Tc-MIBI and (99m)Tc-HMDP scans were equivalent in 168 of 334 lesions (50.3%). (99m)Tc-MIBI scans correctly detected more lesions than (99m)Tc-HMDP scans: 284 lesions (85.0%) versus 218 lesions (65.3%) (P < 0.005), respectively. (99m)Tc-MIBI scans showed a markedly higher sensitivity for detecting metastases in the femur and humerus compared with (99m)Tc-HMDP scans: 97 of 98 lesions (99.0%) versus 35 of 98 lesions (35.7%) (P < 0.005) and 21 of 22 lesions (95.5%) versus 11 of 22 lesions (50.0%) (P < 0.005), respectively. (99m)Tc-HMDP scans of 17 patients showed no abnormal images. However, (99m)Tc-MIBI scans correctly detected bone metastases, and subsequent development of multiple lesions was observed on follow-up (99m)Tc-HMDP scans of 15 patients. (99m)Tc-MIBI scans were superior to (99m)Tc-HMDP scans in the detection of metastases attributed to breast cancer, multiple myeloma, and hepatoma. On the contrary, (99m)Tc-MIBI scans were less sensitive than (99m)Tc-HMDP scans for detecting bone metastases attributed to prostate cancer in the other skeletal sites except for femur and humerus.. (99m)Tc-MIBI scans have better sensitivity for detecting bone metastases and provide more specific complementary findings than conventional bone scans. (99m)Tc-MIBI accumulation attributed to bone marrow metastases may occur at an early stage, before the bone remodeling process in the surrounding bone can be detected on conventional bone scans.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Marrow Neoplasms; Bone Neoplasms; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The authors report a case of alveolar soft-part sarcoma with lung metastases demonstrated by "double imaging" with Tc-99m HDP and Tc-99m MIBI. The tumor originated in the soft tissue with direct invasion to the right scapula, which was hypoactive on bone scan and hyperactive on Tc-99m MIBI images. A focus of dense accumulation of Tc-99m MIBI in the lungs, suggesting metastasis was also demonstrated.

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma, Alveolar Soft Part; Scapula; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

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

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

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; False Negative Reactions; Femur; Humans; Ilium; Laryngeal Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The bone scan flare phenomenon, defined as an increase in the number or intensity of bone lesions with subsequent improvement while the patient is receiving chemotherapy, has been described in solid tumors including breast cancers and small-cell lung cancers. The purpose of this study was to verify the existence of the bone scintigraphic flare phenomenon in patients with non-small-cell lung cancer (NSCLC) during chemotherapy and thus determine the utility of bone scintigraphy in the follow-up of these patients.. Thirty-three patients with NSCLC with bone metastases and who had been treated with chemotherapy were included in the study. The outcome of bone scintigraphy was compared with that in other neoplastic sites.. The flare phenomenon was considered likely in 8 of the 33 patients. It was confirmed in two patients, invalidated in four, and remained doubtful in two.. The bone flare phenomenon occurs in NSCLC. It renders bone scintigraphy less useful in the evaluation of tumoral response in the patients in whom it is considered likely.

Topics: Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Disease Progression; False Positive Reactions; Follow-Up Studies; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Humans; Leg Bones; Male; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Spine; Technetium Tc 99m Medronate; Whole-Body Counting

This report describes a case of bone involvement by epithelioid sarcoma, which on imaging had the appearance of a primary intraosseous lesion of the scapula. The tumor initially presented as a subcutaneous nodule which was mistakenly diagnosed as "fibrosis" following initial resection. The lesion recurred locally and after several resections presented with several ulcerated subcutaneous nodules, at which time all imaging studies were performed. The patient was treated with en bloc upper humeral interscapulothoracic resection and shoulder reconstruction. Two years after the operation the patient is alive without local recurrence or metastasis.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Sarcoma; Scapula; Shoulder; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

A 62-year-old woman with right breast carcinoma who had a breast biopsy 3 weeks earlier was referred for a whole-body Tc-99m MDP bone scan to identify possible osseous metastases. Twenty-four hours later, she underwent lymphoscintigraphy using four peritumoral injections of 250 microCi filtered Tc-99m sulfur colloid of 0.22 microm each. The lymphoscintigraphic images showed good delineation of three right axillary lymph nodes in relation to the rib cage. Performing a bone scan just before lymphoscintigraphy for sentinel node detection may help the surgeon to identify sentinel lymph nodes. This is more anatomically precise than using a flood source to delineate body contour. A Tc-99m MDP bone scan followed by lymphoscintigraphy should be considered in patients with breast carcinoma who will have both bone imaging and lymphoscintigraphy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

A 68-year-old man with a history of prostate carcinoma and increasing levels of prostate-specific antigen was referred for a radionuclide bone scan. In addition to a probable metastatic lesion in the right femoral head, focal radiotracer accumulation was seen overlying the left aspect of the urinary bladder. Plain radiographs and pelvic computed tomography confirmed the presence of a calcified mass in the bladder. Cystoscopic examination revealed an exophytic bladder lesion. Biopsy indicated low-grade papillary transitional cell carcinoma, and the patient successfully underwent transurethral resection of this tumor.

Topics: Aged; Bone Neoplasms; Calcinosis; Carcinoma, Transitional Cell; Femur; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urinary Bladder; Urinary Bladder Neoplasms

Carcinoma of the prostate was diagnosed in a 74-year-old man. A Tc-99m HDP bone scan was performed as part of the initial staging process. The findings on the bone scan were normal except for an area of increased tracer uptake projected over the left sacroiliac joint, which was seen best on the anterior view. When this was investigated further, the findings of a plain radiograph were inconclusive. Computed tomography showed a large diverticulum projecting from the left side of the bladder; the tracer retained within this diverticulum had produced the findings on the bone scan.

Topics: Aged; Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Diverticulum; Humans; Male; Pelvic Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urinary Bladder Diseases

Topics: Bone Neoplasms; Diagnosis, Differential; Humans; Ilium; Male; Middle Aged; Multiple Myeloma; Plasmacytoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The aim of this study was to assess the value of 99mTc-hexakis2-methoxyisobutylisonitrile (MIBI) scintigraphy in patients with clinical and radiologic features of primary or metastatic musculoskeletal tumors.. The scintigraphic findings for 84 patients were compared with the surgical and histologic findings. Each patient underwent three-phase bone scanning with 99mTc-methylene diphosphonate (MDP) and dynamic and static MIBI scintigraphy. The MIBI scans were evaluated by visual and quantitative analysis. The count ratio of the lesion to the adjacent or contralateral normal area (L/N) was calculated from the region of interest drawn on the MIBI scan. The Mann-Whitney test was used to determine the differences between the uptake ratios of malignant and benign lesions.. Although increased MDP uptake was not specific for bone malignancy, a significant difference was found between benign tumors (L/N = 1.22 +/- 0.43) and malignant tumors (L/N = 2.25 +/- 1.03) on MIBI scans. Sensitivity and specificity were 81% and 87%, respectively. Forty-six of 53 proven benign lesions did not show significant MIBI uptake. The negative predictive value was 88%. In all seven sites of pathologic fracture, significant uptake was seen. However, three malignant lesions were not detected by MIBI scintigraphy, whereas seven benign lesions showed false-positive results.. The major diagnostic worth of MIBI scintigraphy is its high negative predictive value. Although not capable of replacing tissue biopsy as a definitive diagnostic modality for musculoskeletal neoplasms, MIBI scintigraphy does appear to have a role in better preoperative assessment and in distinguishing between pathologic and simple fractures.

Topics: Bone Neoplasms; Diagnosis, Differential; Female; Fractures, Spontaneous; Humans; Male; Middle Aged; Muscle Neoplasms; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Bone and Bones; Bone Neoplasms; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Strontium Radioisotopes; Technetium Tc 99m Medronate

Recent advances in the treatment of hepatocellular carcinoma (HCC) have prolonged patient survival. However, the number of patients with bone metastases identified during follow-up examinations has increased. Tc-99m Sn-N-pyridoxy-5-methyltryptophan (Tc-99m PMT) has been reported to accumulate at a high rate in HCC lesions and bone metastases. In the patient described here, whole-body scintigraphy showed accumulation of DTPA galactosyl human serum albumin (Tc-99m GSA) and Tc-99m PMT in bone metastases from HCC. The authors suggest that asialoglycoprotein receptors may be present in bone metastases from well-differentiated HCC. Tc-99m GSA whole-body imaging can be used to detect bone metastases from HCC and to evaluate hepatic reserve.

Topics: Albumins; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tryptophan

Metastases to the bony pelvis is an unusual pattern of the spread of primary pancreatic tumors. The authors report the presence of metastatic disease in the bony pelvis observed on bone scans in several patients who had been treated recently for pancreatic carcinoma. When bone scans that show metastatic disease in the pelvis are evaluated in patients with unknown primaries, the diagnosis of pancreatic carcinoma should be considered.

Topics: Bone Neoplasms; Humans; Pancreatic Neoplasms; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Calcaneus; Female; Humans; Osteitis Deformans; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We present a rare case of anaplastic large cell lymphoma of the bone in the leg of a child. The patient initially presented with suspected osteomyelitis of the fibula and was treated by antibiotics without apparent success. Thereafter, an open biopsy of the lesion was performed and the correct diagnosis was established. This rare case demonstrates the difficulties that a treating physician meets in establishing the correct diagnosis in a child presenting with limping. A review of the pertinent literature is introduced.

Topics: Bone Neoplasms; Child, Preschool; Gait; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Fibroma, Ossifying; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

Topics: Aged; Bone Neoplasms; Erythrocytes; Female; Hemangiosarcoma; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sacrum; Splenic Neoplasms; Technetium Tc 99m Medronate

Topics: Adult; Biopsy; Bone Marrow; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Lymphoma, Non-Hodgkin; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tonsillar Neoplasms

Topics: Aged; Bone Neoplasms; Hernia, Inguinal; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

Monostotic Paget's disease of the patella was detected with Tc-99m MDP and Tl-201 scans. Diffuse intense uptake of MDP in the left patella was observed on the blood-pool and late phases of the bone scan. Tl-201 imaging was performed to differentiate a malignant process and showed diffuse marked accumulation at the same site. Semiquantitative analysis of the patella region on both Tc-99m MDP and Tl-201 scans did not support a diagnosis of cancer. Radiographs showed the features of Paget's disease of the bone. Findings of a pathologic evaluation were compatible with the diagnosis of osteitis deformans. This case represents the unusual skeletal involvement of monostotic Paget's disease of the bone in the patella. Tl-201 accumulation in the Paget's lesion was suggested to be caused by increased metabolic activity of the lesion but was not indicative of a malignant process.

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Osteitis Deformans; Patella; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes

A comparative study of the images obtained with a dual-head coincidence gamma camera with thick NaI crystals (19 mm), a dedicated PET camera with BGO crystals and a conventional gamma camera with thin NaI crystals (9.5 mm) was conducted to clarify the clinical feasibility of a dual-head coincidence gamma camera with thick NaI crystals.. FDG images of 27 patients with malignant tumors were obtained by means of a dual-head coincidence gamma camera with thick NaI crystal and a dedicated PET camera with BGO crystals. The images of bone scintigraphy in 10 cancer patients obtained with the dual-head coincidence gamma camera were compared with those taken by a conventional dual-head gamma camera with thin NaI crystals.. Patient-basis sensitivity in 27 patients with neoplasms and lesion-basis sensitivity of the dual-head coincidence gamma camera and the dedicated PET camera were 74.1% and 85.2% (n.s.), 66.7% and 72.2% (n.s.), respectively. The tumor to background FDG uptake ratio derived from the coincidence gamma camera was significantly lower than that derived from the dedicated PET camera (mean +/- s.d.; 3.48 +/- 3.77 vs. 8.12 +/- 8.92, p < 0.0001), but the tumor to background FDG uptake ratio obtained with both methods correlated well (r = 0.84, p < 0.001). Similar whole body bone scans were obtained with the dual-head coincidence gamma camera and the conventional dual-head gamma camera in all 10 patients.. These results suggest that the dual-head coincidence gamma camera with thick NaI crystals has potentially high clinical applicability for community hospitals.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Gamma Cameras; Humans; Male; Middle Aged; Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Sodium Iodide; Technetium Tc 99m Medronate; Tomography, Emission-Computed

This study correlates the findings of bone marrow biopsy with those of bone scan in patients with common cancers and highlights the comparable sensitivities of the two methods at the authors' institution. The results show that bone scintigraphy may be slightly more sensitive than bone marrow examination for the detection of carcinomatous metastases. This experience suggests that institutions should devise clinical pathways based on their testing sensitivities and patient characteristics. These considerations will ultimately result in better and more cost-effective treatment of these patients.

Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Bone Marrow; Bone Neoplasms; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

The purpose of this study was to determine the potential role of positron emission tomography (PET) using 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) for the evaluation of bony metastasis compared with 99Tcm-methylene diphosphonate (99Tcm-MDP) bone scintigraphy in patients with breast cancer. Fifty-one female patients with breast cancer who had PET together with a bone scan within 1 month between September 1994 and March 1997 were included in this study. The median age was 49 years (range 29-79 years). The sensitivity, specificity and accuracy of the bone scan were 77.7%, 80.9% and 80.3%, respectively. On the other hand, for the detection of bone metastases PET had a sensitivity, specificity and accuracy of 77.7%, 97.6% and 94.1%, respectively. In the diagnosis of bony metastasis derived from breast cancer, FDG-PET was statistically superior to bone scintigraphy in its specificity. In conclusion, FDG-PET appears to be a powerful tool not only in the diagnosis of the primary lesion and soft tissue metastasis, but also in the diagnosis of bony metastasis among patients with breast cancer.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Technetium 99m-2-methoxyisobutylisonitrile (Tc-99m MIBI) is a lipophilic agent that accumulates preferentially within living malignant cells due to the higher transmembrane electrical potential as a consequence of the higher metabolic rate than in the surrounding normal cells. It has been effectively used to detect malignant tumors at diagnosis and follow-up and has been reported to be useful in detecting disease lesions in multiple myeloma. We studied 28 consecutive patients with multiple myeloma at diagnosis to determine the value of Tc-99m MIBI in comparison with Tc-99m methylene diphosphonate (MDP), conventional X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI). We found 26 patients with obvious osteolytic lesions in X-rays, 22 patients with positive Tc-99m MIBI scans, and 15 patients with positive Tc-99m MDP scans. There was no coincidence of the positive lesions in the two scans, while in two patients the osteolytic areas were positive in the Tc-99m MDP scans, and in one case the osteolytic area was positive in the Tc-99m MIBI scan. The intensity of Tc-99m MIBI scans correlated with disease activity as determined by lactate dehydrogenase (LDH) (p<0.05), C-reactive protein (CRP) (p<0.01), beta2-microglobulin (p<0.05), and serum ferritin (p<0.01). We believe that Tc-99m MIBI scintigraphy can detect bone marrow lesions in myeloma patients that cannot be detected by other imaging methods and that it can be useful especially in solitary myeloma to exclude other involved sites. In addition, it could be a prognostic factor related to disease activity and multidrug resistance. We believe that a multicenter study is needed to evaluate the usefulness of this agent.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Prospective Studies; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Several studies have found that administration of etidronate results in competitive interference with 99mTc-labeled bone scanning reagents. In contrast, in other studies this problem was not encountered with other bisphosphonates.. We prospectively studied 9 patients with hormone-refractory prostate cancer. 99mTc-methylene diphosphonate (MDP) bone scanning was performed before they received alendronate, and scanning was repeated a mean of 16.6 d afterward, when the patients had been receiving 40 mg alendronate daily for a mean of 6 d. In addition, 7 patients who underwent delayed scanning when they had been receiving alendronate for a mean of 111 d were also restudied. Quantitative whole-body bone scanning was performed, and radioactivity deposited in the bone metastasis was determined using region-of-interest analysis.. A <6% increase in whole-body retention of 99mTc-MDP was seen on the initial postalendronate scan compared with the baseline scan. No significant differences in activity were seen in the bone lesion evaluated on the baseline and initial postalendronate studies. The delayed postalendronate scan generally showed similar or higher tracer accumulation compared with the baseline scan.. Alendronate did not competitively inhibit uptake of 99mTc-MDP in the skeleton or tumor metastasis. Use of alendronate before bone scanning is unlikely to result in decreased detection of lesions or falsely decreased 99mTc-MDP activity at metastatic bone tumor sites.

Topics: Aged; Alendronate; Bone Neoplasms; Humans; Male; Middle Aged; Prospective Studies; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

In order to investigate the feasibility of the assessment of renal function with 99mTc-MDP, we compared renographical images, renogram patterns and the glomerular filtration rate (GFR) obtained by means of a modified Gates' method and 200 MBq of 99mTc-MDP with those obtained by means of 99mTc-DTPA. Because 19 of 20 patients had malignant tumors in the genitourinary tract, there was no difference between the two tracers in identifying a parenchymal defect corresponding to renal cancer. Of eight patients with hydronephrosis, four had a defect or decreased uptake with a dilated pelvis, whereas the other four had marked radioisotope retention in the renal pelvis or the whole kidney on serial images. There was also no difference between the two tracers in identifying hydronephrosis. Of 38 paired renograms 35 showed the same renogram patterns with both tracers. Of three patients with different renogram patterns, two had hydronephrosis. In 20 patients including three patients with bone metastasis, total GFR and split GFR obtained with both tracers correlated with a correlation coefficient of r = 0.920 (p < 0.001) and r = 0.944 (p < 0.001), respectively. Excluding bone metastasis from the analysis, a linear-regression analysis showed excellent agreement between the two measurements with a correlation coefficient of r = 0.960 (p < 0.001) and r = 0.963 (p < 0.001), respectively. The linear regression equations were Y = 1.009X - 0.111 and Y = 1.034X - 0.714, respectively. In conclusion, 99mTc-MDP can be used as a supplement to evaluate renal function incidental to the survey of bone metastases in patients with malignant tumor.

Topics: Aged; Aged, 80 and over; Blood Urea Nitrogen; Bone and Bones; Bone Neoplasms; Creatinine; Female; Glomerular Filtration Rate; Humans; Hydronephrosis; Kidney; Kidney Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radioisotope Renography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution; Urinary Bladder Neoplasms; Urogenital Neoplasms

Axillary or elbow lymph node visualization after subcutaneous infiltration of the bone-imaging agent on a routine bone scintigraphy has been reported. The prostate cancer patient in this case report underwent bone scintigraphy; in 3-h bone images, the lymph nodes in the wrist, elbow, and axillary regions were simultaneously visualized. This was caused by extravasation of the intravenous injection of bone-imaging agent in the dorsal part of the patient's hand.

Topics: Aged; Bone and Bones; Bone Neoplasms; Extravasation of Diagnostic and Therapeutic Materials; Hand; Humans; Injections, Intravenous; Lymph Nodes; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Surgery is the treatment of choice for bronchial carcinoid tumor (BCT), whenever the staging is adequate. There is little information about the capability of the somatostatin receptor scintigraphy (SRS) to detect bone metastases in the carcinoid tumor.. This work has aimed to evaluate retrospectively the diagnostic accuracy of the SRS in the detection of bone metastases in BCT.. Based on their clinical indication, the patients were classified into two different groups: Group A (n = 4), staging of a known BCT; and Group B (n = 6), treatment control. The SRS results could be correlated with the CT results in all 4 patients from the group A, and in one patient from the group B, and the SRS results were compared with the clinical follow up during at least one year in the other 5 patients.. The SRS scan detected the 4 BCT from the group A; in 2 of them the patient staging was superior when the SRS was used than with the CT, whereas the scan overestimated the tumor stage (BCT + sarcoidosis) in another patient. During the clinical course, one of these patients developed bone and liver metastases. The SRS was normal in 5 asymptomatic patients from group B, whereas the scan showed disseminated metastatic disease (liver, bone, spleen and lymph nodes) in another patient. In the 2 patients with bone metastases, the total number of bone metastases detected by the bone scan was 12, and by the SRS 8. The four lesions that were not detected by SRS were located in the ribs (n = 3) and 12-D (n = 1).. The capability of the SRS to detect bone metastases makes it more useful in BCT staging. Over the next few years, the role of the bone scan and SRS in the detection of bone metastases in carcinoid tumors needs to be established.

Topics: Adult; Aged; Biomarkers, Tumor; Bone Neoplasms; Bronchial Neoplasms; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Proteins; Octreotide; Pentetic Acid; Radiopharmaceuticals; Receptors, Somatostatin; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

Topics: Adolescent; Bone Neoplasms; Humans; Lung Neoplasms; Male; Neoplasm Recurrence, Local; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Topics: Adult; Bone Neoplasms; Hemangiopericytoma; Humans; Male; Meningeal Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Bone scintigraphy is widely used to detect bone metastasis owing to its high sensitivity, but solitary focus of increased uptake often causes diagnostic problem because of its low specificity. The purpose of this study was to assess the significance of solitary hot spot detected in patients with extraskeletal malignancies. We reviewed 1,167 consecutive bone scintigraphies of patients with history of lung, breast or prostatic cancer. There was 185 bone scans showing solitary hot spot (lung; 121, breast; 36, prostate; 28). Of the solitary hot spots, 30 (24.8%) in lung cancer, 8 (22.2%) in breast cancer, and 4 (14.3%) in prostatic cancer were a result of metastatic disease. There was no significant difference in the frequency of bone metastasis according to the site of primary tumor. It was relatively higher in the location of pelvis, scapula and thoracic spine. Clinical symptoms, particularly local bone pain, were helpful to diagnose the solitary hot spot.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Clavicle; Humans; Ilium; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Pyrrolidines; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Scapula; Skull; Technetium Tc 99m Medronate; Tetracycline

Although TI-201 is highly sensitive for detecting bone and soft-tissue tumors, its uptake is not specific for malignant lesions. This study assessed the differentiation of malignant and benign lesions and evaluated the sensitivity, specificity, and accuracy of TI-201 imaging and three-phase bone scans.. Forty bone and soft-tissue tumors (16 malignant and 24 benign) were evaluated. TI-201 static images were acquired 10 minutes (early) and 2 hours (delayed) after injection of the radionuclide. Within 14 days, three-phase bone scintigraphy was performed using Tc-99m HMDP with the patient in the same position. The count ratio of the lesion compared with the normal contralateral or adjacent site (L:N ratio) was measured.. With TI-201 scintigraphy, mean (+/- SD) values of early and delayed L:N ratios were 3.36 +/- 1.25 and 2.88 +/- 1.20, respectively, in malignant lesions; and 1.88 +/- 1.14 and 1.48 +/- 0.76, respectively, in benign lesions. TI-201 accumulation in benign lesions was significantly less than that of malignancies on early and delayed images. However, an overlap of both ratios between malignant and benign lesions was seen. No such significance was detected on three-phase bone scintigraphy (L:N ratios of malignant and benign tumors were 2.57 +/- 1.22 and 2.24 +/- 2.11, respectively, for blood flow imaging; 2.41 +/- 0.78 and 2.26 +/- 1.54, respectively, for blood pool imaging; and 2.80 +/- 2.10 and 2.89 +/- 4.55, respectively, for bone imaging). When we assumed that the tumor was malignant when the delayed TI-201 L:N ratio exceeded the blood pool phase L:N ratio with bone scintigraphy, the sensitivity rate was 81%, specificity rate was 100%, and accuracy rate was 93%.. TI-201 imaging for bone and soft-tissue tumors was better than three-phase bone scintigraphy alone but was not good enough to clearly differentiate malignant lesions from benign ones. TI-201 scintigraphy, performed in combination with three-phase bone scintigraphy, may be superior to either one of the two imaging procedures alone for bone and soft-tissue tumor diagnosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Ilium; Myositis Ossificans; Neurilemmoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone and Bones; Bone Neoplasms; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Necrosis; Pancreatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The detection of bone metastases is important in the management of patients with lung cancer because bone metastasis has a major impact on the prognosis and choice of treatment modality. Bone scan has been widely used for early detection of bone metastases but its low specificity complicates confirmation of bone scan findings. To evaluate the effects of abnormal bone scan findings on the prognosis of patients with lung cancer, we retrospectively analyzed the effect of abnormal uptakes on the prognosis of patients with primary lung cancer. The overall survival of patients with abnormal bone uptake was not significantly different from those without abnormal uptake. However, the patients with more than two abnormal bone uptakes had significantly shorter survival than those with no abnormal uptake (P<0.05). To confirm the effect of abnormal bone uptakes on survival, we compared the survival curves of three patient groups without knowledge of bone scan findings: group A, stage I-IIIB with more than two abnormal bone uptakes (potential stage IV); group B, stage IIIB with no abnormal bone uptake (true stage IIIB); and group C, stage IV with no abnormal bone uptake. Group A revealed shorter survival than group B (P<0.05). But, there was no significant difference in survival times between group A and group C. In the Cox regression analysis, the presence of more than two abnormal bone uptakes was a significant prognostic factor (P=0.0277), together with performance status, stage, and albumin. These results suggest that one or two abnormal bone uptake at diagnosis did not affect overall survival of the patients, and that the patients with more than two abnormal bone uptakes are considered as clinical stage IV because of high probability of bone metastases.

Topics: Bone and Bones; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate

A bone scan in a patient with proved osteogenic sarcoma of the tibia showed intense focal uptake in the gluteal region on the side of his cancer. This was proved to be a metastasis in the muscle.

Topics: Bone Neoplasms; Buttocks; Humans; Osteosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tibia

The authors report an unusual presentation of a solitary bone metastasis in the left midtibial shaft with no other skeletal involvement in a patient with breast carcinoma. The incidence of solitary bone metastasis below the knees is rare. Clinically, the lesion was tender when palpated. A bone scan revealed increased blood flow and blood pool activity, with intense midtibial bony uptake in delayed images. These findings are similar to those of acute osteomyelitis. Biopsy revealed bony metastasis from the patient's breast carcinoma.

Topics: Acute Disease; Biopsy; Bone Neoplasms; Breast Neoplasms; Carcinoma; Diagnosis, Differential; Female; Humans; Middle Aged; Osteomyelitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Whole-Body Irradiation

Topics: Bone Neoplasms; Female; Humans; Lipoma; Magnetic Resonance Imaging; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Topics: Aged; Bone and Bones; Bone Neoplasms; Calcinosis; Chronic Disease; Female; Humans; Pancreatitis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Uterine Cervical Neoplasms

Pasteurized autogenous bone graft sterilized at a low temperature (60 degrees C) is one option for reconstruction after resection of bone and soft tissue tumors. The purpose of this investigation was to assess the normal and abnormal radiographic and scintigraphic findings of pasteurized intercalary autogenous bone graft after resection of bone and soft tissue sarcomas.. This was a retrospective evaluation of the radiography and bone scintigraphy findings in patients after treatment of bone and soft tissue sarcomas using an intercalary pasteurized autogenous bone graft.. Among 10 consecutive patients, eight had intercalary grafts, and they constitute the subjects of this study. All available radiography and bone scintigraphy findings were reviewed for the healing process and the possibility of complications.. Healing and incorporation of the graft were observed in five patients during the follow-up, but the other three did not heal satisfactorily. Rapid incorporation of pasteurized autogenous bone graft can be demonstrated by means of radiography and bone scintigraphy.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Bone Transplantation; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Retrospective Studies; Sarcoma; Soft Tissue Neoplasms; Sterilization; Technetium Tc 99m Medronate; Transplantation, Autologous; Treatment Outcome

Intraoperative localization of rib abnormalities identified on bone scan can be deceptively difficult. Previously used techniques have had limited sensitivity and accuracy. The gamma probe can help localize these bone scan "hot spots.". Over the past 17 months, 5 patients underwent gamma-probe-directed limited rib resections following intravenous administration of Tc99m-MDP. Three patients required biopsies for suspected malignancy, and the other 2 underwent therapeutic resections for pain. The device was easy to work with following minimal training.. Localization was excellent, limiting the extent of surgery needed. Comparison with rib counting and preoperative bone scan localization showed a discrepancy of up to 13 cm. Sensitivity and accuracy were each 100%.. The gamma probe offers a simple and significant advance in the performance of rib biopsies for nonpalpable lesions.

Topics: Biopsy; Bone Neoplasms; Fractures, Ununited; Gamma Cameras; Humans; Monitoring, Intraoperative; Pneumothorax; Radionuclide Imaging; Reproducibility of Results; Ribs; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Aged; Artifacts; Bone Neoplasms; Brachytherapy; Gamma Rays; Humans; Male; Palladium; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Scattering, Radiation; Technetium Tc 99m Medronate

The present study investigates the safety and efficacy of 2590 MBq rhenium-186 (186Re) etidronate (i.e. twice the activity normally used) administered intravenously in 15 patients with disseminated prostatic carcinoma and bone pain.. Pain relief was observed in 11 of 14 evaluable patients (79%), 4 of whom became completely free from pain. Five of the responding patients also noted an improvement in daily activity and two found it possible to reduce or discontinue morphine medication. Pain relief occurred within one week in four patients, and within two weeks in eight of the responding patients. The mean duration of pain relief after the first course of 186Re-etidronate was 6 weeks (range 4-10). The toxicity was mild (< or = grade 2), transient, and restricted to hematological toxicity.. 186Re-etidronate provided rapid pain-relief and had mild toxicity in most patients with disseminated hormone-refractory prostatic carcinoma, but doubling the activity did not markedly improve the efficacy.

Topics: Bone Neoplasms; Humans; Male; Pain Management; Pain Measurement; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Rhenium; Survival Analysis; Technetium Tc 99m Medronate; Treatment Outcome

The aim of this retrospective study was to evaluate the role of routinely performed bone scintigraphy in the clinical assessment of patients with previously untreated Hodgkin's disease (HD). One-hundred and eighty-three patients with a median age of 31 yrs (range 16-85) with newly diagnosed HD underwent bone scintigraphy between 1972 and 1995. Bone scintigraphies and skeletal X-ray examinations of patients with any pathological scintigraphic finding were reassessed. Initially HD bone involvement could be excluded in 173 (95%) of the patients. Among the remaining ten patients, two had diffuse increased tracer uptake but X-rays were normal. One of these patients was classified as normal with regard to HD bone involvement. A bone marrow scintigraphy examination and regression of changes following therapy supported primary osseous involvement in the other patient. Five patients had focal scintigraphic abnormalities but skeletal X-rays remained negative; three of these five patients reported pain in the scintigraphically affected areas, and therefore the suspicion of bone involvement was strong. The remaining three patients had focal findings both on bone scintigraphy and skeletal X-ray examination and were considered as having osseous HD involvement. All seven patients judged to have HD bone involvement were planned to receive combination chemotherapy up-front, irrespective of the scintigraphic findings. In this series of 183 patients bone involvement was detected in seven patients based on bone scintigraphy/symptoms (n=3), bone marrow scintigraphy/symptoms (n=1), and bone scintigraphy/X-ray examination (n=3). The decision to give multiagent chemotherapy to all patients was not influenced by scintigraphic findings. Therefore, routine bone scintigraphy seems to be of limited value in the clinical assessment of untreated patients with HD.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Hodgkin Disease; Humans; Male; Middle Aged; Neoplasm Staging; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

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

AIM of this study was to validate a recently introduced new and easy-to-perform method for quantifying bone uptake of Tc-99m-labelled diphosphonate in a routine clinical setting and to establish a normal data base for bone uptake depending on age and gender.. In 49 women (14-79 years) and 47 men (6-89 years) with normal bone scans as well as in 49 women (33-81 years) and 37 men (27-88 years) with metastatic bone disease whole-body bone scans were acquired at 3 min and 3-4 hours p.i. to calculate bone uptake after correction for both urinary excretion and soft tissue retention.. Bone uptake values of various age-related subgroups showed no significant differences between men and women (p > 0.05). Furthermore, no differences could be proven between age-matched subgroups of normals and patients with less than 10 metastatic bone lesions, while patients with wide-spread bone metastases revealed significantly increased uptake values. In both men and women highest bone uptake was obtained (p < 0.05) in subjects younger than 20 years with active epiphyseal growth plates. In men, bone uptake slowly decreased with age up to 60 years and then showed a tendency towards increasing uptake values. In women, the mean uptake reached a minimum in the decade 20-29 years and then slowly increased with a positive linear correlation of age and uptake in subjects older than 55 years (r = 0.57).. Since the results proposed in this study are in good agreement with data from literature, the new method used for quantification could be validated in a large number of patients. Furthermore, age- and sex-related normal bone uptake values of Tc-99m-HDP covering a wide range of age could be presented for this method as a basis for further studies on bone uptake.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Child; Female; Gamma Cameras; Humans; Male; Metabolic Clearance Rate; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sex Factors; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Aged; Bone Neoplasms; Carcinoma, Adenoid Cystic; Humans; Male; Maxillary Neoplasms; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Salivary Gland Neoplasms; Technetium Tc 99m Medronate

Skeletal manifestation of Non-Hodgkin's lymphoma is rare in pediatric patients. Objective of the study was to determine imaging features, before and after treatment, and to correlate these features with clinical outcome.. A retrospective analysis of 1246 patients from two therapy studies (NHL-BMF-90 and 95) was performed. Imaging studies of 63 patients with bone involvement of lymphoma were reevaluated.. Incidence of initial bone involvement in Non-Hodgkin's lymphoma was 6.8%. Distribution was best assessed by bone scan, MRI revealed larger areas of marrow involvement and detected additional lesions. Sites of predilection were long bones of the lower extremities with epiphyseal involvement in 39%. Residual signal alterations in MRI after successful therapy remained in 71%. Osteonecrosis after therapy was a common finding. Clinical outcome war not correlated to the presence of bone involvement.. Since clinical outcome is not effected by bone involvement in childhood NHL, value of screening may be limited. Knowledge of imaging characteristics is mandatory for initial evaluation of primary osseous lymphomas and symptomatic lesions as well as for therapy controls.

Topics: Adolescent; Bone and Bones; Bone Neoplasms; Child; Humans; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome

The incidence of bone metastases in soft tissue sarcoma (STS) patients seems to be low but has not been studied separately. In this study, the authors aimed to determine the value of routine radionuclide bone scanning in preoperative staging of STS patients.. Preoperative bone scans were evaluated retrospectively in 109 consecutive patients (median age, 44 years; range, 1-86) with intermediate or high grade STS. Scans were scored in 3 categories: 1, metastases very likely; 2, equivocal; and 3, normal or benign lesions.. Category 1 scans were found in 8 of 109 patients (7%); in all 8 patients, bone metastases were confirmed. Six of these eight patients reported pain, and all had additional lung, bone marrow, or lymph node metastases. The highest rate (17%) was found in the rhabdomyosarcoma subgroup (n = 18). Category 2 (equivocal) scans were present in 12 of 109 patients (11%), in all of which bone metastases were excluded through additional investigations. Category 3 (normal) scans were found in 81%. Bone metastases were at least as frequent as lung metastases (4%) and were the single site of systemic disease in 4%. The rate of bone metastases was 55% in patients with bone pain versus 2% in patients without pain.. Bone metastases in primary STS patients are rare (7%) yet in this study at least as frequent as lung metastases. The low rate in asymptomatic patients versus the high rate in symptomatic patients supports the use of bone scanning in symptomatic patients only. The yield of routine bone scanning is low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Pain; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Rhabdomyosarcoma; Sarcoma; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Leiomyoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Bladder; Uterine Neoplasms

Topics: Biopsy; Bone Neoplasms; Diagnosis, Differential; Female; Follow-Up Studies; Hemangioendothelioma, Epithelioid; Humans; Magnetic Resonance Imaging; Middle Aged; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

Because of the limited number of projections, the mathematic reconstruction formula of the filtered backprojection (FBP) algorithm may create an artifact that streaks reconstructed images. This artifact can be imperfectly removed by replacing the ramp filter of the FBP with an ad hoc low-pass filter, the cost being the loss of contrast and definition. In this study, a solution was proposed to increase, by computational means, the number of projections to reduce the artifact at a lower cost. The cost was a postacquisition process, which was reasonably time consuming.. The process was called interpolation of projections by contouring (IPC). First, level lines were plotted on the sinogram to delimit isocount regions; then, the regions containing the interpolated points were found, and to each point was assigned the intensity of its isocount region. Using this process, the data could be resampled, allowing an increase in the number of projections or the number of pixels by projections. A phantom study of bone scintigraphy was performed to compare the slices obtained with and without the IPC process with the true image. A clinical case was also presented.. The phantom study showed that with the IPC process, the reconstructed slice was closer to the model, inside and outside the body, when the sinogram was resampled to multiply by 2 or 3 the number of projections, with the same number of pixels per projection. In the clinical study, the streak artifact was reduced, especially outside the body, although only a ramp filter was used.. The IPC process succeeded in reducing the streak artifact. This process did not require any modification in acquisition and was not operator dependent. The increase in the number of projections is likely a necessary but not a sufficient condition to reduce the streak artifact: if not corrected, the attenuation could be a limiting factor in the removal of this artifact when the number of projections increases.

