technetium-tc-99m-medronate and Hypercalcemia

We report a case of a 39-year-old female with active systemic lupus erythematosus who complained of lethargy and weakness with a moderate renal impairment. Hypercalcemia was confirmed by laboratory examination. Her X-ray revealed significant ectopic calcinosis in subcutaneous tissue of bilateral hands, and Tc-99(m) methylene diphosphonate bone scan revealed a remarkably intense uptake of bilateral lungs. She had no evidence suggestive of other diseases related to hypercalcemia such as hyperparathyroidism and malignancy. She had abnormally high serum parathyroid hormone-related protein (PTHrP) which fell to normal after treatment. Glucocorticoid, cyclophosphamide plus calcitonin and etidronate were administered and the patient improved greatly. Literature review demonstrated that lupus-related hypercalcemia with ectopic calcinosis is a rare complication and increased PTHrP is probably one of the main mechanisms. Lung uptake in bone scan may be a special and reliable clue suggestive of hypercalcemia.

Topics: Adult; Biomarkers; Bone Density Conservation Agents; Calcinosis; Calcitonin; Cyclophosphamide; Drug Therapy, Combination; Etidronic Acid; Female; Glucocorticoids; Humans; Hypercalcemia; Immunosuppressive Agents; Lung; Lupus Erythematosus, Systemic; Parathyroid Hormone; Radiopharmaceuticals; Technetium Tc 99m Medronate; Treatment Outcome; Whole Body Imaging

Radionuclide imaging with Tc-99m diphosphonates is not an effective method for detecting or ruling out most osteoporotic diseases including senile osteoporosis or accelerated postmenopausal osteoporosis, and the slow loss of bone tissue generally remains undetected by this modality. Nonetheless, it frequently surpasses or supplements radiographic findings in evaluating the focal complications of metabolic bone disease, including fractures, microfractures, stress fractures, vertebral compressions, Milkman-Looser zones, aseptic necrosis, and acute infarction. In contrast to its secondary role in osteoporosis, bone imaging is of prime importance in investigating hypercalcemia, because the major cause of this abnormality is skeletal metastatic malignancy. In defective bone mineralization due to hyperparathyroidism or osteomalacia, a general increase in diphosphonate skeletal uptake is detected more frequently than radiographic abnormalities. However, normal skeletal images do not rule out metabolic bone disease. Biochemical testing is more reliable in detecting primary hyperparathyroidism. On the other hand, in renal osteodystrophy, biochemical abnormalities are variable and bone imaging is helpful in assessing the severity of skeletal involvement, but not its etiology. Many methods of quantitating the kinetics of Tc-99m diphosphonates have been explored, such as plasma clearance, bone-to-soft-tissue ratios, 24-hour total body retention and 24-hour urinary excretion. None of these have been widely accepted. The value of bone imaging is established in other systemic diseases, most notably in Paget's disease, hypertrophic pulmonary osteoarthropathy, sickle cell disease, fibrous dysplasia, and sympathetic dystrophy.

Topics: Bone Diseases; Bone Diseases, Metabolic; Chronic Kidney Disease-Mineral and Bone Disorder; Humans; Hypercalcemia; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Over the past 5 years, we have encountered 6 cases of diffuse pulmonary uptake of 99m-Tc bone-scanning agents (incidence, 0.04%). To assess the significance of this phenomenon, we reviewed all of the cases reported since 1974 (Including our series, a total of 32 cases). Three groups can be discerned, the first consisting of 24 patients without radiological calcifications in the lungs and with hypercalcemia of different origins (mostly hyperparathyroidism). Of the eight autopsies performed in this group, seven revealed extensive calcifications in alveolar walls and lung vessels; the other autopsy showed no calcification at all and only bronchopneumonic lesions. The second group consists of 6 patients in chronic dialysis. The last group consists of 2 patients having diffuse pulmonary alveolar microlithiasis with extensive radiologic calcifications. The mechanism of lung uptake of 99m-Tc bone-imaging agents is probably the same as that of bone uptake (chemisorption on hydroxyapatite crystals), although other uptake mechanisms have also been discussed. Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray.

