technetium-tc-99m-medronate and Fibrous-Dysplasia-of-Bone

The purpose of this study was to study the characteristics of fibrous dysplasia (FD) of bone on bone scans and to evaluate the diagnostic value of radionuclide bone scans in FD.. Radionuclide bone scans were performed in 42 cases of histopathologically proven FD and the results were compared with other imaging modalities. A retrospective study method was used to analyze the imaging results.. Although FD showed nonspecific increased 99m-Tc MDP uptake, its appearance is different than bone metastates and other bone diseases. Combining scans with x-rays and other imaging modalities can improve the diagnostic accuracy of this disease.. Radionuclide bone scans are of certain value in the diagnosis of FD. The diagnostic specificity of FD with radionuclide bone scanning can be improved in association with other imaging modalities such as x-rays.

Topics: Adolescent; Adult; Child; Female; Fibrous Dysplasia of Bone; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole-Body Counting

Fibrous dysplasia (FD) is a rare mosaic disorder resulting in fractures, pain, and disability. Bone lesions appear during childhood and expand during skeletal growth. The rate at which FD lesions progress and the biochemical determinants of FD lesion formation have not been established, making it difficult to investigate and implement preventative therapies. The purpose of this study was to characterize FD lesion progression in children, and to identify clinical variables associated with progressive disease. Clinical data and imaging from an ongoing natural history study at the National Institutes of Health (NIH) were reviewed. 99m-Technetium methylene diphosphonate (99Tc-MDP) scans were used to determine Skeletal Burden Score (SBS), a validated quantitative scoring system. FD progression rate was determined by the change in the SBS in each patient per year. Thirty-one children had serial 99Tc-MDP scans, with a median age at first scan of 6 years (interquartile range [IQR] 4-8, range 2-10), and median follow-up 1.1 years (IQR 1.1-2.1, range 0.7-11.2). The median FD progression rate for the total group was 2.12 SBS units/year (IQR 0.81-2.94, range 0.05-7.81). FD progression rates were highest in children under age 8 years and declined with age (p = 0.03). Baseline disease severity was associated with subsequent disease progression (p = 0.009), with the highest FD progression rates in patients with moderate disease (baseline SBS 16-30), and lowest progression rates in those with severe disease (SBS ≥50). Serum levels of the bone formation marker osteocalcin were positively correlated with subsequent FD progression rate (p = 0.01, R = 0.58). There was no association between FD progression and baseline endocrinopathies, fractures, or surgery rates. FD lesions progress during childhood, particularly in younger children and those with moderate involvement. Osteocalcin may potentially serve as a biomarker for progressive disease. These findings may allow clinicians to investigate preventative therapies, and to identify children with FD who are candidates for early interventions. Published 2022. This article is a U.S. Government work and is in the public domain in the USA.

Topics: Biomarkers; Child; Fibrous Dysplasia of Bone; Humans; Osteocalcin; Radionuclide Imaging; Technetium Tc 99m Medronate

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

This was a retrospective review of 21 patients with FD (14 males and 7 females, mean age 51.2 ± 12.5 years) who were referred to have WBS to determine whether there was any osseous metastasis. WBS and SPECT/CT images were independently interpreted by two experienced nuclear medicine physician together with a diagnostic radiologist. In cases of discrepancy, consensus was obtained by a joint reading. The final diagnosis was based on biopsy proof and radiologic follow-up over at least 1 year.. The lesions of FD were most frequently found in craniofacial region (15/21). Eighteen of the 21 (85.7%) cases showed moderate and high metabolism on WBS (compared to sternum). On CT imaging, GGO and expansion were the most common finding, were noted in 90.5% and 85.7% of the patients. Lytic lesions were present in 61.9% of the patients, and sclerosis was present in 38.1% of the patients. Cortical disruption was not seen in any patient.

Topics: Adult; Aged; Diagnosis, Differential; Female; Fibrous Dysplasia of Bone; Humans; Male; Middle Aged; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Young Adult

The aim of this study was to determine the role of whole-body Tc-99m MDP bone scintigraphy (BSc) with dual-phase Tc-99m MIBI scintigraphy (DPMSc) in the assessment of fibrous dysplasia (FD) and the value of DPMSc in the detection of potentially operable lesions for guiding surgical treatment.. Twelve patients with histopathologically confirmed FD were evaluated with BSc and DPMSc. The patients were clinically followed up for a mean duration of 75 months. BSc images have been used as a guide to identify the site and the extent of the skeletal involvement. The symptomatic lesions were evaluated with DPMSc.. Forty-three lesions were evaluated in 12 patients. BSc showed increased uptake in all of the lesions, whereas DPMSc findings correlated more accurately with the symptoms. Fifteen symptomatic lesions showed increased Tc-99m MIBI uptake on DPMSc, especially in the early phase of DPMSc. The sensitivity, specificity and accuracy values for the early phase in detecting the symptomatic lesions were 100 and 93%, and for delayed phase were 100 and 98%, respectively.. BSc is useful in determining the site and extent of the skeletal involvement, especially in polyostotic FD. It seems that the potentially operable symptomatic lesions may be evaluated more accurately with DPMSc as compared with BSc. In addition, it seems that DPMSc findings correlate with the symptoms of FD, and this relationship may have a role in improving the preoperative assessment for guiding surgical treatment. DPMSc could be useful in the work-up of symptomatic patients if our results are validated in a larger patient series.

Topics: Adult; Aged; Child; Female; Fibrous Dysplasia of Bone; Follow-Up Studies; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole Body Imaging

Topics: Adult; Female; Fibrous Dysplasia of Bone; Humans; Radiography; Radiopharmaceuticals; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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: Adult; Diagnosis, Differential; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Polyostotic; Humans; Hyperparathyroidism; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole-Body Counting

Topics: Adolescent; Fibrous Dysplasia of Bone; Gallium Radioisotopes; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporal Bone; Tomography, X-Ray Computed

The literature on diffuse sclerosing osteomyelitis of the mandible has included at least two groups of lesions: (1) those from which bacterial infectious agents are rarely isolated (chronic-tendoperiostitis); and (2) those from which bacteria are readily isolated (true diffuse sclerosing osteomyelitis). The latter should be distinguished from secondarily infected florid osseous dysplasia. In this article the features of 16 patients with sclerotic jawbone lesions associated with symptoms of infection are analyzed. Eleven patients showed a large area of sclerosis of the mandible that was not restricted to the alveolar process and was surrounding an infectious focus. The histologic pattern revealed a deposition of reactive bone. These lesions are considered to represent true diffuse sclerosing osteomyelitis. The remaining five patients showed sclerotic lesions restricted to the alveolar process in one or more quadrants of the jaws. Apart from inflammation and reactive changes, histologic pattern revealed a fibroblastic stroma with bone and cementum-like structures that are formed by metaplasia. These lesions are considered to represent secondarily infected florid osseous dysplasia.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Female; Fibrous Dysplasia of Bone; Humans; Male; Mandibular Diseases; Middle Aged; Osteomyelitis; Periapical Periodontitis; Pericoronitis; Radiography, Panoramic; Sclerosis; Technetium Tc 99m Medronate

Eleven patients with histologically proven fibrous dysplasia (biopsy) were imaged with 3-phase bone scanning, using 99mTc-MDP. Ten had monostotic and one had polyostotic fibrous dysplasia. The perfusion (phase I) and uptake (phase III) of monostotic lesions was compared to the normal contralateral side and the rest of the skeleton was inspected for other abnormalities. Lesions presented with slightly increased perfusion (1.65 normal +/- 0.907) and markedly increased uptake of tracer (6.0 normal +/- 2.58). Other features that were noted are high spinal and scapula and poor renal tracer uptake.

Topics: Adolescent; Adult; Bone and Bones; Child; Female; Fibrous Dysplasia of Bone; Humans; Male; Perfusion; Radionuclide Imaging; Reference Values; Technetium Tc 99m Medronate; Tissue Distribution

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

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

Topics: Adult; Bone Neoplasms; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Polyostotic; Humans; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Bone scintigraphy is a sensitive imaging modality for detecting early lesions and polyostotic involvement in fibrous dysplasia. Common findings include multiple areas of focal uptake that are often unilateral and typically involve the ribs, tibia, femur, and craniofacial bones. A knowledge of various skeletal manifestations of fibrous dysplasia is helpful to distinguish it from Paget's disease, osteoblastic metastasis, and fractures. Several recent cases representing varying involvement of fibrous dysplasia are presented and the literature is reviewed.

Topics: Adult; Bone and Bones; Diagnosis, Differential; Female; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Polyostotic; Humans; Male; Middle Aged; Radionuclide Imaging; 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

Scintigraphic manifestations of fibrous dysplasia were analyzed in 59 lesions of 26 patients (12 monostotic, 14 polystotic). Bone imaging with Tc-99m MDP revealed a high percentage of increased uptake of radioisotope in the lesions of fibrous dysplasia. Four (14%) of 29 cystic lesions and two (7%) of 30 lesions with the appearance of ground glass showed no increase in radioisotope uptake, although roentgenograms showed marked changes. Therefore, care must be taken in the diagnosis of fibrous dysplasia with bone imaging alone. Nuclear methods, however, are indispensable in evaluating the dynamic aspects of bone mineral behavior and in demonstrating disease where none was suspected, or in visualizing polyostotic involvement in those cases where only monostotic disease was suspected clinically. It is concluded that both scintigrams and roentgenograms are complementary procedures in the diagnosis of fibrous dysplasia.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Monostotic; Fibrous Dysplasia, Polyostotic; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Diphosphonates; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Monostotic; Humans; Male; Metacarpus; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Fibrous dysplasia, a bone dysplasia of unknown pathogenesis, may be either monostotic or polyostotic. Not only is the femur involved in nearly all cases of the polyostotic form, but a distinct unilateral predilection is often noted. The following case illustrates the classic polyostotic changes.

Topics: Adult; Diphosphonates; Fibrous Dysplasia of Bone; Fibrous Dysplasia, Polyostotic; Humans; Leg; Male; Radiography; Radionuclide Imaging; Skull; Technetium; Technetium Tc 99m Medronate

Topics: Bone and Bones; Breast Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Fibrous Dysplasia of Bone; Humans; Middle Aged; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate