technetium-tc-99m-medronate and Chondroma

Topics: Chondroma; Female; Humans; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

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

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

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

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

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; Chondroma; Humans; Joint Diseases; Knee Joint; Male; Radionuclide Imaging; Synovial Membrane; Technetium Tc 99m Medronate

A case of hip joint synovial chondromatosis with an unusual scintigraphic pattern is described. This pattern was suggestive of a hip joint destructive reactive articular process or late manifestations of avascular necrosis of the femoral head. Concurrent radiographs were normal, as were laboratory investigations. Follow-up radiographs six months later showed radiolucencies and erosive bone changes in the diseased joint. Surgical and histopathological findings revealed well developed hip synovial chondromatosis (HSC) with thickened synovium and large, loose, cartilaginous bodies occupying and widening the tightened joint space, with destructive secondary juxta articular pressure and bone erosions. This and other scintigraphic patterns in HSC, and the differential diagnosis of the findings in patients with painful hip presentations are discussed.

Topics: Chondroma; Female; Hip Joint; Humans; Middle Aged; Radionuclide Imaging; Synovial Membrane; Technetium Tc 99m Medronate

Topics: Bone and Bones; Chondroma; Diphosphonates; Humans; Knee; Male; Middle Aged; Radionuclide Imaging; Synovial Cyst; Synovial Membrane; Technetium; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Breast Neoplasms; Chondroma; Diphosphonates; Female; Humans; Humerus; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Bone Neoplasms; Child; Chondroma; Chondrosarcoma; Diagnosis, Differential; Diphosphates; Diphosphonates; Female; Humans; Infant; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Employing ROI-technique, a ratio Q was obtained from relating accumulation of 99mTc-MDP at the site of the bone lesion (n = 150) with that of contralateral non-involved osseous areas. Values of Q were correlated with histologic tumor diagnosis, its dignity and frequency. Values of Q of greater than 3.0 were found in 95% of all sarcomas, in 100% of the osteosarcomas but in only 3.8% of all benign bone tumors. Values ranging from 1.0 to 1.2 were exclusively measured in benign tumors (e.g., in 52% of juvenile bone cysts and in 67% of non-ossifying fibromas). Since the threshold--separating benign from malignant lesions--at Q = 3.0 was blurred by tumorlike lesions, metastases and especially by Paget's disease, this method does not precisely predict dignity. However, this method may complement radiographic evaluation with low values supporting the diagnosis of a benign lesion. The combined findings of radiography and these rations gained by nuclear imaging may help determine the pathway of a patient through further diagnosis and treatment.

Topics: Bone Neoplasms; Chondroma; Diphosphonates; Femur; Humans; Osteosarcoma; Radionuclide Imaging; Radius; Technetium; Technetium Tc 99m Medronate; Tibia