Topics: Adenoma; Adult; Aged; Bone Diseases; Calcinosis; Female; Humans; Hypercalcemia; Lung Diseases; Male; Middle Aged; Multiple Myeloma; Parathyroid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Vitamin D

Topics: Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Hypercalcemia; Neoplasm Metastasis; Paraneoplastic Syndromes; Parathyroid Hormone-Related Protein; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Hypercalcemia is a severe complication in cases of vitamin D intoxication that can result in metastatic calcification. We herein report a female case with hypercalcemia due to eldecalcitol administration associated with the increased uptake of technetium-99m hydroxymethylene diphosphonate (

Topics: Bone Density Conservation Agents; Calcinosis; Female; Humans; Hypercalcemia; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Stomach Diseases; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Vitamin D

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

Topics: Alkaline Phosphatase; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Male; Middle Aged; Osteitis Deformans; Pelvic Bones; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Vitamin D Deficiency

In bone scan patients with dialysis-treated chronic kidney disease (CKD) and hyperparathyroidism, soft tissue accumulation of technetium-99 m hydroxy/methylene diphosphonate (Tc-99 m-HDP/MDP) has been reported primarily in case reports and usually explained by hypercalcaemia and/or hyperphosphataemia. As human vascular smooth muscle cells produce hydroxyapatite during cell culture with increased phosphate levels and as Tc-99 m-HDP/MDP primarily binds to hydroxyapatite, we hypothesized that soft tissue accumulation would be found in patients with hyperphosphataemia. We identified 63 CKD patients diagnosed with secondary hyperparathyroidism admitted for Tc-99 m-HDP bone scan. Baseline characteristics and mean concentrations of biochemical markers (including P-calcium and P-phosphate) taken 0-3 months prior to the bone scans were collected. Soft tissue uptake was detected on bone scans in 37 of 63 (59%) patients. Primary locations were in the heart (27/37 = 73%), muscles (12/37 = 32%), lung (9/37 = 24%) and gastrointestinal tract (6/37 = 16%), and 13 of 37 (35%) patients had simultaneous uptake in more than one location. Regarding biochemical markers, patients with soft tissue uptake only differed from patients without in terms of plasma phosphate levels (1·95 ± 0·15 (n = 37) versus 1·27 ± 0·08 (n = 26), P = 0·0012). All patients with myocardial uptake (n = 27) had a coronary arteriography-verified history of coronary artery disease (CAD), whereas CAD was only present in six of the 36 patients without myocardial uptake. In conclusion, dialysis-treated CKD patients with secondary hyperparathyroidism have a high incidence of soft tissue uptake, and this finding is strongly correlated with elevated phosphate, but not calcium values.

Topics: Bone and Bones; Calcium; Coronary Angiography; Durapatite; Female; Humans; Hypercalcemia; Hyperparathyroidism, Secondary; Hyperphosphatemia; Male; Middle Aged; Phosphates; Predictive Value of Tests; Radiopharmaceuticals; Renal Dialysis; Renal Insufficiency, Chronic; Retrospective Studies; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Calcinosis; Humans; Hypercalcemia; Male; Middle Aged; Paget Disease, Extramammary; Paraneoplastic Syndromes; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Sphenoidal sinus carcinoma is a rare cause of hypercalcemia of malignancy. We report on a 37-year-old male with sphenoidal sinus carcinoma with intracranial extension who developed hypercalcemia of malignancy with progressing disease and demonstrated diffuse metastatic visceral calcifications of lungs, myocardium, stomach, kidneys and thyroid on follow-up 99mTc-methylene diphosphonate bone scan. In the absence of extensive skeletal metastases, bone scan help confirm humoral nature of hypercalcaeimia.