Topics: Algorithms; Artifacts; Bone and Bones; Bone Neoplasms; Computer Simulation; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Phantoms, Imaging; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 59-year-old man with prostate cancer and pain from multiple bone metastases was treated with 1,424 MBq (38.5 mCi) rhenium-186 hydroxyethylidene diphosphonate (Re-186 HEDP). In addition, he had nonsteroidal antiandrogen, progestagen, and an analog-luteinizing hormone. Neither chemotherapy nor external-beam radiotherapy was administered. Bisphosponate therapy was stopped 4 weeks before the administration of Re-186 HEDP. The Tc-99m HMDP whole-body scan obtained 6 weeks after therapy showed the same results as before therapy. However, 1 year after therapy, a significant reduction of the mass of the metastases was visible on bone scan. The bone scan index decreased from 34 before therapy to 10 after 1 year. The patient described significant pain relief and stopped his analgesic intake 3 weeks after therapy.

Topics: Bone Neoplasms; Etidronic Acid; Humans; Male; Middle Aged; Organometallic Compounds; Pain; Palliative Care; Prostatic Neoplasms; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Technetium Tc 99m Medronate

A case of transient splenic accumulation of the bone-seeking agent Tc-99m HMDP is reported. This effect was caused by transient megaloblastic anemia induced by 5-fluorouracil chemotherapy. The extent of splenic uptake reflected the development and severity of megaloblastic anemia. The mechanism of splenic accumulation is thought to be similar to transient iron deposition in the spleen by megaloblastic anemia.

Topics: Anemia, Megaloblastic; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Breast Neoplasms; Female; Fluorouracil; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spleen; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Humans; Male; Neoplasms, Glandular and Epithelial; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

The authors evaluated the utility of hepatobiliary scintigraphy for tissue characterization of extrahepatic metastases from hepatocellular carcinoma (HCC) using Tc-99m N-pyrydoxyl-5-methyltriptophane (Tc-99m PMT).. We examined 13 patients with HCC (29 extrahepatic metastases and 3 benign bone lesions) and 5 patients with other cancers (15 extrahepatic metastases). Thirty minutes to 6 hours after intravenous administration of Tc-99m PMT, planar (all 47 lesions) and SPECT (42 lesions) images were obtained. Accumulation of Tc-99m PMT in the lesion was evaluated visually by comparing bone scintigraphy, computed tomography, magnetic resonance imaging, or all of these.. Findings were positive in 12 of 13 patients with HCC and extrahepatic metastases (16 of 29 on planar imaging and 21 of 26 on SPECT). Findings in all three benign bone lesions and 15 metastatic lesions from non-HCC primary lesions were negative (0 of 18 on planar imaging, 0 of 16 on SPECT). There were no false-positive findings in these lesions. Lesion-by-lesion sensitivity, specificity, accuracy, and positive and negative predictive values were 55%, 100%, 72%, 100%, and 58% by planar imaging and 81%, 100%, 88%, 100%, and 76% by SPECT, respectively.. Because of the high specificity and reasonable sensitivity, Tc-99m PMT appears to be useful for the differential diagnosis of extrahepatic metastases from HCC. SPECT improves the detectability of small or faint accumulation in metastases from HCC.

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Liver Neoplasms; Male; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon; Tryptophan

Bone and gallium scans have been shown to be useful in imaging Ewing's sarcoma. Here we report on a case of recurrent Ewing's sarcoma with multiple skeletal metastases demonstrated by the FDG-PET whole body scan, while the bone scan revealed fewer lesions and a non-remarkable finding was found on the gallium scan. The following pathologic examination showed bone marrow involvement. This case demonstrated that the FDG-PET could detect more lesions of metastatic Ewing's sarcoma than bone and gallium scans, especially for those with bone marrow involvement.

Topics: Adult; Bone Neoplasms; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Male; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Considering the current need to improve cost-effectiveness in cancer patient management, a prospective study was undertaken in order to define the optimal combination of bone scan and tumour marker assays in breast and lung cancer strategies, as has been done in the case of prostate cancer. All patients with breast or lung cancer referred to the Nuclear Medicine Department of the Grenoble Teaching Hospital between December 1995 and April 1997 were included. A blood sample was drawn in each case for marker assay (CA15-3 or CEA and CYFRA 21-1) on the same day as the bone scan. Two hundred and seventy-five patients were included: 118 with lung cancer and 157 with breast cancer. With regard to lung cancer, no information useful for guiding bone scan prescription was obtained through CEA and CYFRA 21-1 assays. For breast cancer, the results suggest that in asymptomatic patients, a CA15-3 level of less than 25 U/ml (upper normal value chosen as the threshold) is strongly predictive of a negative bone scan; by contrast, high tumour marker levels are predictive of neoplastic bone involvement. When a doubtful bone scan is obtained in a patient with breast cancer, a normal marker level makes it highly probable that bone scan abnormalities are not related to malignancy.

Topics: Aged; Aged, 80 and over; Antigens, Neoplasm; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Carcinoembryonic Antigen; Female; Humans; Keratin-19; Keratins; Lung Neoplasms; Male; Middle Aged; Mucin-1; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The aim of this study was to evaluate the value of three-phase dynamic bone scintigraphy (TPBS) in the assessment of the response of bone sarcomas to pre-operative chemotherapy and to correlate serial scintigraphic changes with histological findings. The study group comprised 27 patients (osteogenic sarcoma, n = 20; Ewing's sarcoma, n = 5; malignant fibrous histiocytoma, n = 2) with a mean age of 19.2 years. All patients received 99Tcm-methylene diphosphonate TPBS before and after pre-operative chemotherapy. Each phase of the imaging procedure was interpreted qualitatively and quantitatively. The percentage of tumour necrosis was analysed on resection materials following surgery. Histologically, 12 patients were non-responsive (tumour necrosis less than 90%) and 15 patients were responsive (tumour necrosis more than 90%). A decrease in the tumour blood flow ratio and extension were the most notable findings in the responders. The mean change in the tumour blood flow ratio following therapy was 58.7 +/- 8.3% and 19.9 +/- 26.6% (P < 0.005) in responders and non-responders respectively. The accuracy of three-phase imaging and static bone scintigraphy was 88% and 74% respectively. Since bone scintigraphy is a valuable technique owing to its ability to detect distant metastases in clinically early disease, TPBS should be helpful in monitoring therapy effects without any additional cost or radiation dose.

Topics: Adolescent; Adult; Antineoplastic Agents; Bone and Bones; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Data Interpretation, Statistical; Female; Histiocytoma, Benign Fibrous; Humans; Male; Middle Aged; Osteosarcoma; Radiopharmaceuticals; Regional Blood Flow; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Bone and Bones; Bone Neoplasms; Humans; Intestines; Male; Middle Aged; Radiopharmaceuticals; Rectal Neoplasms; Stomach; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Urine; Whole-Body Counting

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

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

Nephron-sparing surgery has become established as an effective treatment for localized renal cell carcinoma when preservation of renal function is necessary. The surgery usually requires temporary renal artery occlusion and may induce ischemic renal damage. In this study, we retrospectively evaluated renal activity on bone scintigraphy after nephron-sparing surgery.. Eleven patients who underwent nephron-sparing surgery for renal cell carcinoma and had a normal contralateral kidney were studied. A total of 12 bone scintigraphy images with 99mTc-labeled methylene diphosphonate were obtained within 1 y after surgery in these patients to assess skeletal metastasis. Activity in the spared renal parenchyma was compared visually with that in the contralateral normal kidney.. The tumor was successfully resected in every patient, and no clinically significant complications occurred. Activity in the spared renal parenchyma was elevated in six of seven examinations performed within 21 d after surgery. In three examinations, the increase in renal activity was heterogeneous, being relatively prominent near the surgical margin. Increased renal activity was not observed on five examinations performed 3 mo or more after surgery.. Renal retention of bone-seeking agents is elevated in the early period after nephron-sparing surgery, probably as a result of ischemic insult during the surgical procedure. Bone scintigraphy may aid in evaluating the presence and degree of ischemic damage of the spared renal parenchyma.

Topics: Adult; Bone and Bones; Bone Neoplasms; Carcinoma, Renal Cell; Female; Humans; Kidney; Kidney Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

In this study, we evaluated the efficacy of bone marrow immunoscintigraphy (BMIS) for the detection of skeletal metastases in 23 patients with histologically confirmed breast cancer. All patients underwent whole-body BMIS 3-6 h after the intravenous injection of 0.20-0.33 mg of the intact anti-NCA 95 MAb BW 250/183 labelled with 259-555 MBq 99Tcm and a whole-body 99Tcm-MDP bone scan. In four patients, BMIS SPET of the lumbar spine was also performed. Serum alkaline phosphatase was determined in all patients and the level of human anti-mouse antibody (HAMA) in 16. Final diagnosis was confirmed by radiology and 2 years follow-up. Compared with the 99Tcm-MDP bone scan, BMIS demonstrated better specificity (88% vs 75%) and a better positive predictive value (92% vs 85%). There were no significant differences between BMIS and the bone scan in the detection of skeletal metastases (P > 0.05). In one patient with normal planar BMIS of the lumbar spine, SPET disclosed a metastatic lesion in the bone marrow. The correlation coefficient between BMIS and bone scan and between BMIS and serum alkaline phosphatase was r = 0.688 and r = 0.483 respectively. One patient developed a minor HAMA response after BMIS. Patients with diffuse increased activity of the skull on the bone scan had a significantly higher skull to whole body ratio on BMIS (P < 0.01). Thus BMIS can improve the specificity and positive predictive value of bone scanning in the detection of skeletal metastases, with a low HAMA response. Diffuse increased activity of the skull on bone scans could be explained by bone marrow extension. SPET scanning of the spine may improve the sensitivity of BMIS.

Topics: Adult; Aged; Antibodies, Monoclonal; Antigens, Neoplasm; Bone Marrow; Bone Marrow Neoplasms; Bone Neoplasms; Breast Neoplasms; Cell Adhesion Molecules; Female; Humans; Lumbosacral Region; Membrane Glycoproteins; Middle Aged; Radioimmunodetection; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Whole-Body Counting

Topics: Adolescent; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Male; Orbital Neoplasms; Osteoma, Osteoid; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Age of Onset; Antibodies; Bone Marrow; Bone Marrow Neoplasms; Bone Neoplasms; Granulocytes; Humans; Male; Neoplasm Metastasis; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The aim of this work was to study and compare the usefulness of dynamic contrast-enhanced spin-echo MR imaging with high temporal resolution hydroxymethylene diphosphonate technetium-99 m skeletal angioscintigraphy in predicting the osteosarcoma histological response to neoadjuvant chemotherapy. Twelve patients with resectable osteosarcoma were prospectively monitored with dynamic MR imaging and skeletal scintigraphy before start of neoadjuvant chemotherapy, after two cycles of therapy and before surgery. Neoplasm signal intensity and activity intensity were plotted against time, and slopes were calculated for percentage increase over baseline values in the first minute. Stability and increase in slope values during or after chemotherapy were defined as a "radiological non-response". Changes in slopes were compared with the "histological response" (Huvos grading). At midpoint of the chemotherapy, these two imaging modalities failed in predicting final histological response. After the completion of the chemotherapy, these imaging modalities allowed the prediction of histological response with the same accuracy (91 %). In this series, dynamic MR imaging and technetium skeletal scintigraphy provide similar results regarding the prediction of final histological response during neoadjuvant chemotherapy; these results cannot be used to modify the therapeutic protocol at midpoint of chemotherapy; these imaging tools predict accurately the histological response at the end of chemotherapy. These latter results may permit anticipation of the adjuvant chemotherapy strategy during decalcification procedures in resected osteosarcoma and thus to monitor chemotherapy in non-surgical osteosarcoma.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Contrast Media; Female; Gadolinium DTPA; Heterocyclic Compounds; Humans; Magnetic Resonance Imaging; Male; Organometallic Compounds; Osteosarcoma; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Antineoplastic Agents; Biopsy; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Female; Humans; Male; Middle Aged; Neoplasm Staging; Osteosarcoma; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sarcoma, Ewing; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

Accurate staging of malignancies is essential to guide the clinician in selecting the most appropriate therapy. Metastases to bone suggested by radionuclide bone scans must be proven histologically because of the high frequency of false-positive results. If the plain bone radiographs, however, are normal and there are no localizing symptoms, precise biopsy of the area of bone scan abnormality is usually difficult and time-consuming. The recently described intraoperative use of the hand-held gamma probe now allows for great accuracy and sensitivity in the radioisotope-guided open biopsy of clinically suspected bone metastases.

Topics: Biopsy; Biopsy, Needle; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate

Since breast cancer is frequently associated with bone metastasis, bone scintigraphies have been performed to determine pre-operative staging and to survey postoperative bone metastasis. The sternum, in particular, is a site at which is difficult to differentiate between benign bone disease and bone metastasis, because of varied uptake and wide individual variations. In this study, chronological bone images were scintigraphied in six cases with solitary sternal metastasis and three cases with benign bone disease including two fracture cases and one arthritis case. On bone scintigrams in which solitary sternal metastasis appeared, increased uptake was found in five cases, and photon deficiency was observed in one case. During follow-up scintigraphies, abnormal accumulations, such as hot spots and cold lesions, increased in the bone metastasis while abnormal uptake disappeared or was unchanged in the benign bone disease cases. On CT, four cases showed osteolytic change, and one exhibited osteosclerotic change. These findings indicate that sternal metastasis usually shows osteolytic change, even if a hot lesion is recognized on bone scintigraphy. In solitary sternal metastasis, for which early diagnosis is difficult, both an integrated diagnosis using other imaging techniques and chronological bone scintigraphy are important.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sternum; Technetium Tc 99m Medronate

Tc-99m sestamibi, originally developed for myocardial studies, has been used as a tumor-seeking agent. Recently, the agent also was reported to be a functional tracer to predict multidrug resistance-related p-glycoprotein expression in tumor tissue. The current report presents the authors' experience with sestamibi tumor scintigraphy in a neuroblastoma. Although I-131 MIBG tumor imaging and Tc-99m MDP bone scanning accurately demonstrated the extent of the disease, Tc-99m sestamibi showed no accumulation in primary and metastatic foci. Lack of sestamibi uptake was initially thought to be suggestive of failure to respond to chemotherapy because of p-glycoprotein expression. However, the patient responded well to chemotherapy and complete remission was achieved. The failure of Tc-99m sestamibi to detect a neuroblastoma and the lack of sestamibi accumulation in the tumor may not always be related to chemotherapy resistance.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child, Preschool; Drug Resistance, Neoplasm; False Negative Reactions; Gene Expression Regulation, Neoplastic; GTP-Binding Proteins; Humans; Male; Mediastinal Neoplasms; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Remission Induction; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

To apply postprocessing techniques to register three-dimensional TI-201 bone SPECT datasets with MRI. This may provide more accurate anatomic-functional correlation when localizing active tumors.. Three-dimensional datasets were constructed from previously acquired MRIs using routine imaging protocols. Registration software was used to coregister the TI-201 SPECT studies and the MRIs in three dimensions.. Adequate TI-201 uptake in muscles and soft tissues along with relatively low accumulation in tendons and joint spaces provided adequate landmarks for visually aligning SPECT and MRI datasets. MR abnormalities were more extensive because of surrounding reactive tissue, and more focal TI-201 uptake could be demonstrated within the region of MR signal abnormality, allowing the focal metabolically active tissue to be distinguished from adjacent edema.. Image registration of SPECT and anatomic imaging (CT or MRI) is used routinely to evaluate functional abnormalities within the brain. This technique has now been applied to the combination of TI-201 SPECT and MR data for evaluating bone lesions and may provide additional anatomic information for localizing functional abnormalities. This may be valuable for defining targets for biopsy, planning surgical treatment, and using minimally invasive therapies.

Topics: Bone Neoplasms; Feasibility Studies; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Osteosarcoma; Radiopharmaceuticals; Retrospective Studies; Software; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

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

An 83-year-old man with testicular lymphoma demonstrated progressive scrotal enlargement with non-homogeneity sonographically and abnormally increased uptake in the scrotum of Tc-99m HMDP and Tc-99m MIBI scintigraphically. Extensive bone/bone marrow metastases were exhibited by Tc-99m MIBI and Tc-99m HMDP scintigraphies and MRI of the spine. In addition, focal/tubular activity of the femoral bone marrow on Tc-99m MIBI imaging was consistent with skeletal scintigraphic findings. It is emphasized that Tc-99m MIBI total body imaging enabled the demonstration of testicular lymphoma as increased uptake and the illustration of skeletal/bone marrow metastases as diffuse and/or focal increased uptake, especially focal/tubular MIBI activity of the femoral marrow.

Topics: Aged; Bone Marrow Neoplasms; Bone Neoplasms; Humans; Lymphoma, B-Cell; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Testicular Neoplasms; Ultrasonography

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

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

Eight patients were inadvertently administered, and imaged with, 99mTc-labeled MDP which was 45 months expired. Two cases are presented. All patients were subsequently imaged with normal MDP. The images obtained with expired MDP were clinically acceptable. No differences in scan abnormalities were observed compared with normal MDP for any of the patients. None of the patients suffered any side effects attributable to the expired MDP.

Topics: Adult; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Drug Stability; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Safety; Technetium Tc 99m Medronate

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.

Topics: Bone Neoplasms; Carcinoid Tumor; Follow-Up Studies; Humans; Indium Radioisotopes; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms, Unknown Primary; Octreotide; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

A 78-year-old patient with prostate cancer and osseous metastases had a pain symptomatic. In the Urology he was treated with antiandrogenes. The outcome of the bone scintigraphy showed a super bone scan with normalization after antiandrogene-therapy which seemed to be a sign of remission, before he showed a progressive form with multiple osseous metastases. Pain could not be treated with non steroidal antiphlogistics and opiates, so the indication for treatment with Rhenium-186-HEDP was given in this case.

Topics: Aged; Androgen Antagonists; Bone Neoplasms; Disease Progression; Follow-Up Studies; Humans; Male; Pain; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The aim of this study was to evaluate breast parenchymal activity on scintimammography with bone-seeking agents and 99mTc-MIBI. Scintimammography was performed with bone-seeking agents in 61 patients and with 99mTc-MIBI in 33 patients. Activity in the breast parenchyma contralateral to the suspected lesion was visually assessed by two independent observers. Increased breast parenchymal activity was shown in 19 of 61 patients examined with bone-seeking agents, while it was demonstrated in only two of 33 patients examined with 99mTc-MIBI. Breast parenchymal activity of bone-seeking agents was higher in patients aged 50 years or younger than in those older than 50. Increased parenchymal activity of bone-seeking agents may disturb visualization of primary breast cancer especially in relatively young patients. Low parenchymal activity is suggested to be a favorable characteristic of 99mTc-MIBI as a scintimammographic agent.

Topics: Adult; Aged; Bone Neoplasms; Breast; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Tc-99m bone scintigraphy is widely used for evaluation of osseous spread of malignant tumors.. A 60-year-old man had multiple areas of increased uptake on a bone scan in a pattern considered characteristic for extensive metastatic disease. However, a primary neoplasm could not be identified. Finally, acute myelofibrosis--a rare, fatal myeloproliferative syndrome--was diagnosed.. To avoid delays and extensive diagnostic procedures, acute myelofibrosis should be considered in the differential diagnosis of bone scans showing multiple hot spots. In such cases, a diagnosis can be made on an a tissue sample.

Topics: Acute Disease; Adrenal Cortex Hormones; Antineoplastic Agents; Biopsy; Bone Neoplasms; Diagnosis, Differential; Fatal Outcome; Humans; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Primary Myelofibrosis; Radionuclide Imaging; Radiopharmaceuticals; Recombinant Proteins; Technetium Tc 99m Medronate

We prospectively compared the ability of two techniques--bone scintigraphy with single-photon emission computed tomography (SPECT) of the chest and CT of the chest--to reveal potential osteosarcoma metastases of the lung.. Our study included 27 patients with osteosarcoma who prospectively underwent both bone scintigraphy with SPECT of the chest and CT of the chest. The imaging results were compared with outcome or pathologic analysis of any lung lesions found.. Eight (30%) of the 27 patients had pulmonary metastases. Four of these eight patients had positive results on both CT studies and bone SPECT studies, with additional lesions detected with bone SPECT in two of these four patients. The other four patients with pulmonary metastases had positive results on CT studies, whereas the results of bone SPECT studies remained negative. The results of bone SPECT studies were negative in the 19 patients without pulmonary metastases. CT, however, showed abnormalities in seven (37%) of the 19 patients, which were eventually attributed to benign conditions.. Negative results on a bone SPECT study of the chest should not be used to exclude the possibility of lung metastases. However, if the results are positive, a bone SPECT study can be used to confirm abnormalities seen on CT scans and may also reveal subtle lesions missed on CT scans.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Female; Humans; Lung Neoplasms; Male; Middle Aged; Osteosarcoma; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The regional blood flow of 30 distraction segments in 27 patients was measured during distraction osteogenesis. There were three groups of patients. Group A consisted of seven patients with high grade malignant tumors who received chemotherapy preoperatively and postoperatively. Group B consisted of eight patients with low grade malignant and aggressive benign tumors, who all were treated without chemotherapy. Group C (the control group) consisted of 12 patients with nontumoral conditions. Using quantitative technetium scintigraphy, the regional blood flow within the distracted segment and surrounding soft tissues was measured. The measured radioisotope count was expressed as the ratio of the distracted site to the control site (blood flow ratio). The blood flow ratio for all the cases averaged 1.70 +/- 0.70. Group A had a lower blood flow ratio, which was statistically significant in comparison with the other two groups. The external fixation index showed no significant difference in callus formation among these three groups. No correlation was found between the blood flow ratio and external fixation index. Chemotherapy decreases regional blood flow, but with distraction osteogenesis the regional blood flow can be kept within the normal range or higher. Distraction osteogenesis may overcome the effects of chemotherapy by increasing blood flow.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Female; Femoral Neoplasms; Humans; Leg; Male; Middle Aged; Osteogenesis, Distraction; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Technetium Tc 99m Medronate; Tibia

Topics: Bone and Bones; Bone Neoplasms; Carcinoma; Diaphragm; Female; Humans; Middle Aged; Pelvis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Uterine Neoplasms

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

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

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Photons; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Shoulder; Spinal Neoplasms; Sternum; Technetium Tc 99m Medronate; Thoracic Neoplasms

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

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

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

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

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

A patient with disseminated osseous metastases due to breast cancer reported multifocal pain. Because of persisting pain after a first cycle of chemotherapy, 1,295 MBq Re-186 HEDP was administered intravenously. Excellent pain relief was observed. Subsequently, the patient received further combined chemotherapy and Re-186 HEDP therapy and remained pain free. Tc-99m MDP bone imaging showed a significant regression of osseous metastases. It may be speculated that the combination of Re-186 HEDP and chemotherapy results in significantly increased palliation of metastatic bone disease.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Breast Neoplasms; Carcinoma, Ductal, Breast; Combined Modality Therapy; Etidronic Acid; Female; Humans; Middle Aged; Palliative Care; Radioisotopes; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Fractures, Spontaneous; Humans; Ilium; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Neoplasms; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Medical Oncology; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC.

Topics: Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Local malignant bone tumor excision followed by high-dose extracorporeal irradiation (300 Gy) and subsequent reimplantation is a unique technique for treatment of primary bone and cartilage tumors. The long-term scintigraphic findings of irradiated bone autografts in relation to clinical patient data were reviewed retrospectively.. Thirty-seven patients (12 women, 25 men; age range 13.0-66.7 yr; average age 29.1 yr) were studied. Postsurgical anatomopathological diagnoses included osteosarcoma, 20 patients; chondrosarcoma, 7 patients; and other less-frequent primary osteogenic tumors, 10 patients. Three hundred ninety 99mTc-methylene diphosphonate (MDP) whole-body scans performed between 3 mo and 18.3 yr (mean 6.5 yr) after treatment were reviewed.. The 10-yr actuarial survival rate was 78%. After a mean period of 19.4 mo, 6 patients developed a local recurrence, and MDP scintigraphy detected the recurrence in 4. Distant metastases developed in 11 patients (30%), of which 10 were nonosseous. Initially, all autografts appeared as photon-deficient areas. Diffusely increased bone uptake was present at osteotomy sites and at articulating surfaces contiguous with autografts within the first few months after surgery. Of all 25 patients with adequate follow-up, 7 showed persistent decreased uptake up to 129 mo after surgery. The other patients developed partial tracer uptake after 19.6 mo, on average. In 6 patients, scintigraphic images consistent with complete revascularisation were noted later (mean 31.5 mo). Local, sometimes multiple, complications were noted in 22 patients, mainly mechanical graft-related (15) or infections (11). Scintigraphic sensitivity for mechanical complications was 100%. Significantly more fractures and collapses were seen when partial tracer uptake suggestive of revascularisation occurred. Altered bone stress gave rise to focal and diffuse scintigraphic abnormalities, often in the spine and lower extremities. In recent literature, similar clinical complication patterns are found for massive allografts.. Skeletal scintigraphy is a sensitive technique for evaluating long-term follow-up of massive grafts to treat primary malignant bone tumors. Revascularisation and partial bone ingrowth are not sufficient conditions for a lower complication rate.

Topics: Adult; Bone Neoplasms; Bone Transplantation; Chondrosarcoma; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Survival Rate; Technetium Tc 99m Medronate; Time Factors; Transplantation, Autologous

Lymphangiomatosis is an extremely rare congenital disorder affecting visceral organs and/or the skeletal system. In bone is is usually characterized by multiple lytic lesions with a lacelike pattern and sclerotic margins of various thickness. In this case report we demonstrate the rare sclerotic variant of lymphangiomatosis. We report the development of predominantly sclerotic lesions at different sites by serial radiographs with a long-term follow-up, and show the MRI findings of lymphangiomatosis of the spine.

Topics: Adult; Bone Neoplasms; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lymphangioma; Magnetic Resonance Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors

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

99mTechnetium methylene diphosphonate (99mTc MDP) bone scintigraphy is currently the method of choice for the detection of bone metastases, but 18F-fluoro-deoxy-D-glucose positron emission tomography (18FDG PET) offers superior spatial resolution and improved sensitivity. We have compared 18FDG PET with 99mTc MDP bone scintigraphy in patients with skeletal metastases from breast cancer and have analyzed the data in subgroups based on radiographic characteristics of lesions.. Twenty-three women with breast cancer and confirmed bone metastases were studied with both 99mTC MDP bone scintigraphy and 18FDG PET, and the number of lesions detected and the quantitation of uptake (standardized uptake values [SUVs]) of 18FDG in osteolytic and osteoblastic metastases were compared. Survival was compared for both lytic and blastic bone metastases and for patients with high and low accumulation of 18FDG.. 18FDG PET detected more lesions than 99mTc MDP scintigraphy (mean, 14.1 and 7.8 lesions, respectively; P < .01). However, 18FDG detected fewer bone metastases compared with 99mTc MDP scintigraphy in a subgroup of patients with osteoblastic disease (P < .05). Higher SUVs were observed for osteolytic than osteoblastic disease (mean, 6.77 and 0.95, respectively; P < .01). Survival was lower in patients with osteolytic disease compared with the remainder (P=.01). A difference in survival was not found for those patients with high SUVs (> 3.6; P=.4).. 18FDG PET is superior to bone scintigraphy in the detection of osteolytic breast cancer metastases, which led to a poorer prognosis. In contrast, osteoblastic metastases show lower metabolic activity and are frequently undetectable by PET. The biologic explanation for this observation remains to be elucidated.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Radiopharmaceuticals; Survival Analysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed

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

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

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

Topics: Adult; Bone and Bones; Bone Neoplasms; Colon; Female; Humans; Medicine, Traditional; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urine

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

Tissue deposits of amyloid may lead to various clinical symptoms and signs, depending on the site of deposition. In addition, a specific subtype of amyloidosis, AL protein type, is associated with multiple myeloma. Two cases representing contrasting examples of altered radiopharmaceutical biodistribution in myeloma and amyloidosis are presented and discussed, with a bone tracer depicting the heart and a heart tracer depicting the bones.

Topics: Aged; Amyloidosis; Bone and Bones; Bone Neoplasms; Cardiomyopathies; Heart; Humans; Male; Multiple Myeloma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

A case of a 55-year-old man was remitted to Traumatology Department to present back pain of two weeks of evolution. The results of bone scintigraphy and the patient's evolution allowed the diagnosis. This case report and a literature review showed the importance of using a routine bone scan in diagnosis of bone metastases.

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Palliative Care; Radiography, Thoracic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The aim of this study was to evaluate the diagnostic role of bone scan in patients with breast carcinoma. With this purpose, we have studied 591 patients (4 males). In 261 of them, we were able to establish the stage of disease: 33 in stage I, 137 in stage II, 71 in stage III y 20 in stage IV. Metastatic lesions were detected in 6% of patients in stage I, 8.8% in stage II, 12.7% in stage III y 50% in stage IV. Altogether, 71 from 591 patients (12%) had metastatic lesions. In 4 patients (5.3%) we obtained a false positive result. The bone lesions found in the scintigraphic studies were classified as not metastatic lesions in 236 patients (39.9%) but 26 of them were malignant (11%). Another 193 patients (32.6%) presented scintigraphic studies considered as equivocal for metastasis and 33 of them were also malignant (17%). In 150 patients scintigraphic studies did not present lesions during the follow up. In other 156 patients isolated lesions were detected and 24 of them (15.4%) were malignant. Only 4 <> lesions were detected and not any <> image was observed in this study.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Carcinoma; Evaluation Studies as Topic; False Positive Reactions; Female; Humans; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Femoral Neoplasms; Humans; Humerus; Lymphatic Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

We quantitatively analyzed images of 99mTc-HMDP bone scintigraphy in 34 bone sarcomas before and after preoperative chemotherapy. The isotopic uptake was calculated as tumor-to-background ratio (TBR), and the changes in TBR before and after chemotherapy were calculated as the alteration ratio. The histological effect of preoperative chemotherapy was classified in 4 grades, according to Huvos. We defined good scintigraphic responders as cases having decreased uptake after chemotherapy, with an alteration ratio > or = 60%. There was a positive correlation (Rho = 0.76, p < 0.001) between the histological effect and the alteration ratio. Of the 17 good histological responders, 13 showed a good scintigraphic response. The average alteration ratio in 17 cases with good response (68%) was higher than that in 17 cases showing poor response (-9.9%) (p < 0.001). 3 patients with pathologic fractures and 1 with primarily normal uptake showed false negative findings. The sensitivity of this method was 100% and the specificity was 81%.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Female; Histiocytoma, Benign Fibrous; Humans; Image Processing, Computer-Assisted; Leg; Male; Neoadjuvant Therapy; Osteosarcoma; Radionuclide Imaging; Sarcoma; Sarcoma, Ewing; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

Lutetium-177 (177Lu) has both beta particle emissions for a therapeutic effect and gamma emissions for imaging. This study was undertaken to synthesize and evaluate 177Lu-EDTMP (ethylenediaminetetramethylene phosphonic acid) as a therapeutic radiopharmaceutical for the palliation of pain from bone metastases. Chelation of 177Lu to EDTMP was obtained by heating for 30 min in boiling water at pH 8.8, resulting in a radiochemical yield of over 99%. The compound was stable for 20 days without any appreciable dissociation. Biodistribution studies in normal rats indicated selective bone accumulation, showing faster blood clearance, higher bone uptake and higher bone-to-soft tissue ratios than 99Tcm-MDP. In conclusion, 177Lu-EDTMP has favourable biological and physical characteristics for the palliative treatment of painful bone metastases.

Topics: Animals; Beta Particles; Bone and Bones; Bone Neoplasms; Femur; Gamma Rays; Humans; Lutetium; Male; Organometallic Compounds; Organophosphorus Compounds; Pain; Palliative Care; Radiopharmaceuticals; Rats; Rats, Wistar; Technetium Tc 99m Medronate; Time Factors; Tissue Distribution

Topics: Aged; Bone and Bones; Bone Neoplasms; Colon; Cystadenocarcinoma, Papillary; Female; Humans; Ovarian Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Eighteen bone marrow transplanted multiple myeloma patients had imaging studies on 24 occasions with radiography as well as bone and bone marrow scintigraphy within 2 months. Twelve of the radionuclide bone marrow studies were performed with Tc-99m human serum albumin colloid and 12 were performed with a Tc-99m tagged monoclonal antigranulocyte antibody. The total detection rate of bone marrow lesions increased by 5% when the findings on bone marrow scintigraphy were combined with the findings and at radiography bone scintigraphy. For lesions in the spine and sacrum, the increase was 25% and 33% respectively, including patients with focal radiotherapy. Peripheral red bone marrow expansion was noted in 17 patients. In a comparison of Mab and Tc-99m HSA colloid imaging, Mab resulted in a higher bone marrow to soft tissue uptake and to a much smaller part of the skeleton being obscured by liver and spleen uptake. It is concluded that bone marrow imaging is valuable for showing red bone marrow distribution. It thereby shows possible sites for malignant lesions; it also shows that Mab imaging is superior to Tc-99m HSA colloid imaging in bone marrow transplanted multiple myeloma patients.

Topics: Adult; Antibodies, Monoclonal; Bone and Bones; Bone Marrow; Bone Marrow Transplantation; Bone Neoplasms; Female; Follow-Up Studies; Granulocytes; Humans; Liver; Male; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Radiography; Radioimmunodetection; Radiopharmaceuticals; Sacrum; Spine; Spleen; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

Based on the data by Armas et al, avascular necrosis, a not uncommon treatment-associated complication in patients with lymphoma, it should be easily distinguishable from osseous lymphomatous involvement in patients with Ga-67 avid lymphoma. In avascular necrosis, Ga-67 uptake will be either absent, decreased, or normal, whereas in lymphoma Ga-67 uptake will be increased. The authors present a patient with Hodgkin's disease who had new foci of simultaneously increased Ga-67 and Tc-99m MDP uptake because of avascular necrosis as proven by biopsy and long-term follow-up. The authors hypothesize that a possible-explanation for the discrepancy between this patient report and the series by Armas et al may be that increased Ga-67 is a delayed phenomenon related to healing.

Topics: Adult; Antineoplastic Agents; Biopsy; Bone Marrow Transplantation; Bone Neoplasms; Combined Modality Therapy; Diagnosis, Differential; Femur; Follow-Up Studies; Gallium Radioisotopes; Hodgkin Disease; Humans; Male; Osteonecrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Wound Healing

Topics: Aged; Bone and Bones; Bone Neoplasms; Colonic Diseases; Humans; Intestinal Fistula; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Urinary Bladder Fistula

Topics: Adult; Bone Neoplasms; Chondrosarcoma; Humans; Knee; Magnetic Resonance Imaging; Male; 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

Topics: Aged; Bone Neoplasms; Disease Progression; Humans; Male; Orbit; Orbital Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Adult; Bone Neoplasms; Humans; Lung Neoplasms; Male; Osteosarcoma; Radiopharmaceuticals; Ribs; Solitary Pulmonary Nodule; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adult; Bone Neoplasms; Brain Neoplasms; Glioblastoma; Humans; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

We present a case of transitional cell carcinoma of the bladder visualized by 99mTc-HMDP bone scintigraphy and suggest possible uptake mechanisms. Pelvic CT demonstrated a sessile bladder tumor with punctate and curvilinear calcifications on the surface areas (incrustation). Technetium-99m-HMDP bone scintigraphy demonstrated intense uptake corresponding to the site of the bladder tumor. Chemisorption of urinary 99mTc-HMDP, rather than of blood-born 99mTc-HMDP, may have occurred at the tumor surface.

Topics: Bone Neoplasms; Calcinosis; Carcinoma, Transitional Cell; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Urinary Bladder Neoplasms

To describe scintigraphic characteristics of bone allografts used in limb salvage reconstruction after resection of lower extremity osteosarcoma.. The authors reviewed 85 skeletal scintigrams of 20 pediatric patients followed up for 0.5-5.7 years after resection of lower extremity osteosarcoma and allograft reconstruction. Uptake in the allograft and adjacent host tissues was assessed visually.. Lack of tracer uptake in the allografts was seen in 99% of the studies and a faint rim of tracer localization outlining the allograft's periphery was seen in 95% of the studies. Increased uptake was noted at the allograft-host bone junction in 78% of the studies. Uptake was increased in the joint surfaces of native bones articulating with allografts (97% of studies), including the patella (93% of studies) when the knee was involved. These findings were stabilized as time passed.. Cadaveric bone allografts have a characteristic scintigraphic appearance in this selected patient group that reflects the physiology of their incorporation process.

Topics: Adolescent; Bone Neoplasms; Bone Transplantation; Child; Female; Femur; Follow-Up Studies; Humans; Male; Neoplasm Metastasis; Osteosarcoma; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Remission Induction; Strontium Radioisotopes; Technetium Tc 99m Medronate; Terminal Care; Thyroid Neoplasms

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

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

The aim of this study was to optimise the parameters affecting the Bremsstrahlung scintigraphy of patients injected with strontium-89 chloride. The parameters considered were : (1) instrumental detection efficiency, and (2) tissue attenuation factor for 89Sr calibrated sources, which permit quantitative evaluation of the activity in a given bone lesion. Some typical examples of in vivo 89Sr imaging are presented to illustrate the clinical utility of the imaging procedure developed by us, which is implemented in our department for all patients treated with 89Sr chloride.

Topics: Bone Neoplasms; Breast Neoplasms; Calibration; Gamma Cameras; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Strontium Radioisotopes; Technetium Tc 99m Medronate

We counted the lesions at the time of detection of bone metastases and calculated the rate of increase in the number of bone metastases from changes in serial bone scintigrams, and investigated the usefulness of serial scintigrams as a prognostic indicator in patients with metastatic bone tumors. Subjects were 112 patients with bone metastases from four types of primary lesion: 21 with prostate cancer, 27 breast cancer, 39 lung cancer and 25 stomach cancer. Of these, 18 (prostate), 19 (breast), nine (lung) and eight (stomach) underwent serial bone scintigrams in which bone metastases were first detected and identified as progressing. The numbers of lesions at the time of detection of bone metastases for prostate and stomach cancers were significantly greater than those for lung cancer. The rate of increase in the number of bone metastases for stomach cancer was significantly higher than that for prostate or breast cancers. There was no correlation between the survival time after the detection of bone metastases and the number of lesions at the time of detection in the four types of cancer. However, in prostate cancer, a negative correlation existed between the survival time after the detection of bone metastases and the rate of increase in the number of bone metastases. Thus, in patients with bone metastases from prostate cancer, it appears that the rate of increase in the number of bone metastases, estimated from serial bone scintigrams, was indicative of prognosis.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Disease Progression; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Injections, Intravenous; Lung Neoplasms; Male; Middle Aged; Prognosis; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Regression Analysis; Stomach Neoplasms; Survival Rate; Technetium Tc 99m Medronate; Whole-Body Counting

This study was undertaken to compare whole-body turbo short inversion time inversion recovery MR imaging and 99mTc-methylene diphosphonate planar scintigraphy in the examination of patients with suspected skeletal metastases.. Twenty-five patients with known or suspected skeletal metastatic disease underwent both whole-body turbo short inversion time inversion recovery MR imaging and whole-body 99mTc-methylene diphosphonate scintigraphy.. MR imaging revealed metastases at 57 of 175 possible sites (sensitivity, 96.5%, specificity, 100%; positive predictive value, 100%). Scintigraphy revealed metastases at 43 of 175 possible sites (sensitivity, 72%; specificity, 98%; positive predictive value, 95%) (McNemar test, 0.01; p = .016). Discrepancies in skeletal evaluation by whole-body MR imaging and scintigraphy were observed in six (24%) of 25 patients. Soft-tissue abnormalities were identified in 13 (52%) of 25 patients with MR imaging alone.. Preliminary results suggest that whole-body MR imaging is an effective method of examining patients with suspected skeletal metastases, with better sensitivity than conventional planar 99mTc-methylene diphosphonate scintigraphy.

Topics: Adult; Aged; Bone Neoplasms; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate

The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma.. Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex.. Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 +/- 0.32) and NSCLC (1.43 +/- 0.19) tumour types did not show statistical difference (p > 0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases.. Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Topics: Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Humans; Injections, Intravenous; Lung Abscess; Lung Neoplasms; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

To compare whole body magnetic resonance imaging (MRI) using fast sequences with radioisotope bone scintigraphy (BS) for the detection of metastases in the entire skeleton.. In forty-four patients suffering from carcinoma of lung, breast and prostate whole body MRI could generally be accomplished in about 39 minutes and it was shown to have a higher skeletal metastases detection compared with BS in the spine, pelvis, limb bones, sternum, scapula, and clavicle, but lower in the ribs and skull.. We think for addressing the status of skeletal metastases only, bone scintigram is still preferred over whole body MRI. When bone scintigram is unavailable, whole body MRI is a practical and acceptable alternative especially when extra-osseous metastases are also of concern.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Bronchial Neoplasms; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prostatic Neoplasms; Radiopharmaceuticals; Technetium Tc 99m Medronate

We report a case of metastatic insular carcinoma of the thyroid evaluated with 201TI, 99mTc-MIBI, 99mTc-(V)DMSA, 99mTc-MDP and 131I whole-body scans, which were obtained after total thyroidectomy. For the majority of lesions detected in the skeleton and soft tissue, 131I images were generally available, although most were visualized easier with 99mTc-(V)DMSA. Technetium-99m-MDP images were considered better than 99mTc-(V)DMSA images in showing bone lesions but not soft-tissue lesions. Both 201TI and 99mTc-MIBI scans provided sufficient advantage to exhibit neck and mediastinal metastases, but they did not surpass 99mTc-(V)DMSA in detecting abdominal or bony lesions. In this patient with various metastases from insular carcinoma of the thyroid, 99mTc-(V)DMSA seemed to be the tracer of choice for whole-body imaging.

Topics: Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Iodine Radioisotopes; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

To assess the reliability of bone scintigraphy, a random sample of 100 bone scans was reviewed twice by each of two physicians. Observer variation in the description and interpretation of bone scintigrams varied by diagnosis. Good to excellent k values were obtained for inter- and intraobserver variation in relation to metastasis or normal scans. For degenerative bone disease, as well as the specific agreement on major pathologies other than metastases, k values were found to be moderate. The agreement on the need for further radiographic studies was poor to moderate. The interpretation of bone metastases or normal scintigrams was found to be more reliable in a research setting than in the usual clinical framework, and the latter requires improvement. The interpretation of bone scintigraphy as consistent with degenerative changes is not reliable. The diagnosis should be evaluated by radiography.

Topics: Bone and Bones; Bone Neoplasms; Data Interpretation, Statistical; Female; Humans; Male; Middle Aged; Observer Variation; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate

Signet-ring cell carcinoma of the breast, first recognized in 1976, behaves aggressively and is associated with a poor prognosis. The tumor is a rare type of breast cancer and often metastasizes to the gastrointestinal tract and female genital tract. The authors report a case of a 48-year-old woman with bilateral signet-ring cell carcinoma of the breasts with multiple skeletal metastases and gastric metastasis. The breast cancer was depicted on a Tc-99m MIBI scintimammogram.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Signet Ring Cell; Female; Humans; Middle Aged; Neoplasms, Multiple Primary; Radionuclide Imaging; Stomach Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Focal renal concentration of radioactivity can simulate metastatic deposits in the lower ribs on bone scintigrams. 400 consecutive bone scintigrams were reviewed for focal areas of increased tracer activity in the kidneys. 62 patients (15.5%) had at least one renal hot spot. In 42 of these 62 patients (67.7%) there was an increased focal uptake in the left kidney (18 upper pole, 18 middle pole and six lower pole). 50 out of 62 bone scans (80.7%) showed increased activity in the right kidney (14 upper pole, 32 middle pole and four lower pole). With the incidence of focal areas of activity in the upper poles of the kidneys being 8%, the interpretation of a single focal abnormality projected over the lower ribs should be made with particular care, especially in cancer patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasms, Unknown Primary; Radionuclide Imaging; Retrospective Studies; Ribs; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Diagnosis, Differential; Female; Histiocytoma, Benign Fibrous; Humans; Ilium; Middle Aged; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Uptake of Tc-99m MDP tracer was noted within prostatic calcifications in a 48-year-old man with no known malignancy who underwent a three-phase bone scan for left knee and thigh pain. Routine anterior and posterior views of the pelvis demonstrated focal tracer uptake within the right pubic bone, which mimicked a metastatic lesion. Additional imaging showed the uptake to be extraosseous and localized within the prostate in a distribution similar to the extensive prostatic calcifications seen on the corresponding plain film and computed tomography examinations of the pelvis. This unusual presentation illustrates another potential artifact that may be present in scintigraphic bone imaging of the pelvis.

Topics: Bone and Bones; Bone Neoplasms; Calcinosis; Diagnosis, Differential; Humans; Male; Middle Aged; Prostatic Diseases; Radionuclide Imaging; Technetium Tc 99m Medronate

The complete removal of a lesion which resembles, or is covered by adjacent tissue may be difficult. Therefore, the capacity of certain lesions to specifically concentrate a radiopharmaceutical has been used to orient progress during surgery. Usually, the measurements of radioactivity in the operative field are carried out by means of small, handy radiation-detecting probes which can be sterilized. "Intra-operative nuclear medicine" or "radionuclide-guided surgery" has steadily gained in importance. However, this technique is not being taught. Our study, based on radionuclide-guided surgery of 175 orthopaedic patients suspected of having osteoid osteoma, is well suited to teach the particularities of intra-operative radiation detection, as well as the collaboration between the nuclear physician and the surgeon in the operating theatre.

Topics: Adult; Bone Neoplasms; Femoral Neoplasms; Humans; Intraoperative Care; Lumbar Vertebrae; Osteoma, Osteoid; Radiation Protection; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Tibia

Topics: Adult; Bone and Bones; Bone Neoplasms; False Positive Reactions; Female; Gallium Radioisotopes; Hodgkin Disease; Humans; Lymphoma, Non-Hodgkin; Male; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

A 49-year-old female with breast cancer after mastectomy and chemotherapy was found suffering from diabetes insipidus and panhypopituitarism syndrome. Whole body bone scan showed hyperfixation in sella turcica. This site is extremely rare, especially in breast cancer metastases.

Topics: Adrenal Cortex Hormones; Bone Neoplasms; Breast Neoplasms; Combined Modality Therapy; Diabetes Insipidus; Female; Humans; Hypopituitarism; Mastectomy, Modified Radical; Middle Aged; Radiography, Thoracic; Radionuclide Imaging; Sella Turcica; Technetium Tc 99m Medronate

The objective of this study was to evaluate the postoperative technetium-99m-labeled methylene diphosphonate (99mTc-MDP) scintigraphic appearance of limb-sparing procedures in patients treated for bone tumors.. We retrospectively reviewed the medical records and assessed planar bone scans, subjectively and semiquantitatively, of all patients treated with limb-sparing procedures at our institution who survived at least 1 year following resection of the primary lesion.. The operative sites of 20 of the evaluable 45 patients (44%) demonstrated normal tracer avidity during follow-up (median 12 months). Nine patients (20%) demonstrated normal avidity on their first follow-up bone scans (median 6 months). Coincident 99mTc-MDP bone scans were obtained on 11 patients who developed 12 postoperative complications or injury during the study and accurately identified the lesion in eight (67%).. Although many patients have abnormal 99mTc-MDP avidity in the operative site after limb-sparing surgery, almost half eventually have normalization of uptake. However, planar bone scans have limited use for assessing the primary tumor site postoperatively as persistent abnormal avidity may preclude detection of changes associated with development of postoperative complications.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Extremities; Female; Follow-Up Studies; Humans; Male; Postoperative Complications; Prostheses and Implants; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

To evaluate treatment of osteoid osteoma with computed tomography (CT)-guided percutaneous excision and immediate follow-up scintigraphy.. Sixteen consecutive adolescent and adult patients underwent CT-guided percutaneous excision of a nidus with 14-gauge biopsy cutting needles, with local anesthesia. After the presence of nidus was confirmed at immediate follow-up scintigraphy, curettage of the bored cavity was performed to remove any residual fragments of the nidus. Scintigraphic and histologic findings were correlated.. The nidus was removed successfully in 14 of the 16 patients, with no complications (mean follow-up, 15 months; range, 3-25 months). In five of the 14 patients, immediate follow-up scintigraphy showed incomplete resection of the nidus and immediate second resection was successful. Surgical resection was necessary in two of the 16 patients.. CT-guided percutaneous excision with immediate follow-up scintigraphy was safe and effective for localization and removal of osteoid osteoma in outpatients.

Topics: Adult; Anesthesia, Local; Biopsy, Needle; Bone Neoplasms; Curettage; Female; Follow-Up Studies; Humans; Male; Needles; Osteoma, Osteoid; Radiology, Interventional; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray Computed

Topics: Adult; Bone Neoplasms; Carcinoma, Squamous Cell; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Thymus Neoplasms

Topics: Bone Neoplasms; Colonic Diseases; Diagnosis, Differential; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Ilium; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Sigmoid Diseases; Technetium Tc 99m Medronate; Vascular Neoplasms

Topics: Adolescent; Bone Neoplasms; Humans; Male; Neoplasm Recurrence, Local; Osteoma, Osteoid; Radionuclide Imaging; Talus; Technetium Tc 99m Medronate

Scintigraphy using Tc-99m MDP and Tl-201 was performed in a patient with polyostotic Paget's disease and sarcomatous degeneration in the right iliac bone. Tc-99m MDP imaging showed abnormal uptake in both types of lesions. Tl-201 imaging showed increased uptake in the sarcomatous lesion and absent uptake in pagetic lesions. This result supports the idea that Tl-201 scintigraphy may have a potential role to play in the differentiation of Paget's disease from malignancy. To the authors' knowledge, Tl-201 has never been reported for the detection of sarcomatous change of pagetic bone.

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Ilium; Middle Aged; Osteitis Deformans; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Thallium Radioisotopes

Strontium-89 chloride is widely available in the U.S. and Europe for patients afflicted by bone metastasis associated with pain. 89Sr is a pure beta-emitter and it is thought to be difficult to estimate its distribution externally. We tried to image the distribution of 89Sr uptake with bremsstrahlung from beta-minus decay of 89Sr by using Nal scintillation camera. Pronounced 89Sr depositions in the bone metastatic sites were imaged in the energy windows from 50 keV to 150 keV bremsstrahlung. The distribution of these depositions corresponded to 99mTc-HMDP image may be suspected to the effectiveness of this therapy. The identification of 89Sr distribution might be useful in evaluating the bone marrow radiation dose too.

Topics: Aged; Bone and Bones; Bone Neoplasms; Female; Gamma Cameras; Humans; Male; Middle Aged; Pain, Intractable; Radionuclide Imaging; Radiotherapy, High-Energy; Scattering, Radiation; Scintillation Counting; Strontium Radioisotopes; Technetium Tc 99m Medronate

The aims of this study were to assess whether 99Tcm-phytate can detect metastatic skeletal lesions, and to compare it with 99Tcm-methylene diphosphonate (99Tcm-MDP) and 99Tcm-labelled human serum albumin nanocolloids (99Tcm-NC). Twenty-four patients with multiple bony metastases, investigated by 99Tcm-MDP whole-body scintigraphy, underwent 99Tcm-phytate bone marrow imaging. A separate bone marrow scintigram with 99Tcm-NC was performed in 20 of the patients. All of the metastatic lesions detected on the 99Tcm-phytate scintigrams exhibited photon-abundant foci only. Most of the 99Tcm-phytate scintigrams detected fewer metastatic lesions than the corresponding bone scintigrams. Visual comparison of the 99Tcm-NC images showed that 13 of 20 99Tcm-NC images were superior to the 99Tcm-phytate images in the detection of metastatic involvement of the skeleton. Thus 99Tcm-phytate should not be used as a bone marrow imaging agent for the detection of skeletal metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Phytic Acid; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

Tc-99m MIBI is taken up avidly by viable tumor tissue and does not accumulate in the necrotic carcinoma. We present a patient who underwent Tc-99m MIBI and Tc-99m HMDP thoracic SPECTs: a large area of increased MIBI uptake with central photopenia (ring appearance) in the right upper lung localizes bone imaging agent and does not localize multiple areas of intense uptake in the metastatic hilar mediastinum lymph nodes. Rapid growth of tumor cells in the lung leading to central necrosis/ischemia accounts for bone imaging agent localization in the tumor, as well as the ring-appearance of lung mass on Tc-99m MIBI imaging. These findings may reflect less viability of the lung tumor as compared with intense MIBI uptake in hilar/mediastinal lymph node uptake without bone agent localization.

Topics: Bone Neoplasms; Carcinoma, Small Cell; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thorax; Tomography, Emission-Computed, Single-Photon

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

Although bone scintigraphy is a sensitive method for detecting skeletal metastases, it is often equivocal for metastases due to poor specificity. This study evaluates 99mTc-antigranulocyte antibody (AGA) bone marrow scintigraphy in differentiating malignant from benign lesions, in 42 patients with skeletal tumors who had equivocal bone scans.. AGA scans performed approximately 1 wk after 99mTc-MDP bone imaging were visually assessed for the presence of concordant marrow defects. Final diagnoses were made from radiological results, follow-up bone scans or clinical evaluation for 12 mo or longer.. The final diagnoses were: skeletal metastasis (19 patients), no metastasis (20 patients) and unconfirmed (3 patients). AGA scans could not determine the presence of a concordant defect in three patients because of overlying liver activity or previous irradiation of the region. Seventeen patients had bone marrow defects concordant with bone scan lesions, whereas 15/19 patients without metastasis had normal AGA scans. The sensitivity and specificity of AGA for detecting skeletal metastases were 100% and 79%, respectively.. AGA scans had a low incidence of skeletal metastases in patients who had equivocal bone scans. Although a concordant marrow defect increases the possibility of metastasis, further radiological investigation to exclude benign disease is warranted.

Topics: Antibodies, Monoclonal; Antigens, Neoplasm; Bone and Bones; Bone Marrow; Bone Neoplasms; Cell Adhesion Molecules; Female; Humans; Male; Membrane Glycoproteins; Middle Aged; Predictive Value of Tests; Radioimmunodetection; Sensitivity and Specificity; Technetium; Technetium Tc 99m Medronate

The objective of this study was to compare Tc-99m MDP bone and Ga-67 scans for the therapeutic response to bone lymphoma in 40 patients. The authors retrospectively compared 40 Tc-99m MDP bone scans and 20 Ga-67 scans before therapy, 29 bone scans and 13 Ga-67 scans during the therapy, and 33 bone scans and 15 Ga-67 scans after therapy. Tc-99m MDP and Ga-67 whole body scans were obtained within 2 weeks of each study and were graded visually (grades 1-4) in which grade 3 means similar count density to that of normal iliac alar activity on bone scans and normal liver activity on Ga-67 scans, respectively. The findings of lesion improvement during and after therapy were found in 66.0% (19 of 29) and 72.7% (24 of 33) with Tc-99m MDP bone scans, 84.6% (11 of 13) and 86.7% (13 of 15) with Ga-67 scans, respectively. The mean grades of Tc-99m MDP uptake were 3.06 before, 2.34 during, and 1.75 after therapy. The mean grades of Ga-67 uptake were 3.22 before, 1.42 during, and 1.30 after therapy. Ga-67 scans appear to be more reliable than Tc-99m MDP bone scans in evaluating the therapeutic response of bone lymphoma.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Female; Gallium Radioisotopes; Humans; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Adolescent; Adrenal Gland Neoplasms; Bone Neoplasms; Humans; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Bisphosphonates have marked affinity for bone that makes them useful in both the treatment and imaging of bone lesions. Bone scintigraphy is very sensitive for the detection of bone metastases, which can cause life-threatening hypercalcemia requiring emergency treatment. This prospective study was done to determine whether intravenous administration of pamidronate, a second-generation bisphosphonate used to treat hypercalcemia, affects the affinity of the radiopharmaceutical 99m technetium-labeled hydroxymethylene bisphosphonate (99mTc-HMDP) for bone and bone lesions. Six patients with metastatic bone disease and five with Paget's disease of bone had a 99mTc-HMDP bone scan before and two to four days after an intravenous infusion of pamidronate. The number and activity of metastatic bone lesions were unchanged after pamidronate, even when the second bone scan was done only 24 hours after the pamidronate infusion. Our data suggest that emergency treatment of life-threatening hypercalcemia by intravenous pamidronate does not decrease the sensitivity of subsequent bone scanning done to detect bone metastases.

Topics: Aged; Bone Neoplasms; Diphosphonates; Female; Humans; Hypercalcemia; Infusions, Intravenous; Male; Middle Aged; Osteitis Deformans; Pamidronate; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

Tumour markers are a potentially powerful means of obtaining information about cancers whilst causing minimal morbidity, inconvenience and cost. CA15-3 has been suggested as a marker of distant metastasis (M+ disease) in breast cancer. We have measured CA15-3 in 77 patients with carcinoma of the breast in order to determine whether routine assay of this tumour marker would be useful in the oncology unit of a district general hospital. A highly significant correlation existed between elevated CA15-3 levels (> or = 30 U/ml) and M+ disease. The CA15-3 assay was found to have a sensitivity of 70%, a specificity of 96% and a predictive value of 87%, in agreement with previous studies. There was evidence that CA15-3 levels frequently increased in advance of otherwise detectable distant metastases. 70 patients had a 99m Tc bone scan close to the date on which CA15-3 was measured. All patients with a positive bone scan and raised levels of CA15-3 were subsequently confirmed as having bony metastases; no patient with normal bone scan and normal CA15-3 developed M+ disease (to the date of follow-up). CA15-3 levels were raised in 83% of patients who developed non-bony distant metastases. In clinical practice it may be possible to exploit the high specificity of CA15-3, in order to provide additional information to that already determined by current investigations. For example, CA15-3 might be assayed alongside a bone scan to confirm positive or negative results. Another role might be as a screen for breast cancer metastases in departments with limited access to bone scans and other imaging facilities. CA15-3 might also be used in monitoring patients for the development of distant metastases during follow-up. It is, however, unlikely that CA15-3 can substitute directly for a bone scan or other imaging currently used routinely by a department. Clinical trials are now necessary to determine the effect of using tumour markers such as CA15-3 on patient morbidity and mortality.

Topics: Biomarkers, Tumor; Bone Neoplasms; Breast Neoplasms; False Negative Reactions; False Positive Reactions; Follow-Up Studies; Humans; Mucin-1; Prognosis; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma, Transitional Cell; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Urinary Bladder Neoplasms

A 37-yr-old man presented with increasing abdominal girth and multiple palpable intra-abdominal masses 3 yr after colectomy for polyposis coli. Whole-body skeletal scintigraphy performed prior to laparotomy demonstrated diffuse abdominal uptake of 99mTc-HDP consistent with mesenteric fibromatosis confirmed at surgery. When diffuse abdominal uptake of skeletal imaging agents occurs in patients with prior colectomy for polyposis coli, mesenteric fibromatosis as a manifestation of Gardner's syndrome should be suspected. This case illustrates another cause of diffuse abdominal uptake of skeletal imaging agents.

Topics: Abdomen; Adult; Bone Neoplasms; Colectomy; Colonic Polyps; Fibromatosis, Abdominal; Gardner Syndrome; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

A 50-y-old male patient with prostate cancer showed two suspicious lesions in bone scintigrams. They were assessed to be bone metastases by biopsy of the os ilium. After i.v. injection of 99mTc-HMDP a probe-guided localization permitted optimal surgical treatment. A bone metastasis in the os ilium was confirmed. The intraoperative detection with a hand-held gamma probe permitted accurate and complete excision of the tumour; the bone defect could thus be reduced to a minimum.

Topics: Bone and Bones; Bone Neoplasms; Gamma Rays; Humans; Intraoperative Period; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Medronate

Topics: Alendronate; Bone and Bones; Bone Neoplasms; Clodronic Acid; Diphosphonates; False Negative Reactions; Female; Humans; Hypercalcemia; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child; Citrates; Citric Acid; Diagnosis, Differential; Female; Gallium Radioisotopes; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Tuberculosis, Osteoarticular

A patient with osteomalacia secondary to vitamin D deficiency after gastrectomy for gastric cancer is presented. Initial bone scintigrams showed both asymmetric and symmetric focal areas of intense uptake due to pseudofractures reminiscent of bone metastases. Radiographs only confirmed the presence of pseudofractures at some, but not all, of the abnormal sites demonstrated by bone scintigraphy. At first, metastatic bone disease was suspected. However, the appearance of repeated bone scintigram was normalized after treatment with vitamin D. A diagnosis of osteomalacia was established. The present case serves to illustrate that symmetric focal lesions are important features of pseudofractures secondary to osteomalacia, and comparison with radiographs and repeated bone scintigraphy are necessary in distinguishing between bone metastases and pseudofractures.

Topics: Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Fractures, Bone; Gastrectomy; Humans; Male; Middle Aged; Osteomalacia; Postoperative Complications; Radionuclide Imaging; Stomach Neoplasms; Technetium Tc 99m Medronate; Vitamin D Deficiency

The authors conducted a retrospective review of 234 bone scans of stomach cancer patients who had been diagnosed at the Seoul National University Hospital. In 106 of the 234 cases (45.3%), there were abnormal bone scan results, suggestive of bone metastases. The most common site of bone metastases was the spine, followed by the ribs, pelvis, femur, and skull. These sites were similar to those known for other malignant diseases. The incidence of bone metastases increased according to the duration of disease, especially within 12 months after diagnosis in patients with stage III gastric cancer. The incidence of bone metastases increased as the clinical stage increased. However, the incidence of metastases did not relate to gastric cancer pathologic type. The authors found 6 cases of "superscan" in the 234 bone scans (2.6%). The bone scan findings correlated positively with the level of serum alkaline phosphatase.

Topics: Bone Neoplasms; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Stomach Neoplasms; Technetium Tc 99m Medronate

Technetium-99m (V) DMSA scintigraphy was performed in 17 patients with 37 chondrogenic tumors (13 osteochondromas, 14 enchondromas, and 10 chondrosarcomas) that had previously shown uptake of Tc-99m HMDP. Technetium-99m (V) DMSA showed high uptake by all chrondrosarcomas, but low or no uptake always indicated benign chondrogenic tumors. Technetium-99m (V) DMSA scintigraphy may be superior to Tc-99m HMDP scintigraphy for distinguishing benign and malignant chondrogenic tumors, and could also be useful for diagnosing the malignant transformation of chondrogenic tumors.

Topics: Bone and Bones; Bone Neoplasms; Chondroma; Chondrosarcoma; Humans; Organotechnetium Compounds; Osteochondroma; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

A 52-year-old man with metastatic poorly differentiated bronchogenic carcinoma and serum calcium levels as high as 14.6 had intense Tc-99m MDP uptake found throughout the stomach wall on SPECT imaging. FDG uptake assessed by PET imaging was not elevated in the stomach, whereas multiple hyper-metabolic tumor foci could be found throughout the body. Three months later, when calcium levels normalized, no Tc-99m MDP uptake was found in the stomach despite persistence of neoplastic lesions elsewhere. This case study indicates that gastric MDP uptake in patients with malignancy related hypercalcemia can be reversible and not necessarily indicative of neoplastic infiltration.

Topics: Bone Neoplasms; Carcinoma, Bronchogenic; Deoxyglucose; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Hypercalcemia; Lung Neoplasms; Male; Middle Aged; Stomach; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

A patient with a history of breast cancer and known lung metastases was referred for a bone scan to investigate the cause of severe neck and right shoulder pain. The bone scan showed massive uptake of the radiopharmaceutical in the soft tissue surrounding the right shoulder. A review of the patient's history indicated that the patient had undergone radiation therapy to the right upper thorax and breast area 14 months previously and an acute radiation dermatitis of the proximal right arm and should had developed. This had long since resolved. Physical examination and plain radiographs of the right shoulder and humerus failed to demonstrate any abnormality.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Radiodermatitis; Radionuclide Imaging; Shoulder; Soft Tissue Injuries; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

We report on the diagnostic validity of the serum concentrations of the C-terminal propeptide of type I procollagen (a marker of bone formation) and of the urinary excretion of deoxypyridinoline (a marker of bone resorption) in a consecutive series of 89 tumour patients who were routinely examined by 99mTc-methylene bisphosphonate bone scintigraphy for detection of bone metastases. Z score analysis reveals that the discriminating power of deoxypyridinoline is superior to that of calcium excretion whereas the discriminating power of the C-terminal propeptide concentrations is inferior to that of bone alkaline phosphatase values. Accuracy (as assessed by the area under the receiver-operating characteristic curve) was 0.75 for deoxypyridinoline and 0.82 for the C-terminal propeptide. Combination of both markers did not yield an increase of accuracy (0.82) compared with the determination of the C-terminal propeptide concentrations alone. There was a correlation (r = +0.398; p < 0.0001) between C-terminal propeptide concentrations and deoxypyridinoline excretion values in the group of 89 patients examined. Further studies should be done to elucidate whether the determination of bone collagen turnover is suitable as a screening procedure for detecting bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Amino Acids; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Bone Resorption; Calcium; Collagen; Female; Humans; Immunoassay; Male; Middle Aged; Peptide Fragments; Procollagen; Radionuclide Imaging; ROC Curve; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Citrates; Citric Acid; Gallium Radioisotopes; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Focal and diffuse hepatic uptake of bone-seeking radiopharmaceuticals may be due to a variety of conditions including tumors and radiopharmaceutical impurity. However, uptake in the gallbladder is unusual with currently used skeletal agents. Three patients (aged 10, 15, and 16 years) underwent routine whole-body bone scans during a course of intensive chemotherapy with VP-16 and ifosphamide. Images showed intense gallbladder and faint liver uptake. No patient had symptoms of cholecystitis. Radiopharmaceutical quality control revealed no impurities. Repeat bone scans after completion of chemotherapy showed no liver or gallbladder uptake. The authors conclude that this finding represents altered distribution induced by the chemotherapy regimen, and should not be misinterpreted as intrinsic liver or gallbladder disease.

Topics: Adolescent; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bone and Bones; Bone Neoplasms; Child; Etoposide; Female; Gallbladder; Humans; Ifosfamide; Liver; Male; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tissue Distribution

At their initial emergency room presentation, four children were thought to have hip osteomyelitis. Skeletal scintigraphy, however, demonstrated multiple areas of abnormal tracer uptake in the bones in all four, and in three there was abnormal uptake in a soft tissue abdominal mass. The skeletal scintigraphic findings promptly led to the correct diagnosis of neuroblastoma.

Topics: Adrenal Gland Neoplasms; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Hip; Hip Joint; Humans; Infant; Male; Neuroblastoma; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate

To determine whether temporal changes in scintigraphic and bone radiographic findings have prognostic significance in patients with skeletal metastases from breast cancer.. Clinical information and films were retrospectively reviewed in 101 randomly selected patients with skeletal metastases. Images from sequential bond scans and bone radiographs were correlated with survival after detection of the metastases.. Time to detection of skeletal metastases and the length of time for which patients were classified as radiologically stable after development of skeletal metastases correlated with survival (r = 0.843; r = 0.821, respectively). Failure to develop a radiographically and scintigraphically stable pattern after treatment was associated with significantly decreased survival compared with the rest of the patients (mean survival 2.1 +/- 1.3 years vs 4.3 +/- 2.3 years; p < 0.001). Scintigraphic regression of metastases was associated with significant survival benefit and longer stabilization of disease compared to all other patterns (mean survival 5.0 +/- 2.7 years of regressive disease vs 3.7 +/- 1.9 years for stable disease and 2.2 +/- 1.3 years for progressive disease; p < 0.001).. Sequential scintigraphic and radiographic imaging is useful in breast cancer patients not only for detection of metastases and monitoring of treatment effect, but also because these studies provide valuable prognostic information.

Topics: Adult; Aged; Analysis of Variance; Bone Neoplasms; Breast Neoplasms; Disease Progression; Female; Follow-Up Studies; Forecasting; Humans; Middle Aged; Osteosclerosis; Outcome Assessment, Health Care; Prognosis; Radiography; Radionuclide Imaging; Remission Induction; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate; Treatment Outcome

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

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

Topics: Bone Neoplasms; Child; Chondroblastoma; Clavicle; Contrast Media; Diagnosis, Differential; Gadolinium DTPA; Humans; Humerus; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Radiopharmaceuticals; Shoulder Fractures; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Calcium Oxalate; Cystine; Hardness; Humans; Kidney Calculi; Kinetics; Magnesium Compounds; Phosphates; Preoperative Care; Radionuclide Imaging; Struvite; Technetium Tc 99m Medronate; Uric Acid; Urinary Calculi

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Neoplasms; Humans; Iodine Radioisotopes; Iodobenzenes; Radionuclide Imaging; Technetium Tc 99m Medronate

The purpose of this study was to evaluate the value of bone and Ga-67 imaging in patients with malignant fibrous histiocytoma (MFH). Thirty-four patients with biopsy-proven MFH were studied. Of these patients, 15 underwent Ga-67 imaging, 26 underwent Tc-99m MDP imaging, and 7 underwent both imaging procedures. In evaluation of the primary tumors, intense Ga-67 uptake was observed in 14 of 15 patients with a diagnostic sensitivity of 93.3%. However, positive bone imaging results were observed in only 10 of 26 patients with a diagnostic sensitivity of 38.5%. Most of these were secondary to Tc-99m MDP uptake in adjacent bone invaded by the primary tumor. Only two patients, of the 18 patients without direct bone invasion, had increased radioactivity in the tumors (11.1%). In evaluation of the metastatic lesions, increased Ga-67 uptake was observed in 8 of 8 metastatic sites (100%). However, Tc-99m MDP could only detect 5 of 12 metastatic sites (41.7%), which were all diagnosed to be bone metastases. None of the extraskeletal metastasis could be detected by Tc-99m MDP imaging. Ga-67 scintigraphy appears to be a very useful tool in the evaluation of both primary and metastatic lesions of MFH and is assumed to be useful in the follow-up. However, it is emphasized that bone scintigraphy is useful only when the tumor invades the skeletal system and is of limited value in the evaluation of extraskeletal lesions.

Topics: Bone and Bones; Bone Neoplasms; Evaluation Studies as Topic; Gallium Radioisotopes; Histiocytoma, Benign Fibrous; Humans; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

The objective of this study was to determine the value of magnetic resonance (MR) imaging in diagnosing local recurrence of Ewing sarcoma. We retrospectively reviewed radiographs, Tc99m-methylene diphosphonate (MDP) skeletal scintigraphy, computed tomography scans, and MR studies of 11 patients who had local recurrences of osseous Ewing sarcoma following initial responses to chemotherapy and local radiation. The MR images were compared to those of a control group of nine patients who had no evidence of relapse. T1- and T2-weighted MR images identified 9 of the 11 recurrences. Computed tomography was diagnostic in 4 of 6 cases evaluated, Tc99m-MDP bone scintigraphy in 4 of 11 cases, and plain radiographs in 2 of 10. MR findings at relapse included changes in signal intensity, increased extent of abnormal marrow signal on T1- and T2-weighted images, and identification of a new soft tissue mass. These findings suggest that MR imaging is valuable in the routine follow-up of primary osseous Ewing sarcoma.

Topics: Adolescent; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Radionuclide Imaging; Retrospective Studies; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Thirty-seven patients with newly diagnosed or treated sarcomas had 47 sets of sequential thallium scans (TS) followed by three-phase bone scan (TPBS) on the same day. The diagnosis in all patients was verified by biopsy (n = 40) or long-term follow-up studies (n = 7). The sensitivity, specificity, and accuracy of TS and TPBS in detecting sarcomatous lesions was calculated: TS sensitivity was 88%, specificity 69%, and accuracy 83%; blood flow (BF) and blood pool (BP) sensitivity was 91%, specificity 54%, and accuracy 81%; delayed bone scan (DB) sensitivity was 88%, specificity 38%, and accuracy 74%. In 17 studies the flow and blood pool parts of the TPBS and TS demonstrated the soft tissue component of sarcomas, which would have been missed if only the delayed bone scan had been performed. The TS lesion to normal tissue ratio alone was not very helpful in differentiating sarcomas from benign conditions because some benign lesions are highly cellular and vascular while some malignant lesions, such as chondrosarcoma, have poor vascularity and a less cellular chondroid matrix. However, when the thallium ratio was correlated with similar ratios calculated from the BP image, it was found that if the TS lesion to normal tissue ratio exceeded the BP lesion to normal tissue ratio (12 patients), the specificity for detecting sarcomatous lesions was 100%. Nevertheless, the reverse was not true. The positive predictive value of this observation was 100% and the negative predictive value was 37%.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Child; Chondrosarcoma; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes

Topics: Adenoma; Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Osteitis Fibrosa Cystica; Parathyroid Neoplasms; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

After establishing the diagnosis of carcinoma in the head and neck, routine examinations comprise chest x-ray, bone scan and abdominal ultrasound and are often initiated to exclude or confirm metastatic disease. Data are few on the frequency of metastases at the time of initial diagnosis and reliability of bone scanning and sonography to detect metastases. The aim of the present retrospective study was to define criteria for the use of these latter two methods of examination. The medical records of 382 patients with squamous cell carcinoma who were examined for the first time were analyzed during a four-year period. Bone scanning was performed on 360 patients, but suspect scintigraphic evidence of bone metastasis could be confirmed in only one patient. Only three of 367 patients undergoing abdominal ultrasound were found to have hepatic metastases. Reasons for a practical use of these two methods of examination are discussed.

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; Diagnosis, Differential; Diagnostic Imaging; Head and Neck Neoplasms; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Staging; Otorhinolaryngologic Neoplasms; Prognosis; Technetium Tc 99m Medronate; Ultrasonography

Topics: Adolescent; Bone Neoplasms; Femoral Neoplasms; Humans; Male; Radiography; Radionuclide Imaging; Sarcoma, Ewing; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

Strontium-89 is an effective agent for palliation of pain due to bony metastases from breast and prostate carcinoma. As a functional analog of calcium, 89Sr is taken up by bone in areas of osteoblastic activity. Since patients with multiple myeloma frequently have osteolytic metastases, 89Sr might not be considered to be a therapeutic option. However, metastases which appear osteolytic by radiographs may demonstrate osteoblastic activity on bone scans. Consequently, the bone scan may be used to identify a subset of patients with osteolytic metastases who may benefit from 89Sr treatment. This report describes a patient with severe rib pain due to multiple myeloma whose chest radiograph showed multiple lucent lesions throughout the bones of the chest wall but whose bone scan showed marked osteoblastic activity. The patient was treated with 89Sr and received substantial pain relief. Bone scans may be useful in selecting myeloma patients or other cancer patients with osteolytic radiographic lesions who may benefit from 89Sr therapy.

Topics: Bone and Bones; Bone Neoplasms; Female; Follow-Up Studies; Humans; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Strontium Radioisotopes; Technetium Tc 99m Medronate

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

A patient with diffuse osteoblastic metastases from invasive lobular carcinoma of the breast is presented in whom radionuclide bone scan was negative for skeletal lesions. Skeletal metastases were documented by plain radiography, CT, MRI, and bone marrow biopsy. This case report points to the value of plain-film, CT, and MRI findings in situations of high clinical suspicion of metastatic disease despite a normal scintigraphy.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma, Lobular; False Negative Reactions; Female; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The authors present comparative triple-phase bone scan findings in three cases of histologically proven aggressive fibromatosis both before (initial evaluation) and after radiation therapy. The purpose of the study was to compare triple-phase bone scan findings in aggressive fibromatosis both before and after radiation therapy and to determine whether any additional physiological information could be obtained. Before radiation therapy, the triple-phase bone scintigraphy demonstrated increased flow and radiotracer pooling in the areas of tumors on dynamic flow and immediate blood pool images, respectively. However, the delayed static images demonstrated variable radiotracer uptake. When compared to preradiation therapy triple-phase bone scan, decreased vascularity was well demonstrated in all three patients after radiation therapy. In addition, it also provided information regarding the changes in the size and extent of tumor, noninvaded underlying bone, and remainder of the skeleton. This additional information can be particularly useful in patients with equivocal or questionable histologic diagnosis especially from small, unrepresentative biopsies.

Topics: Adult; Biopsy; Bone and Bones; Bone Neoplasms; Female; Fibromatosis, Abdominal; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiotherapy Dosage; Technetium Tc 99m Medronate; Time Factors

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

Retention of 99mTc-MDP in the fetal skeleton and placenta at 30 and 32 wk gestation was observed during bone scan examination of the maternal skeleton for staging of malignant tumors. The implications and significance of these observations are discussed.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Fetus; Gestational Age; Giant Cell Tumor of Bone; Humans; Infant, Newborn; Male; Placenta; Pregnancy; Pregnancy Complications, Neoplastic; Radiation Dosage; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia

Topics: Bone and Bones; Bone Neoplasms; Child; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

We report a case of histologically proven intraosseous hemangiomatosis in which marked accumulation of pentavalent technetium-99m-dimercaptosuccinic acid (99mTc(V)DMSA) and technetium-99m-hydroxymethylene diphosphonate (99mTc-HMDP) was observed in the osteolytic hemangiomatous lesions.

Topics: Adult; Bone Neoplasms; Hemangioma; Humans; Male; Organotechnetium Compounds; Osteolysis, Essential; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Intratibial injection in nude rats of 1 x 10(6) OHS, MHMX, and LOX human tumor cells resulted in each case in progressively growing bone tumors. When the diameter of the affected leg had increased by 2-3 mm, the animals were examined for uptake of 99mTc-methylenediphosphonate. The OHS osteosarcoma tumors caused sclerotic lesions with high and uniform isotope uptake, and the MHMX unclassified sarcoma showed a mixed pattern with both sclerotic and lytic areas, whereas the LOX melanoma caused lytic bone lesions with low uptake of the radionuclide. These findings were compared with the results of analogous investigations previously performed in the patients from whom the tumor lines originated. Striking similarities in both the morphology and the scintigraphic images were observed between corresponding tumors in rats and humans, with results supporting the clinical relevance of the model systems. When the LOX model was used for therapy experiments, doxorubicin had no effect on the growth of the tibial tumors, which in the control group appeared after a latency of 13.5 days. The alkylating agent mitozolomide increased the median tumor-free latency to 47 days in 7 rats, and 5 animals did not develop tumors within the observation period of 60 days. Doxorubicin was ineffective also against the OHS tumor, whereas ifosfamide and the radionuclide 89Sr-chloride showed significant antitumor activity. The disease-free latency increased from 20 days, in the control animals, to 45 and 28.5 days, respectively, in the 2 treated groups, in which 2 of 7 and 2 of 10 rats were without tumors at 60 days. The data demonstrate that the tibial models discriminated between the action of the different therapeutic agents, and suggest that they may be useful in selecting compounds with clinical activity against skeletal tumors.

Topics: Animals; Bone Neoplasms; Cell Line; Doxorubicin; Female; Femur; Ifosfamide; Male; Melanoma, Amelanotic; Osteosarcoma; Radionuclide Imaging; Rats; Rats, Nude; Sarcoma; Strontium; Technetium Tc 99m Medronate; Tibia; Transplantation, Heterologous; Tumor Cells, Cultured

A Tc-99m bone scan of a patient with classic roentgenographic findings of osteopoikilosis revealed multiple foci of increased activity that corresponded to many of the sclerotic foci on the roentgenograms. The authors presume that the abnormal bone scan in this patient reflects active osseous remodeling, similar to what has been observed in bone islands. Previous reports have emphasized the critical role of the radionuclide bone scan for distinguishing osteopoikilosis from osteoblastic bone metastases in patients with a known or suspected primary malignancy. In a young patient, an abnormal bone scan does not exclude the diagnosis of osteopoikilosis if the roentgenographic findings are characteristic of that entity.

Topics: Adult; Bone and Bones; Bone Neoplasms; Bone Remodeling; Diagnosis, Differential; Humans; Male; Osteopoikilosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

46 patients with recently diagnosed carcinoma of the breast were included in a prospective comparative study of MRI and bone marrow scintigraphy. The aim of the study was to compare these procedures within a histologically unified patient collective. It was shown that MRI was superior to bone marrow scintigraphy in respect of sensitivity (92% vs 58%) and specificity (97% vs. 85%), although only about three quarters of the marrow spaces are examined by MRI screening. Bone marrow scintigraphy suffered particularly from a relatively high number of false positive findings (haemangiomas, degenerative changes). MRI remains the method of choice for investigating the bone marrow.

Topics: Bone Marrow; Bone Neoplasms; Breast Neoplasms; Carcinoma; Evaluation Studies as Topic; False Negative Reactions; False Positive Reactions; Female; Humans; Magnetic Resonance Imaging; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole-Body Counting

Compared to other primary neoplasms, bone metastases from carcinoid tumor are rare. Because some lesions may be clinically or radiographically occult, the radionuclide bone scan can be very helpful in delineating the extent of disease. The authors report a case of a patient with clinically occult widespread metastatic disease detected by bone scan, with radiographic correlation.

Topics: Bone and Bones; Bone Neoplasms; Carcinoid Tumor; Female; Humans; Middle Aged; Radiography; Radionuclide Imaging; Rectal Neoplasms; Technetium Tc 99m Medronate

In clinical practice, it may be difficult to distinguish a metastatic bone superscan appearance from a normal bone scan. To determine if assessment of bone marrow is helpful in the diagnosis of bone invasion in patients with suspected bone superscans, the authors performed antigranulocyte antibody bone marrow scans in 10 consecutive cancer patients who had a conventional bone scan interpreted as metastatic superscan appearance. All patients presented with bone marrow scans showing marked absence of tracer uptake in the central skeleton suggesting tumour replacement. Laboratory tests showed decreased peripheral blood cells in 9 patients. Bone radiographs showed metastatic involvement with diffuse osteoblastic lesions in 9 patients. Antigranulocyte bone marrow scans show extensive bone marrow invasion in cancer patients with suspected bone superscans. This result reinforces the concept of these patients having extensive bone invasion despite mild abnormalities in the bone scan. Confirmation of extensive bone invasion on patients with suspected bone superscans may contribute to a proper staging of these patients.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Female; Granulocytes; Humans; Male; Middle Aged; Prostatic Neoplasms; Radioimmunodetection; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Humans; Male; Middle Aged; Osteoma, Osteoid; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Thumb

A case is presented of synovial chondromatosis within a bursal sac overlying an osteochondroma in a patient with osteochondromatosis. This condition presented with a symptomatic soft tissue mass containing calcified bodies. It can be mistaken clinically and radiographically for malignant degeneration of an osteochondroma with development of chondrosarcoma. Magnetic resonance findings have not previously been described in this entity and proved helpful in the preoperative diagnosis. Magnetic resonance imaging was also helpful in defining the extent of the lesion. Ultrasound and other imaging modalities are also discussed, including the pathologic basis for the radiographic findings.

Topics: Adult; Bone Neoplasms; Bursa, Synovial; Chondromatosis, Synovial; Diagnosis, Differential; Female; Humans; Magnetic Resonance Imaging; Osteochondromatosis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Carcinoma of the prostate is the commonest malignancy of the genitourinary tract in the male and is frequently associated with metastatic bone disease. Serial isotope bone scans for screening secondary deposits are not cost-effective. We have evaluated the serum prostate markers prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP) as an alternative to conventional serial bone scanning in 129 patients with newly diagnosed prostate cancer over a period of 3 years. Although serum PSA did not reflect local tumour burden at presentation, it was significantly elevated in those who presented with stage D disease (p < 0.01). 45 patients presented de novo with metastatic bone deposits and a further 18 patients developed metastases during the study period. The sensitivity of PSA in detecting secondary deposits at presentation for levels in excess of 100 micrograms/l was 93.75%, the positive predictive value 95.7% and the negative predictive value for levels less than 5 micrograms/l was 90.6%. During the follow-up period the sensitivity was 94.4%, the positive predictive value 100% and the negative predictive value 100%, with a median lead time of 3 months in predicting metastases in the 18 patients with progressive disease. When compared with PAP, PSA was found to be a statistically superior marker of bone metastases both at presentation and follow-up (p < 0.05). We recommend that PAP measurements are no longer necessary and should be replaced by PSA, and that serial serum PSA estimations should determine the need for future isotope bone scans in the patient with established prostate cancer.

Topics: Acid Phosphatase; Bone and Bones; Bone Neoplasms; Follow-Up Studies; Humans; Male; Predictive Value of Tests; Prostate; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

There have been few studies and case-reports of bone metastases from hepatocellular carcinoma. To determine the characteristics of these metastases, we retrospectively studied 22 patients in whom the diagnosis was established either on the basis of concomitant occurrence of malignant bone lesions and hepatocellular carcinoma in the absence of other detectable malignant disease (n = 15) or on the basis of histological evidence of bone metastasis from an hepatocellular carcinoma (n = 7). There were 21 males and one female. Mean age was 62.5 years. Most patients (88.2%) had chronic alcohol abuse. The bone metastases occurred as the first manifestation of the liver cancer in half the cases (11/22). Time interval between onset of bone symptoms and admission was less than one month in 6 of 11 patients; mean interval was 7.4 weeks. Hepatomegaly was found upon initial physical evaluation in 9 of 11 patients. Pain was the main symptom of bone disease (18/22). Palpable bone masses were found in 6 of 22 patients. Purely osteolytic lesions were seen on roentgenograms in every case; rupture of the cortex and spread to adjacent soft tissues were common findings. The radionuclide bone scan was normal in four of 12 patients. An advanced primary hepatic tumor was found in 84.2% of cases. Histologic examination of bone specimens established the diagnosis of metastasis from a hepatocellular carcinoma in 7 of 9 patients (77.8%). Severe bleeding occurred during one of the nine biopsy procedures. Patients were given symptomatic treatment. Systemic chemotherapy was used in five patients, unsuccessfully. Median survival was three months.

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Osteolysis; Radiography; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Decision Trees; Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Technetium Tc 99m Medronate

In a group of 22 patients with a stage 4 neuroblastoma, MIBG and 99mTc-MDP scintigraphy and radiological skeletal survey were performed at diagnosis to assess the presence of metastatic skeletal disease. In 20 out of 22 patients the MIBG scan was repeated during follow-up at a time when maximum tumoral regression was expected, i.e. after 3-4 cycles of chemotherapy; scan results were correlated to clinical and laboratory data. At diagnosis MIBG scan showed bone involvement in 19/22 patients, 99mTc-MDP in 20/22 and radiological skeletal survey in 11/22. In 1 patient only marrow aspirate revealed diffusion of disease beyond the primitive lesion. A total of 117/161 (72%) bone lesions were detected by MIBG, 89/161 (55%) by 99mTc-MDP and 47/161 (29%) by radiological skeletal survey. MIBG scintigraphy revealed bone marrow involvement in 11/22 patients in whom either marrow aspirate or bone biopsy were positive. In 5 patients 14 soft tissue lesions were also discovered and all but one primitive lesion accumulated MIBG. Although MIBG scan detected a greater number of bone lesions than 99mTc-MDP, in two patients in whom MIBG scan was negative 99mTc-MDP revealed the presence of bone involvement. Therefore we conclude that 99mTc-MDP scan is necessary to fully assess bone involvement in neuroblastoma at diagnosis. When MIBG scan was repeated after chemotherapy there was a general reduction of the number of detected lesions and in 8/17 patients both bone metastases and marrow involvement could no longer be detected.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Contrast Media; Female; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Quantitative bone scintigraphy was performed in 24 patients with prostatic carcinoma before orchiectomy and up to one to four years after operation. The gamma camera count rate was recorded over the lower thoracic and all lumbar vertebrae 4 h after injection of 99mTc-MDP. Twelve patients had normal bone scintigrams throughout the study. They showed from two years after operation a slight increase in count rate values compared with the preoperative values, probably due to hormonal changes after orchiectomy and to age-related alterations in skeletal metabolism. Twelve patients had abnormal bone scintigrams. They showed as a response to treatment the flare phenomenon with an increase in count rate over the abnormal vertebrae when measured two weeks after operation followed by a decrease after two months. The lowest count rate values were obtained between six months and one year after operation. Thereafter the count rate seemed to remain on the same level. An increase in count rate was connected to progression of disease and the patients died of prostatic carcinoma within one year thereafter.

Topics: Acid Phosphatase; Aged; Aged, 80 and over; Alkaline Phosphatase; Bone Neoplasms; Humans; Male; Orchiectomy; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Treatment Outcome

Multifocal bone involvement was seen on bone scintigraphy in a young woman being examined for a suspected bone lesion noted on pelvic radiographs. Biopsy of the third lumbar vertebral body demonstrated a vascular lesion. The tumor was resected and a bone graft was performed. The patient was followed with serial scans to assess the viability of the bone graft and course of the disease. This report analyzes the scintigraphic characteristics of this rare tumor and emphasizes the importance of bone scintigraphy in the diagnosis, treatment, and follow up of this condition.

Topics: Adult; Bone Neoplasms; Female; Follow-Up Studies; Humans; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

A patient with hyperparathyroidism secondary to chronic renal failure had multiple bony lesions with increased activity on both immediate static as well as delayed scintiphotos. One lesion in the distal femur was also exceptionally hot on the flow phase. Plain radiographs demonstrated lytic lesions with sclerotic margins and a narrow zone of transition. Open biopsy revealed histology consistent with brown tumor (osteoclastoma).

Topics: Acetabulum; Adult; Bone Neoplasms; Female; Femoral Neoplasms; Giant Cell Tumor of Bone; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Eleven patients who underwent nuclear medicine bone scanning were reviewed to determine the incidence of bone scan abnormalities associated with hepatoblastoma. Of these, six patients had abnormal bone scan findings--four with focal involvement. Correlating plain radiographs and/or follow-up nuclear bone scans were available for three of these four. All plain films indicated the presence of osteoporosis. Follow-up scans showed improvement or resolution of abnormalities. None of the patients had documented metastatic bone disease. While there has been no prior reported association, the authors attribute the abnormal bone scan findings to a paraneoplastic syndrome of osteoporosis associated with this primary tumor. They conclude that bone scanning is not routinely indicated in the initial diagnostic staging of hepatoblastoma.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Hepatoblastoma; Humans; Infant; Liver Neoplasms; Male; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Iodine-131 is uniquely able to demonstrate iodine uptake of differentiated thyroid carcinoma (DTC), but precise localization may be difficult, especially in the thorax, due to the quality of image resolution with 131I and the lack of anatomical landmarks. When bone metastases do not show radioiodine uptake bone scintigraphy can be used to detect them. We studied two groups of patients. In group 1, 15 patients with known bone metastases of DTC were treated with 3.7 GBq 131I. After 4 or 5 days, technetium-99m hydroxymethylene diphosphonate (HMDP; 740 MBq) was injected and a whole-body scan with simultaneous acquisition of 131I and 99mTc-HMDP images was carried out using a large field of view gamma camera fitted with a high-energy collimator. Technetium uptake was abnormal in 47 of 63 localizations, being increased in 29 foci, decreased in 7 and heterogeneous in 11. The superimposition of 131I and 99mTc-HMDP scans permitted an accurate localization in 80% of spine metastases and in 46% of osseous thoracic localizations, even in the presence of lung metastases. In group 2, 9 patients, who had bone pain, neurological signs or elevated serum thyroglobulin, had DTC bone metastases without iodine uptake. They received a diagnostic dose of 99mTc-HMDP 3h prior to scintigraphy with a large field of view gamma camera fitted with a low-energy collimator. Technetium uptake was abnormal in 37 of 38 localizations, being increased in 34 foci and decreased in 3. One false-negative was found in a skull metastasis. In both groups of patients, 99mTc-HMDP scans were useful.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenocarcinoma, Follicular; Adult; Aged; Bone Neoplasms; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

The prognosis of localized osteogenic sarcoma (OS) has improved considerably since the introduction of neoadjuvant chemotherapy. However, there is a subset of patients who do not show full benefit from neoadjuvant chemotherapy because of chemoresistance. The early identification of poor responders to chemotherapy during neoadjuvant therapy remains difficult. In order to evaluate the role of bone scintigraphy we report our experience of dynamic technetium-99m hydroxymethylene diphosphonate bone scintigraphy in 19 cases of paediatric osteogenic sarcomas. Before the beginning of chemotherapy, a dynamic scan was recorded during 30 min followed by static images at 3 h. The procedure was repeated halfway through the course of chemotherapy (6th week). Histological grading of the response to chemotherapy was carried out in the 12th week, showing nine good responses and ten poor responses. Factor analysis of dynamic structures (FADS) applied to dynamic scans allowed us to identify three factors termed vascular, "soft tissue" and osseous factors. The effect of chemotherapy on each factor was evaluated. Using FADS we were able to detect all the poor histological responders with the combination of vascular and osseous factors. Six out of nine good histological responders were also classified as scintigraphic responders. FADS applied to dynamic bone scans allowed us to identify at an early stage all the poor histological responders to neoadjuvant chemotherapy. This method may have clinical relevance for the therapeutic strategy in patients with OS.

Topics: Adolescent; Antineoplastic Agents; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Factor Analysis, Statistical; Female; Humans; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Because of their high affinity for bone, bisphosphonates are used both in the treatment of benign and malignant bone disease and in radiopharmaceutical bone imaging. A prospective study was undertaken to evaluate whether intravenous clodronate (dichloromethylene bisphosphonate) therapy might affect the results of bone scintigraphy with 99mTc-labeled methylene diphosphonate (MDP). In 11 female patients with breast cancer and metastatic bone disease, quantitative bone scans were obtained using a region of interest (ROI) method on Days 0 and 22. After intravenous clodronate therapy from Day 1 to Day 21, all metastatic bone lesions were still detectable, and median ROI ratios did not differ to a statistically significant extent from baseline values. Serum calcium levels decreased (p = 0.0449), whereas parathyroid hormone concentrations showed an increase (p = 0.0053). Mean serum levels of creatinine, inorganic phosphorus, osteocalcin, gamma glutaminyl-transpeptidase and alkaline phosphatase remained unchanged. However, a more than twofold rise in the serum activity of alkaline phosphatase was measured in three patients. We conclude that 3 wk of intravenous clodronate treatment did not impair the sensitivity of 99mTc-MDP bone scintigraphy in detecting bone lesions in patients with metastatic breast cancer.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Clodronic Acid; False Negative Reactions; Female; Humans; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

Thirty-five children (aged 0-9 yr) who had presented with Stage IV neuroblastoma were studied to see if avidity for 67Ga or 99mTc-methylene diphosphonate (MDP) uptake in both primary and secondary sites at diagnosis conferred any prognostic significance. Twenty-three percent of the patients were disease free and off treatment at the time of study. Crude survival did not differ between groups. Duration of survival and the likelihood of completing treatment were related to the scintigraphic appearance at the time of diagnosis, after adjustment for potential confounding effects, using Cox's proportional hazards regression and multiple logistic regression. After adjustment for confounding influences, neither 67Ga avidity nor uptake of 99mTc-MDP was associated with a significantly worse prognosis, both in terms of adjusted survival and likelihood of completing treatment. Patients with 67Ga-avid scans at diagnosis did not demonstrate significantly worse survival (HR 1.47, 95% CI 0.43-5.11) than those without 67Ga avidity. They were somewhat less likely to complete treatment (OR 0.23, 95% CI 0.03-1.63), but this did not reach statistical significance. Similarly, although patients with 99mTc-MDP positive scans demonstrated somewhat worse survival (HR 2.47, 95% CI 0.45-13.54), this result did not reach statistical significance, nor were they less likely to complete treatment (OR 0.69, 95% CI 0.07-6.67) than those with 99mTc-MDP negative scans. Uptake of 99mTc-MDP into extraosseous sites was also not associated with worse survival (HR 1.45, 95% CI 0.58-3.62) nor with decreased likelihood of completing treatment (OR 0.78, 95% CI 0.12-5.09). Other than indicating disease stage, these results do not support the hypothesis that the scintigraphic appearance at diagnosis confers prognostic information in children with advanced neuroblastoma.

Topics: Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Citrates; Citric Acid; Female; Gallium; Gallium Radioisotopes; Humans; Infant; Male; Neuroblastoma; Prognosis; Radionuclide Imaging; Regression Analysis; Survival Rate; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child; Child, Preschool; Citrates; Citric Acid; Gallium; Gallium Radioisotopes; Humans; Infant; Neuroblastoma; Prognosis; Radionuclide Imaging; Risk Factors; Survival Analysis; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Humans; Ilium; Male; Osteoma, Osteoid; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate previously described radiologic prognostic factors in extremity osteosarcoma.. In 47 pediatric patients, available images were evaluated for seven prognostic factors at diagnosis and seven additional factors after preoperative chemotherapy. These factors were correlated with histopathologic response and clinical outcome. The association of histopathologic response and outcome was also evaluated.. Metastases at presentation and a > 20-cm-diameter soft-tissue mass were predictive of a poor outcome but occurred in few patients. Factors most predictive of < 90% tumor necrosis after chemotherapy included an increase or no change in soft-tissue mass size and increased bone destruction. Although a significant relationship (P < .05) was found between histopathologic response and outcome, no factors predictive of histopathologic response were also predictive of outcome. The accuracy of pathologic response in predicting outcome was 66%.. Radiologic studies are of only limited use in predicting which patients with extremity osteosarcoma will have a poor response to chemotherapy or a poor outcome, and are not useful in predicting a good response or outcome.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child; Child, Preschool; Diagnostic Imaging; Female; Femoral Neoplasms; Follow-Up Studies; Humans; Humerus; Magnetic Resonance Imaging; Male; Osteosarcoma; Prognosis; Salvage Therapy; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Iliac crest bone marrow biopsy (BMB) has often been used as the gold standard for the detection of bone marrow metastases in small cell lung cancer (SCLC). However, it is likely to lead to numerous false-negative results. For this reason, we compared the results of bone scintigraphy (BS), magnetic resonance imaging (MRI), and BMB in 48 sequential patients affected with pathologically confirmed SCLC (47 were evaluable; mean age, 58.4 years). The three procedures were carried out within 1 week, no treatment being performed during this period. Whole-body scans and spot views were obtained in the anterior and posterior projections. For MRI, only the thoracolumbar spine, the sternum and the pelvis were scanned, using spin-echo T1-weighted sequences, resulting in an acquisition time of less than 45 min. Only five BMBs were rated as positive. In these cases, both BS and MRI were also positive. The other 42 biopsies were negative. Among them, in ten cases both BS and MRI were positive. In 21 cases, both BS and MRI were negative. In five cases MRI was positive while BS was negative. Finally, in six cases MRI was negative whilst BS was positive. In most cases in which either BS or MRI was positive, follow-up scans confirmed the initial findings. This study suggests that BMB is more invasive and less sensitive than BS or MRI in detecting bone metastases. MRI seems to be more sensitive than BS in detecting small spinal or pelvic metastases. Whole-body bone scintigraphy is more sensitive in detecting skull, costal or peripheral metastases.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Biopsy; Bone and Bones; Bone Marrow; Bone Neoplasms; Carcinoma, Small Cell; Female; Humans; Ilium; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

The diagnostic value of N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) scintigraphy was evaluated in 12 patients with 20 bone metastases from hepatocellular carcinoma, in comparison with 99mTc-methylene diphosphonate (99mTc-MDP) bone scintigraphy. Sixteen lesions (80%) were detected by 123I-IMP scintigraphy, whereas four lesions (two lesions in the rib and two lesions after a radiation of 40 Gy) were missed. Of 16 lesions demonstrated as areas of increased uptake in 123I-IMP scan, only eight (50%) showed an increased pattern of uptake in 99mTc-MDP bone scintigraphy. In conclusion, 123I-IMP is a promising radiopharmaceutical for the detection of bone metastases from hepatocellular carcinoma.

Topics: Amphetamines; Bone and Bones; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Iodine Radioisotopes; Iofetamine; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

We have encountered two cases of bone tumors with high 18F-fluorodeoxyglucose (FDG) uptake and negative 99mTc-HMDP bone scintigraphy, including a patient with myeloma and a patient with a metastatic bone tumor from esophageal cancer. Bone scintigraphy with a 99mTc-phosphate complex reflects osteoblastic activity in the bone tissue surrounding the tumor, whereas the accumulation of FDG is associated with the metabolic activity of the tumor itself. An FDG-PET study can therefore be used as a complementary study for the detection and follow-up of bone tumors when a 99mTc-phosphate bone scintigram is negative.

Topics: Adult; Bone Neoplasms; Deoxyglucose; False Negative Reactions; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multiple Myeloma; Ribs; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Soft tissue localization of radiotracer on bone scintigraphy may result in false-positive interpretations, if the activity overlies a bony structure. A case is presented in which special views and follow-up clarified the soft tissue nature of focal uptake in arm and axilla.

Topics: Aged; Arm; Axilla; Bone and Bones; Bone Neoplasms; False Positive Reactions; Humans; Lymph Nodes; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

Eighty-Six patients of neuroblastoma ranging in age from four months to 15 years were studied with 99m Tc-MDP for total skeletal survey over a period of seven years (1983-1990). The diagnosis of neuroblastoma was based on bone marrow examination, FNAC, lymph node biopsy, histopathology. Bone imaging was performed three hrs. after intravenous administration of 99m Tc-MDP. Out of 86 patients, 45 patients had positive bone scan showing osseous concentration in 122 sites and extraosseous concentration in 34 sites. Seven patients had liver metastases. None of these liver metastases showed concentration of MDP. Fourteen patients underwent surgery for the primary tumour at the time of bone scanning. Ten patients were studied at the time of follow up, of which four patients showed good response as bony metastases were not demonstrated on bone scintigraphy and X-rays. In conclusion, bone scan is an useful test in neuroblastoma in delineating the bony metastases and also in assessing the efficacy of chemotherapy in these patients.

Topics: Abdominal Neoplasms; Adolescent; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Thoracic Neoplasms

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

Combined Tc-99m MDP skeletal imaging and Tc-99m(V) DMSA whole body scans to detect metastases were performed during the follow-up of 30 patients who underwent surgery for breast carcinoma. Eight patients had normal Tc-99m MDP and Tc-99m(V) DMSA scans and were declared free of metastatic disease, further confirmed by no change in symptomatology over a 1-year follow-up period. Twenty-two patients had positive Tc-99m MDP scans with varied skeletal involvement. Tc-99m(V) DMSA scans showed matched areas of increased radiotracer concentration in bony metastases in 20 of these patients. Tc-99m(V) DMSA concentration was not seen in traumatic vertebral collapse or in coexistent osteoarthritic disease in vertebral metastatic involvement. Interestingly, Tc-99m(V) DMSA showed increased concentration in brain and liver metastases. Pentavalent Tc-99m(V) DMSA appears useful for detecting skeletal and soft-tissue metastases in breast carcinoma, and can improve the specificity of Tc-99m MDP bone scans in screening for bone metastases.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Humans; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

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

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

A simplified technique for localizing and verifying the correct biopsy site of lesions identified on a bone scan has been utilized. A hand-held gamma counter was used for localization of incision placement, determination of extent of bone to be resected, and verification that appropriate tissue was resected. This technique was used to guide biopsy of bony lesions in five patients and to guide resection of a pubic ramus chondrosarcoma. We conclude that intraoperative use of a gamma counter to guide biopsy of bony lesions minimizes surgery time, increases the confidence of obtaining correct tissue, and makes a frequently frustrating procedure very simple. In addition, the probe may assist with determining adequate margins at definitive resection of tumours which accumulate technetium-99m MDP.

Topics: Adult; Biopsy; Bone Neoplasms; Female; Gamma Cameras; Humans; Male; Middle Aged; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

Metaiodobenzylguanidine (MIBG) has been shown to be both sensitive and highly specific for the detection of neuroblastoma. However, controversy surrounds its sensitivity in detecting neuroblastoma when compared with radionuclide (technetium 99m-methylene diphosphonate [99mTc]-MDP) bone scans. Because a diagnostic test ideally should be easy to interpret in addition to being sensitive and specific, this study aims to determine the most efficacious scintigraphic agent for diagnostic use in neuroblastoma.. Twenty patients with neuroblastoma had a total of 26 paired MIBG and 99mTc-MDP bone scans obtained less than 4 weeks apart. Each study was evaluated independently of its counterpart by six separate observers (3 experienced and 3 inexperienced in MIBG scintigraphy) to determine the presence or absence of disease and the tumor burden.. Inexperienced observers reported more confidence in their interpretations of 99mTc-MDP bone scans; however, seven false-positive bone scans were reported. Using MIBG, all true-positive and true-negative scans, as well as significantly more sites of both primary and metastatic disease, were identified by all observers.. This study suggests that MIBG is the more efficacious agent for the scintigraphic evaluation of neuroblastoma.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Neoplasms; Contrast Media; Humans; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Sensitivity and Specificity; Technetium Tc 99m Medronate

The purpose of this study was to compare the utility of bone and metaiodobenzylguanidine (MIBG) scintigraphy for the detection of primary and metastatic deposits of neuroblastoma. 99mTc methylene diphosphonate (MDP) bone and 131I-MIBG scans performed within 1 mo of each other in 85 patients with known or suspected neuroblastoma were evaluated for evidence of skeletal and extraskeletal disease. In 77 of 77 patients with confirmed neuroblastoma, the MDP and MIBG scans were concordant for the presence or absence of skeletal disease. A nearly twofold greater number of skeletal lesions were evident on MIBG scanning. No patients with normal bone scans had MIBG studies indicating bone involvement. In patients with histologic evidence of bone marrow involvement, each study suggested skeletal lesions in approximately 70%. In patients with extraskeletal disease demonstrated by CT, there was soft-tissue uptake of MIBG in 80% and MDP in 39%. We conclude that both MIBG and MDP are useful for the detection of skeletal neuroblastoma. MIBG is the better agent for characterizing the extent of disease, and MDP is a valuable adjunctive agent that provides skeletal landmarks for comparison. MIBG is clearly superior for the detection of extraskeletal neuroblastoma.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Marrow Diseases; Bone Neoplasms; Child; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

When radiation therapy is performed on a patient with malignant tumor, vertebral spines are sometimes included in the irradiation field. In the present study, 99mTc-HMDP uptake was examined in 102 cases of malignant tumors treated with radiation therapy (irradiated total doses from 10 to 70 Gy) in order to clarify the time course of accumulation. The scintigram on the film was transformed with a film digitizer into objective data, and the Accumulation Decreasing Index (ADI) was calculated each month after irradiation. In the group receiving less than 30 Gy, recovery of 99mTc-HMDP accumulation was seen after a mild decrease in the ADI. However, in the group that received more than 40 Gy, no recovery of accumulation was seen, and a large decrease in the ADI followed. Vertebral MRI was performed with and without Gd-DTPA enhancement to calculate the vertebral Signal Intensity Ratio (SIR), and decreased blood flow in the irradiated bone marrow was estimated from the changes in SIR values. In the irradiated area, no definite abnormal accumulation of 99mTc-HMDP was observed against the new metastatic bone tumor. In such cases, MRI should be performed soon after bone scintigraphy in order to detect the tumor.

Topics: Bone and Bones; Bone Marrow; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Models, Structural; Radionuclide Imaging; Radiotherapy Dosage; Spine; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Humans; Male; Middle Aged; Osteoma, Osteoid; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

A sodium-iodide scintillation probe and a portable scaler rate-metre were used to localize small bone tumours at operation, after the preoperative injection of technetium-99m methylene diphosphonate. This technique allows complete removal of the tumour nidus of an osteoid osteoma or the active part of other lesions without undue sacrifice of the surrounding bone. The method has been used for successful relief of pain in thirteen patients.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Female; Humans; Intraoperative Period; Male; Osteoma, Osteoid; Radionuclide Imaging; Technetium Tc 99m Medronate

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

The authors report a rare case of a symptomatic hematogenous osseous metastasis from a pleural mesothelioma. The lesion was initially detected by bone scintigraphy and was confirmed by MRI and subsequent open biopsy, despite a negative CT scan.

Topics: Acetabulum; Aged; Bone Neoplasms; Female; Humans; Mesothelioma; Pleural Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Although the radiopharmaceuticals used for bone scintigraphy are of very high quality, the search for an "ideal" agent continues. To optimise the detectability of bone lesions, we analysed 244 different 99mTc-labeled phosphonates in animal experiments. In osteosarcoma-carrying rats 99mTc-labeled 1-Hydroxy-3-methyl-phosphinic-1, 1-propanediphosphonic acid (HMPD) was shown to produce the best lesion/normal bone ratio. 99mTc-MDP was used as reference. The ratio was found to be 1.28 for 99mTc-HMPD. The transferability of our results in animals to the situation in man was studied in 10 patients with bone metastases. There was for 99mTc-HMPD an improvement of the lesion/normal bone ratio by more than 60% but also an additional reduction of the soft tissue contrast by about 40%. 15% of the metastases were detected by scintigraphy using 99mTc-HMPD only and not with 99mTc-MDP. The new agent should make possible a better and earlier discrimination of bone lesions in the scintigram.

Topics: Aged; Aged, 80 and over; Animals; Bone Neoplasms; Diphosphonates; Female; Humans; Male; Middle Aged; Neoplasm Transplantation; Organophosphorus Compounds; Organotechnetium Compounds; Osteosarcoma; Radionuclide Imaging; Rats; Rats, Sprague-Dawley; Sarcoma, Experimental; Technetium Tc 99m Medronate; Tissue Distribution

Thirty-four patients with prostatic carcinoma were studied with quantitative bone scintigraphy and whole-body counting (WBC) 1 and 24 h after injection of 99mTc-MDP before as well as two weeks and two months after orchiectomy. Thirteen of the patients had normal bone scintigrams and WBR at the three different investigations; 21 had skeletal metastases. The latter showed throughout the study higher local gamma camera count rates as well as WBR values than the patients with normal scintigrams. In these patients a "flare phenomenon", with an increase in count rate two weeks after orchiectomy followed by a decrease two months post-operatively, was seen with quantitative bone scintigraphy but not with WBC. However, WBC may be a valuable method indicating the total extent of skeletal metastases in the body, while quantitative bone scintigraphy is more accurate in the interpretation of individual skeletal metastases.

Topics: Aged; Bone Neoplasms; Humans; Male; Middle Aged; Orchiectomy; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole-Body Counting

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

1725 bone scans, done for evaluation of metastatic involvement from malignant neoplasms, were reviewed. The fraction of positive scans (multiple lesions in the bone scan) was 34% of the patients with different malignancies. In 251 patients (12%) a single bone lesion was detected and 114 of these patients were followed-up and re-scanned once or twice within 1 to 4 years. 39 of the 93 patients with solitary bone lesion who on follow-up developed multiple lesions had carcinoma of the breast as the primary.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Child; Humans; Jordan; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma; Hormones; Humans; Longitudinal Studies; Male; Prostatic Neoplasms; Radionuclide Imaging; Remission Induction; Technetium Tc 99m Medronate; Treatment Outcome

A 49-year-old woman had longstanding renal impairment. Markedly increased uptake of Tc-99m MDP in the heart, lungs, and kidneys was an incidental finding on bone scintigraphy performed to exclude metastatic bone disease. These findings persisted on repeat bone imaging 1 year later. In addition, gastric and skeletal muscle uptake was subsequently seen. Soft tissue microcalcification was confirmed by computed tomography and renal biopsy. A consideration of the differential diagnosis is presented.

Topics: Bone Neoplasms; Calcinosis; Diagnosis, Differential; Female; Humans; Kidney; Lung; Middle Aged; Myocardium; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

Three patients with osteosarcoma of the femur developed abnormal radiopharmaceutical uptake in the bones of the contralateral leg. This uptake was not due to metastases. The histology in one patient, the form of the lesion and the disappearance of the abnormal uptake without treatment in the other two, indicated that the uptake was probably due to stress fractures. Changes in weight bearing and walking in the normal leg as a result of the osteosarcoma in the other leg could have been the cause of the stress fractures. It should be recognized that new abnormal uptake on bone scintigraphy in patients with osteosarcoma of the leg may not necessarily indicate metastasis. It may be caused by a stress fracture and disappears after rest.

Topics: Adult; Bone Neoplasms; Child; Female; Femur; Fibula; Fractures, Stress; Humans; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

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: Bone Neoplasms; Child; Citrates; Citric Acid; Female; Gallium; Gallium Radioisotopes; Humans; Lymphoma, T-Cell; Radionuclide Imaging; Technetium Tc 99m Medronate

In 25 of 30 patients with bone metastases from prostatic carcinoma, red bone marrow extension was observed by scintigraphy of the reticuloendothelial system (RES). The degree of bone marrow extension in the lower extremities increased with increasing number of bone metastases. In 8 patients, 15 peripheral metastases were detected, all located in areas with extended red bone marrow. The distal level of bone marrow extension coincided with that of the most distal metastases. This is of importance for the detection of peripheral metastases at risk for fracture. Bone marrow extension was also seen in 5 of 8 patients with prostatic carcinoma without bone metastases and was interpreted as a paramalignant activation of RES.

Topics: Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Humans; Male; Middle Aged; Mononuclear Phagocyte System; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Fibroma; Humans; Male; Melanoma; Pseudarthrosis; Radionuclide Imaging; Skin Neoplasms; Technetium Tc 99m Medronate

Etidronate disodium (EHDP) therapy is often instituted emergently for treatment of hypercalcemia associated with malignancy, and a staging bone scan is part of the evaluation of the patient with extensive metastatic disease. In these patients in whom high dose EHDP therapy has been instituted, uptake of the bone scan agent is markedly diminished. The case presented illustrates this finding: a breast cancer patient who had received two 500-mg intravenous doses of EHDP prior to bone scan staging. No skeletal visualization was present at 3 hr after 99mTc-MDP injection. Blood-pool activity and uptake in large metastatic sites were observed.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoma, Squamous Cell; Drug Interactions; Etidronic Acid; Female; Humans; Hypercalcemia; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Female; Humans; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

Bone scintigraphy with Tc-99m HMDP and gallium scintigraphy were evaluated in four patients with a primary sacrococcygeal chordoma. All lesions showed a photon-deficient or cold lesion corresponding to the tumor on bone scintigraphy, with no abnormal accumulation clearly observed on gallium scintigraphy. These findings led the authors to conclude that a midline sacrococcygeal tumor showing reduced uptake or a cold lesion on bone scintigraphy and no increased accumulation on gallium scintigraphy could be a chordoma rather than the malignant neoplasm suspected in this region.

Topics: Adult; Aged; Bone Neoplasms; Chordoma; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sacrococcygeal Region; Sacrum; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Nasal Cavity; Neuroectodermal Tumors, Primitive, Peripheral; Nose Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Aged; Bone Neoplasms; Chondrosarcoma; Humans; Humerus; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Carcinoid Tumor; Humans; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Parameters that predict tumor aggressiveness or response to therapy are potentially useful in selecting the most appropriate treatment. In theory, the biologic aggressiveness of an untreated bone tumor may be reflected in bone scan parameters. The purpose of this study was to assess the usefulness of bone scintigraphy as a predictive indicator of subsequent metastasis in 25 dogs with primary osteosarcoma. Dogs received radiotherapy and/or intra-arterial cisplatin prior to limb-sparing surgery. Quantitative bone scintigraphy of the tumor was performed prior to treatment (25 dogs) and following treatment but prior to limb-sparing surgery (22 dogs). All dogs developed metastasis at a median time of 202 days (range, 41-444 days) after initiation of treatment. A statistically significant relationship was identified between time to metastasis and: (1) the radiographic tumor area, (2) the pretreatment ratio of mean counts per pixel in tumor-to-adjacent nontumor bone (T/NTT), and (3) the pre:post-treatment T/NTT. Larger tumor area and high pretreatment tumor activity were associated with earlier metastasis. Tumors characterized by greater decreases in scintigraphic uptake after treatment were associated with earlier metastasis. These data suggest that osteosarcomas with high pretreatment mean counts per pixel signify aggressive tumors subject to early metastasis.

Topics: Animals; Bone Neoplasms; Cisplatin; Combined Modality Therapy; Dogs; Infusions, Intra-Arterial; Neoplasm Metastasis; Neoplasm Recurrence, Local; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Twenty patients with known primary untreated and recurrent bone and soft tissue tumors underwent thallium imaging and three-phase bone imaging in the same session. The ratio of thallium uptake in the tumor tissue to the contralateral normal tissue areas was compared with the same ratio for phase 1 (blood flow or arterial phase), phase 2 (blood pool), and phase 3 (delayed medroxy-diphosphonate, MDP, uptake). There was poor correlation between Tl uptake and phases 1 and 3 of the bone scan ratios; r = 0.37 and 0.46; P = 0.097 and 0.047, respectively. The thallium uptake ratios correlated well with blood pool ratios (phase 2) (r = 0.84 and P less than 0.01). In contrast to uptake into normal muscle, Tl-201 uptake into tumor is not highly dependent on blood flow alone and other factors predominate in determining its magnitude.

Topics: Bone Neoplasms; Female; Humans; Male; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes; Time Factors

In 20 patients with multiple myeloma, the results of MR, x-ray, bone scintigraphy, bone marrow scintigraphy and bone marrow biopsy were compared. MR proved the most sensitive imaging method for the detection of bone marrow infiltration followed by x-ray examinations. Bone marrow scintigraphy and especially bone scintigraphy revealed false-negative results more often. These findings were more impressive by the direct comparison of several investigated regions showing different findings of each imaging method. False-positive results were not found. In 4 patients false-negative results of bone marrow biopsy had to be assumed because of definitely pathological findings by x-ray and MRI.

Topics: Aged; Aged, 80 and over; Biopsy; Bone and Bones; Bone Marrow; Bone Neoplasms; False Negative Reactions; False Positive Reactions; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Plasmacytoma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

A pentavalent 99mTc-dimercaptosuccinic acid (DMSA) scan was performed on a patient with multiple myeloma without amyloidosis. A high accumulation of the tracer was found in numerous tumors. We believe that the accumulation of DMSA is unrelated to amyloidosis and that the DMSA scan may have potential for the staging of tumors in patients presenting with multiple myeloma.

Topics: Bone Neoplasms; Female; Humans; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

The authors retrospectively reviewed the Tc-99m medronate scan findings in six patients who had no evidence of metastatic disease following en bloc resection of a primary osteosarcoma and subsequent limb reconstruction using allograft bone. Persistently increased radionuclide uptake was noted at the junction between the host bone and the graft, while the graft cortical bone showed persistently decreased activity. Radionuclide uptake at the periphery of the graft varied. Over time the youngest patient in the series had increasingly normal scan findings.

Topics: Adolescent; Adult; Bone Neoplasms; Bone Transplantation; Child; Child, Preschool; Histiocytoma, Benign Fibrous; Humans; Leg; Osteosarcoma; Radionuclide Imaging; Retrospective Studies; Sarcoma, Ewing; Technetium Tc 99m Medronate; Time Factors

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

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

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

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

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

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

The aim of this study was to assess the diagnostic value of five biological markers--prostate acid phosphatase (PAP), prostate specific antigen (PSA), tartrate resistant (Tr-ACP), and tartrate labile (TI-ACP) acid phosphatases, and alkaline phosphatase bone isoenzyme (B-ALP)--for the detection of bone metastases in patients with prostate carcinoma. Using the Tc-99m HMDP bone scans of 80 patients scored from 0 (normal) to 2 (diffuse bone involvement) as the "gold standard," a receiver operating characteristic (ROC) analysis was performed. This method allows the determination of different threshold values (corresponding to different couples of sensitivity and specificity) for the assays. An ROC curve comparison was also performed. Results show that B-ALP is the best test for such detection (area under the ROC curve = 0.93; Spearman Rank correlation with bone scan r' = 0.81). Among the other markers, PSA was found to be the best (area under the ROC curve = 0.81; Spearman Rank correlation with bone scan r' = 0.58). In addition to the prostatic tumor markers (PSA and PAP), we suggest the use of the low-cost B-ALP assay in the follow-up of prostate carcinoma patients to determine the optimum moment to perform a bone scan. A normal result of this assay indicates a very low probability of bone metastasis; conversely, raising of B-ALP concentration must lead to a bone scan.

Topics: Acid Phosphatase; Aged; Alkaline Phosphatase; Antigens, Neoplasm; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Evaluation Studies as Topic; Humans; Isoenzymes; Male; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate

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

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

We discuss three cases irradiated to their bone metastases. 99mTc-MDP bone scan before irradiation showed normal uptake in the lesions. In all the cases, the irradiation therapy was effective, but focal increased uptake area corresponding to the site of bone metastasis was revealed by the follow-up bone scan one to three months after irradiation. We concluded that the change of tracer uptake was so-called flare in formerly false negative lesion. The cause of this phenomenon was considered either elevation of osteoblastic activity with control of tumor or progression of osteolysis until tumor got well-controlled.

Topics: Aged; Bone and Bones; Bone Neoplasms; Bone Resorption; Breast Neoplasms; Carcinoma, Squamous Cell; Esophageal Neoplasms; False Negative Reactions; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; 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

Two cases of prostatic cancer with single bone metastasis in the tibia are discussed. The intense uniform involvement of a solitary limb bone with high perfusion and blood pool activity in the 3-phase bone scan and the positive white blood cell scan (observed in one case) were not typical for a metastatic bone lesion. Conventional radiomorphology--lamellar, periosteal reaction, disseminated medullar sclerosis, no localized lesion--also led to other differential considerations such as osteomyelitis and malignant lymphoma, which could not be specified by CT and MRI. Even if there is no typical morphology in scintigraphic and radiologic imaging, biopsy should be performed to exclude bone metastasis in prostatic cancer.

Topics: Adenoma; Aged; Bone Neoplasms; Humans; Magnetic Resonance Imaging; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Quantitative bone scintigraphy was performed at 4 and 24 h after injection of 99mTc-MDP. The lower thoracic and all the lumbar vertebrae were recorded in 37 patients with prostatic carcinoma before orchiectomy as well as two weeks, two and six months postoperatively. Fourteen patients had normal bone scintigrams. By means of the measured variation in the count rate between normal vertebrae, the criterion for a vertebra to be considered as abnormal was determined using the 4 h-uptake values. For patients with normal scintigrams the count rate at 24 h was below the 4 h level and the mean 24 h/4 h ratio was determined to be 0.85 +/- 0.09 (1 SD). Normal vertebrae in patients with skeletal metastases had only slightly lower count rate values at 24 h than at 4 h. Abnormal vertebrae showed a higher count rate at 24 h, especially two weeks postoperatively, while a tendency towards lower values than at 4 h was seen after 6 months. If the 24 h/4 h ratio is used as an extra criterion to the count rate at 4 h, the vertebrae will be more accurately defined as normal or abnormal.

Topics: Aged; Bone and Bones; Bone Neoplasms; Follow-Up Studies; Humans; Male; Orchiectomy; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Three-phase bone scintigraphy elegantly demonstrates the vascular nature of the expansile, lytic lesions of skeletal angiomatosis and the induced bony changes in the involved areas. Unusual features of the case include its confinement to the hand and rapid progression as shown by serial radiographs.

Topics: Adolescent; Angiomatosis; Bone Neoplasms; Hand; Humans; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Since 1981, intraoperative bone scanning has been used at Stanford University Hospital to assist in the localization and excision of skeletal lesions in the surgical suite. The utility of bone scans to detect lesions not otherwise "visible" is valuable in guiding the surgeon to the pathological site. In addition, intraoperative scanning can define the exact amount of tissue to be excised, averting excessive surgery near joints or along weight-bearing bones. Seventeen cases are presented.

Topics: Adult; Bone and Bones; Bone Neoplasms; Humans; Intraoperative Care; Osteoma, Osteoid; Radionuclide Imaging; Technetium Tc 99m Medronate

A patient with ovarian carcinoma was evaluated for skeletal metastasis with a routine whole body bone scan. Although no bone metastases were visualized, there was dramatic accumulation of tracer in the soft tissues of the abdomen. CT revealed calcifying soft tissue metastases on the liver surface, the bowel serosa, and in the pelvis corresponding to the abnormal areas of Tc-99m MDP uptake. Tumor necrosis and ongoing calcification within the metastatic sites are possible explanations for this unusual soft tissue concentration of the bone-seeking radiopharmaceutical. In patients with metastatic ovarian carcinoma, careful review of extraosseous regions on bone scan images may provide valuable diagnostic information.

Topics: Abdominal Neoplasms; Adult; Bone Neoplasms; Carcinoma, Papillary; Female; Humans; Ovarian Neoplasms; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Photopenic osseous lesions are a well-recognized but unusual manifestation of metastatic disease on bone scintigraphy. Common primary tumors giving rise to such lesions include lung, breast, renal, and thyroid. This case report illustrates multiple "cold" osseous metastases from aggressive penile squamous cell carcinoma without radiographic destruction.

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; Humans; Male; Middle Aged; Penile Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

One hundred thirty-two new patients with nasopharyngeal carcinoma and no evidence of distant metastases were evaluated for bone metastases with bone scanning. Forty-four patients had abnormal hypercaptation. These abnormal findings were considered related to benign diseases in 39 patients after correlating clinical examinations and skeletal radiographs. The remaining five patients had positive bone scanning which was suggestive of bone metastasis. There were 13 patients who developed symptomatic bone metastases over a follow-up period of 0.2-41 months. In three of these, the bone metastases corresponded to the sites of abnormal hypercaptation in the initial positive bone scanning. In view of the low sensitivity and specificity of bone scanning in this setting, routine bone scanning for staging nasopharyngeal carcinoma is not recommended. But in the research setting, baseline scanning is useful to make subsequent scanning more valuable, and it reduces false-positive results.

Topics: Bone and Bones; Bone Neoplasms; Carcinoma; Evaluation Studies as Topic; Female; Hong Kong; Humans; Incidence; Male; Middle Aged; Nasopharyngeal Neoplasms; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

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

Magnetic resonance imaging (MRI) is a sensitive method for the diagnosis of bone marrow abnormalities, but its usefulness in detecting active disseminated cancer in this tissue in treated patients has not been determined. We therefore examined 14 children who had been treated for disseminated bone marrow involvement by neuroblastoma (n = 6), lymphoma (n = 3), Ewing's sarcoma (n = 3), osteosarcoma (n = 1), and leukemia (n = 1). MRI studies were performed at 21 marrow sites to evaluate residual or recurrent tumor and were correlated with histologic material from the same site. T1- and T2-weighted sequences were employed in 21 and 14 studies, respectively; short tau inversion recovery (STIR) in 18; and static gadolinium diethylene triamine pentaacetic acid (Gd-DPTA)-enhanced. T1-weighted sequences in 13. All MRI studies showed an altered bone marrow signal. Technetium 99m methylene diphosphonate (99mTc-MDP) bone scintigraphy was also performed (19 studies). On histologic examination, 7 marrow specimens contained tumor, and 14 did not. Of the 7 tumor-positive lesions, all T1-weighted, 4 of 6 T2-weighted, and all 6 STIR sequences showed abnormal signal; all 5 Gd-DTPA-enhanced. T1-weighted sequences showed enhancement of the lesion. However, abnormal signals were also observed on all T1-weighted, 6 of 8 T2-weighted, 11 of 12 STIR, and 5 of 8 Gd-DTPA-enhanced, T1-weighted images of the tumor-negative sites. In this clinical setting, MRI did not consistently differentiate changes associated with treatment from malignant disease.

Topics: Biopsy; Bone Marrow; Bone Neoplasms; Child; Contrast Media; Fibrosis; Follow-Up Studies; Gadolinium; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Necrosis; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Technetium Tc 99m Medronate

Bone marrow scintigrams (MS) were performed on 73 men with histologically proven prostatic carcinomas. Follow-up data were available in 24 cases. Thirty-six patients had skeletal metastases at the time of the first MS investigation. They were compared with conventional bone scintigrams (BS) as well as clinical, biological, radiological and other follow-up data obtained for the same patients. At the present stage of revision and of follow-up of our patients, MS appeared less sensitive than BS in diagnosing skeletal metastases (94% as against 100% if all abnormal MS and BS presentations are considered as diagnostic or 83% as against 86% if more restrictive analytic criteria were applied). On the other hand, MS showed slightly higher specificity (81% for MS as against 73% for BS) when all abnormal MS and BS presentations are considered as diagnostic. With more restrictive diagnostic criteria, BS remains more specific (100%) than MS (87%). Nevertheless, the likelihood of bone metastasis is low when a normal MS is found in case of dubious BS situations, but high when the MS is pathological. In 11 patients with skeletal metastasis for whom follow-up investigations were available, MS appeared better than (4 cases) or equivalent to (6 cases) BS for evaluating the responses and the ultimate evolution of the disease. Marrow scintigrams are thus a useful tool in cases of dubious BS and for evaluating the response of skeletal metastasis to treatment.

Topics: Aged; Aged, 80 and over; Bone and Bones; Bone Marrow; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; Sensitivity and Specificity; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

67Ga scintigraphy was performed in 865 patients, and in 1078 examinations. 67Ga accumulation was evaluated retrospectively for asymmetric accumulation in the shoulders. Approximately 50% of patients showed no asymmetric distribution of 67Ga in the shoulders. About 40% of patients showed increased accumulation in the right side and about 10% of patients showed increased accumulation in the left side. A change of 67Ga distribution in the shoulder joints was recognized in about 30% of patients during the follow-up study. Reasons for asymmetric distribution of 67Ga in the shoulders were considered to be due to bone metastasis, changes of local blood flow, edema, irradiation, muscle atrophy after cerebral paralysis, and operation. 67Ga scintigraphy showed a broader range and more prominent accumulation in the soft tissues around the shoulder joint than 99mTc-MDP scintigraphy. The accumulation of 99mTc-MDP was recognized to be in the center of the region of 67Ga accumulation. 99mTc-MDP scintigraphy showed more prominently increased accumulation than 67Ga scintigraphy in patients with osseous lesions. Similar factors appeared to have had an influence on the abnormal accumulation of 67Ga and 99mTc-MDP around the shoulder joint.

Topics: Adult; Aged; Bone Neoplasms; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Shoulder Joint; Technetium Tc 99m Medronate

The present study compares the reliability of MIBG and MDP bone scans in detecting bone metastases of neuroblastoma. Out of 57 patients, 23 had both 99mTc-MDP and 123I/131I-MIBG scans within a 2-week period. In 10 patients at primary diagnosis there was an underestimation of skeletal involvement by MIBG in 1/5, in 13 patients at follow-up in 3/9; 99mTc-MDP scans were able to visualize skeletal involvement in all those cases. There was only one false positive MDP scan. These results suggest that MIBG alone may fail to visualize skeletal involvement of neuroblastoma and should therefore be complemented by additional 99mTc-MDP scintigraphy.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Ganglioneuroma; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

The serial technetium 99 (99Tc) bone scans of 76 patients with Stage D-2 prostate cancers were reviewed. Sites of metastases in skeletal areas in decreasing order were vertebrae, ribs, pelvis, long bones, and skull. Patients with one or two involved skeletal areas had a significantly longer progression-free interval and survival time than patients with three or more bony areas of uptake. Bone scans might be used as a stratification variable in future prospective clinical trials of Stage D-2 prostate cancer.

Topics: Aged; Bone Neoplasms; Humans; Male; Neoplasm Staging; Predictive Value of Tests; Prostatic Neoplasms; Radionuclide Imaging; Survival Rate; Technetium Tc 99m Medronate

The correlation of technetium-99m-HMDP bone scintigraphic findings, serum osteocalcin as a measure of bone turnover and prostate-specific antigen (PSA) and/or prostate acid phosphatase (PAP) was determined in 19 men with bone metastasis due to prostatic carcinoma. Six of the 19 patients with metastases on bone scan showed elevation of osteocalcin. These patients had extensive metastatic disease. All 19 men with positive bone scans had high serum PSA and/or PAP levels. Serum osteocalcin measurement is less sensitive to detection of bone deposits than PSA/PAP measurements (p less than 0.0008).

Topics: Acid Phosphatase; Aged; Antigens, Neoplasm; Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Humans; Male; Middle Aged; Osteocalcin; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Solitary abnormalities in bone scintigrams of cancer patients are a finding causing special diagnostic problems. In a prospective study the value of MRI imaging of the bone marrow was to be ascertained when compared to recognized X-ray studies, as a method of clarifying suspect bone scintigraphy findings. 25 cancer patients presenting with a solitary suspect abnormality in bone scintigrams were examined by X-rays and MRI. In 15 patients, MRI showed that metastases were the probable cause of the hot spot. In 7 patients, radiography, the routinely used method to confirm or exclude the presence of metastases, failed to detect these metastases. In the remaining 10 patients other causes of increased activity in the bone scintigrams could be demonstrated, e.g. fracture, degenerative disease, benign tumour. The results were confirmed by biopsy, operation, autopsy or follow-up. Considering the clinical consequences of the diagnosis of bone metastases, we suggest that a bone marrow MRI of the affected region should be performed to clarify the cause of a solitary hot spot in bone scintigrams of cancer patients, especially if X-ray studies are inconclusive.

Topics: Adult; Aged; Bone Marrow; Bone Neoplasms; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

Pelvic pain in cancer patients can result from several causes. The most appropriate choice of imaging techniques for evaluating such patients has not been established. We evaluated 27 cancer patients with pelvic pain by using radionuclide bone scintigraphy (24 patients), abdominal CT (27 patients), and pelvic MR imaging (27 patients) and used the correlation between symptoms and imaging findings to compare these imaging methods. The study population included 11 patients with Ewing sarcoma, six with other sarcomas, five with colorectal cancers, and five with other tumors. All patients had pelvic pain, and eight had pain radiating to a leg. Twenty-three patients had soft-tissue masses, and 19 had bone metastases; 16 had both. Findings on bone scans explained the symptoms in 17 (71%) of 24 patients, findings on CT in 23 (85%) of 27 patients, and findings on MR imaging in 25 (93%) of 27 patients. The difference between bone scanning and CT or MR was statistically significant (p less than .05); however, the difference between CT and MR imaging was not significant (p greater than .05). MR imaging detected 41 (98%) of 42 relevant lesions, whereas CT detected 31 (74%) of 42, and bone scanning 17 (44%) of 39. We conclude that MR is superior to either bone scanning or CT in the initial evaluation of pelvic pain in cancer patients. Such information can be important in directing the treatment of these patients.

Topics: Adolescent; Adult; Bone Neoplasms; Diagnostic Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pain; Pelvic Neoplasms; Retrospective Studies; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Bone scanning plays a pre-eminent role in tumor staging procedures, but its reliability is often questioned because of the high incidence of false positive results; not even bone biopsy can always clarify these questionable findings. To verify what actually becomes of the pathological hot spots lacking radiological evidence, we studied 49 patients with this discrepancy and followed them for an average period of 10 years (range: 8-11). The patients were divided into 3 subgroups: 1) 13 N+ patients with multiple hot spots (greater than 2) (N+ IM); 2) 24 N+ patients with single hot spots (less than or equal to 2) (N+ IS); 3) 12 N- patients with single hot spots (less than or equal to 2) (N- IS). Bone metastasis-free survival rate (SLMO) was calculated, which was confirmed by radiology, and overall survival rate (SG). SLMO was considered to coincide with the percentage of "true" false positives. At 10 years SLMO was 7%, 65%, and 83%, whereas SG was 15%, 70%, and 90%, respectively, in the 3 subgroups N+ IM, N+ IS, and N- IS. The Log-rank test demonstrated a highly significant difference (p less than 0.001) between SLMO and SG in these subgroups, due to the poor prognosis of N+ IM patients. The cumulative examination of all N+ N- patients with single hot spots (36 patients) demonstrated 75% probability of "true" false positives at 10 years. Moreover, the risk of bone metastases resulted higher in the hot spots of the spine than in those of the skull and ribs. The possible role is discussed of microfractures and bone traumatisms in the genesis of "true" false positives.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Female; Follow-Up Studies; Humans; Middle Aged; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Whole-Body Counting

The scintigraphic "flare" phenomenon on bone imaging refers to an increase in intensity of tracer uptake in sites of bone metastases and/or the appearance of "new" lesions, which occur shortly after commencement of hormonal therapy or chemotherapy for breast, prostate, or lung cancer. In this study, we observed that scintigraphic flare can occur in patients with prostate cancer following treatment with the "hormone-like" luteinizing hormone releasing hormone analog, leuprolide acetate. Twenty-six patients with prostate cancer being treated with leuprolide acetate underwent serial bone scans at three-month intervals. Five (19.2%) of the 26 patients had findings consistent with a scintigraphic flare on bone scans obtained between three and six months after initiation of therapy. These scan findings should not be confused with progression of skeletal metastases.

Topics: Antineoplastic Agents; Bone Neoplasms; Gonadotropin-Releasing Hormone; Humans; Leuprolide; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

For many years it has been known that the sensitivity of bone scanning to the presence of destructive bony lesions favors its use in screening for bone metastases and osteomyelitis. More recently bone scanning has been routinely employed in evaluating benign skeletal pathology that may be the cause of low back pain. Bone scanning can play an important part in (1) identifying the cause of pain, (2) clarifying the significance of radiographic findings, and (3) evaluating the results of spinal surgery. This expansion of the role of nuclear medicine in diagnosing and managing low back pain is based in part upon novel diagnostic applications of 99mTc-methylene diphosphonate, a radiopharmaceutical that has been available for over 15 years. Equally important for this development, however, has been the recent availability of SPECT, a tomographic imaging technique that can be used to display the spine in a series of 6- to 8-mm thick sections. Slightly more than one-half of newly purchased gamma cameras are rotating systems suitable for bone SPECT studies. Thus, many community hospitals can now perform state-of-the-art bone scans for low back pain.

Topics: Adult; Back Pain; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Adult; Bone and Bones; Bone Neoplasms; Carcinoma, Small Cell; Diagnosis, Differential; Humans; Indium Radioisotopes; Leukocytes; Lung Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

The effect of preoperative chemotherapy (PCT) on the uptake of 99mTc-labeled diphosphonates into tumor bone was quantitatively assessed from serial scan studies of 30 osteosarcomas and correlated with the histomorphological changes determined from the surgical specimens. The parametric images of the tumor blood pool and labeled methylene diphosphonate (99mTc-MDP) plasma clearance by the tumor bone enabled a sensitive distinction to be made preoperatively between a good (greater than 90% tumor cell destruction) and a poor (less than 90% tumor cell destruction) tumor response. Overall accuracy in presurgical prediction of tumor regression was found to be 88% and 96% for the blood pool and 99mTc-MDP clearance measurements, respectively (P less than or equal to 0.0004). In addition, it proved possible to localize resisting areas of viable tumor up to 1.0 cm in diameter. Even at the half-way stage of PCT, a poor response could be reliably predicted (overall accuracy 91% and 100%, respectively; P less than or equal to 0.011). Therefore, 99mTc-MDP parametric imaging is a highly sensitive and specific modality for an objective and accurate assessment of tumor regression during PCT of osteosarcoma.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Extremities; Female; Humans; Male; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

One hundred and forty-three patients (Group 1) with histologically proven nasopharyngeal-carcinoma (NPC) had bone scintigraphy with 99Tcm methylenediphosphonate (MDP) or dihydroxypropanediphosphonate (DPD) within 2 months of the initial diagnosis. A further 162 patients (Group 2) had bone scans during the course of follow-up if there were symptoms of bone pain or evidence of metastases at other sites. Twenty-three per cent (33/143) of the newly diagnosed NPC patients (Group 1) had evidence of bone metastases. Of these 143 patients, 101 were T0-T2, 16 were T3 and 25 were T4. Thirty-six patients had no neck nodes (NO), 44 were N1, 25 N2 and 38 N3. Of the 162 patients in Group 2, 96 (59%) had a positive bone scan. The commonest sites for bony metastases from NPC were the spine, ribs, pelvis and lower limbs in order of frequency. There is a highly significant association with the nodal stage but no association with the UICC T staging which is not adequate in nasopharyngeal carcinoma. In our part of the world, bone metastases from NPC are a common cause of an abnormal bone scan.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Nasopharyngeal Neoplasms; Neoplasm Metastasis; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Medronate

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

Topics: Adolescent; Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Lung; Lung Neoplasms; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Humans; Necrosis; Osteosarcoma; Preoperative Care; Radionuclide Imaging; Remission Induction; Technetium Tc 99m Medronate

This case illustrates two different patterns of absorption of Iron Dextran in the gluteal soft tissues due to an intramuscular and a more proper Z-track technique. A 65 year old female presented to the nuclear medicine service for a bone scan to rule out metastatic disease from a surgically resected colon cancer. While the first bone scan showed no evidence of metastases, an abnormal accumulation of Technetium-99m methylene diphosphonate was noted in the left gluteal soft tissue region.

Topics: Aged; Bone and Bones; Bone Neoplasms; Buttocks; Female; Humans; Injections, Intramuscular; Iron-Dextran Complex; Radionuclide Imaging; Technetium Tc 99m Medronate

A bone scan and red blood cell scan in the rare epidermal naevus syndrome, associated with multiple haemangiomas of the bone and hypophosphataemic osteomalacia in a 20-year-old man are reported. The typical pattern of osteomalacia on the bone scan was associated with lesions of increased bone metabolism in the peripheral bones. The haemangiomas did not pool labelled red blood cells. Thus, the bone scan seems to be suitable for diagnosing the complete extent of haemangiomas in bone, but they could not be specifically proven by red blood cell pooling.

Topics: Adult; Bone and Bones; Bone Neoplasms; Erythrocytes; Hemangioma; Humans; Male; Neoplasms, Multiple Primary; Nevus, Pigmented; Osteomalacia; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate

Bone scintigraphy was performed as part of an initial diagnostic evaluation of 70 dogs admitted with primary bone tumors during a 2-year period. Tumors involved major long bones of the appendicular skeleton and included 62 osteosarcomas, 6 fibrosarcomas, and 2 chondrosarcomas. All dogs were free of radiographically detectable pulmonary metastases. Bone scintigraphy was not of value in distinguishing among various types of primary tumors. One dog with an ulnar chondrosarcoma had a scintigraphically detectable occult osseous metastasis or synchronous primary tumor, and 1 dog with osteosarcoma had a scintigraphically detectable lymph node metastasis. Pulmonary metastases were not detected scintigraphically. Of the 70 dogs, 44.3% had areas of increased isotope uptake associated with nonneoplastic disease processes.

Topics: Animals; Bone Neoplasms; Chondrosarcoma; Dog Diseases; Dogs; Female; Fibrosarcoma; Lung Neoplasms; Lymphatic Metastasis; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

This study was carried out to compare iodine-123 metaiodobenzylguanidine ([I123I]MIBG) and technetium-99m-methylene diphosphonate bone scans (99mTc-MDP) in the detection of skeletal involvement by neuroblastoma. Forty-four children with neuroblastoma underwent both [123I] MIBG and 99mTc-MDP scans within a 4-wk period; bone marrow examination also was performed; all these investigations were done both at diagnosis and at follow-up. At diagnosis, four children with Stage 4 disease had normal [123I]MIBG scans but abnormal 99mTc-MDP scans, while at follow-up there were four children with negative [123I]MIBG studies who later died from disseminated neuroblastoma. All eight scans are considered false-negative. In 24 children, the [123I]MIBG revealed more extensive disease with 161 positive sites while the 99mTc-MDP scan showed only 100 positive sites; 34 of these sites were common to both studies. This study shows that underassessment of skeletal involvement by neuroblastoma occurred using [123I]MIBG scans and that one cannot therefore substitute [123I]MIBG for 99mTc-MDP bone scans in the staging of neuroblastoma.

Topics: 3-Iodobenzylguanidine; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; False Negative Reactions; Female; Humans; Infant; Infant, Newborn; Iodine Radioisotopes; Iodobenzenes; Male; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Radionuclide Imaging; Ribs; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

Carpal bone is an uncommon location for metastases, and diagnostic problems can occur when a solitary metastasis mimics acute arthritis or osteomyelitis clinically as well as radiologically.

Topics: Bone Neoplasms; Carcinoma, Bronchogenic; Carpal Bones; Humans; Lung Neoplasms; Male; Middle Aged; Radiography; Radionuclide Imaging; 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

Topics: Adult; Bone and Bones; Bone Neoplasms; Female; Humans; Osteosarcoma; Pleural Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

This study attempts to characterize thallium-201 (201TI) uptake in patients with bone and soft-tissue sarcoma and to compare these findings with gallium-67 (67Ga) and bone scintigraphy with emphasis on evaluating tumor viability before and after chemotherapy. Thirty-eight patients with surgically-proven sarcomas were evaluated. All patients had gallium and thallium studies. Nineteen patients underwent pre- and post-chemotherapy thallium and evaluation. Seven patients also had technetium-99m-MDP (99mTc-MDP) bone scintigraphy comparisons. Pathologic changes pre- and postchemotherapy were graded on the basis of %tumor necrosis as defined histologically. Scintigraphic comparisons demonstrated a high degree of correlation with 201TI and poor correlation with 99mTc-MDP. Thallium-201 was superior to 99mTc-MDP and 67Ga in predicting tumor response to chemotherapy as determined by %tumor necrosis determined histologically. Gallium was superior to Tc-MDP in predicting response to chemotherapy. However, both 67Ga and 99mTc-MDP appear to be affected by factors other than tumor activity.

Topics: Adolescent; Adult; Antineoplastic Agents; Bone Neoplasms; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate; Thallium Radioisotopes

The advent of improved chemotherapy has changed the natural course of osteosarcoma. The role of bone scintigraphy in the workup of metastatic osteosarcoma is being re-evaluated. Extra-osseous osteogenic sarcoma metastases, particularly pulmonary metastases, are known to accumulate bone-avid agents. In this case, there is also uptake by noncalcified metastases to the brain and to soft tissues of the leg and arm which has not been previously reported. Correlation with computed tomography and magnetic resonance imaging is made.

Topics: Adult; Bone Neoplasms; Brain Neoplasms; Humans; Lung Neoplasms; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

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

The distribution of skeletal metastases in prostatic and lung cancer was examined to test the hypothesis that prostatic carcinoma spreads by a unique hematogenous route. Abnormal technetium-99m methylene diphosphonate bone scans were retrospectively reviewed in 71 patients with prostatic carcinoma and 41 patients with lung cancer comparing patterns of osseous involvement. Differences in the distribution of lesions were not significant. It is concluded that prostatic carcinoma does not metastasize to specific skeletal sites by a singular hematogenous pathway.

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

To evaluate the incidence of a positive bone scan at presentation in women with primary breast cancer, 389 consecutive 99Tcm bone scans over a ten-year period (1978-87) were retrospectively and blindly reviewed by a single observer. The study comprised all women clinically staged I-III (UICC criteria) and irradiated with radical intent in the Professorial Unit of Radiotherapy at this institution. The initial scan was performed within six weeks of primary surgery, and was judged to show metastatic disease in only 24/389 (6%) overall. The incidence of a positive scan increased with stage from 2/80 (2.5%), and 9/226 (4%) to 13/83 (16%) for stages I, II, and III respectively. Pre-operative haemoglobin, serum alkaline phosphatase level, age, menstrual status and degree of nodal involvement were not significantly associated with the risk of a positive scan. Patients found to have a positive scan experienced a significantly shorter overall survival than those with a normal scan (p greater than 0.001). After a mean follow-up time of 46 months (range 3-120 months), 45/365 originally normal scans 15% had converted to an abnormal scan, and a further 32 patients developed radiological evidence of bone metastases.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Female; Humans; Menopause; Middle Aged; Radionuclide Imaging; Retrospective Studies; Risk Factors; Survival Rate; Technetium Tc 99m Medronate; United Kingdom

Topics: Bone Neoplasms; Evaluation Studies as Topic; Humans; Image Processing, Computer-Assisted; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

From November 1988 to March 1989, 20 patients with serious multiple bone metastases were treated by high dose 99mTc-MDP bolus. In the adult, 99mTc-MDP at a dose of 200-300 mCi was injected intravenously and repeated at 24-48 hour intervals as a course. The total dose was 1,200 mCi. Subjective response rate was 100% and pain was relieved within 24 hours of the treatment in 55% of patients. The average and mean remission period was 60 days and 61 days, respectively. At least 50% of the treated patients did not require further analgesic treatment any more. Scintillation count rate ratio of the bone lesion to control was reduced by 32.13% after treatment. Repair of the destroyed bone was shown by X-ray films in some cases. No toxicity to the liver, kidney or marrow was observed.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Male; Middle Aged; Technetium Tc 99m Medronate

Two hundred and two patients with bone pain from metastatic cancer were treated with 40 microCi/kg of Sr-89. Patients were followed with pain diaries, records of medication taken, sleep patterns, serial bone scans and a Karnofsky Index. One hundred and thirty-seven patients with adequate followup survived at least 3 months, including 100 with prostate and 28 with breast carcinoma. Eighty of the 100 patients with prostate cancer responded, and 25 of the 28 breast cancer patients improved. Ten patients with prostate cancer and five with breast cancer became pain free. Little hematologic depression was noted. Sr-89 kinetic studies showed that strontium taken up in osteoblastic areas remained for 100 days. The tumor-to-marrow absorbed dose ratio was 10:1.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Pain, Intractable; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Strontium Radioisotopes; Technetium Tc 99m Medronate

For an evaluation of the clinical utility of prostate-specific antigen (PSA), 32 prostatic carcinoma patients (ages 54-76) and 13 nonprostatic carcinoma patients (ages 60-70) underwent PSA measurements and bone imaging. At the time of bone imaging, each patient's PSA value was measured by a monoclonal immunoradiometric assay. All 13 nonprostatic carcinoma patients (11 bronchogenic, 1 colon, and 1 urinary bladder) gave normal PSA values, although 6 had metastatic bone disease. The 32 prostatic cancer patients were divided into 2 groups of 16 each; PSA levels in Group 1 were abnormal (greater than or equal to ng/ml): PSA levels in Group 2 were normal (less than 4 ng/ml). In Group 1, bone images of 14 patients showed bone metastases; 6 of the 14 showed progression of metastases in a 6- to 12-month period. Two patients in Group 1 were negative for skeletal metastases. Twelve patients in Group 2 were negative for skeletal metastases; bone imaging in 1 showed regression of skeletal metastases; and 3 patients had unchanged bone lesion(s). The data indicate that PSA measurements may enhance bone imaging interpretation and provide valuable clinical monitoring of prostatic carcinoma. In the case of a patient with positive bone imaging and an unknown primary, PSA measurements may definitively determine if metastases originated from prostatic carcinoma.

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

In this article, the authors present their experience with the diagnosis of bone metastases in patients with breast cancer using bone scintigraphy with 99mTc phosphonate and radioimmunological determination of carcinoembryonic antigen (CEA) and tissue polypeptic antigen (TPA). In a group of 395 patients, there was agreement between tumour markers (CEA, TPA) and the results of bone scintigraphy in 331 cases (84%)--negative in 193 cases (49%) and positive (i.e. in terms of bone scintigraphy results and the presence of at least one tumour marker) in 138 cases (35%). On the basis of this good agreement of the results between bone scintigraphy and CEA and TPA levels, the authors recommend the following algorithm in monitoring patients with breast cancer: follow-up of tumour markers at several-month intervals and, any increase in their levels will refer the patient to further examination using imaging techniques including bone scintigraphy.

Topics: Biomarkers, Tumor; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Carcinoembryonic Antigen; Female; Humans; Technetium Tc 99m Medronate; Tomography, Emission-Computed

We examined the roentgenographical features of 5 patients who were diagnosed histopathologically as malignant fibrous histiocytoma (MFH) of bone, especially on the imaging of bone scintigraphy. Two patients had multiple lesions on the initial examination, and two of 3 patients who showed solitary lesion on the first examination could be detected more pathological sites by bone scintigraphy which was studied within two months of the first investigation. On bone scintigraphy, the mixture of hot and cold lesions which was coincident with the osteolytic change on plan X-P could be noticed, and with the progression of osteolysis it had a tendency to increase the area of cold lesions. These features are similar to metastatic bone tumor which is the most questionable disease on diagnosis, and we conclude that bone scintigraphy will be absolutely necessary when MFH of bone is highly suspected in the clinical course.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Female; Histiocytoma, Benign Fibrous; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The clinical records of 94 patients with regionally advanced melanoma (nodal disease or regional satellites) were reviewed to determine the value of preoperative bone and liver imaging. Of 68 bone scans obtained, none were suggestive of metastases. of 97 liver imaging studies (computed tomography, scintiscan, or sonography) in 88 patients, only two were found to have demonstrable metastases. Liver enzyme elevation was present in both of these patients. Bone and liver imaging in the absence of signs or symptoms of dissemination by history, physical examination, chest x-ray, and enzyme determination for regionally advanced melanoma appears to be of little value unless the patient is involved in a protocol study.

Topics: Alkaline Phosphatase; Bone Neoplasms; Female; Humans; Liver Neoplasms; Male; Melanoma; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

As the routine follow-up studies in patients with malignant diseases, bone scintigraphy is often performed to detect bone metastasis, before, during and/or after the treatments. Among these patients who were treated, especially, with CDDP, we often encountered the markedly increased renal radioactivity during the follow-up period by bone scintigraphy. In this study, 68 patients with 76 bone scintigraphy performed within 30 days after the administration of CDDP were evaluated. Forty-five of the 76 bone scintigraphy (60.5%) in the 68 patients exhibited more prominent accumulation of the radionuclide in the kidneys than that normally seen. Among them, twenty-four cases (31.6%) showed markedly increased accumulation of the radionuclide in the kidneys so called the "hot kidneys", when the bone scintigraphy was performed later than 3 weeks after the treatment with CDDP. Moreover, the frequency of the "hot kidneys" were well correlated with the degree of renal damage in terms of serum creatinine levels. These findings suggest that the "hot kidneys" might represent the presence of transient renal damage caused by the administration of CDDP. As the causes of this finding called as the "hot kidneys", various factors and/or many causes are reported recently, however, the highest incidence of this phenomenon is thought to be occurred by CDDP as the factor of drug incidence.

Topics: Adult; Aged; Bone Neoplasms; Cisplatin; Female; Humans; Kidney; Male; Middle Aged; Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Bone Neoplasms; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Polyostotic; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the incidence of metastasis in in different malignancies (P less than 0.02). The metastatic rates of nasopharyngeal, lung, prostate and breast cancers were higher than gastrointestinal, kidney, and other malignancies. There was significant differences in the different sites of skeletal metastasis (P less than 0.01). They were thorax, spine, pelvis, limbs and skull in order of incidence. Solitary metastatic rate was 15.9%. Biopsy is advised for patients suspected to have metastatic disease but with only one single "hot spot" in skeletal imaging, particularly in the rib.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Male; Nasopharyngeal Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Tc-99m-HMDP bone imaging was performed in 114 patients with various carcinomas. Ninety-four patients gave positive results. In 65 patients, bone imaging was compared with radiograms. The two methods were both positive in 40 patients (62%). Of these 65 patients, 17 (26.1%) had negative radiograph but positive bone imaging. Bone metastases were mainly found in the axial skeleton. It is important to differentiate bone fracture from metastasis when only one single lesion is found. The best differentiation is bone imaging follow-up.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate

Peroperative isotopic detection, which was rendered possible by use of the cadmium telluride semi-conductor probe developed by C. Proye et al., has permitted nidus removal, as well as promoting cure in case of osteoid osteoma, by limiting bone resection to a strict minimum. Five cases are presented, all children. The method seems to present great value, particularly in case of localisations involving the spine or the neck of the femur.

Topics: Adolescent; Bone Neoplasms; Child; Female; Humans; Intraoperative Care; Male; Osteoma, Osteoid; Radionuclide Imaging; Sacrum; Technetium Tc 99m Medronate; Tibia

A five year review of 224 Tc-99m methylene diphosphonate (MDP) scintiscans of 194 patients with proven nasopharyngeal carcinoma revealed evidence of craniofacial asymmetry in 73.7 per cent. In virtually all instances tracer accumulation corresponded to the side of the primary lesion, cervical node enlargement and or cranial nerve dysfunction. It was concluded that the high frequency of asymmetric ipsilateral MDP accumulation about the face may be attributed to one or all of the following; tumour extension into contiguous structures, localised inflammatory or necrotic changes or even tracer uptake by the tumour itself.

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; Facial Bones; Humans; Nasopharyngeal Neoplasms; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

Incidental accumulation of bone-scanning agents in a noncalcified splenic hemangioma was observed on a bone scan performed for staging carcinoma of the prostate in a 68-yr-old man. This entity may be considered in the gamut of splenic activity on bone scans.

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

The bone scan findings of 160 consecutive cases of breast cancer metastatic to bone presenting to Guy's Hospital between 1982-1987 were retrospectively assessed for number and distribution of lesions. Twenty-one percent of patients relapsed with a solitary bone metastasis. The spine was the commonest site for both solitary (52% of cases) and multiple (87%) metastases. Solitary bone metastases are more common than previously thought.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

Four cases are presented to show the value of bone scintigraphy as an aid in the diagnosis of benign bone tumours. Scintigraphy is not only capable of localising these tumours but is also a useful monitor of local recurrence after surgery. In addition, a whole-body bone scan done at the same time will exclude active multifocal disease.

Topics: Adolescent; Bone Neoplasms; Child; Chondroma; Female; Humans; Male; Middle Aged; Osteoma, Osteoid; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Adult; Bone Neoplasms; Humans; Intraoperative Period; Male; Osteoma, Osteoid; Radionuclide Imaging; Technetium Tc 99m Medronate; Wrist

Nine patients with histologically proven medullary carcinoma of the thyroid (MCT) were imaged using pentavalent [99mTc]dimercaptosuccinic acid [(V)DMSA], [131I] metaiodobenzylguanidine (MIBG) and [99mTc]methylene diphosphonate (MDP). Technetium-99m (V)DMSA demonstrated most of the tumor sites in eight patients with proven metastases, with an overall sensitivity of 95% in lesion detection. Iodine-131 MIBG showed definite uptake in some of the tumor sites in three of the nine patients imaged, with equivocal uptake seen in a further one patient, with sensitivity of only 11% for lesion detection. Technetium-99m MDP demonstrated bony metastases only, in four of the patients imaged yielding a sensitivity of 61%. Technetium-99m (V)DMSA has been demonstrated in this study to be a useful imaging agent in patients with MCT, showing uptake in significantly more lesions and with better imaging qualities than [131I]MIBG, and with the ability to detect soft tissue as well as bony metastases.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Carcinoma; Humans; Iodine Radioisotopes; Iodobenzenes; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Thyroid Neoplasms

The diagnostic value of bone scintigraphy and radiography in the detection of lymphomatous bone involvement, and the role of bone scintigraphy in the evaluation of lymphomatous bone marrow involvement, were investigated in 41 patients with malignant lymphoma. 10 patients had lymphomatous bone involvement. Whereas scintigraphy detected all the 10 cases, radiography was false negative in 2 cases. The lytic bone lesions on radiography were in most cases not detected by scintigraphy. Scintigraphy is insensitive for the detection of early bone marrow metastases. The simultaneous use of bone scanning and x-ray, however, seems to be helpful in the detection of lymphomatous bone involvement and consequently in the clinical management of patients with malignant lymphoma.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Marrow; Bone Neoplasms; Female; Hodgkin Disease; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Biopsy; Bone Neoplasms; Humans; Lymphoma, Large B-Cell, Diffuse; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Radius; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 77-year-old man with prostate cancer was serially evaluated for bone metastases using Tc-99m methylene disphosphonate (Tc-99m MDP) both on and off treatment with etidronate disodium (EHDP). While the patient was receiving the medication only minimal bony uptake of the tracer was seen with the majority remaining in the soft tissues. The similarly structured EHDP probably saturated the binding sites that the radioactive MDP usually adheres to. Physicians should be aware of this interaction and may have to wait until the EHDP has been discontinued for several months before performing bone imaging on these patients.

Topics: Aged; Bone Neoplasms; Etidronic Acid; False Negative Reactions; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Carcinoma, Transitional Cell; Humans; Male; Neoplasm Recurrence, Local; Ossification, Heterotopic; Radionuclide Imaging; Technetium Tc 99m Medronate; Ureteral Neoplasms

The purpose of this study was to develop a quantitative bone scintigraphy (QBS) method in order to evaluate the evolution of bone metastases in patients treated for disseminated prostatic cancer. Data obtained by whole body scintigraphy after injection of 99mTc-methylene diphosphonate enabled us to define three indexes, GR, R1 and R2. They respectively represent the amount of activity retained in the bones, in the metastatic sites and in pathological sites related to the global activity of the skeleton. Repeated QBSs have been performed on 59 patients with prostatic carcinoma treated for bone metastasis with hormonal therapy. Results of QBS are well correlated to clinical findings, particularly pain evolution. In addition, the calculated indexes of QBS made it possible to distinguish three groups of patients according to regression, stabilization or evolution of their lesions under hormonal therapy. QBS seems to be a sensitive and useful test for the evaluation of the therapeutic efficiency on bone metastases from prostatic carcinoma.

Topics: Bone and Bones; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Reference Values; Technetium Tc 99m Medronate; Whole-Body Counting

Bone scintigraphy was performed in 16 men with newly diagnosed prostatic carcinoma before orchiectomy as well as 2 weeks and 2 months after operation. The uptake in the lower thoracic and lumbar vertebrae was registered up to 240 min after injection of 99mTc-MDP and was then calculated for each patient and vertebra. The relative standard deviation in measured uptake due to measuring technique was estimated to be +/- 7%. In eight patients, who had normal bone scintigraphies before orchiectomy, there were no changes in the uptake values after operation. The remaining eight patients had widespread metastatic involvement prior to treatment. Six of these patients showed a so called "flare phenomenon" in the abnormal vertebrae which means an initial increase in uptake after operation followed by a decreased uptake in response to therapy. One patient had a continuously increased uptake in all the abnormal vertebrae which correlated well with the clinical progression of the disease, while in another patient both reactions were seen. Thus, repeated quantitative bone scintigraphies using 99mTc-MDP can be made in a reproducible way and can be a useful tool to follow a patient's response to treatment.

Topics: Aged; Bone and Bones; Bone Neoplasms; Carcinoma; Follow-Up Studies; Humans; Male; Orchiectomy; Postoperative Care; Preoperative Care; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

The detection of focal pathology on a bone scan is dependent on the contrast between uptake in a lesion compared with the affinity of the scanning agent for the surrounding normal bone. Dimethyl-amino diphosphonate (DMAD) has a relatively low uptake in normal bone compared with methylene diphosphonate (MDP). We have compared the bone scan appearance with MDP and DMAD in 11 patients with multiple bone metastases from breast cancer. The median time between scans was 7 days (range 6 to 14). In two patients additional lesions were identified on the DMAD scan. No additional lesions were visible on the MDP scans. In five patients some lesions were visualized more clearly with DMAD and others with MDP. In six patients no differences were seen. Anatomical resolution was generally less clear with DMAD and precise anatomical localization was sometimes impossible. We have demonstrated superior lesion detection with DMAD. The clinical value of this for the detection of early relapse of disease in the skeleton requires further study.

Topics: Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

In searching for disease on skeletal images it is important to identify areas of increased activity and cold lesions, which are usually more difficult to identify. Focal photon-deficient lesions are due to metastatic disease in over 80% of cases. They may occur if the tumor is extremely aggressive, if there is disruption of the blood supply to the bone, or if there is significant marrow involvement, particularly in a vertebral body. Some of the common causes of a photopenic lesion are avascular necrosis, malignant bone tumors such as multiple myeloma, metastasis, radiation therapy, attenuation artifacts such as prosthesis or pacemaker, and early osteomyelitis. A case of hemangioma of the dorsal vertebra, a rare cause of photopenic lesion, is reported here.

Topics: Aged; Bone Neoplasms; Hemangioma; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

We present a 93-year-old man with prostatic carcinoma whose 99mTc-HMDP skeletal images showed multiple areas of abnormally increased radioactivity in the bone and virtual absence of renal activity. These findings were interpreted as representing multiple skeletal metastases. When correlated with concurrent radiographs, the abnormalities were found to be due to Paget's disease. Multiple areas of bone involvement are not rare in Paget's disease. We reemphasize that an abnormal bone scintigram should always be correlated with regional radiographs to rule out conditions other than malignancy.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Diagnosis, Differential; Humans; Male; Osteitis Deformans; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Full-length skeletal scintiscans were acquired onto a data processor in a series of 256 X 256 matrices. A series of interactive computer programs enables the operator to select profiles down the spine and to standardize them by interpolation to a standard length and by normalization to a given count level. The counts within any section of a profile can then be calculated and the profile examined for any significant deviation from a reference 'normal' curve. In a study of 68 patients, 66% of the spinal profiles were judged abnormal, compared with 26% of scans assessed by visual inspection alone. Of 14 patients with positive profiles and negative or equivocal visually assessed scans, 11 had developed metastases within 14 months of the scan. All five patients with positive profile and raised alkaline phosphatase have died of metastatic disease. The technique appears to increase the sensitivity of bone scintigraphy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Reference Values; Software; Spine; Technetium Tc 99m Medronate

Bone scintigraphy was performed in 17 patients with previously known lung metastases of osteosarcoma. 99Tcm-MDP uptake was observed in all primary bone lesions but lung metastatic lesions were positive in only six patients (35%). 99Tcm-MDP uptake by lung metastases was significantly correlated with bone and osteoid formation in the metastatic lesions and preoperative serum ALPase values. These clinical observations were confirmed by using nude mice transplanted with human lung metastatic osteosarcoma. 99Tcm-MDP scintigraphy appears to be useful for detecting lung metastases of osteosarcoma only in a selected group of patients.

Topics: Adolescent; Adult; Animals; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Mice; Mice, Nude; Middle Aged; Neoplasm Transplantation; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Transplantation, Heterologous

Examination for liver and bone metastases was performed in 30 women suffering from carcinoma of the uterus and in 27 with cervical and 37 with ovarian carcinoma. Scintigraphy was the examination method of choice in bone metastases and computed tomography in liver metastases. Bone metastases were not seen in any patient in the stages I to IV with carcinoma of the cervix and ovarian carcinoma. Bone metastases were found in one patient in stage III and in one in stage IV with carcinoma of the uterus. Liver metastases were found in four patients in stages III and IV with carcinoma of the uterus and in five patients with ovarian carcinoma.

Topics: Bone Neoplasms; Female; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Ovarian Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Uterine Cervical Neoplasms; Uterine Neoplasms

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

An unusual case of osteopoikilosis was found in a 52-year-old black woman. The rather large diffuse focal increased densities involving the ribs, spine, and pelvis as seen in the roentgenograms were believed to represent metastatic bone lesions. The normal nuclide bone images helped revise the diagnosis to osteopoikilosis. Early recognition of osteopoikilosis would have prevented the patient's apprehension and the extensive work-up for the primary tumor.

Topics: Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged; Osteopoikilosis; Osteosclerosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Male; Pain; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Antineoplastic Agents; Bone Neoplasms; Cyclophosphamide; Diethylstilbestrol; Drug Combinations; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of giant cell tumor of bone is reported in which the blood flow study along with SPECT imaging improved the visualization and diagnosis of the abnormality.

Topics: Adult; Bone Neoplasms; Giant Cell Tumors; Humans; Male; Technetium Tc 99m Medronate; Tomography, Emission-Computed

We have been among the first authors to point out that false negative cases could be observed with 131I-MIBG scintigraphy for neuroblastoma. We have observed until now ten of such false negative cases, 7 with primary tumor and 3 with bone metastases. Fifty 131I-MIBG scans were performed in 35 children with histologically proven neuroblastoma (24 grade IV) and compared to bone scans, CT and NMR images, ultrasound and clinical results. The visualization of the primary tumor shows a higher sensitivity with MIBG (79%) than with bone scans (47%) and a 100% specificity with each method. MIBG and bone scans, for bone metastases, are similar in the sensitivity (87.5%) but MIBG is much more specific (100%) than bone scan (81%). These results clearly confirm the superiority of MIBG scan for detection of primary tumor as well as bone metastases. However, MIBG is not always the most appropriate investigation, as shown by 11 observed pitfalls. Ten false negative cases have been observed and must be considered: in five out of 10 cases, bone scans performed with 99m Tc-HMDP made the diagnosis (3/7 cases of primary tumor and 2/3 cases of bone metastases). Moreover, one case was not usable due to a large digestive uptake. Our aim is to understand the reasons of the false negative by a meticulous analysis of every single case. The optimal procedure for neuroblastoma diagnosis, extent and follow up clearly seems to be the following strategy: MIBG scan must be firstly performed; in case of non-demonstrative scan the bone scan, which is complementary, will greatly contribute to the diagnosis.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Neoplasm Metastasis; Neuroblastoma; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

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

Isolated scintigraphic sternal lesions are rare. In a retrospective review of the bone scan results of 1,104 patients with breast cancer, 34 individuals (3.1%) presented with this abnormality. Of these foci, 26 (76%) were found to represent metastatic disease. There did not appear to be a relationship with axillary lymph node metastasis, the quadrant involved by primary breast tumor, or selected serum chemistries. These sternal lesions may be associated with regional lymphatic tumor spread rather than hematogenous seeding and therefore could be considered a local recurrence.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Retrospective Studies; Sternum; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child, Preschool; Diagnostic Errors; False Positive Reactions; Ganglioneuroma; Humans; Radionuclide Imaging; Retroperitoneal Neoplasms; Sympathectomy; Technetium Tc 99m Medronate

Seventy children (3.7 +/- 3.3 y) with definitely confirmed diagnosis of neuroblastoma had 115 whole body scans carried out 24 h after injection of 3.7 MBq/kg of I-123 mIBG (83 scans) or 0.7 MBq/kg of I-131 mIBG (17 scans) or 0.9 to 4.5 GBq of I-131 mIBG (15 post-therapeutic scans). The scans were interpreted as positive in the presence of any non-physiological uptake area or of any bone uptake of the tracer, even at the level of the metaphyseal complex. For the primary tumour, the sensitivity of mIBG scans was 73%. Ten false negative patients had an overlap of the tumour with the bladder or heart images (4 cases) or with positive metastatic images (6 cases: liver, spine). Three false negative patients had neuroblastomas which did not secrete catecholamines. The specificity of mIBG was 94%. In our opinion, mIBG scans have a complementary role to assess the activity of post-therapeutic remnants. For the detection of hepatic and lymph node metastases, the sensitivity was about 50% and the specificity was 100%. The standard used for the detection of bone marrow metastases was the cytological and histological examination of 10 bone marrow aspirations and one or more biopsies (CHBMS). The sensitivity of mIBG scans was 90% and the specificity 68%. However, reviewing the data from the 16 false positive scans, we found 11 definitely proven bone metastases, 3 biological relapses and 2 cases of delayed abnormal CHBMS supporting the positivity of the mIBG scans, raising the specificity to 100%. Tc-99m diphosphonate bone scans had a sensitivity of 78% and a specificity of 51%. We suggest that positive mIBG scans may save other procedures since our data do not support false positive detection of bone or bone marrow metastases. In contrast, patients with negative mIBG findings should be further explored.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Lymphatic Metastasis; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

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

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

Baseline staging bone scans in 1,267 consecutive women with breast cancer attending a single clinic between 1980 and 1986 were reviewed. 0.3% of patients with T1, 3% with T2, 8% with T3, 13% with T4 tumors and none of those with Stage 1, 3% with Stage 2, 7% with Stage 3, and 47% with Stage 4 disease had a positive scan due to bone metastases. Two hundred eight-nine (23%) had bone scan abnormalities secondary to radiologically confirmed benign bone disease. In 20 patients, no cause for a bone scan abnormality could be found after a median follow-up of 3.50 yr, a false-positive frequency of 1.6%. The false-negative rate was 0.08%. It is concluded that patients with tumors less than 2 cm are most unlikely to have a positive scan. In this instance, scans are not required routinely. However, we recommend a baseline scan in all patients with Stage 2, 3, or 4 disease.

Topics: Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Humans; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: 3-Iodobenzylguanidine; Adrenal Gland Neoplasms; Bone and Bones; Bone Neoplasms; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Middle Aged; Pheochromocytoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Fibroma; Humans; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

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

Topics: Adult; Aged; Bone Neoplasms; Female; Gallium Radioisotopes; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

51 patients suffering from 125 bone metastases of various primary tumors were investigated with three-phase skeletal scintigraphy in an attempt to define criteria characteristic for bone metastases with regard to differential diagnosis. During the 3 phases of imaging, the metastases exhibited 5 different patterns of activity concentration. None of these patterns was correlated either to the size and morphological X-ray appearance of the metastases or to the histology of the primary tumors. The intensity of radionuclide concentration was also varying. The most frequent patterns of activity concentration were increased uptake during the blood-pool phase and skeletal phase combined with absence of concentration during the angiographical phase (43%), and increased uptake during all of the 3 phases (34%). In this series, a pattern of scintigraphical findings characteristic for bone metastases or helpful in the differential diagnosis could not be determined. In our experience, three-phase skeletal scintigraphy is not useful in the diagnosis and differential diagnosis of bone metastases.

Topics: Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Male; Methods; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

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

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Carcinoma; Humans; Kidney; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Ninety-one radiologically confirmed osteolytic metastases in 30 patients with hypernephromas were studied with regard to their uptake of 99mTc-MDP and this was compared with the radiological findings. In 16% of the radiologically proven metastases, there was no correlation with their isotope uptake. Compared with other bone metastases whose isotope uptake has been studied and described in the literature, there appears to be a higher proportion of hypernephroma secondaries that do not show uptake of 99mTc-MDP.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Renal Cell; Evaluation Studies as Topic; Female; Humans; Kidney Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The status of patients with skeletal metastases from prostatic carcinoma was determined from a quantitative uptake and retention measurement of the bone scanning radiopharmaceutical 99mtechnetium-methylene diphosphonate. Whole body counts were performed 5 minutes and 24 hours after intravenous administration of 99mtechnetium-methylene diphosphonate, and were expressed as the percentage uptake by the skeleton at 24 hours. Skeletal uptake determinations were done in 29 patients with prostatic cancer (17 with osseous metastases) who were evaluated at 3 to 6-month intervals. Group 1 consisted of patients who responded to therapy and achieved remission, group 2 included patients with relapse or progressive disease, group 3 consisted of those with metastases who were in remission for longer than 6 months and group 4 included those without evidence of any bony metastases. The baseline mean +/- standard deviation 24-hour skeletal uptake values were 46.1 +/- 12.0 per cent in group 1, 34.3 +/- 13.9 per cent in group 2, 27.0 +/- 5.9 per cent in group 3 and 28.9 +/- 5.5 per cent in group 4. At 3 to 6 months the values in group 1 (responders) decreased by 18 per cent, while those in group 2 (relapse or progression) increased by 19 per cent and those in group 3 (remission) increased by 1.5 per cent. The quantitative 24-hour skeletal uptake test was performed easily, reproducible and at least as useful as concurrent chemical blood tests and subjective bone scan interpretations.

Topics: Acid Phosphatase; Alkaline Phosphatase; Bone Neoplasms; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

Two new radiopharmaceuticals, 186Re-1-hydroxyethylidenediphosphonate (186Re-HEDP) and 153Sm-ethylenediaminetetramethylenephosphonate (153Sm-EDTMP), have been proposed as palliative treatments for metastatic bone cancer. Biolocalization properties of these chelates in animals as well as the physical decay and production properties of the respective radionuclides are consistent with those of a therapeutic agent. Subtherapeutic doses of both agents have been administered to human cancer patients to determine their biokinetics and skeletal localization. The 186Re-HEDP studies were conducted at the University of Cincinnati while the 153Sm-EDTMP studies were conducted at the University of Missouri-Columbia. The pharmacokinetics of these agents in humans were consistent with those found in animals. Imaging studies show that the retained activity localizes primarily in the skeleton with high selective uptake in skeletal lesions; there is no visualization of other organs or soft tissue. This paper will review the development and preparation procedures for these radiopharmaceuticals and briefly summarize the animal and patient data.

Topics: Animals; Bone Neoplasms; Dogs; Etidronic Acid; Humans; Kinetics; Organophosphorus Compounds; Pain; Rabbits; Radioisotopes; Radionuclide Imaging; Rhenium; Samarium; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Bone Transplantation; Child; Female; Humans; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Female; Humans; Kidney Neoplasms; Leukemia, Lymphocytic, Chronic, B-Cell; Neoplasms, Multiple Primary; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Kidney; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Findings of bone scintigraphy with 99mTc-MDP were compared with bone radiography and biochemical data including total acid phosphatase (T. ACP), prostatic acid phosphatase (P. ACP), and alkaline phosphatase (ALP) in 35 patients with histologically proven prostatic cancer. Bone metastases were diagnosed in 20 of 35 cases (57%) by scintigraphy. The common sites of metastases were the pelvic bones, ribs, lumbar and thoracic vertebrae. In vertebrae, metastases were mainly distributed in the lower level. The most frequent radiographic change due to metastases was the osteoblastic type. On follow-up studies, there was a relatively good agreement in the results of bone scintigraphy and radiography. However, there was a good number of cases showing discrepancy between either scintigraphy or radiography and laboratory data. Bone scintigraphy seems to be the most contributory in monitoring bone metastases from prostatic cancer.

Topics: Aged; Bone and Bones; Bone Neoplasms; Follow-Up Studies; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

If bone biopsies are performed after the sites are located under radionuclide guidance, the chances of sampling the pathologic tissue are greatly improved. After bone scanning, two to three areas for biopsy are chosen and locating is done with 0.05 ml of Tc-99m in a tuberculin syringe under an Anger camera. Methylene blue-xylocaine is injected into the skin up to the periosteum for marking the site of the biopsy. Using this technique, 27 biopsies in 20 patients have been performed (four were open and 23 were closed needle). Pathology was found in 25 biopsies (92.6%), cancer in 22 (81.5%), benign lesions in three (11.1%), and normal bone in two (7.4%).

Topics: Adult; Aged; Biopsy; Biopsy, Needle; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Methylene Blue; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

An investigation to correlate histologic changes in 12 osteosarcoma specimens from patients undergoing chemotherapy was performed using functional images of regional 99mTc methylene diphosphonate (MDP) plasma clearance rates assessed from dynamic bone scintigraphies taken during chemotherapy. Residual tumor cell viability was determined by microscopic examination of multiple thin sections from surgical specimens and quantitated by histomorphometry. Regions that showed decreases in 99mTc MDP plasma clearance of more than 20% were associated with areas of necrotic tumor, and regions that showed absent decline or increasing clearance rates were associated with high residual cell viability and incomplete response to chemotherapy. Therefore, functional bone scintigraphy allows an objective presurgical assessment of tumor response to chemotherapy.

Topics: Adolescent; Adult; Antineoplastic Agents; Bone Neoplasms; Cell Survival; Female; Humans; Male; Metabolic Clearance Rate; Osteosarcoma; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate

To determine how often stress fractures occur in patients who have undergone surgery for osteosarcoma of a lower limb and to characterize such lesions, 156 bone scans obtained in 43 such patients were reviewed for bone stress. Of 43 patients who had undergone amputation or limb-preserving procedures, 42 (98%) had abnormalities on scintiscans attributable to bone stress; 31 had focal or mixed focal and diffuse lesions. Bones most commonly involved were those of the contralateral leg, pelvis, ipsilateral leg, and arms. Focal and mixed lesions seemed to be associated with increased work load on the limb involved. Findings indicated that the more active the patient, the more severe the bone stress. Because of their distribution, appearance, and intensity of tracer uptake, most stress-related lesions were readily distinguishable from bony metastases on scintiscans. Questionable lesions should be evaluated further with other imaging methods.

Topics: Adolescent; Adult; Amputation, Surgical; Bone Neoplasms; Child; Female; Follow-Up Studies; Fractures, Bone; Humans; Leg Injuries; Male; Osteosarcoma; Radionuclide Imaging; Stress, Mechanical; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child; Humans; Humerus; Mediastinal Neoplasms; Osteosarcoma; Pericardium; Radionuclide Imaging; Technetium Tc 99m Medronate

Malignant degeneration to chondrosarcoma occurred in the left hemipelvis of a patient with multiple hereditary exostosis. Tc-99m HDP bone scintigraphy revealed markedly increased focal uptake in the areas of left superior pubic ramus, obturator foramen, and ischium with displacement of the urinary bladder. Of particular interest was the presence of vascularities seen in the flow and blood pool scintigrams. Following surgical exeresis, the gross appearance and histologic features of the tumor were identified as those of a low grade chondrosarcoma.

Topics: Adult; Bone Neoplasms; Chondrosarcoma; Exostoses, Multiple Hereditary; Humans; Male; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate the use of radionuclide bone scan in staging patients with primary and local-regional recurrence of breast cancer, we reviewed the results in 265 patients with primary breast cancer who had the scan either preoperatively or within 6 weeks of surgery, and in 39 patients presenting with their first local-regional recurrence. All patients were clinically staged according to the revised 1983 criteria of the American Joint Committee for Cancer Staging and End-Results Reporting. None of the 92 with stage I and four of 95 patients with stage II had a positive scan. Eleven of 41 with stage IIIA and 13 of 37 with stage IIIB had a positive bone scan. In patients with their first local-regional recurrence, 12 of 39 had a positive scan. Follow-up scans were available in 61 patients with clinical stage I and II breast cancer who had adjuvant chemotherapy for pathological involvement of axillary node. There were six conversions observed in 61 scans obtained during the first year. Seven converted in follow-up scans in 47 patients in the second year. We conclude that although bone scans have a low positive yield in stage I and II breast cancer, their use in the preoperative setting and in the follow-up of patients with axillary node involvement detects early converters. Bone scans are justified in stage IIIA and IIIB breast cancer and in patients being evaluated for local-regional recurrence.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Medronate

A child with diffuse accumulation of [99mTc]MDP in the liver on a bone scan, at the time of study the patient had a severe, but reversible, hepatic dysfunction on the basis of methotrexate toxicity. Visualization of the liver on skeletal scintigrams can be a consequence of high-dose methotrexate therapy, as there was no other explanation for this unusual finding.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Chemical and Drug Induced Liver Injury; Child; Female; Humans; Liver Diseases; Methotrexate; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Female; Humans; Liver Neoplasms; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Diagnostic Errors; Female; Humans; Humerus; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Radionuclide scanning is usually contraindicated in pregnancy because of the danger of fetal radiation exposure. Radionuclide bone scanning with Tc-99m MDP is a sensitive indicator of early osseous metastases in breast cancer. Three cases of breast cancer during pregnancy are reported; modified bone scanning was utilized for staging and decision analysis. Modifications of bone scanning techniques to minimize fetal radiation exposure and fetal dosimetry calculations are described.

Topics: Abdomen; Adult; Bone Neoplasms; Breast Neoplasms; Female; Fetus; Humans; Pregnancy; Pregnancy Complications, Neoplastic; Radiation Dosage; Radionuclide Angiography; Technetium Tc 99m Medronate

One hundred thirty patients with lung cancer were studied to determine the incidence of unilateral thoracic soft-tissue accumulation (UTS) of 99mTc methylene diphosphonate (MDP). The finding was present in 60 of 130 (46%) of the patients. Of 52 patients who had received radiation therapy to the primary tumor in the chest, 46 (88%) had UTS, while six (12%) did not. Radiation therapy to lung tumors was the most significant of the factors studied in unilateral soft-tissue uptake of bone agent in the thorax of patients with lung cancer.

Topics: Aged; Bone Neoplasms; Connective Tissue; Female; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Thorax

Occasionally, osteoid osteoma can be difficult to radiographically differentiate from osteomyelitis. The precise localization of the nidus of an osteoid osteoma often can be difficult using nothing more than conventional radiographs. In a series of 35 patients, a radionuclide and double density sign facilitated localization of the nidus, confirmed the diagnosis, and aided the surgeon in excision biopsy. This series of cases demonstrates how computed tomography (CT) scanning can more precisely localize the nidus in areas deep in complex joints such as the hip. Fifteen cases of osteoid osteoma were studied with Tc-99m-MDP radionuclide bone scan. Each one exhibited the double density sign. Seven of these patients had CT scans in addition for further localization of the nidus. All were excised with accurate localization of the nidus, and thereby reduced morbidity and postoperative recovery time.

Topics: Bone Neoplasms; Humans; Osteoma, Osteoid; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In a 45-year old patient with serous cystadenocarcinoma of the ovary CT showed small calcifications in metastases along peritoneal surfaces. These "psammoma bodies" indicated abdominal implants, which in other respects would not have been demonstrable via CT scans because of their small size. During bone scintigraphy the calcifications caused unusual extraskeletal focal uptake of 99mTc-MDP in the abdomen.

Topics: Bone Neoplasms; Calcinosis; Cystadenocarcinoma; Female; Humans; Middle Aged; Ovarian Neoplasms; Peritoneal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adolescent; Angiography; Bone Neoplasms; Humans; Male; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Thumb; Tomography, X-Ray Computed

Urinary tract distortion caused by pelvic rhabdomyosarcoma was imaged during 99mTc-oxidronate bone scintigraphy for suspected metastatic disease. This appearance correlated well with the anatomy defined on other imaging modalities. Bone scanning also proved valuable in detecting an otherwise occult osseous metastasis from this unusual tumor.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Pelvic Neoplasms; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate; Urinary Tract

Pulmonary mean transit time was assessed in 32 patients. A significant difference in this parameter is demonstrated between normals and those patients who have received radiotherapy.

Topics: Age Factors; Bone Neoplasms; Female; Humans; Lung; Male; Middle Aged; Pulmonary Circulation; Radionuclide Imaging; Radiotherapy; Sex Factors; 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

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

In the clinical staging of malignancy, radionuclide bone scanning has played an increasingly important role. An area of increased radionuclide uptake on technetium 99 (99Tc) bone scan which is not visualized on skeletal radiographs can present a significant diagnostic dilemma. This can be further compounded by nonrevealing percutaneous or open surgical biopsies. The authors present a method of definitively localizing the appropriate site for bone biopsy in such circumstances. Use of this technique has allowed us to ascertain that isolated rib lesions in two patients with extra-osseous malignancies were not due to metastatic disease.

Topics: Aged; Biopsy; Bone Neoplasms; Fibrous Dysplasia of Bone; Humans; Male; Middle Aged; Radionuclide Imaging; Rib Fractures; Technetium Tc 99m Medronate

Seventy-nine cases with known carcinoma of the lung or breast who underwent both bone marrow aspiration and Tc-99m MDP bone scintigraphy were reviewed. The bone images were assessed for the presence of the pattern of bone marrow expansion which is visualized by diffuse increased metaphyseal activity, particularly evident at the knees, ankles, and elbows. This pattern was found to be an insensitive marker for the presence of marrow metastases (sensitivity 15%). The specificity of the finding was 86%. When diffuse increased metaphyseal activity is present on a Tc-99m MDP bone scan in a patient with malignant disease, the possibility of bone marrow metastases should be pursued by marrow aspiration and biopsy.

Topics: Biopsy, Needle; Bone and Bones; Bone Marrow; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Humans; Lung Neoplasms; Neoplasm Metastasis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Female; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Liver Neoplasms; Male; Middle Aged; Radiography; Radionuclide Imaging; Ribs; Spinal Neoplasms; Technetium Tc 99m Medronate

The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.

Topics: Adult; Aged; Bone Marrow; Bone Neoplasms; Breast Neoplasms; False Negative Reactions; False Positive Reactions; Female; Hodgkin Disease; Humans; Lymphoma; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Female; Humans; Middle Aged; Pentetic Acid; Radionuclide Angiography; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Pentetate

In 16 patients with a long bone osteosarcoma treated after the therapy regimen of COSS 80/82 (Cooperative Osteosarcoma Study) the tumour response to preoperative chemotherapy was assessed by conventional roentgenograms (plain films, tomograms, angiograms). The histological grade of regression determined in the operative specimen was used as a reference for the extent of tumour devitalisation. By their different typical roentgenological course the osteosarcomas with a very good and those with a rather poor response could be correctly identified (100%). On following the clinically used differentiation between "good responders" (histological grades I to III) and "poor responders" (grades IV to VI) the corresponding classification of these tumours by roentgenograms and functional scintigraphic imaging was found to be correct in 94% of the cases. The coincidence of the correct as well as the false results in both radiological methods was as high as 100% if those osteosarcomas showing only a "medium response" in their roentgenograms were added to the clinical group of good responders. There were no fundamentally discrepant results obtained by each of the two radiological techniques. With the combined workup of the roentgenological and the scintigraphic material any incorrect preoperative estimation of tumour regression with a harmful influence on therapy (date and type of surgery, mode of postoperative chemotherapy) could be avoided.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Combined Modality Therapy; Female; Humans; Male; Osteosarcoma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Two cases of extra-osseous uptake of 99mTc-methylene diphosphonate (MDP) by non-osseous metastatic tumors are reported. One was a metastasis with ossification in the abdominal wall from carcinoma of the sigmoid colon and the other was a metastasis with calcification from an ovarian carcinoma. The mechanism of extra-osseous uptake of 99mTc-MDP is discussed. Bone scintigraphy can be a potential means to assess tumor spread with ossifications and calcifications.

Topics: Abdominal Neoplasms; Adenocarcinoma, Mucinous; Adult; Bone Neoplasms; Calcinosis; Cystadenocarcinoma; Female; Humans; Male; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Sigmoid Neoplasms; Technetium Tc 99m Medronate

Hospital records of 27 children with osteogenic sarcoma were reviewed in an effort to define the usefulness of skeletal scintigraphy in the initial evaluation and follow-up of their disease. Serial bone scans as well as plain radiographs, linear tomograms, and computed tomograms were evaluated for evidence of bone or lung metastases. Eighteen patients developed lung metastases and three developed bone metastases. Seven patients demonstrated uptake of tracer in lung metastases, however, the lesions were all easily identifiable by radiographic means. All bone metastases were detected by scintigraphy, in one instance prior to radiographic abnormality. In no cases were bone metastases known to occur in the absence of lung metastases. None of the bone scans performed for routine follow-up purposes resulted in altered therapy for the patient. We propose that skeletal scintigraphy is useful in the initial metastatic work up of osteogenic sarcoma, and may be helpful in some patients with specific indications during their follow-up, but is less valuable when there is no clinical suspicion for bone metastases.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; Etidronic Acid; Female; Humans; Lung Neoplasms; Male; Organotechnetium Compounds; Osteosarcoma; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

A single blood sample method was used to measure total skeletal activity during routine radionuclide bone scans in 114 patients with known carcinoma of the prostate. The method is based on the measurement of radioactivity in plasma after administration of 99mTc MDP and 51Cr EDTA, providing an assessment of total skeletal activity independent of renal function. The results showed a significant elevation of skeletal activity in patients with untreated bone metastases when compared with patients with no metastatic spread. Significant elevation with increasing extent of metastases was also shown, the highest activity being in patients with diffuse metastatic spread (superscan). Patients with treated metastatic disease showed significantly lower skeletal activity than patients with untreated bone metastases. The method requires the use of two radiopharmaceuticals injected as a mixture and potential errors may arise from pharmaceutical instability. In addition, elevation of total skeletal activity may be caused by coexistent metabolic bone disease. The results suggest that the measure may provide quantitative information in the assessment of the activity of bone metastases from prostatic carcinoma.

Topics: Bone Neoplasms; Chromium Radioisotopes; Edetic Acid; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

A series of 315 patients with histologically proven breast cancer had skeletal scintigraphy performed for defined reasons other than initial staging. Of these, 173 (55%) were found to be abnormal. The yield of abnormalities was highest (83%) in patients with bone pain or tenderness and radiographic evidence of metastases: 38% in those with bone pain or tenderness alone, 37% in asymptomatic patients with local or regional recurrence and 54% in those with non-bony metastases. The overall actuarial survival over a maximum follow-up of 9 years was significantly worse for those with abnormal scintigraphy. Non-staging skeletal scintigraphy is useful in detecting asymptomatic bone metastases at the time of local or regional recurrence or in the presence of non-bony metastases.

Topics: Actuarial Analysis; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Etidronic Acid; Follow-Up Studies; Humans; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A simple technique for determining the whole body retention of 99mTc labeled methylene diphosphonate (MDP) at 4-h and 24-h was applied to 28 adult patients (22 prostate cancer, 6 osteoporosis). Following administration of 20 mCi (740 MBq) 99mTc-MDP, a qualitative scintigram was performed and whole body retention was recorded at 4 and 24 h. The prostate cancer patients all had positive bone scintigrams, and of this group, 7 were in relapse and 15 in remission on chemotherapy. The osteoporotic groups whole body retention values were determined prior to the initiation of drug therapy. Mean percent whole body retention values were significantly greater at 4 and 24 h for the cancer patients in relapse relative to both the prostate cancer patients in remission and the osteoporotics: 4-h%/24-h%; equals 74.3/60.2, 57.5/33.5, and 48.0/30.3, respectively. The whole body retention values of the latter two groups, however, were only significantly different at 4-h. An additional index of skeletal pathology was developed by combining the 4-h/24-h values to calculate the biological half time (t1/2b) for this time period using a single exponential model. Again the cancer patients in relapse exhibited a significantly longer half time relative to those in remission and the osteoporotics (70.4 vs 25.7 h and 29.2 h, respectively). The combination of 4 and 24-h whole body retention values with the associated t1/2b has potential for following and classifying patients during the course of their skeletal disease. These values have been shown to be especially valuable with cancer patients with metastatic disease.

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Male; Osteoporosis; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole-Body Counting

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Data on 1,601 patients with node-positive operable breast cancer who were randomized in four different prospective adjuvant therapy trials were analyzed to evaluate the role of routine bone scans and the alkaline phosphatase value at regular intervals in screening for bone involvement. Bone scan was a prerequisite for randomization and was repeated within the first 12 months in 90% (1,441) of the patients. Abnormal or doubtful scan findings had to be verified by x-ray examination. The repeated scan results were normal in 1,263 (87.8%) patients, doubtful but with no radiologic evidence of bone metastasis in 161 (11%), and abnormal (radiologically confirmed) in 17 (1.2%). After a median observation of 4 years bone metastases as the first relapse developed in 136 (8.5%) patients. This occurred in 87 of 1,263 (6.9%) of the patients with normal repeated scan results and in 18 of 161 (11.2%) of those with doubtful repeated scan findings. Based on the results of the first repeated scan, early detection of a first recurrence in bone might have been possible for 2.4% of the population. Serum alkaline phosphatase levels were also without clinical use. Bone scan in the observation of patients with operable breast cancer should be performed only as dictated by the clinical situation.

Topics: Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Female; Follow-Up Studies; Humans; Liver Neoplasms; Risk; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Chondrosarcoma is a rare complication in hereditary multiple exostoses. The six patients in this study have had a complete follow-up and constitute the largest group of such cases to have been studied so far. Five patients had histologic evidence of malignancy. Since histologic examination can be very difficult, any other diagnostic features, may it be clinical, radiologic, or scintigraphical, should be taken into account for early surgical treatment. Bone scintigraphic examination is a valuable adjunct to early diagnosis of malignant change by showing highest uptake in malignant areas. It is also very useful for posttherapeutic follow-up.

Topics: Adolescent; Adult; Bone Neoplasms; Chondrosarcoma; Exostoses, Multiple Hereditary; Humans; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Androgen Antagonists; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Gonadotropin-Releasing Hormone; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of huge renal cell carcinoma with localization of a skeletal imaging agent is presented. Two unusual scintigraphic findings of bone agent localization in the tumor were observed: a ring-like configuration, and low-intensity uptake. The large ring-like appearance of the extraosseous radioactivity may reflect a bulky tumor with central necrosis and a less active calcification process.

Topics: Aged; Bone Neoplasms; Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Extraosseous uptake of radiophosphate compounds i well recognized in primary neural crest tumors. In a review of 32 cases of neuroblastoma presenting over a three-year period at Children's Hospital of Philadelphia, nine patients were noted to have secondary lesions in eleven different sites accumulating radiotracer. The extraosseous uptake in metastases included: ascites, liver, lung, anterior mediastinum, and posterior mediastinum. These cases are reported to emphasize the ability of bone imaging to detect the presence of extraosseous soft tissue metastases and primary lesions.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Ganglioneuroma; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

The bone scan features of different types of sacral tumors in 16 patients were assessed. Four out of five patients with chordoma, the most common sacral tumor, demonstrated either reduced uptake or normal distribution of isotope at the site of this midline tumor. Plasmacytoma, which is not usually central, also caused reduced uptake on the bone scan. Ewing's sarcoma gave no consistent pattern. All other tumors caused increased uptake except for one unusual case of osteogenic sarcoma. Bone scintigraphy can be very useful in the assessment of sacral tumors. A midline sacral tumor that is cold on the bone scan is very likely to be a chordoma.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Chordoma; Female; Humans; Male; Middle Aged; Plasmacytoma; Radionuclide Imaging; Retrospective Studies; Sacrum; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

Two cases are reported in which bone imaging with Tc-99m MDP showed sternal areas without tracer uptake corresponding to bone metastases compromising blood supply to the sternum itself. Radiographs were normal in both cases.

Topics: Adult; Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma, Bronchogenic; Female; Humans; Lung Neoplasms; Male; Neoplasms, Multiple Primary; Radionuclide Imaging; Sternum; Technetium Tc 99m Medronate

Bone lesions with a ring-shaped appearance (the doughnut sign) have been encountered during routine reporting of bone scintigrams performed on patients with multiple myeloma. Such a ring-shaped appearance has been revealed in four (8%) of the last 50 bone scintigrams performed on patients with myeloma at the Royal Marsden Hospital. In contrast, a review of the last 300 bone scintigrams performed on patients with bone metastases failed to reveal any such ring-shaped appearance. Examination of the case notes and radiographs of the multiple myeloma patients did not reveal any correlation between the presence of the ring-shaped appearances and the histology, biochemistry, treatment, or course of the disease nor were any specific radiographic features noted. Three of the four patients have had local radiotherapy to the sites of the lesions. We conclude that the ring-shaped appearance on bone scintigrams is usually related to myelomatous bone lesions, particularly following local radiotherapy to these lesions. The reason for this appearance in three of the four scintigrams may be the stimulation of vascularity and osteoblastic activity around the periphery of the myelomatous lesions by the response of the lesions to radiotherapy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Male; Multiple Myeloma; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Surgical localization of osteoid osteomas is a major problem in the diagnosis and therapy of this lesion. Visual, tactile, and radiographic localization is often equivocal and as a consequence incomplete excision of the tumor, or excessive removal of bone may result. We performed magnification intraoperative bone scintigraphy using a portable gamma camera and a radioactive pointer in six patients with osteoid osteoma. Accurate localization and complete removal of the tumor was achieved in all six with only minimal delays in the surgical procedure. The advantages of this technique and recommendations for its use are discussed.

Topics: Adolescent; Bone Neoplasms; Child; Female; Humans; Intraoperative Period; Male; Methods; Osteoma, Osteoid; 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

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Hypercalcemia; Male; Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Of 790 patients, 772 with proven cancerous disease have been studied without any selection using either MDP (three different kits), HDP (two types) or DPD. The groups were identical in age distribution, male/female ratio, body weight and verified percentage metastatic involvement. Technical conditions (Mo/Tc-generator used, dilution volume, total activity of the final product per vial, preparation/injection and injection/examination delays) were identical. Analogous scintigrams according to qualitative criteria (image quality, bone delineation, soft tissue fixation, metastatic/normal tissue contrast, aspecific uptake by non-target organs) and superior to MDP. Quantitative data were quite similar for all types of diphosphonates spine; metastatic/normal bone fixation ratio, bone/soft tissue ratio) have been evaluated. The results obtained showed that there was no criterion to demonstrate that HDP or DPD would be superior to MDP. Quantitative data were quite similar for all types of diphosphonates studied. Two out of the three MDPs were slightly superior to the other products with regard to detectability of metastatic lesions. Our results show, that in non-selected clinical routine work for bone scintigraphy HDP and DPD do not present any decisive qualitative or quantitative advantage in comparison to MDP.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Diagnostic Tests, Routine; Diphosphonates; Drug Evaluation; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

Topics: Bone Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged; Patella; Radionuclide Imaging; Technetium Tc 99m Medronate

Four patients are presented with malignant tumors involving both bone and adjacent soft tissue. In each of these neoplasms (two representing adenocarcinoma of the prostate, and one each of squamous cell carcinoma of lung and chondrosarcoma), the lesions were detected by accumulation of Tc-99m MDP. Involvement of both bone and soft tissue was confirmed by CT examination or surgery. It is probable that the lesions originated in bone and then extended to soft tissue.

Topics: Adolescent; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Male; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

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

Although skeletal metastases from malignant neoplasms are common, the spread of cancer to the distal phalanx of the hand is quite rare. We have presented two cases with a distal phalangeal metastasis which could be definitely detected by radionuclide imaging.

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; Esophageal Neoplasms; Female; Fingers; Gallium Radioisotopes; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The immediate Tc-99m MDP image of a neoplastic right wrist mass in a 10-year-old boy demonstrated intense focal accumulation that suggested a very vascular tumor, but delayed images showed only slightly increased activity in the mass. A Tc-99m labeled RBC study was performed to permit whole-body blood pool imaging for other vascular lesions, and it did not demonstrate an increased blood volume in the mass. Biopsy showed the tumor to be a Ewing's sarcoma, probably of soft tissue origin. The sarcoma was not very vascular. The intense immediate accumulation of Tc-99m MDP in this case may be attributed to increased microvascular permeability.

Topics: Biopsy; Blood Volume; Bone and Bones; Bone Neoplasms; Capillary Permeability; Child; Diagnosis, Differential; Erythrocytes; Humans; Male; Microcirculation; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Ulna

Topics: Bone Neoplasms; Female; Humans; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Zollinger-Ellison Syndrome

The prognostic significance of bone scintigraphy was investigated by following 587 consecutive patients with lung cancer, in whom this investigation had been performed, for up to 9 years, or until death. Survival was unrelated to age, sex or cell type. However, pain and abnormal bone scintigraphy were both independently associated with a significantly reduced survival compared with those who were free of pain or who had normal bone scintigraphy. These factors were cumulative. The association remained equally valid for all cell types. Claims that a single metastasis is not prognostically significant are unfounded. It is suggested that the results of some chemotherapy trials must be reconsidered in the light of present findings, because of the lack of adequate control groups; the results could be construed to show a beneficial effect only in patients with bone metastases and a poor prognosis, but little or no effect in patients with normal bone scintigraphy. As judged by clinical and radiological follow-up and post-mortem examination, skeletal scintigraphy in patients with lung cancer had a sensitivity of 0.89, a non-specificity (false positives/true negatives) of 0.00 and an accuracy of 0.78. With existing radiopharmaceuticals there is an irreducible residue of false negatives due to deposits which provoke little or no osteoblastic response. Bone scintigraphy is, thus, indicated in any patient with lung cancer with unexplained symptoms and whenever staging is required, because of the prognostic implications. It should precede other staging investigations because the high detection rate may render other tests unnecessary.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

A unique case of documented prostatic carcinoma with radiographically evident osteoblastic lesions and a false-negative bone image is presented.

Topics: Aged; Bone Neoplasms; False Negative Reactions; Humans; Male; Osteoblasts; Pelvic Bones; Prostatic Neoplasms; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Extracranial metastases of meningioma are very rare, with a reported incidence of less than one in 1000 cases of meningioma. Metastases have been reported in the lungs and pleura, in the liver, in the lymph nodes, and in bone. The appearance of osseous metastases in the bony pelvis from intracranial angioblastic meningioma is described.

Topics: Bone Neoplasms; Brain Neoplasms; Hemangiosarcoma; Humans; Male; Middle Aged; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate

A bone image demonstrating a "photopenic" vertebral lesion was found to be caused by tumor infiltration of adjacent muscle and probable secondary osseous ischemia. Magnetic resonance imaging was valuable in detecting the muscle abnormality.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Muscles; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

During preoperative chemotherapy regional 99mTc-MDP clearance by tumor and healthy bone as well as tumor blood flow were determined in 13 patients with osteosarcoma. The results were compared to histologic regression grades. After good response (tumor vitality less than 10%) tumor blood flow normalized and regional 99mTc-MDP clearance decreased by 66% (range 56-82%). After poor response to chemotherapy (tumor vitality greater than 10%) tumor blood flow remained increased, whereas regional 99mTc-MDP clearance was unchanged or increased except in one patient. After 4-7 weeks of chemotherapy tumor viability was accurately assessed in 8 of 9 patients (89%) by means of regional 99mTc-MDP clearance. Tumor viability could be evaluated also by simple tumor/non-tumor ratios. A decrease of 99mTc-MDP clearance by more than 20% indicated an effective chemotherapy with a specificity of 80%. After 10-13 weeks of chemotherapy the specificity was improved including the results of tumor blood flow determination.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone and Bones; Bone Neoplasms; Child; Cisplatin; Cyclophosphamide; Dactinomycin; Diphosphonates; Drug Evaluation; Female; Humans; Male; Osteosarcoma; Preoperative Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

The diagnosis of chondrosarcoma may be difficult if there is an atypical radiographic appearance or an inconclusive biopsy. Radionuclide bone scans of 13 patients with chondrosarcoma were reviewed to assess if a pattern of scan features could be recognised in association with this tumour. A combination, including increased blood pool activity, moderate intensity of uptake, patchy uptake with cortical predominance of activity, minimal distortion of bony outline, and a well-defined scintigraphic margin, occurred regularly in the series. Recognition of this characteristic pattern of scintigraphic features in cases of suspected chondrosarcoma may assist in the diagnostic assessment.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Chondrosarcoma; Diphosphates; Diphosphonates; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Adverse allergic reactions to radiopharmaceuticals are rare but have been documented in the literature. This report presents data consistent with a definite adverse reaction to the radiopharmaceutical [99mTc]MDP.

Topics: Bone Neoplasms; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Diphosphonates; Drug Hypersensitivity; Female; Humans; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Topics: Adenocarcinoma, Mucinous; Aged; Bone Neoplasms; Diphosphonates; Female; Humans; Lymphatic Metastasis; Radionuclide Imaging; Stomach Neoplasms; Technetium; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Calcaneus; Diphosphonates; Humans; Infarction; Lipoma; Male; Middle Aged; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A comparison is made between the sensitivity of detection of focal abnormalities in radionuclide bone images by visual examination and by using simple quantification. The quantitative method calculates the ratio of radiopharmaceutical uptake in a region of interest drawn around a lesion to that in an area of normal bone. Quantification is found to be far more sensitive than visual examination in detecting focal metastases. The use of "baseline" images improved the precision of quantitation of rib lesions, but appeared not to alter the sensitivity of visual detection. This method of quantification is therefore limited more by the inability of observers to notice suspicious areas to which it should be applied than by inaccuracies inherent in the method itself. Further work should concentrate more on image enhancement than on improving quantitative techniques.

Topics: Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Radionuclide Imaging; Ribs; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Bone scan is an essential method of investigation for the detection of metastases; it is also used to follow the evolution of the disease and the response to treatment in prostatic cancer. The authors tried a bone scan quantification method to better evaluate the efficiency of hormonal treatment. 28 patients were followed up by this method. Taken as a whole, quantitative scans show results very similar to those of standard scans. However, there are some differences between the two methods of interpretation. The quantitative method seems to be more effective.

Topics: Bone Neoplasms; Combined Modality Therapy; Diphosphonates; Follow-Up Studies; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

This is a retrospective analysis of bone scans in 72 patients with Ewing's sarcoma. Sites of primary disease were found to be evenly distributed among the axial skeleton and the proximal and distal extremities. Primary disease sites in the axial skeleton were more frequently associated with metastases. Fifty-three of these patients had their first scans done at presentation; among them, 25 were found to have metastases. Unsuspected metastases were picked up in 28 of all the patients. Metastases at presentation were seen to be associated with a poorer prognosis.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Diphosphonates; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Radionuclide Imaging; Sarcoma, Ewing; Technetium; Technetium Tc 99m Medronate; Time Factors

Nuclear medicine provides several methods for increasing the accuracy of surgical removal of bone lesions with focally increased uptake. In this paper, three intraoperative procedures are discussed: remote control by imaging, intraoperative control by imaging, and intraoperative control by scintillation probe. All techniques require preoperative injection of bone imaging tracer. Remote operative control calls for a gamma camera to mark the skin over the lesion prior to surgery, providing optimal preoperative localization and imaging of the excised lesion to ensure complete removal. Intraoperative control procedures require that a portable camera or a scintillation probe be used in the operating room; these permit direct monitoring of localization and resection. Our experience with 18 procedures performed on 15 patients suggests that these techniques are worthy of continued use.

Topics: Adolescent; Bone Neoplasms; Child; Diphosphonates; Humans; Intraoperative Care; Male; Osteoma, Osteoid; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Diphosphonates; Female; Humans; Ilium; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Thoracic Neoplasms

A 37-year-old woman presented with a neck mass that proved to be medullary thyroid carcinoma by histologic and immunoperoxidase examinations. Serum calcitonin values were greatly elevated (over 100,000 pg/ml). There were widespread metastases in bone and liver. As the peripheral lesions showed only slight response to chemotherapy and local radiation therapy, potential use of radioiodine was studied. The bone lesions showed uptake of both Tc-99m MDP and radioiodide (I-131). Metastatic lesions were similar to the primary tumor in terms of histology, presence of calcitonin, and absence of thyroglobulin. Hence, the patient had a medullary thyroid carcinoma that took up radioiodide in its metastases. Two large oral doses of radioiodide (over 100 mCi each) did not significantly alter the serum calcitonin values, although there was a slight response in the activity of bone lesions. The whole body turnover of radioiodide was rapid (T 1/2 = 0.7 days). Upon oral administration of lithium carbonate, whole-body radioiodide turnover slowed slightly (T 1/2 = 1 day). If this effect were reflected in greater tumor retention of radioiodide (slower release), then agents that block radioiodide egress might have a role to play in therapy.

Topics: Adult; Bone Neoplasms; Calcitonin; Carcinoma; Combined Modality Therapy; Diphosphonates; Female; Humans; Iodine Radioisotopes; Lithium; Lithium Carbonate; Liver Neoplasms; Radionuclide Imaging; Sodium Iodide; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

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

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

Topics: Aged; Bone Marrow; Bone Neoplasms; Diphosphonates; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Bone Neoplasms; Digestive System Neoplasms; Diphosphonates; Humans; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Whole-Body Irradiation

Bone scans from 43 children referred with hip pain of uncertain cause were reviewed. The bone scan was abnormal in 36 patients: normal in 7. In 12 the findings were diagnostic: osteomyelitis, osteoid osteoma, osteomyelitis with septic arthritis, Perthes' Disease and juvenile chronic arthritis. Twenty-four patients had abnormal scans including diffuse peri-articular increase and of these 18 had transient synovitis. Immobilisation and trauma accounted for the remainder. Isotope bone scans have been found to be a valuable investigation in children presenting with hip pain or limp, where the x-rays may appear normal or nondiagnostic.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Hip Joint; Humans; Infant; Male; Osteoma, Osteoid; Osteomyelitis; Radionuclide Imaging; Synovitis; Technetium; Technetium Tc 99m Medronate

From a series of technetium-99m labelled agents based on a vicinal diphosphonic acid structure, the ligand 1,2-diphosphonoethyleneglycol (DPEG) was selected for clinical study on the basis of a biodistribution in rats which compared well with that of methylene disphonphonate (MDP). The 99Tcm-DPEG agent was assessed in ten patients in whom bone metastases had been demonstrated by 99Tcm-MDP imaging two to seven days previously. Visual comparison of the skeletal images obtained with the two agents revealed the same number of bone metastases at the same locations. Statistical analysis of the data revealed no significant differences between the two radiopharmaceuticals on the basis of lesion to soft tissue ratio and lesion to normal bone ratio, although a slightly higher lesion to soft tissue ratio was found for MDP than for DPEG (p less than 0.03). At least for the formulation tested, it is concluded that this new radiopharmaceutical based on the P-C-C-P structure does not possess diagnostic advantages over 99Tcm-MDP for the detection of bone metastases.

Topics: Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Fourteen children with histopathologically confirmed neuroblastoma underwent 38 studies using 99mTc-methylene-diphosphonate (MDP) and galliumcitrate Ga67 whole-body scintigraphy during various stages of the disease. Ten patients (71%) showed 99mTc-MDP accumulation in the primary tumoral site, whereas 11 patients (78.6%) showed 67Ga concentration. In 12 patients (86%), at least one of these two radiopharmaceuticals concentrated in the primary tumor. Nine patients had osseous or extraosseous metastases. All of these metastases (100%) were positive on 99mTc-MDP scintigraphy. No 67Ga-citrate uptake was demonstrable in osseous metastases; only one extraosseous lung metastasis concentrated this radiopharmaceutical. 67Ga-citrate was superior to 99mTc-MDP with regard to accurately demonstrating the extent of primary tumors. Only 99mTc-MDP indicated the relationship of the tumor to the kidneys and neighbouring osseous structures, providing early screening of kidney compression and possible damage caused by the tumor. From these results, we found these two methods to be complementary for the diagnosis and follow-up of neuroblastoma; their combined use resulted in high diagnostic accuracy and a considerable gain of information. We therefore recommend sequential 99mTc-MDP and 67Ga-citrate scans for the diagnosis and evaluation of the primary tumor; periodic 99mTc-MDP whole-body scans should be used in the follow-up of treatment, and for discovering disease exacerbations and metastases.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Gallium Radioisotopes; Humans; Infant; Male; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

The diagnostic contribution of single photon emission tomography for detection of bone lesions of the skull was explored in 125 cases and compared with planar imaging. Twenty-one localizations (16% of the total group) were only visualized by scintitomography, these were predominantly lesions of the base of the skull and facial bones. Scintitomography gave a false negative result in only one lesion out of 49 visible on skull radiographs. Together with the revelation of unsuspected bone abnormalities, SPECT generally provides a better visualization of the skull lesions and their extent than does planar imaging. In cases where disease of the facial bones and the base of the skull is suspected, scintitomography is an indispensable adjunct to planar scintigraphy.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Male; Maxillary Sinus Neoplasms; Middle Aged; Organ Specificity; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Accumulation of Tc-99m labeled phosphonate bone scanning agent in a pleural effusion usually shows a mild and diffuse increase in radioactivity of the involved thorax. A malignant neoplasm was thought to account for this accumulation. The photon deficiency of the hemithorax on Tc-99m HMDP bone scintigraphy was shown in a case of massive pleural effusion, which was proved by autopsy to be due to metastatic breast carcinoma in the pleura. Two factors caused these scintigraphic findings: 1) a large amount of fluid in the pleural cavity caused photon attenuation; 2) the higher body background in the noninvolved hemithorax and other areas of the body was due to renal dysfunction resulting from chronic pyelonephritis. Whether the accumulation of the radiopharmaceutical agent in the pleural effusion was malignant or benign could not readily be distinguished.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Neoplasms

Topics: Aged; Bone Neoplasms; Hernia; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Scrotum; Technetium Tc 99m Medronate; Urinary Bladder Diseases

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

Topics: Bone Neoplasms; Humans; Liver; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

The role of modern techniques of 99mTc methylene diphosphonate bone imaging in the management of lymphoma patients was assessed by comparing results of 107 bone scans in 16 patients with Hodgkin's disease, and 45 patients with non-Hodgkin's lymphoma to simultaneous radiologic, clinical, and histopathologic features as well as to subsequent disease course. The sensitivity and specificity were both greater than or equal to 0.96 in both Hodgkin's disease and non-Hodgkin's lymphoma and the overall accuracy by site was 98%. The scan proved to be useful in the definition and follow-up of skeletal lymphomatous disease in both symptomatic and asymptomatic patients, and defined abnormalities which were not predicted by either serum alkaline phosphatase activity or the presence of bone marrow involvement. In no patient, however, did the bone scan result by itself alter either initial staging or estimates of extent of disease at the time of relapse. Bone scanning, therefore, cannot be recommended as a screening procedure in patients with lymphoma; rather, this test is best reserved for the definition and follow-up of skeletal metastases in patients with active, concomitant, extraosseous disease.

Topics: Bone Neoplasms; Diagnostic Errors; Female; Follow-Up Studies; Hodgkin Disease; Humans; Lymphoma; Male; Middle Aged; Neoplasm Staging; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Skeletal scintigraphy is useful for detecting primary renal carcinomas and associated osseous metastatic deposits. Usually, renal masses present as photon-deficient foci, and osseous metastases, as foci of increased response. A case is presented with the unusual combination of focal increased Tc-99m MDP localization to the primary renal cell carcinoma and photopenic osseous metastatic foci. Proposed mechanisms are discussed.

Topics: Adult; Bone Neoplasms; Carcinoma, Renal Cell; Humans; Kidney Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of osteomalacia with multiple asymmetrically distributed pseudofractures (Looser's zones) simulating metastases is presented. Radiographic correlation is essential to increase specificity and avoid misinterpretation.

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Femoral Fractures; Fractures, Spontaneous; Humans; Male; Osteomalacia; Radionuclide Imaging; Rib Fractures; Scapula; Technetium Tc 99m Medronate

We used a combination of bone and bone-marrow scintigraphy to study 25 patients with prostatic cancer. Of the 18 cases whose 99mTc-methylene diphosphonate (MDP) bone scans showed hot spots in the lower lumbar region of the spine and/or the pelvic bone, 8 had normal bone-marrow scintigrams. These 8 patients were subsequently shown to have senile, degenerative changes of the spine. On the other hand, in 9 of the 10 patients whose bone-marrow scintigrams showed accumulation defects, follow-up study and characteristic X-ray findings confirmed the presence of metastases. In all 6 cases with extensive bone metastases shown by 99mTc-MDP bone scintigraphy, 99mTc-sulphur-colloid bone-marrow scintigraphy showed multiple accumulation defects. In conclusion, bone-marrow scintigraphy was found to be useful in distinguishing metastatic lesions from benign degenerative changes in the cases with suspected bone involvement, as well as in evaluating equivocal lesions in the pelvis.

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

After radiation therapy regional 99mTc-MDP clearance by 17 metastatic lesions was determined repeatedly in 13 patients. 99mTc-MDP clearance rates decreased within 14 weeks after irradiation of osteoblastic metastases, but were normalized in only one lesion. In osteolytic lesions 99mTc-MDP clearance increased 4 weeks after completion of radiation therapy indicating reossifications evident from X-ray examinations subsequently. 99mTc-MDP clearance decreased subsequently and returned to normal after 28-50 weeks in 6 out of 11 metastases demonstrating reossification on X-ray. Monitoring of radiation therapy of bone metastases should be adapted to these complex variations of tracer kinetics. The initial increase of tracer accumulation in osteolytic metastases due to bone repair should not be misinterpreted as a local progression of metastatic bone disease.

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

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Hepatocellular; Diphosphonates; Female; Gallium Radioisotopes; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In a retrospective study of 254 women with carcinoma of the breast (mean age 55.4 years) the occurrence of bone pain was compared with results of skeletal scanning, skeletal X-ray examinations and routine biochemical findings. Typical signs of skeletal metastases were found in bone scans of 119 patients, 88 (74%) of whom had bone pain. Alkaline phosphatase was elevated in 54 (45%), LDH in 32 (27%), and gamma-GT in 69 patients (58%). There was a statistical correlation between the number of affected skeletal parts and the absolute level of alkaline phosphatase (P less than 0.001) and of LDH (P less than 0.05). Skeletal scans gave no evidence of bone metastases in 36 patients who had bone pains. In this group of patients alkaline phosphatase was elevated in 4, LDH in 1 and gamma-GT in 12 patients. Routine scanning of 254 patients revealed skeletal metastases in 12% without any clinical symptoms. Bone pain and (or) increased activity of alkaline phosphatase occurred in 91% of patients with skeletal metastases. In our view, bone scan in the postoperative control of breast cancer is justified only after onset of clinical symptoms and (or) if there is an abnormally raised alkaline phosphatase activity.

Topics: Adult; Aged; Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; Clinical Enzyme Tests; Diphosphonates; Female; gamma-Glutamyltransferase; Humans; L-Lactate Dehydrogenase; Middle Aged; Pain; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

Computerized bone scanning (CBS), a technique used to measure quantitative changes in bone scans, is described. Ten patients with histologically proven metastatic carcinoma of the prostate had sequential CBS performed. Good correlation was found between marked improvement in CBS (more than 50% average decrease in counts) and objective responses. Two patients had partial remission with more than 50% average decrease in uptake by prostatic cancer project criteria; both of them had good pain control. Three patients had worsening of their disease by CBS, which correlated with other parameters of disease progression (new lesions in bone survey, loss of weight and poor survival). In those patients with less than 50% average change the correlation is not so clear cut. An increase in percentage of uptake occurs in the first month after beginning of therapy, and no significant change is observed until 3 months. CBS is a technique that allows for objective measurement of quantitative changes in bone uptake, which is potentially useful for the evaluation of response to treatment in patients with metastatic bone disease from carcinoma of the prostate.

Topics: Acid Phosphatase; Aged; Body Weight; Bone and Bones; Bone Neoplasms; Diphosphonates; Humans; Male; Middle Aged; Prospective Studies; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

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

Topics: Adult; Aged; Biopsy, Needle; Bone Neoplasms; Diphosphonates; Female; Humans; Male; Middle Aged; Technetium; Technetium Tc 99m Medronate

The double-density sign, seen on radionuclide bone scans, is described for diagnosing osteoid osteomas and for localizing the nidus. Its use in differentiating the nidus of an osteoid osteoma from osteomyelitis is also described. The utility of computed tomography in localization of the nidus is also illustrated. The double-density sign was helpful in diagnosing seven cases of surgically confirmed osteoid osteoma.

Topics: Adolescent; Adult; Bone Neoplasms; Diphosphonates; Female; Femoral Neoplasms; Humans; Humerus; Male; Osteoma, Osteoid; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

The role of ultrasonography, computed tomography (CT), and radioisotopic scanning in the staging of bilharzial bladder cancer has not been reported previously. Forty patients with invasive bladder cancer seen at the King Faisal Specialist Hospital and Research Centre between January 1978 and June 1981 underwent complete preoperative workup for staging of their tumors prior to radical cystectomy. The preoperative radiologic investigations included excretory urography (IVP), ultrasonography (US), CT of the pelvis, and liver and bone scans. The results of these investigations were compared with the operative and pathologic staging. Ninety-three percent of the patients with bilharzial cancer had evidence of ureteric obstruction on IVP compared with 22% of the nonbilharzial cancer patients. The presence of ureteric obstruction in these patients did not correlate with the stage of the disease with 83% of the patients with superficial tumors (T1 and T2) having hydroureteronephrosis. Ultrasonography and CT had an 83% accuracy in the staging of superficial tumors. Stage T3 tumors were understaged in 14% of the cases. Ultrasonography did not differentiate Stages T3 and T4 tumors while CT scan differentiated these two stages in 57% of the cases. Bone scan failed to reveal evidence of metastatic disease in any of the bilharzial cancer patients. Liver scan was suspicious for liver metastases in two patients with bilharzial cancers in whom open liver biopsy revealed only hepatic bilharziasis. Of all the radiographic studies, US or preferably CT scan seem to be of some value in the staging of bilharzial tumors localized to the bladder. Bone and liver scans are probably of no cost effective benefit.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Diphosphonates; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Prognosis; Radionuclide Imaging; Schistosomiasis; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography; Urinary Bladder Neoplasms; Urography

Sequential gallium scans were performed in 37 patients with newly diagnosed osteogenic sarcoma. High gallium uptake was found more often in males in the 10 to 19 age group and in femoral lesions. High uptake was also seen in patients who had predominantly osteoblastic or mixed changes on radiographs and in those who had a soft tissue mass. Following chemotherapy, significant decrease of tumor to nontumor ratio occurred in the patients who responded to treatment as shown by a Grade III or IV response on histologic examinations at the time of en bloc resection. It is concluded that semiquantitative gallium scintigraphy is useful in monitoring therapeutic response in patients with osteogenic sarcoma.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Femoral Neoplasms; Gallium Radioisotopes; Humans; Male; Osteosarcoma; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Topics: Bone and Bones; Bone Neoplasms; Diphosphonates; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

Technetium-99m methylene diphosphonate bone scans were performed in 21 patients with giant cell tumors of bone. All tumors showed increased radiophosphate uptake, often more intense at the tumor periphery than in its center. However, radionuclide bone scanning often overestimated intraosseous tumor extent as a result of increased tracer uptake beyond true osseous tumor limits. In addition, it failed to detect soft-tissue tumor extension in nine patients. Therefore, scintigraphy is less useful than either computed or conventional tomography in planning surgical margins of giant cell tumors. Gallium-67 citrate scans obtained in seven patients showed slight uptake in four tumors and no uptake in three. Radiogallium imaging is thus of limited use in evaluation of suspected giant cell tumors of bone.

Topics: Adolescent; Adult; Angiography; Bone Neoplasms; Diphosphonates; Female; Gallium Radioisotopes; Giant Cell Tumors; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Diphosphonates; Humans; Knee Joint; Male; Osteosarcoma; Radionuclide Imaging; Synovial Fluid; Technetium; Technetium Tc 99m Medronate; Tibia

This is a comprehensive review of 85 patients who had bone sarcoma associated with Paget disease and who were seen at Memorial Sloan-Kettering Cancer Center between 1927 and 1982. There was an almost equal distribution of tumors in the axial and the appendicular skeletons. The pelvis, humerus, femur, and skull were the tumor sites in 80% of cases. The tumors were bulky large soft tissue masses. Lytic lesions were more common than sclerotic lesions. Mixed lytic and sclerotic lesions were much less common than either single type. Periosteal reaction was uncommon and found in less than 7%. Methylene diphosphonate scans of the bone often showed a cold area that was associated with marked increase in uptake on the gallium scan. Angiography, which was performed in 13 patients, was useful, but CT was much more helpful in showing the soft tissue mass as well as the extent of bony disease. Only three patients in this study survived for five years. Present chemotherapy protocols were disappointing in the treatment of this highly lethal tumor.

Topics: Adult; Aged; Angiography; Bone and Bones; Bone Neoplasms; Diphosphonates; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Sarcoma; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Breast Neoplasms; Chondroma; Diphosphonates; Female; Humans; Humerus; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Serial bone scans, x-rays and records of bone pain were reviewed in order to determine the relative contributions of these parameters in the assessment of response of bone metastases to treatment. Twenty-seven patients with abnormal bone scans due to metastatic breast cancer were studied. Ten of the patients showed an early temporary flare on bone scan including five with apparent new lesions. Confirmation that such new lesions did not denote progressive disease was provided by subsequent improvement in symptoms and reduction in intensity and number of lesions on a follow-up bone scan, without any change in systemic therapy. Serial x-rays were found to be unreliable as a sole method for assessing response to therapy or disease progression, as in only seven of the 27 patients could a definitive radiological assessment of response be made. In only one patient did x-rays improve the accuracy of the scan by distinguishing between a healing flare and progressive disease. In contrast, this distinction was made in seven of the 10 patients on the basis of improvement in bone pain at the time of the flare. The other 3 patients had no bone pain prior to therapy or at the time of the flare. Tentative response criteria incorporating bone scan, x-ray and symptoms are suggested. The criteria incorporate recognition of the fact that new lesions appearing on a bone scan within six months of initiation of therapy may comprise part of a healing flare response.

Topics: Antineoplastic Agents; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Prognosis; Radiography; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Time Factors

Evaluation of 100 consecutive Tc-99m MDP bone scans revealed in 36 patients a well defined area of increased accumulation of radiotracer at the Angle of Louis--the palpable ridge along the anterior surface of the sternum at the fibrocartilaginous junction of the sternum and manubrium. Twenty-five of the 36 patients had comparison radiographs; all were normal. None had sternal pain or a prior history of chest trauma. Increased uptake at the Angle of Louis ("Louie's Hot Spot") is a relatively common finding (36%) and should be recognized as a normal bone scan finding. It should not be confused with increased uptake due to an osseous abnormality, i.e., metastasis, degenerative disease, trauma, etc.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Male; Manubrium; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sternum; Technetium; Technetium Tc 99m Medronate

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

Technetium-99m phosphate compounds may occasionally accumulate in malignant pleural effusions. A case of metastatic pleural effusion first diagnosed by bone scan, prior to its clinical or roentgenographic detection, is reported.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Pleural Effusion; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The scintigraphic appearance of giant cell tumor of bone in six patients is presented. Patients were studied by means of Tc-99m MDP bone scanning. On early blood pool and delayed imaging, markedly increased activity was noted, characteristically displaying a "ring" pattern that is readily discernible from patterns seen in bone cysts and nonosteogenic fibroma. The extent of the lesion, as judged by scintigraphic techniques, was roughly equal to estimates of extent by other radiographic modalities. Only one example of a different lesion mimicking giant cell tumor was encountered in over 100 cases of a variety of primary bone neoplasms reviewed. We conclude that giant cell tumor has a characteristic scintigraphic appearance.

Topics: Adult; Bone Neoplasms; Diphosphonates; Female; Giant Cell Tumors; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Indium is generally presumed to localize in the bone marrow within the erythroid cell line. Fibrosis, inflammation, lymphoma, extended field radiation, chemotherapy, or combinations of both treatment modalities generally depress the uptake of indium by the marrow a complex fashion. We report a case of metastatic breast carcinoma and pancytopenia in which the In-111 scan appeared qualitatively similar to a Tc-99m MDP bone scan. Findings were confirmed by bone marrow biopsy.

Topics: Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Indium; Middle Aged; Pancytopenia; Radioisotopes; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Topics: Bone Neoplasms; Diphosphonates; Humans; Neoplasm Recurrence, Local; Prospective Studies; Radiotherapy, High-Energy; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray

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

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

We reviewed the cases of twenty-four patients with solitary or multiple exostoses to correlate their radiographic, scintigraphic, and histological evaluations. We studied twenty-five excised lesions, two of them exostotic chondrosarcomas, from twenty-two patients. There were two patterns of bone-scan activity and there was a direct correlation between enchondral bone formation and radionuclide uptake in all patients, both skeletally immature and mature. So-called quiescent lesions--those with inactive scans--were those that lacked histological evidence of enchondral bone formation. Those with increased uptake--active exostoses--all demonstrated active formation of enchondral bone. Evidence of active exostotic growth could be demonstrated on bone scans well beyond the time of skeletal maturity. The bone scan did not qualitatively differentiate the benign active exostoses from the two lesions with malignant degeneration. Increased uptake related to enchondral bone formation was a feature of both. An inactive scan, however, seemed to exclude the possibility of malignant degeneration in the exostosis.

Topics: Adult; Bone Neoplasms; Child; Chondrosarcoma; Diphosphonates; Exostoses; Exostoses, Multiple Hereditary; Female; Humans; Male; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray; Xeroradiography

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

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

Although the "doughnut" sign in brain scintigraphy is a well known phenomenon, similar findings have recently been reported in bone scintigraphy in osseous and nonosseous lesions. A skeletal doughnut sign in bone scintigraphy caused by giant cell tumor of the proximal fibula is presented with a brief review of literature.

Topics: Adult; Bone Neoplasms; Diphosphonates; Female; Fibula; Giant Cell Tumors; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

In two patients with metastatic disease more lesions were detected on scintigraphs obtained with the 'low uptake' bone-scanning agent dimethyl-amino-diphosphonate. The results in these two patients provide practical support for the suggestion that bone-scanning agents with low uptake in normal bone, but high tumour-to-normal bone ratios, will allow better delineation of focal bone abnormalities.

Topics: Aged; Bone Neoplasms; Carcinoma, Bronchogenic; Diphosphonates; Humans; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

Topics: Bone Neoplasms; Diphosphonates; False Positive Reactions; Female; Humans; Middle Aged; Radionuclide Imaging; Resuscitation; Rib Fractures; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Diphosphonates; Humans; Kidney; Kidney Diseases; Kidney Neoplasms; Male; Middle Aged; Pilot Projects; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Urinary Bladder Neoplasms; Urodynamics

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

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

Two hundred cancer patients with bone metastases were studied by gammagraphy employing 555 MBq of 99mTc-MDP. The results were compared with those obtained by radiology and alkaline phosphatase determination, showing that gammagraphy is positive in 93 per 100 of the cases and is more useful than the other procedures to make a pre-radiologic diagnosis of bone metastases (27 per 100).

Topics: Adult; Aged; Bone Neoplasms; Digestive System Neoplasms; Female; Genital Neoplasms, Female; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Urologic Neoplasms

An intratibially transplantable osteogenic sarcoma in rats, that regularly disseminates osteogenic metastases in the lung, is described. The tumor take rates exceeded 90% 30 days after transplantation. Pulmonary metastases were diagnosed in about 99% of the animals, while metastases in the kidneys (14%), lymph nodes (13%) and liver (3%) occurred less frequently. The mean survival time of untreated animals varied between 36 and 48 days, depending on the age at transplantation. Histologic and scintigraphic findings are reported.

Topics: Animals; Bone Neoplasms; Cell Line; Diphosphonates; Female; Femoral Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Neoplasm Transplantation; Osteosarcoma; Radiography; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Tibia; Time Factors

Fifty patients with bone primary tumors (multiple myeloma, osteogenic sarcoma, Ewing's sarcoma, giant cell tumor, and others) were studied gammagraphically after injecting 555 MBq of 99mTc-MDP. Eighty per cent of the cases were found in long bones, specially femur and tibia. These two bones were the preferent localization of osteosarcomas. Ewing's neoplasms were mostly diaphysial and osteoclastomas epiphysial.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Female; Femur; Fibrosarcoma; Giant Cell Tumors; Humans; Male; Middle Aged; Multiple Myeloma; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tibia

Bone scans of 35 patients were evaluated as to the quality and the number of bone lesions that could be detected at studies 2 hours and 3 hours after injection of Tc-99m HDP. It was found that 2 hour bone scans are of high "cosmetic" and diagnostic quality and that all lesions present at 3 hour scans are well visualized at 2 hours. These features are among the major advantages of the use of Tc-99m HDP over other diphosphonates.

Topics: Adult; Aged; Bone Neoplasms; Diphosphonates; Humans; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Of 1116 patients receiving primary treatment for breast carcinoma at the Royal Marsden Hospital since 1976, 651 had an abnormal bone scintigram either at primary diagnosis (378) or on subsequent follow-up (273) and 167 developed radiographically detectable bone metastases (21 at the time of primary diagnosis). Comparison of bone scintigrams and X-rays showed that scintigraphy was an inaccurate localiser of existing radiographic detectable metastases. If X-rays alone are used to detect bone metastases a limited examination with five plates will detect metastases with 92% accuracy. After primary surgery, routine X-ray screening for bone metastases is not necessary since it is possible to identify patients at risk on the basis of clinical examination, chest X-ray, and serum alkaline phosphatase and gamma-glutamyl transpeptidase levels.

Topics: Alkaline Phosphatase; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Follow-Up Studies; gamma-Glutamyltransferase; Humans; Radiography, Thoracic; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

Five cases of clinically suspected osteoid osteomas were studied by preoperative injection of technetium-99m methylene disphosphonate, intraoperative localization with a radiation-sensitive scintillation probe, and postoperative examination of the entire tissue specimen (including the presumed nidus and surrounding bone). Microradiography and light microscopy were also used. In addition, a new autoradiography technique was introduced in which the excised surgical specimen was placed on undeveloped x-ray film for pathologic localization, diagnosis of the lesions, and a study of the relative intensity of radioactive uptake in the nidus vs. surrounding bone. Autoradiography revealed that the nidus showed the greatest concentration of radioactivity, followed by the surrounding bone. The authors conclude that 99mTc can be used clinically in localizing osteoid osteomas and that preoperative and intraoperative scanning can assist in conservative surgical excision, e.g., minimal extirpation of bone in delicate areas such as the spine. For small lesions, autoradiography assists the pathologist in identifying an osteoid osteoma.

Topics: Adolescent; Adult; Autoradiography; Bone Neoplasms; Diphosphonates; Female; Humans; Intraoperative Care; Male; Microradiography; Osteoma, Osteoid; Postoperative Period; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

Surgical excision of osteoid osteomas is curative, but intraoperative localization and pathologic identification in submitted fragments may be difficult. We used preoperative technetium-99m methylene diphosphonate injection and intraoperative probing to localize the nidus of three clinically suspected cases of osteoid osteoma. Then in the pathology department, fine grain specimen x-rays and specimen autoimaging on undeveloped film were utilized. In all cases, technetium radioactivity localized within the lesion. Although the nidus was identified by fine grain specimen x-rays in only one case, the subsequent histologically proved osteoid osteoma corresponded in all cases to the fragment with the most intense autoimaging. We conclude that isotope scanning is effective in localizing osteoid osteomas at surgery, and autoimaging is effective in identifying the nidus itself by the pathologist.

Topics: Adult; Autoradiography; Bone Neoplasms; Diphosphonates; Female; Humans; Male; Osteoma, Osteoid; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Three-phase radionuclide scintigraphy of the hand was performed on 116 patients. Normal and abnormal patterns for radionuclide angiography, immediate post-injection blood-pool images, and delayed scans (3-4 hr.) were established. Of 80 patients with normal circulation, 61 (76%) had equal radial and ulnar artery flow bilaterally, while in 19 (24%) either the radial or ulnar artery was dominant. Abnormal studies were grouped into three categories: suspected vascular lesions (Group I), pain of uncertain etiology (Group II), and patients evaluated before and after reconstructive surgery (Group III). The diagnosis was correct in 89% of the patients in Group I (34/38), 89% of those in Group II (57/64), and all of those in Group III (14/14). Three-phase scintigraphy of the hand yields significant information about perfusion and bone metabolism.

Topics: Adolescent; Adult; Aged; Arteriovenous Malformations; Arthritis; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Hand; Hand Injuries; Hemangioma; Humans; Male; Middle Aged; Radionuclide Imaging; Raynaud Disease; Reference Values; Regional Blood Flow; Technetium; Technetium Tc 99m Medronate; Thrombosis

In the diagnosis of multiple myeloma (MM), the radiological skeletal survey (RSS) was proven to be most useful for the detection of bone lesions. Since 1961, a new technique radioisotopic bone scan (RIBS), for the detection of such lesions, using 85Sr and 99mTc, has been shown to be highly sensitive for the detection of skeletal metastases of epithelial tumors. We have studied 30 patients with plasma cell dyscrasia (PCD) by both methods and concluded that RSS is clearly superior to RIBS in PCD. As RIBS detected less than 50% of the lesions demonstrated by RSS there seems to be no indication for a routine RIBS in the initial work-up of patients suspected to have PCD. However, due to the fact that RIBS is useful for the detection of new bone formation it has a certain value in the localization of pathological fractures in MM, mainly in vertebral compression.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Diphosphonates; Fractures, Spontaneous; Humans; Middle Aged; Multiple Myeloma; Osteoporosis; Pelvic Bones; Plasmacytoma; Radiography; Radionuclide Imaging; Ribs; Skull; Spinal Injuries; Spine; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Diphosphonates; Humans; Humerus; Male; Osteosarcoma; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A comparison of radiographic and 99mTechnetium methyldiphosphonate scintigraphic evaluations for extent of skeletal disease was made retrospectively in 17 pediatric patients with Group III and IV rhabdomyosarcoma. Thirteen children had evidence of skeletal metastases. Of these, four exhibited multiple sites of blastic as well as lytic skeletal involvement on x-rays that were not detected by bone scans: two at the time of initial diagnosis, and two at relapse in children with prior radiotherapy to involved bones. In three additional patients a greater extent of bony disease was evident on x-rays than on bone scan. Neither the pathology of the tumor, lytic versus blastic quality of the bone lesion, nor lesion size per se was found to correlate with the failure to detect them on the bone scan. Although bone scans have greater sensitivity than x-rays for the detection of metastatic bone involvement in several adult and pediatric neoplasms, in the case of rhabdomyosarcoma, the radiographic exam appears to be a more sensitive indicator in some patients and should be considered an essential study in the evaluation of skeletal involvement by this tumor.

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

Forty-two bone images carried out on 33 patients with renal carcinoma have been evaluated. The bone image seems more sensitive than conventional radiology in detecting bone secondaries, but covert metastases are unlikely in the patient presenting with purely urological symptoms.

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

We have investigated the clinical efficacy for the detection of bone metastases of two recently marketed bone-seeking radiopharmaceuticals, HDP and DPD, compared with traditionally used MDP. Twenty patients received 15 mCi 99mTc-MDP; after assessment ten of these patients later received 15 mCi 99mTc-DPD and ten other patients of this group were injected with 15 mCi 99mTc-HDP. Scintigraphy took place 3 h after tracer injection. Quantitative analysis included the calculation of normal bone to soft tissue ratios, lesion to soft tissue ratios and lesion to normal bone ratios for all three radiopharmaceuticals. Visual inspection of the scintiphotos revealed the same number of bone lesions at the same localisations. Statistical evaluation of our quantitative data showed that the lesion to normal bone ratio was significantly higher for MDP than for DPD. No further significant differences in the uptake in normal bone or in the metastatic lesions were found between all three radiopharmaceuticals. It is concluded that the new bone-seeking agents DPD and HDP do not possess clinical advantages over MDP for the detection of skeletal metastases.

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

Topics: Bone Neoplasms; Diphosphonates; Female; Humans; Hypercalcemia; Lung; Middle Aged; Pulmonary Embolism; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

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

The 24 h-whole-body retention (WBR), determined by a whole-body counter, may be used to quantify exactly bone seeking properties of a radiopharmaceutical. The 24h-WBR of 99mTc-methylene-diphosphonate was determined in 200 patients and was found to be independent of kidney function if this function was normal or only slightly diminished. The 24h-WBR was slightly dependent on age since it decreased up to 20 years of age, reaching a minimum at 20-25 years, and then increased with increasing age. Normal values of 24h-WBR for individuals of more than 20 years of age were 31.8 +/- 5% of injected dose. Not more than two focal accumulations, i.e. skeletal metastases, failed to elevate the 24h-WBR significantly (p less than 0.1). However, a highly significant (p less than 0.001) difference to normals was found in patients with multiple metastases (24h-WBR: 38.2 +/- 7%), with diffuse osseous involvement as in primary hyperparathyroidism (24h-WBR: 49 +/- 11.7%, p less than 0.001) or with osteoporosis (24h-WBR: 45%). The 24h-WBR was found to be very sensitive in grading diffuse osseous involvement. This was shown in single-tumor patients by follow-up as the 24h-WBR in addition to bone scans was useful to describe progression or remission. Moreover, the 24h-WBR correlated closely with results of bone marrow biopsies in a small group of patients with malignancies of the lymphoreticular system.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Hyperparathyroidism; Leukemia; Lymphoma; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

Topics: Aged; Bone Neoplasms; Diphosphonates; Female; Femoral Neoplasms; Fibrosarcoma; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibia

The kidneys are nearly always visible on a routine radionuclide bone scan. To assess the reliability of the bone scan in detecting ureteral obstruction, 220 bone scans and excretory urograms were compared in 53 patients followed serially for prostatic cancer. There were 15 kidneys obstructed on excretory urograms. Only nine were diagnosed as obstructed on the bone scans. Seven of the nine cases of unilaterally obstructed kidneys were detected, whereas only two of the six kidneys in three patients with bilateral obstruction were correctly diagnosed. The results indicate that unilateral obstruction is more likely to be detected, whereas bilateral obstruction is more likely to be missed, on bone scans. Therefore, the routine radionuclide bone scan is an unreliable test for ureteral obstruction.

Topics: Bone Neoplasms; Diphosphonates; Evaluation Studies as Topic; False Negative Reactions; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Ureteral Obstruction; Urography

Of 42 radionuclide bone scans in 35 children with neuroblastoma, 21 were abnormal for the presence of skeletal metastases. Of the 21 abnormal scans, 16 were corroborated by positive bone-marrow biopsy or clinical data. The false-negative and false-positive rates for bone scanning were 4.8% and 9.5%, respectively. Calcification of the primary tumor was seen on pretreatment computed tomographic (CT) scans in 24 (89%) of 27 cases, while only 13 (48%) of 27 were detectable by plain radiographs. Uptake of technetium-99m methylene diphosphate (99mTc-MDP) by the primary tumor occurred in 20 of 27 cases, but correlation between tumor uptake and calcification was not statistically significant. All children with markedly elevated urinary vanillylmandelic acid exhibited primary tumor uptake. Survival was not affected independently by primary tumor uptake.

Topics: Bone Neoplasms; Calcinosis; Child; Diphosphonates; False Negative Reactions; False Positive Reactions; Humans; Neuroblastoma; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Vanilmandelic Acid

Topics: Adolescent; Adult; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Intraoperative Period; Male; Osteoma, Osteoid; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Diphosphonates; Female; Humans; Male; Radionuclide Imaging; Rhabdomyosarcoma; Sternum; Technetium; Technetium Tc 99m Medronate

5 consecutive patients with osteoid osteoma were examined with bone scintigraphy and 67Ga scintigraphy. In 2 cases a 'three-phase' bone scintigraphy was performed. Scintigraphic features included obvious 67Ga uptake and diffusely increased accumulation on blood pool images. Thus, osteoid osteoma may possess the same scintigraphic characteristics as osteomyelitis.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Diagnosis, Differential; Diphosphonates; Extremities; Gallium Radioisotopes; Humans; Osteoma, Osteoid; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

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

Our experiences with more than 2000 bone scintigrams in 803 tumour patients underline the high ranking of skeletal scintigraphy in oncology. Among our patients--who, as a matter of fact, represented a selected material--the rate of false negative scintigraphs was less than 1%. The incidence mentioned in literature is between 1 and 3% (6, 11, 38, 41). By balanced and differentiated assessment of bone scintigrams and analogous x-ray films (plain radiographs, spot-film radiographs, if necessary x-ray tomograms), taking into consideration storage anomalies in respect of localization, form and storage intensity, false-positive results can be reduced to a minimum; as a matter of fact, we believe that in oncology patients the quota of false-positive results can be reduced to less than 3%. In tumour patients, the question as to whether there are any bone metastases, can be correctly answered with a probability of about 96% by means of skeletal scintigraphic imaging and the analogous x-ray film as a complementary examination. The bone scintigram is excellently suited for effecting malignoma staging. It is, in fact, superior to all other methods. Skeletal scintigraphic imaging enables the identification of metastases earlier than any other method. It is the most sensitive primary search method which can be utilized for on-target application of x-ray diagnostic methods. Both solitary and multiple osseous metastases can be accurately localized by scintigraphy. The early identification of skeletal metastases in skeletal regions with endangered stability, is particularly important, since an impending spontaneous fracture can be prevented by osteosynthesis or local radiation therapy. Changes in the growth of metastases under radiation and/or chemotherapy can be reliably observed by scintigraphic follow-ups, and can be assessed to determine whether there is a continued growth or a remission. If scintigram and x-ray film are employed side by side--a procedure which is imperative during first examination and later with specific courses of the disease, the low grade specificity of scintigraphy is largely compensated by the x-ray method.

Topics: Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Fractures, Spontaneous; Hodgkin Disease; Humans; Lung Neoplasms; Male; Plasmacytoma; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Sarcoma; Skull Neoplasms; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Various abnormalities of the renal tract can be detected from the renal images seen on 99Tcm methylene diphosphonate (MDP) bone scintigrams. Diffusely increased renal parenchymal activity has been associated with cytotoxic and other drug therapy, radiation nephritis, iron overload and cirrhosis. A further association--with hypercalcaemia--is reported here. In a retrospective study, 1950 bone scintigrams were reviewed and a significant relationship between high renal activity and hypercalcaemia was found. This was subsequently confirmed by a small prospective study. None of the patients whose bone scintigrams showed this association had evidence of nephrocalcinosis on X rays. It is postulated that in these hypercalcaemic patients there may be high tissue calcium in the kidneys which results in the high uptake of MDP, and it is suggested that serum calcium be measured in patients with previously unsuspected hypercalcaemia whose bone scintigrams exhibit the finding of high parenchymal renal activity.

Topics: Bone and Bones; Bone Neoplasms; Calcium; Diphosphonates; Humans; Hypercalcemia; Kidney; Prospective Studies; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

A case is described of reversible, intense gastric uptake of 99mTc-MDP in the fundal region of a patient with myeloma, while very little transient pulmonary fixation was seen. The significance of this unusual finding in terms of relevant blood chemistry, results of gastric biopsies, which failed to show metastatic calcification, and the drugs administered is discussed.

Topics: Aged; Bone Neoplasms; Diphosphonates; Gastric Mucosa; Humans; Male; Multiple Myeloma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

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

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

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

A case of hepatocellular carcinoma demonstrating intense uptake of Tc-99m methylene diphosphonate (MDP) is described. This is one of three cases seen by the authors who suggest that hepatoma be considered along with other previously described entities when there is localized accumulation of a bone-scanning agent in the liver.

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Diphosphonates; Female; Humans; Liver; Liver Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Diphosphonates; Female; Humans; Radionuclide Imaging; Sternum; Technetium; Technetium Tc 99m Medronate

Radionuclide joint imaging with the technetium-99m-labeled phosphates is a sensitive technique for the detection of inflammatory articular disease, although it is nonspecific as to the cause of the increased uptake and offers poor resolution in comparison to conventional radiography. There does not appear to be any place for the routine use of joint imaging of the peripheral joints, as there is little evidence that it benefits patient management. Scintigraphy is of benefit in the detection of osteomyelitis, Legg-Perthes' disease, and osteonecrosis, where changes may antedate roentgenologic abnormalities. Technetium-99m-phosphates may have an increasing role in the evaluation of knee and hip prosthetic joint loosening and infection, especially regarding the femoral components. Scintigraphy may be useful in excluding synovitis and allaying concern in selected patients with chronic articular pain in whom a conventional diagnostic evaluation is unrewarding. Attempts have been made to use radionuclide joint imaging to quantitate the degree of synovitis present in individual joints, particularly the sacroiliac joints. To date, reliable methods that distinguish normal from abnormal joints have not been established, although this remains an area of potential usefulness and active research. Scintigraphy with 99mTc-phosphates is useful in the detection of spinal fracture and pseudoarthrosis in individuals with ankylosing spondylitis.

Topics: Adult; Arthritis; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Gallium Radioisotopes; Humans; Joint Diseases; Legg-Calve-Perthes Disease; Male; Middle Aged; Osteoarthritis; Osteomyelitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spondylitis, Ankylosing; Synovitis; Technetium; Technetium Compounds; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Adolescent; Biopsy; Bone Neoplasms; Diphosphonates; False Negative Reactions; Female; Humans; Radionuclide Imaging; Sacrum; Sarcoma, Ewing; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Eleven patients with untreated primary Ewing sarcoma were studied with intravenously administered 13N-labeled L-glutamate. Seven were repeatedly scanned during chemotherapy using this agent and 99mTc-methylene diphosphonate (99mTc-MDP). The untreated primary tumor was distinctly visualized with 13N-L-glutamate in all cases; the distribution of 13N label in the tumor sometimes differed from that of 99mTc. A kinetic study showed rapid uptake of 13N by tumor tissue. Repeat scans following therapy indicated that 13N-L-glutamate and 99mTc-MDP uptake showed changes consistent with histological findings following subsequent surgery. 13N uptake often decreased more markedly than 99mTc uptake during chemotherapy, but metastatic lesions were not visualized with 13N-L-glutamate. Tumor imaging with this labeled amino acid may be of value in assessing the response of primary Ewing sarcoma to chemotherapy.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Diphosphonates; Female; Glutamates; Glutamic Acid; Humans; Male; Middle Aged; Nitrogen Radioisotopes; Radionuclide Imaging; Sarcoma, Ewing; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

Benign bone tumors can be successfully treated by local resection with the use of intraoperative bone imaging. Intraoperative bone imaging provided accurate localization of an osteoid osteoma in a patella of a 16-year-old girl when standard radiographs failed to demonstrate the lesion. In a case of osteoblastoma of the sacrum in a 12-year old girl, intraoperative scanning was used repeatedly to guide completeness of resection. In these cases in which routine intraoperative radiographs would have failed, intraoperative scanning proved to be essential for success.

Topics: Adolescent; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Intraoperative Period; Osteoma, Osteoid; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Amphotericin B; Bone Neoplasms; Child, Preschool; Diphosphonates; Histoplasmosis; Humans; Kidney; Kidney Tubular Necrosis, Acute; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

When the bone scintigram reveals high diffuse skeletal activity, it may be misinterpreted as normal. Some authors have reported such scintigrams in articles entitled "Significance of absent or faint kidney sign on bone scan" and "False negative bone scintigram". Three cases with bone metastasis showing high diffuse skeletal activity are presented in this paper. The recognition of abnormally high diffuse skeletal activity on bone scintigrams is discussed. The exposure time of all three cases was short when compared with normal cases, when the bone image was taken with a preset count. Therefore, exposure time is very important for objective differentiation between the cases showing high diffuse skeletal activity and normal cases.

Topics: Bone Neoplasms; Diphosphonates; Female; Humans; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Stomach Neoplasms; Technetium; Technetium Tc 99m Medronate; Time Factors

Tc-99m labeled dimethyl-amino-diphosphonate (DMAD) was compared with methylene diphosphonate (MDP) in five healthy volunteers and 28 patients with a variety of bony afflictions. Although the normal bone uptake of DMAD is less than MDP, the lesion-to-normal bone ratio is significantly higher with DMAD. All 71 lesions detected with MDP were also seen with DMAD. However, 10 lesions were disclosed with DMAD that were not seen with MDP. These lesions tended to have low grade concentrations of the radiopharmaceutical and were detected with DMAD by virtue of the lower normal bone uptake rather than higher lesion uptake.

Topics: Adult; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Humans; Kidney Neoplasms; Lung Neoplasms; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Osteitis Deformans; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma; Diphosphonates; Humans; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

Topics: Bone Neoplasms; Breast; Breast Neoplasms; Calcinosis; Diagnosis, Differential; Diphosphonates; Female; Humans; Mammography; Mastectomy; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

A 5-year-old girl presented with a rapidly growing osteosarcoma of the proximal right tibia. The radiographically osteoblastic lesions appeared as a "cold" on the 99mTc-MDP bone scan. Possible explanations for this unusual finding on the bone scan are discussed.

Topics: Bone Neoplasms; Child, Preschool; Diphosphonates; Female; Humans; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibia

Topics: Aged; Angiography; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Male; Osteosarcoma; Technetium; Technetium Tc 99m Medronate; Thermography; Tomography, X-Ray Computed; Ultrasonography

Topics: Animals; Arthritis, Rheumatoid; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Male; Radioisotope Renography; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Tissue Distribution

Technetium-99m methylene diphosphonate bone scans of 18 medullary chondrosarcomas of bone were correlated with pathologic macrosections of the resected tumors. There was increased scan uptake by all 18 tumors, and the uptake in 15 scans corresponded accurately to the anatomic extent of the tumors. Only three scans displayed increased uptake beyond the true tumor margins; thus, the "extended pattern of uptake" beyond the true tumor extent is much less common in medullary chondrosarcomas than in many other primary bone tumors. Therefore, increased uptake beyond the apparent radiographic margin of the tumor suggests possible occult tumor spread. Pathologically, there was intense reactive new bone formation and hyperemia around the periphery of all 18 tumors, and there were foci of enchondral ossification, hyperemia, or calcification within the tumor itself in nearly every tumor. Three scans displayed less uptake in the center of the tumors than around their peripheries. One of these tumors was necrotic in the center, but the other two were pathologically no different from tumors that displayed homogeneous uptake on the scan.

Topics: Bone Neoplasms; Chondrosarcoma; Diphosphonates; Humans; Humerus; Ilium; Neoplasm Invasiveness; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibia

Topics: Bone and Bones; Bone Neoplasms; Diphosphonates; Fibula; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Osteosarcoma; Pulmonary Embolism; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone Neoplasms; Diphosphonates; False Negative Reactions; Female; Humans; Male; Middle Aged; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone Neoplasms; Breast; Breast Neoplasms; Diphosphonates; Female; Humans; Mastectomy; Middle Aged; Postoperative Period; Radionuclide Imaging; Ribs; 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: Adult; Anemia, Hemolytic, Autoimmune; Bone Neoplasms; Diphosphonates; Female; Hodgkin Disease; Humans; Radionuclide Imaging; Spleen; Technetium; Technetium Tc 99m Medronate; Time Factors

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Whole body distribution and accumulation of radionuclide for diagnostic purpose such as 99mTc-MDP (methylene diphosphonate), 67Ga-citrate (67Ga) and 201Tl-chloride (201Tl) in implanted osteosarcoma of human origin were evaluated by macroautoradiography of Balb/c nude mouse. 3H-thymidine of which uptake has a close relation to growth pattern of tumors was used for a partner of target nuclide in double tracer technique to examine the distribution characteristics. Separated distribution pattern of coupled nuclides was imaged by a difference both of half life and energy of radiation between radionuclides. The distribution pattern of each target nuclide and 3H-thymidine were compared to clarify distribution characteristics respectively in specimen. 67Ga and 201Tl were taken around the tumor and the mode of their distribution was identical to that of 3H-thymidine. Uptake of 67Ga in tumor was much higher. 99mTc-MDP accumulated in the central zone of the tumor and its pattern was quite different from that of 3H-thymidine. From above result it was demonstrated that the accumulation mechanism of 67Ga, 201Tl and 99mTc-MDP are quite different in the tumor each other. So we concluded that our method of double tracer technique was useful for evaluation of distribution pattern of radionuclides for diagnostic purpose.

Topics: Animals; Autoradiography; Bone Neoplasms; Diphosphonates; Gallium Radioisotopes; Half-Life; Male; Mice; Mice, Nude; Osteosarcoma; Sarcoma, Experimental; Technetium; Technetium Tc 99m Medronate; Thallium; Thymidine; Tritium

Seven patients with Paget's disease, mimicking the radiographic appearance of metastatic disease, are illustrated. This disorder may simulate metastases if the simultaneous processes of bone resorption and new bone formation are not apparent, especially if there is no evidence of bone enlargement. Additional confusion may arise if the lesion is monostotic, has an unusual location, or occurs in a patient with known or suspected malignant disease.

Topics: Adult; Aged; Bone Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Osteitis Deformans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Single photon emission computed tomography using newly designed whole body imaging system which was composed of opposing dual gamma cameras, a rotating gantry and a sliding table was clinically evaluated for bone imaging. Two hundred and seventeen portions of various bone diseases were performed single photon emission computed tomography following conventional bone imaging with 99mTc-MDP (methylen diphosphonate) or -HMDP (hydroxymethylene diphosphonate) and the results were discussed. Transaxial images were sometimes superior than conventional images in the diagnosis of the tumor localization and extension of the facial bone. Combination of emission computed tomography to conventional methods also presented more exact informations for the diagnosis of the vertebral change. Separation of the overlapped radioactivities of the bone and the soft tissue is another advantage of the tomographic image, and cross-sectional images with enoughly high qualities were available in early time after administration of 99mTc-phosphate compounds. Useful diagnostic informations could be obtained by tomographic bone imaging combined with conventional imagings.

Topics: Adult; Bone Neoplasms; Child; Diphosphonates; Evaluation Studies as Topic; Facial Bones; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Organotechnetium Compounds; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed