technetium-tc-99m-medronate and Histiocytosis--Langerhans-Cell

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

Histiocytosis X is a disease of unknown origin which usually affects multiple organs, including the lung. The age of onset, the clinical course and the pattern of spread allow a distinction to be made between 3 varieties: Letterer-Siwe, Hand-Schüller-Christian and eosinophilic granuloma. The latter form, in adult patients, may predominantly or solely affect the lungs. The authors reviewed clinical, radiographic and CT findings of 7 adult patients with pulmonary eosinophilic granuloma, picked out of a series of 265 cases of interstitial lung pathology, diagnosed since 1973. Typical pulmonary involvement is bilateral, symmetrical and predominates in the upper areas. Honeycomb pattern was found in 1 patient at the onset of symptoms, and in 2 cases during the follow-up, without severe reduction in pulmonary volumes. Pneumothorax was observed in 3 cases and bone lesions in 2. CT added new and important informations such as presence, size and wall thickness of "cystic" lesions. New laboratory tests and bronchoalveolar lavage demonstrated minor diagnostic usefulness than radiological findings. The authors conclude by discussing such problems as prognostic factors and differential diagnosis.

Topics: Adolescent; Adult; Biopsy; Bone and Bones; Bronchoalveolar Lavage Fluid; Citrates; Citric Acid; Eosinophilic Granuloma; Follow-Up Studies; Gallium Radioisotopes; Histiocytosis, Langerhans-Cell; Humans; Lung; Lung Diseases; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole-Body Counting

Topics: Adult; Histiocytosis, Langerhans-Cell; Humans; Magnetic Resonance Imaging; Male; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Aged; Bone and Bones; Diagnosis, Differential; Epiphyses; Female; Histiocytosis, Langerhans-Cell; Humans; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

An unusual location for Langerhans cell histiocytosis of the cervical spine is presented. The osteolytic lesion, instead of being located in the vertebral body, was visualised in the left lateral mass of the fifth cervical vertebra, extending into the vertebral body and through the interapophyseal joint into the lateral mass of the fourth cervical vertebra.

Topics: Cervical Vertebrae; Child; Histiocytosis, Langerhans-Cell; Humans; Male; Radiopharmaceuticals; Spinal Diseases; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 55 year old woman with multifocal eosinophilic granuloma (MEG) is described. She developed facial numbness and twitching followed by slowly progressive cerebellar symptoms. Two years later polyuria and polydipsia were noted. A CT of the brain showed multifocal enhancing lesions, and MRI showed areas of hyperintensity on T2 weighted studies in the cerebellar peduncles, pons, and midbrain. Radiographs of the skull, pelvis, and long bones were normal, but a 99mTc diphosphonate bone scan and MRI showed bone lesions compatible with granuloma. The diagnosis of MEG was made by bone biopsy. This is believed to be the first case of MEG with such unusual clinical profiles and radiographical findings. Skeletal surveys are indicated for patients with unexplained focal or multifocal inflammatory changes in the cerebellum.

Topics: Biopsy; Brain Diseases; Brain Stem; Cerebellar Diseases; Female; Histiocytosis, Langerhans-Cell; Humans; Magnetic Resonance Imaging; Middle Aged; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

We have compared whole body skeletal scintigraphy with X-ray examination in 15 children suffering from histiocytosis X, 14 of whom also showed involvement of the skeleton. In 9 of 20 cases, relapses, included, involvement of the skeleton was found both in scintigraphy and X-ray examination. In 7 cases only X-ray examinations have revealed lessons, which could not be proved by scintigraphy. Vice versa, in 4 cases scintigraphy was positive alone. These results confirm the necessity to use both methods for an exact documentation of the extent of the disease before undertaking any therapy. Dispensing with one of the two methods may cause incorrect therapeutic decisions and increase the risk of relapses and late complications.

Topics: Bone and Bones; Child; Child, Preschool; Female; Histiocytosis, Langerhans-Cell; Humans; Infant; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

The aim of this study was to compare the roentgenological and scintigraphic osseous changes in 25 resp. 18 patients with histiocytosis X and to analyse them. In particular, it was also interesting to discuss the divergent reports in the literature in respect of scintigraphic storage behaviour. In all the patients examined before initiation of therapy (39 osseous foci) high activities were found scintigraphically. The extension of the scintigraphically active zone was much greater than the corresponding translucencies on the x-ray film. On the other hand, patients after therapy still showed foci on the x-ray film whereas the scan had already become inactive. This striking discrepancy between scan findings before and after therapy could be one of the reasons for divergent literature reports on this problem.

Topics: Adolescent; Adult; Bone and Bones; Child; Child, Preschool; Female; Histiocytosis, Langerhans-Cell; Humans; Infant; Male; Radiography; Technetium Tc 99m Medronate

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

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