Topics: Adult; Bone and Bones; Calcinosis; Humans; Hypercalcemia; Male; Paranasal Sinus Neoplasms; Prognosis; Radionuclide Imaging; Sphenoid Sinus; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Calcinosis; Chronic Disease; Female; Humans; Hypercalcemia; Hyperparathyroidism; Kidney Failure, Chronic; Lung; Lung Neoplasms; Middle Aged; Ossification, Heterotopic; Peritoneal Dialysis, Continuous Ambulatory; Radiopharmaceuticals; Respiratory Function Tests; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Metastatic calcifications are associated with chronic renal failure, hyperparathyroidism, metastatic neoplasms, hypervitaminosis D, and hypercalcemia of other origins. Bone scanning agents accumulate within these extraskeletal metastatic calcifications. The authors describe two patients with hypercalcemia associated with Tc-99m MDP uptake in the lungs, stomach, and soft tissues. Ga-67 scintigraphy was also performed and showed increased uptake in the same locations as those of Tc-99m MDP, suggesting the existence of an inflammatory process. Despite adequate treatment, only partial resolution of extraskeletal uptake was observed.

Topics: Aged; Bone and Bones; Calcinosis; Connective Tissue; Female; Gallium Radioisotopes; Humans; Hypercalcemia; Lung; Male; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Medronate

Topics: Calcinosis; Calcium; Female; Goiter; Humans; Hypercalcemia; Hypoparathyroidism; Lung; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroidectomy; Vitamin D

Topics: Carcinoma, Squamous Cell; Humans; Hypercalcemia; Laryngeal Neoplasms; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Oropharyngeal Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution; Viscera

Topics: Humans; Hypercalcemia; Hyperparathyroidism, Secondary; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Calciphylaxis is a rapidly developing, fatal process of vascular calcium deposition with prominent cutaneous manifestation. We treated a long-term haemodialysis patient who developed an analogous disorder limited to the lungs. A 57-year-old man was admitted for initiation of peritoneal dialysis because limited cardiac reserve precluded further haemodialysis. He was treated successfully for pneumonia until hypoxia and progressive hypercalcaemia developed. (99m)Tc-methylene disphosphonate scintigraphy showed diffusely increased pulmonary uptake. Death supervened despite aggressive and successful treatment of hypercalcaemia. Autopsy studies included immunohistochemistry and morphometric studies of bone. Alveolar capillary walls showed diffuse calcium deposition. Both gross and microscopical findings differed from those of typical metastatic calcification in dialysis patients. Immunoreactivity for parathyroid hormone-related protein was present in the lesions. Bone histomorphometry indicated mild osteitis fibrosa. Pneumonia is believed to have caused local synthesis of parathyroid hormone-related protein that, along with high calcium x phosphorus product, contributed to calcium deposition. By analogy with the cutaneous process we termed the deposition "pulmonary calciphylaxis".

Topics: Acute Disease; Calciphylaxis; Fatal Outcome; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Respiratory Insufficiency; Technetium Tc 99m Medronate

Bone scintigraphy is not usually performed in multiple myeloma (MM), as marrow deposits characteristically show no tracer uptake. However, metastatic bone disease often mimics MM both clinically and biochemically, resulting in a substantial number of MM patients undergoing bone scintigraphy. Variable appearances in these cases have been reported, ranging from normal to a superscan, the latter a result of massive tracer uptake within bone. Soft tissue uptake has been documented, often when MM is complicated by secondary amyloidosis. This usually results in mainly solid organ uptake of tracer. We report a case of MM where massive soft tissue uptake occurred, primarily within muscles, with very little isotope elsewhere.

Topics: Aged; Aged, 80 and over; Fatal Outcome; Humans; Hypercalcemia; Male; Multiple Myeloma; Muscle, Skeletal; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Marrow; Female; Humans; Hypercalcemia; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tissue Distribution

We describe a patient with unexplained hypercalcemia who under went bone scintigraphy, which demonstrated marked tracer uptake within the hilar lymph nodes. The pattern strongly suggested sarcoidosis, which was subsequently confirmed by bronchoscopy-directed biopsy.

Topics: Adult; Bone and Bones; Female; Humans; Hypercalcemia; Lymphatic Diseases; Radionuclide Imaging; Renal Insufficiency; Sarcoidosis; 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

Metastatic calcification within soft tissue, such as the lung and stomach, is associated with hyperparathyroidism, chronic renal failure, hemodialysis, metastatic neoplasm and hypervitaminosis D. Bone scanning agents variably accumulate within these extraskeletal metastatic calcifications. We report a patient with primary hyperparathyroidism whose bone scan revealed abnormal uptake in the liver, lung, stomach and parathyroid gland followed by complete resolution of extraskeletal uptake less than 1 wk after parathyroidectomy.

Topics: Adenoma; Aged; Bone and Bones; Calcinosis; Female; Humans; Hypercalcemia; Hyperparathyroidism; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Technetium Tc 99m Medronate

We report on 99mTc-MDP uptake in lungs and stomach in a patient with hypercalcaemia and renal failure due to elevated 1,25(OH)2vitD3 because of sarcoidosis. Presently, this typical scan pattern has only been described in patients with malignancies, parathyroid adenoma and drug-induced vitamin D intoxication. We offer possible explanations for the findings in our patient.

Topics: Aged; Bone and Bones; Calcinosis; Humans; Hypercalcemia; Lung Diseases; Male; Radionuclide Imaging; Sarcoidosis; Stomach Diseases; Technetium Tc 99m Medronate

We describe herein a case of parathyroid carcinoma accompanied with metastatic calcification identified by technetium-99m methylene diphosphonate (Tc-99m MDP) scintigraphy in the lungs, kidneys and stomach. Parathyroid carcinoma remains a rare disorder despite the increased prevalence of primary hyperparathyroidism. Metastatic calcification is noted infrequently even in primary hyperparathyroidism and it may cause respiratory failure. Tc-99m MDP scintigraphy three months after surgery showed a complete disappearance of Tc-99m uptake in the stomach and an obvious reduction in the kidneys but no significant change in the lungs, indicating metastatic calcification can be reversibly reabsorbed. This case indicates that the adequate excision of parathyroid carcinoma as well as the early detection of metastatic calcification by Tc-99m MDP are obligatory.

Topics: Calcinosis; Carcinoma; Female; Humans; Hypercalcemia; Kidney Neoplasms; Lung Diseases; Middle Aged; Neoplasm Invasiveness; Parathyroid Neoplasms; Radionuclide Imaging; Respiratory Insufficiency; Stomach Diseases; 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

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

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

Topics: Bone and Bones; Calcinosis; Citrates; Citric Acid; Gallium Radioisotopes; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung Diseases; Radionuclide Imaging; Stomach Diseases; Technetium Tc 99m Medronate

A case of milk-alkali syndrome is described in a 34-year-old man taking an over-the-counter antacid preparation for gastroesophageal reflux. A Tc-99m MDP bone scan performed in the initial investigation of the hypercalcemia was markedly abnormal with a "metabolic" pattern of tracer uptake similar to that seen in hyperparathyroidism and humoral hypercalcemia. Following withdrawal of the antacid and calcium, the bone scan appearance returned to normal, as did the biochemical markers of his disease.

Topics: Animals; Antacids; Bone and Bones; Calcium Carbonate; Gastroesophageal Reflux; Humans; Hypercalcemia; Male; Middle Aged; Milk; Nonprescription Drugs; Radionuclide Imaging; Self Medication; 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: Aged; Bone and Bones; Etidronic Acid; Humans; Hypercalcemia; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

There have been several reports of etidronate disodium (EHDP) interference upon the biodistribution of 99mTc-methylene diphosphonate (MDP). With the increasing use of etidronate for the treatment of Paget's disease, hypercalcemia, and osteoporosis, nuclear physicians can expect to encounter increasing numbers of cases in which EHDP-induced artifacts impair the diagnostic utility of bone scans. The temporal duration of this effect is unknown yet obviously important. We report serial bone scintigraphy in a patient who received a single dose of EHDP for hypercalcemia. Normal biodistribution of 99mTc-MDP was noted at 15 days, suggesting that 2 wk are sufficient before performing a bone scan after a single intravenous dose of etidronate.

Topics: Aged; Bone and Bones; Drug Interactions; Etidronic Acid; Humans; Hypercalcemia; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Calcinosis; Humans; Hypercalcemia; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

The bone scintigrams of 600 patients performed over a 12-month period were reviewed. Thirty-six demonstrated abnormalities of the urinary tract of which six cases of intense renal parenchymal activity ("hot kidneys") were found. Two cases were related to treatment with the new antineoplastic agent mitoxantrone. In one patient it was related to treatment with calcitonin. Neither of these associations has been previously reported. Recognized causes of hypercalcemia and recent radiotherapy were present in two patients. No cause could be found in the final patient.

Topics: Adult; Bone and Bones; Calcitonin; Female; Humans; Hypercalcemia; Kidney; Male; Middle Aged; Mitoxantrone; Neoplasms; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Urinary Tract

A 59-year-old woman with hypercalcemia due to hyperparathyroidism and 1-year-old boy with cryptogenic hypercalcemia were referred for bone scanning. There were increased accumulations of the technetium-phosphate complex in thyroid, stomach, lung, heart, and kidney. 99mTc-MDP bone scanning was useful for detecting metastatic calcification.

Topics: Calcinosis; Female; Humans; Hypercalcemia; Infant; Male; Middle Aged; 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: Bone Diseases, Metabolic; Humans; Hypercalcemia; Hyperthyroidism; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Female; Humans; Hypercalcemia; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Uptake of Tc-99m MDP by extraskeletal tissues is a rare, serendipitous finding during bone scanning studies. It can be clinically correlated with the presence of hypercalcemia in association with renal failure, as may occur in multiple myeloma. While the precise mechanism of non-osseous uptake of MDP is not certain, it may represent metastatic calcification based upon histological examination. A critical calcium-phosphate ion product appears to be requisite for deposition within soft tissues, and all cases in the literature for which data were available exceeded this ion product value. While MDP bone scanning is not generally useful in the diagnosis or staging of multiple myeloma, these findings may indicate secondary effects of the disease. The authors report the first case of liver, spleen, and lung uptake by MDP in a patient with hypercalcemia secondary to multiple myeloma, with a review of the literature.

Topics: Aged; Bone and Bones; Female; Humans; Hypercalcemia; Liver; Lung; Multiple Myeloma; Radionuclide Imaging; Spleen; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Aged; Diuresis; Female; Humans; Hypercalcemia; Kidney; Technetium Tc 99m Medronate

Vitamin D intoxication, which may result from zealous intake of health food supplements, may cause metastatic calcification. This is the first reported case of a patient with vitamin D intoxication who had massive gastric uptake of [99mTc]MDP, but no lung uptake, with histologic documentation of the metastatic calcification by gastric biopsy. It is probable that the metastatic calcification was a highly metabolic process in this patient since the gastric uptake resolved within 3 wk when serum calcium and phosphate had returned to normal.

Topics: Bone and Bones; Calcinosis; Cholecalciferol; Female; Gastric Mucosa; Humans; Hypercalcemia; Lung; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Stomach Diseases; Technetium Tc 99m Medronate

Abnormal pulmonary uptake of Ga-67 citrate and Tc-99m MDP and reversible liver uptake of Tc-99m MDP was seen in a patient with hypercalcemia of lymphoma and biopsy-proven metastatic pulmonary calcification. Abnormal lung uptake of Tc-99m MDP may confirm the diagnosis of pulmonary calcification, lessening the need for invasive procedures to evaluate pathologic lung uptake of Ga-67 citrate.

Topics: Calcinosis; Female; Gallium Radioisotopes; Humans; Hypercalcemia; Liver; Lung; Lung Diseases; Lymphoma, Follicular; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Hypercalcemia; Male; Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Female; Humans; Hypercalcemia; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

A patient exhibited an unusual constellation of findings: His extraosseous lymphoma sequestered [99mTc]MDP, a bone-seeking agent, while at the same time it appeared to produce a factor that caused hypercalcemia. The dispersed lymphoma cells took up more [99mTc]MDP in vitro than did cultured lymphoblasts suggesting that the in vivo sequestration may have been, at least in part, an active intracellular process.

Topics: Cells, Cultured; Diphosphonates; Humans; Hypercalcemia; Liver; Liver Neoplasms; Lymphocytes; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

The kidneys were evaluated on [99mTc]phosphonate bone scans using 35 studies from 23 individuals with multiple myeloma; these images were compared with those from 50 controls. In each case, the kidneys could be visualized and calculation was made of the renal:skeleton ratio. Two myeloma patients showed an elevated renal:skeleton ratio. One was due to reduced vertebral uptake of [99mTc]phosphonate following therapeutic radiation. In the second case, the elevated ratio was related to renal uptake of the tracer (independent of urinary retention), and was consistent with nephrocalcinosis. No significant correlation between the renal:skeleton ratio and the degree of hypercalcemia, proteinuria, or renal impairment was found. We conclude that bone scintigraphy represents a safe, simple means of demonstrating renal presence and activity in multiple myeloma patients. However, calculation of the renal:skeleton ratio is not directly helpful in clarifying the events of calcium metabolism.

Topics: Bone and Bones; Humans; Hypercalcemia; Kidney; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

We present a case of multiple myeloma in which pulmonary calcification was clinically shown by bone scintigraphy and subsequently confirmed at autopsy. It is suggested that, in patients with myeloma, radionuclide bone scanning may be of value for differentiating deposits in the lung due to calcification from those due to other types of pulmonary infiltration revealed by chest X-rays. A thorough review of the relevant literature is presented.

Topics: Bone and Bones; Calcinosis; Humans; Hypercalcemia; Lung Diseases; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

A method is described for the quantitation of total skeletal activity during bone scans. The method requires a single plasma sample only, taken at the time of imaging. The ratio of % injected dose of 51Cr EDTA to that of 99Tcm MDP is calculated from this sample following combined injection of the two radiopharmaceuticals. The 51Cr EDTA level corrects for the glomerular filtration of 99Tcm MDP. Using this method, which only requires a gamma counter, significant differences from normal controls have been shown in patients with osteomalacia, renal osteodystrophy, Paget's disease and hypercalcaemia. The method provides routine quantitative data to add to the imaging information in the bone scan.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Chromium Radioisotopes; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Edetic Acid; Humans; Hypercalcemia; Metabolic Clearance Rate; Middle Aged; Osteitis Deformans; Osteomalacia; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A patient with end-stage renal disease and hypercalcemia was referred for a radionuclide bone imaging study. Deposition of Tc-99m hydroxymethylenediphosphonate was apparent in the lungs and myocardium as well as in the skeleton. Renal uptake was also noted, despite anuria. Computed tomography demonstrated nephrocalcinosis but no myocardial calcification. The cause of myocardial uptake of tracer is unknown. Amyloidosis is suggested as a possibility but is not validated in this case.

Topics: Acute Kidney Injury; Aged; Bone and Bones; Diphosphonates; Female; Heart; Humans; Hypercalcemia; 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

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

Topics: Adult; Amphotericin B; Anemia, Sickle Cell; Bone and Bones; Diphosphonates; Female; Humans; Hypercalcemia; Kidney; Lupus Erythematosus, Systemic; Male; Middle Aged; Nephritis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Intense diffuse uptake of Tc-99m-labeled methylene diphosphonate was seen in both lungs of a patient submitted to surgery for a primary parathyroid adenoma. Five scans performed over the 3 yr following the operation showed persistence of lung uptake despite restoration of normal blood calcium concentration. Mild chronic renal failure caused by the hypercalcemia also persisted postoperatively. The present case confirms that pulmonary uptake of bone tracer can occur asymptomatically when both hypercalcemia and renal failure are present. Lung uptake of a bone tracer probably reflects tissue deposition of hydroxyapatite rather than of amorphous structures. Correction of the hypercalcemia failed to resolve the abnormal scan pictures.

Topics: Adenoma; Bone and Bones; Diphosphonates; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Calcinosis; Cardiomyopathies; Diphosphonates; Female; Humans; Hypercalcemia; Middle Aged; Myocardium; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate