technetium-tc-99m-medronate and Carcinoma--Hepatocellular

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

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

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: Adrenal Gland Neoplasms; Carcinoma, Hepatocellular; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Middle Aged; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Aged; Bone and Bones; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Peritoneal Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Rupture; 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

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

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

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

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

Topics: Adult; Bone and Bones; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Liver Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Spherocytosis, Hereditary; Spleen; Splenectomy; Technetium Tc 99m Medronate

A case of hepatocellular carcinoma metastatic to the mandible is described. The patient reported swelling, pain, and trismus after a pathologic fracture. After a systematic examination with the use of 99mTc-methylene diphosphonate, 67Ga-citrate, and 99mTc-pyridoxyl-5-methyl triptophan scintigraphy the primary focus was discovered in the right lobe of the liver. The focus was confirmed by computed tomography and magnetic resonance imaging. The histopathologic diagnosis of hepatocellular carcinoma was made from a biopsy specimen of the mandibular lesion.

Topics: Carcinoma, Hepatocellular; Fatal Outcome; Gallium Radioisotopes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mandibular Neoplasms; Middle Aged; Organotechnetium Compounds; Pyridoxal; Radiography, Panoramic; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tryptophan

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; 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

Although bone scintigraphy with 99mTc-MDP is a sensitive diagnostic method to detect bone metastasis, it is not specific for malignancy. A radioactive substance which accumulates specifically into metastatic lesions should be of value. 123I-IMP and bone scintigraphy with 99mTc-MDP were consecutively performed in patients with vertebral bone metastases from hepatocellular carcinoma and lumbar spondylosis deformans in a 7-day interval or shorter. The intensity of uptake was compared. Eighteen of the 20 metastatic lesions (90%) were classified as increased uptake areas in 123I-IMP scintigraphy. MDP-scintigraphy disclosed 16 metastatic lesions (80%), 9 as "hot" lesions (56%) and 7 as "cold" lesions (44%). 123I-IMP scintigraphy was negative in all 12 lesions of lumbar spondylosis deformans. Compared to MDP-scintigraphy, 123I-IMP scintigraphy was more sensitive in detecting vertebral bone metastases of hepatocellular carcinoma with smaller rates of false-positive and false-negative findings.

Topics: Amphetamines; Carcinoma, Hepatocellular; Female; Humans; Iodine Radioisotopes; Iofetamine; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

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

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

Topics: Adult; Carcinoma, Hepatocellular; Hepatorenal Syndrome; Humans; Kidney Cortex; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Considerable accumulation of Tc-99m HMDP was noted in a huge splenic mass in a 62-year-old man with hepatocellular carcinoma. An autopsy revealed a massive hemorrhage within the splenic metastasis. The splenic uptake of the radionuclide corresponded to the marked deposition of hemosiderin.

Topics: Carcinoma, Hepatocellular; Hemorrhage; Hemosiderin; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Neoplasms; Technetium Tc 99m Medronate

Topics: Ascites; Carcinoma, Hepatocellular; Humans; Hydrothorax; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Carcinoma, Hepatocellular; Child, Preschool; Humans; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

In present study, in two cases with hepatocellular carcinoma and cholangioma associated with hypercalcemia, the accumulations of 99mTc labeled phosphorous compound in the primary lesion were demonstrated and its mechanism was discussed.

Topics: Adenoma, Bile Duct; Aged; Bile Duct Neoplasms; Bone and Bones; Carcinoma, Hepatocellular; Humans; Hypercalcemia; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Focal uptake of 99mTc-MDP was seen in a case of hepatoblastoma. The focal uptake corresponded to an area of calcification on CT, which was shown histologically to consist of osteoid with mineralization. The mechanism of uptake by the tumor in this case is likely to be the same as for skeletal uptake.

Topics: Calcinosis; Carcinoma, Hepatocellular; Humans; Infant; Liver Neoplasms; Male; Radiography; Radionuclide Imaging; 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

Topics: Aged; Carcinoma, Hepatocellular; Humans; Liver; Liver Neoplasms; Male; 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

Topics: Adult; Carcinoma, Hepatocellular; Diphosphonates; Humans; Liver Neoplasms; Male; 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

Two cases of bone radiotracer uptake by primary hepatic malignancies of childhood hepatocellular carcinoma and hepatoblastoma and their metastases are presented. These cases are illustrative of a previously unreported cause of extraosseous uptake of bone seeking radionuclide.

Topics: Carcinoma, Hepatocellular; Child; Diphosphonates; Humans; Infant; Liver Neoplasms; Male; Peritoneal Neoplasms; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate