technetium-tc-99m-medronate and Hyperparathyroidism--Secondary

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

Metastatic calcification associated with renal failure is well described. Bone scanning agents accumulate to various degrees within extraskeletal sites of metastatic calcification. The authors describe a patient with polycystic kidney disease resulting in renal failure, with the subsequent development of secondary hyperparathyroidism and metastatic calcification. Bone scintigraphy revealed abnormal uptake in both lungs, the right leg, and the right hand.

Topics: Calcinosis; Female; Hand; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Lung Diseases; Middle Aged; Muscular Diseases; Polycystic Kidney, Autosomal Dominant; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thigh; Thumb

A patient with chronic renal failure and secondary hyperparathyroidism had iliac bone biopsy. The procedure was complicated by a soft-tissue hematoma, which had calcified. A 3-4-cm palpable mass was visible in the lower left abdominal wall. Intense uptake of 99mTc-HMDP corresponded with the location of the calcified hematoma in this patient.

Topics: Adult; Biopsy; Bone and Bones; Calcinosis; Hematoma; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Parathyroid carcinoma is a rare cause of hyperparathyroidism and metabolic osteopathy. The authors report a patient with parathyroid carcinoma who underwent 99mTc-Sestamibi parathyroid and 99mTc-MDP bone scanning. These techniques showed the parathyroid lesion and typical features of severe metabolic osteopathy respectively. The bone scan performed at only four months after surgery showed near complete resolution.

Topics: Bone and Bones; Bone Diseases, Metabolic; Carcinoma; Contrast Media; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Time Factors

A patient with hyperparathyroidism secondary to chronic renal failure had multiple bony lesions with increased activity on both immediate static as well as delayed scintiphotos. One lesion in the distal femur was also exceptionally hot on the flow phase. Plain radiographs demonstrated lytic lesions with sclerotic margins and a narrow zone of transition. Open biopsy revealed histology consistent with brown tumor (osteoclastoma).

Topics: Acetabulum; Adult; Bone Neoplasms; Female; Femoral Neoplasms; Giant Cell Tumor of Bone; Humans; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Humans; Hyperparathyroidism, Secondary; Osteomalacia; Radionuclide Imaging; Technetium Tc 99m Medronate

A patient with undiagnosed, long-standing coeliac disease had multiple hot spots on skeletal scintigraphy, similar to those observed in malignant disease metastatic to the skeleton. A gluten-free diet corrected the pathological laboratory values, and a repeat skeletal scintigram 15 months after the first one was normal. It is important to identify the secondary hyperparathyroidism of coeliac disease as a cause of multiple hot spots in skeletal scintigraphy--the finding resembles malignancy, but is due to a benign, curable condition.

Topics: Adult; Bone and Bones; Celiac Disease; Female; Humans; Hyperparathyroidism, Secondary; Radionuclide Imaging; Technetium Tc 99m Medronate

A patient on chronic hemodialysis, with secondary hyperparathyroidism was referred for a radionuclide bone-imaging study. Deposition of 99mTc-methylene diphosphonate (99mTc-MDP) was apparent in the myocardium and abdominal blood vessels, as well as in the skeleton by four-color processed scintigraphy. Plain radiographs of the chest and abdomen demonstrated no calcification in the myocardium or abdominal blood vessels. Several possible mechanism for this uptake are discussed briefly.

Topics: Adult; Aorta, Abdominal; Bone and Bones; Heart; Humans; Hyperparathyroidism, Secondary; Iliac Artery; Male; Radionuclide Imaging; Renal Dialysis; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Bone and Bones; Child; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Female; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Osteomalacia; Radionuclide Imaging; Renal Dialysis; Technetium; Technetium Tc 99m Medronate

We report on 4 patients with secondary hyperparathyroidism of intestinal origin presenting a characteristical pattern of distribution, namely focal accumulations of 99mTc-methylene diphosphonate on locations typical of Looser's zones. In accordance with other authors we demonstrate the higher sensitivity of skeletal scintigraphy as compared to radiography which is well known from other disorders of bone. We also refer to the problems of differential diagnosis arising when multiple foci are visible on bone scan.

Topics: Aged; Bone and Bones; Diphosphonates; Female; Humans; Hyperparathyroidism, Secondary; Malabsorption Syndromes; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A whole body bone scan obtained on a 21-year-old woman with sickle cell disease and chronic renal failure showed localization of the radionuclide diffusely in the stomach. The localization of the radionuclide represented metastatic calcification of the stomach caused by secondary hyperparathyroidism.

Topics: Adult; Bone and Bones; Calcinosis; Diphosphonates; Female; Humans; Hyperparathyroidism, Secondary; Radionuclide Imaging; Stomach Diseases; Technetium; Technetium Tc 99m Medronate