technetium-tc-99m-medronate and Kidney-Failure--Chronic

In patients with renal bone disease skeletal and extra-skeletal abnormalities can be visualised using conventional bone scintigraphy. Some of these abnormalities are associated with characteristic scintigraphic appearances, which are reviewed in detail, and the possible mechanisms involved are discussed. Specific imaging with iodine 123 serum amyloid P component and iodine 131 beta 2-microglobulin is also discussed in the diagnosis of beta 2-microglobulin amyloidosis specific to patients on dialysis. In the light of available evidence, it appears that bone scintigraphy plays, so far, a limited role in the clinical evaluation of skeletal and extra-skeletal abnormalities in chronic renal failure. The potential role of bone scintigraphy in identifying patients with aluminium-related bone disease needs to be investigated further, and in this respect special attention must be given to the problem of high soft-tissue activity associated with impaired renal function. Timing haemodialysis sessions before scintigraphic imaging deserves wider recognition as it reduces high soft-tissue activity, thereby allowing bone uptake to be assessed more accurately. Specific imaging of amyloidosis resulting from beta 2-microglobulin deposition is a promising technique, but the relative value of the two proposed radiopharmaceuticals needs further clarification.

Topics: Amyloidosis; Calcinosis; Chronic Kidney Disease-Mineral and Bone Disorder; Etidronic Acid; Humans; Kidney Failure, Chronic; Organotechnetium Compounds; Radionuclide Imaging; Renal Dialysis; Technetium Tc 99m Medronate

Renal osteodystrophy is a metabolic bone disease and a common complication of end-stage chronic renal failure and maintenance dialysis treatment. In this study, we examined the correlation between quantifying bone scintigraphy and serum biochemical markers in hemodialysis patients.. Bone scintigraphy with technetium-99m-hydroxy-methylene-diphosphonate (99mTc-HMDP) was performed on 28 patients on maintenance hemodialysis. Bone scintigraphy was performed using a standard protocol and was quantified by setting regions of interest (ROIs) over selected regions. The bone-to-soft-tissue ratio (B/ST ratio) at each region was calculated in all patients. The B/ST ratios were then compared with serum biochemical markers.. The B/ST ratio for the skull correlated well with serum bone-specific alkaline phosphatase (BAP) (r = 0.735, p < 0.001), serum deoxypyridinoline (DPD) (r = 0.806, p < 0.001) and intact parathyroid hormone (intact PTH) (r = 0.701, p < 0.001). The B/ST ratio for the lumbar spine correlated with intact PTH (r = 0.387, p < 0.05) but not with serum BAP or serum DPD. The B/ST ratio for the femoral neck correlated with serum DPD (r = 0.431, p < 0.05) and intact PTH (r = 0.449, p < 0.05) but not with serum BAP.. Our data suggest that quantitative bone scintigraphy is a sensitive and useful method for evaluating bone metabolism in hemodialysis patients. The B/ST ratio for the skull may reflect changes of bone metabolism in hemodialysis patients.

Topics: Adult; Aged; Alkaline Phosphatase; Amino Acids; Biomarkers; Bone and Bones; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Technetium Tc 99m Medronate

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

A 56-year-old man presented with swelling bilateral shoulders for 2 months. Plain radiograph and CT demonstrated symmetric masses with plaque calcification in bilateral shoulders. A Tc-MDP bone scintigraphy revealed intense radiotracer uptake not only in the masses of bilateral shoulders but also in the masses of the right buttock and the left thigh. The masses in bilateral shoulders were resected, and the pathological examination confirmed the ectopic calcification. This is a rare case of multiple ectopic calcification in subcutaneous tissues in a patient with chronic renal failure.

Topics: Calcinosis; Humans; Kidney Failure, Chronic; Male; Middle Aged; Positron-Emission Tomography; Radiopharmaceuticals; Subcutaneous Tissue; Technetium Tc 99m Medronate

A 51-year-old woman on peritoneal dialysis for chronic renal failure secondary to diabetic and nonsteroidal anti-inflammatory drug nephropathy was referred for a Tc-99m MDP bone scan to assess firm subcutaneous plaques in the sacral and gluteal regions. This showed extensive superficial tracer localization in the subcutaneous tissues as well as visceral tracer activity in the myocardium, lungs, stomach, and kidneys. These findings were typical for calciphylaxis (calcific uremic arteriolopathy), a form of metastatic calcification encountered in patients with chronic renal failure that is characterized by subcutaneous soft tissue calcification, painful ulcerations, high morbidity, and mortality. Treatment with sodium thiosulfate resulted in dramatic scintigraphic improvement.

Topics: Bone and Bones; Calcinosis; Calciphylaxis; Female; Humans; Ischemia; Kidney Failure, Chronic; Middle Aged; Necrosis; Neoplasm Metastasis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thiosulfates; Tissue Distribution

The measurement of protein binding is essential for accurate quantitative studies of skeletal kinetics using Tc-methylene diphosphonate (Tc-MDP). In this study, the dependence of Tc-MDP protein binding on total plasma clearance (Ktotal) and serum albumin concentration was investigated using data from two groups of patients.. The first group (study 1) consisted of 71 patients referred for a Tc-MDP bone scan examination. The second group (study 2) consisted of 100 subjects referred for a determination of glomerular filtration rate (GFR) and injected with 3 MBq Tc-MDP and 3 MBq Cr-EDTA. Free Tc-MDP was measured using ultrafiltration and the percentage of free Tc-MDP analysed for the effect of Ktotal and serum albumin concentration using multivariate regression analysis.. When the percentage of free Tc-MDP was analysed for the effect of Ktotal and serum albumin, highly significant relationships were found at the 2, 3 and 4 h time points. Subjects with higher values of Ktotal or serum albumin concentration had a lower percentage of free Tc-MDP and the magnitude of the regression coefficients increased with time.. Multivariate regression analysis confirmed that Ktotal and serum albumin were highly significant factors in determining the percentage of free Tc-MDP measured at the 2, 3 and 4 h time points.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Area Under Curve; Blood Proteins; Bone and Bones; Chelating Agents; Edetic Acid; Female; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Male; Middle Aged; Protein Binding; Radionuclide Imaging; Radiopharmaceuticals; Serum Albumin; Technetium Tc 99m Medronate; Ultrafiltration

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

We prospectively investigated the incidence of femoral head avascular osteonecrosis (AVN) and radio-uptake patterns of femoral heads on bone scintigraphy at 1 year after renal transplantation.. A total of 237 subjects (473 femoral heads) were included. A bone scintigraphy was performed at 12 +/- 1.1 months after renal transplantation, and 17 hips were painful at the time of bone scintigraphy. We graded the radioactivity in each femoral head as normal (grade 0), mildly increased (grade I), and definitely increased (grade II). Typical photon defects in the upper lateral femoral heads were evaluated separately. AVN was confirmed with clinical follow-up of more than 1 year and MRI and/or plain radiography findings.. Femoral head AVN was detected in 15 of the 237 patients and 23 of the 473 femoral heads. When grade I and II activities were used as positive criteria, bone scintigraphy had a sensitivity of 91.3% (100% with pain) and specificity of 74.0% (100% with pain) for AVN diagnosis. When only grade II activity was considered positive, the rates were 56.5% (80.0% with pain) and 99.5% (100% with pain), respectively. The presence of a typical photon defect had a low sensitivity of 47.8%, although the specificity was high (99.1%).. The incidence of femoral head AVN was low among a prospective cohort of renal transplantation recipients at the time of 1 year after engraftment. Planar bone scintigraphy is sufficient to diagnose AVN in symptomatic patients at risk for femoral head AVN using grade I and II activities as positive criteria.

Topics: Adult; Female; Femur Head Necrosis; Follow-Up Studies; Humans; Incidence; Kidney Failure, Chronic; Kidney Transplantation; Korea; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Technetium Tc 99m Medronate

Calciphylaxis is a highly morbid syndrome of vascular calcification and skin necrosis, the pathophysiology of which remains largely elusive. We report a patient with end-stage renal disease and multiple painful skin lesions who underwent a bone scan for extremity pain. Increased tracer accumulation was seen in the subcutaneous tissues of the trunk and lower extremities. In this case, the bone scan aided in the diagnosis and treatment of calciphylaxis for a patient who experienced a relatively short hospital stay.

Topics: Aged; Bone and Bones; Calcinosis; Calciphylaxis; Female; Humans; Kidney Failure, Chronic; Necrosis; Radionuclide Imaging; Radiopharmaceuticals; Skin Ulcer; Syndrome; Technetium Tc 99m Medronate; Vascular Diseases

Topics: Bone and Bones; Calcinosis; Female; Humans; Intestinal Diseases; Kidney Failure, Chronic; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

End-stage renal disease (ESRD) patients receiving chronic hemodialysis (HD) via an arteriovenous (A-V) access often develop unexplained pulmonary hypertension (PHT). This study evaluated the role of pulmonary calcification (PC) in this phenomenon.. The clinical manifestations, systolic pulmonary artery pressure (PAP) values measured by Doppler echocardiography and the presence and the extent of PC expressed by lung uptake of 99mTc-MDP bone scintigraphy, were studied in 49 patients with ESRD receiving chronic HD therapy via A-V access. The correlation between PC and PHT was investigated.. There were 36 men and 13 women with a mean age of 61.7 +/- 13.2 years receiving HD therapy for 38.2 +/- 43.7 months. Twenty (40.8%) patients had PC expressed by increased lung uptake of 99mTc- MDP and 28 (57.1%) patients had PHT with a mean systolic PAP of 46 +/- 11 mm Hg. No correlation was found between PC and PHT.. The data suggest that PC expressed by lung uptake of 99mTc-MDP has no role in the pathogenesis of PHT among ESRD patients undergoing HD therapy via A-V access.

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Calcinosis; Female; Humans; Kidney Failure, Chronic; Lung Diseases; Male; Middle Aged; Pulmonary Wedge Pressure; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Technetium Tc 99m Medronate

Topics: Adult; Calcinosis; Cardiomyopathies; Connective Tissue Diseases; Humans; Kidney Failure, Chronic; Male; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Technetium Tc 99m Medronate

Soft-tissue calcifications are a frequent complication in patients with chronic renal failure. Numerous underlying factors are thought to favor their formation. A case is presented of a patient who was in end-stage renal failure, secondary to glomerulonephritis. A renal transplant had not been successful. She was on long-term dialysis and had suffered aluminum toxicity (positive desferrioxamine test). She complained of proximal myopathy and bone pain.

Topics: Bone and Bones; Female; Humans; Kidney Failure, Chronic; Lung; Radionuclide Imaging; Radiopharmaceuticals; Skin; 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

Topics: Bone and Bones; Calcinosis; Female; Heart; Humans; Kidney Failure, Chronic; Lung; Male; Middle Aged; Radionuclide Imaging; Renal Dialysis; Technetium Tc 99m Medronate; Uremia

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

A report is presented of a liquefaction necrosis of mitral annular calcification in a patient with chronic renal failure and secondary hyperparathyroidism who had been managed by hemodialysis for 11 years. The mass was echogenic with an echo-lucent area inside, high density on computed tomography and low intensity on magnetic resonance imaging. The uptake of gallium-67 (67Ga)-citrate and the bone agent technetium-99m-methylene diphosphate (99mTc-MDP) was seen in the mass. These findings were compatible with liquefaction necrosis of the mitral annular calcification. After treatment with low calcium concentration hemodialysis, the size of the mass reduced with disappearance of the echo-lucent area on the echocardiography and there was no uptake of 67Ga-citrate or 99mTc-MDP. Liquefaction necrosis might be the early and reversible form of mitral annular calcification. When a tumorlike echogenic mass at the base of mitral leaflets is seen in patients with predisposing factors for mitral annular calcification, consider the possibility of this specific form of mitral annular calcification in order to avoid any unnecessary surgical intervention.

Topics: Calcinosis; Calcium; Citrates; Echocardiography; Female; Gallium; Gallium Radioisotopes; Heart Valve Diseases; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Middle Aged; Mitral Valve; Necrosis; Radiopharmaceuticals; Renal Dialysis; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 59-yr-old man with chronic renal failure was admitted for evaluation of generalized skeletal pain and frontal bone mass, which was lytic on radiography. Bone scintigraphy demonstrated several foci of moderately increased uptake, without involvement of the skull mass. Radiographs of these lesions were compatible with brown tumors. Serum parathormone level was elevated and CT demonstrated a lower right cervical mass, consistent with parathyroid tumor. Following the removal of the mass and decrease in parathormone levels, the patient suffered from a prolonged period of hypocalcemia and his bone pain worsened. Repeat bone scintigraphy showed an increase in the number and intensity of the areas of focal uptake, consistent with hungry bone syndrome. This flare-up phenomenon is due to an increase in bone metabolism and is an uncommon finding following parathyroidectomy for primary hyperparathyroidism.

Topics: Bone and Bones; Bone Diseases, Metabolic; Carcinoma; Humans; Hyperparathyroidism; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Female; Fibrous Dysplasia, Polyostotic; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Mandible; Maxilla; Parathyroid Glands; Radionuclide Imaging; Renal Dialysis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Diffuse pulmonary uptake of both technetium-99m- labeled methylene diphosphonate (99(m)Tc-MDP) and gallium (67Ga) citrate was noted in a patient with chronic renal failure and indicated the presence of pulmonary calcinosis. The uptake of 67Ga could be misinterpreted to represent abnormal uptake due to an opportunistic infection.

Topics: Adolescent; Calcinosis; Female; Gallium Radioisotopes; Humans; Kidney Failure, Chronic; Lung; Lung Diseases; Opportunistic Infections; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Staphylococcal Infections; Technetium Tc 99m Medronate

To determine whether quantitative bone scintigraphy (QBS) with single-energy photon emission computed tomography (SPECT) can help predict which patients with chronic renal disease will show bone mineral density (BMD) loss.. In 18 patients, the percentage of injected dose of technetium-99m methylene diphosphonate per cubic centimeter of bone was measured with QBS SPECT in the lumbar vertebrae and femoral neck. The differences in BMD over an average of 20 months were measured and compared with SPECT measurements. QBS values were also compared with serum bone turnover markers.. There was a negative correlation (r = -.54, P < .05 for the lumbar spine and r = -.60, P < .01 for the femoral neck) between QBS values and bone loss. Positive and negative predictive values, sensitivity, and specificity of QBS for bone loss in the lumbar spine were 78%, 71%, 78%, and 71%, respectively, and in the femoral neck, 82%, 100%, 100%, and 78%, respectively. Differences between predictive values of serum bone turnover markers were not statistically significant.. QBS with SPECT enabled prediction of rapid bone loss in patients with renal disease.

Topics: Absorptiometry, Photon; Aged; Alkaline Phosphatase; Biomarkers; Bone Density; Calcium; Chronic Disease; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Femur Neck; Follow-Up Studies; Forecasting; Humans; Kidney Failure, Chronic; Lumbar Vertebrae; Male; Middle Aged; Osteocalcin; Parathyroid Hormone; Technetium Tc 99m Medronate; 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

Metastatic pulmonary calcification (MPC), a complication of chronic renal failure, is uncommonly diagnosed antemortem, yet may be a significant etiology of pulmonary dysfunction in patients with renal failure. The degree of respiratory distress often does not correlate with the degree of macroscopic calcification. Patients with extensive calcification may be asymptomatic, while others with subtle calcification or normal chest radiographs may have severe respiratory compromise. Additionally, the findings on chest radiographs may be confused with air-space disease, including pulmonary edema and pneumonia. Radionuclide imaging may detect MPC in the setting of normal chest radiographs, and confirm the diagnosis when there are radiographic findings of air-space disease without macroscopic calcification. We present a patient with bilateral upper lobe disease suspected to represent edema or pneumonia, proven to represent MPC on 99mTc MDP scintigraphy with single photon emission computed tomography (SPECT), CT, and later at transbronchial biopsy.

Topics: Bone and Bones; Calcinosis; Diagnosis, Differential; Humans; Kidney Failure, Chronic; Lung Diseases; Male; Middle Aged; Pneumonia; Pulmonary Edema; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

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

Extra-skeletal uptake of bone seeking radiopharmaceuticals has been documented by scintigraphy. We present a case of diffuse uptake of 99mTc-methylene diphosphonate (MDP) in the abdomen of a patient while undergoing continuous ambulatory peritoneal dialysis (CAPD) who had no symptoms or findings referable to the abdomen. We hypothesized that the 99mTc-MDP crossed the peritoneal membrane across a concentration gradient. An in-vitro simulation confirms that 99mTc-MDP will cross a semi-permeable membrane. Diffuse uptake of 99mTc-MDP may be a normal variant in patients on CAPD who have no signs or symptoms of peritonitis.

Topics: Abdomen; Adult; Bone and Bones; Female; Femur Head Necrosis; Humans; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Radionuclide Imaging; Technetium Tc 99m Medronate

Deposition of amorphous calcium salts in muscle tissue is not only of pathogenic but also of compensatory adaptive character. This occurs in response to bone exclusion from the system of regulation of calcium homeostasis (aluminum or severe uremic intoxication). Apparently, amorphous depositions of calcium salts may buffer fluctuations in ion concentration. Their accumulation is a marker of the weakening of the cellular mechanisms and enhancement of the physicochemical ones by which calcium homeostasis is maintained.

Topics: Biopsy; Bone and Bones; Calcium; Humans; Kidney Failure, Chronic; Kidney Transplantation; Muscles; Osteoblasts; Renal Dialysis; Spectrophotometry, Atomic; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

During osteomalacia in patients with terminal renal failure, the coefficient of diphosphonate elimination from the blood bed (K1) was less than 0.1 min-1, which was determined by the rise of the concentration of uremic toxins, inhibiting interaction of the radiopharmaceutical with the bone, in the patients' tissues. Dynamic scintigraphy permits one to study the pharmacokinetics of diphosphonate in every patient and thus can be used for differential diagnosis between osteomalacia and other forms of renal osteodystrophy.

Topics: Chronic Kidney Disease-Mineral and Bone Disorder; Diagnosis, Differential; Humans; Kidney Failure, Chronic; Osteomalacia; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Abdominal Muscles; Adenocarcinoma; Humans; Kidney Failure, Chronic; Kidney Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Postoperative Care; Technetium Tc 99m Medronate

Sixteen children and adolescents undergoing regular haemodialysis treatment were studied for the occurrence of metastatic calcifications. By the use of diphosphonate bone-scanning, roentgenography of the chest and skull and ocular slit lamp examination, generalized visceral calcification was diagnosed in two patients. No relationship between visceral calcification and biochemical, radiological or histological abnormalities of renal osteodystrophy was found. Our study demonstrates that visceral calcification also occurs in children with chronic renal failure and may be detected by scintigraphy.

Topics: Adolescent; Adult; Bone and Bones; Calcinosis; Child; Female; Humans; Kidney Failure, Chronic; Male; Radiography; Radionuclide Imaging; Renal Dialysis; Technetium Tc 99m Medronate; Viscera

Two methods of estimating bone turnover were investigated. The 24 h whole body retention (WBR) of intravenously injected 99mTc methylene disphosphonate (99mTc-MDP), a precise, accurate, and generally accepted method, was compared with a new, simple, measurement involving assessment of the 24 h urinary excretion (UE) of 99mTc-MDP. The WBR and UE were measured in 50 normal subjects, 10 patients with thyrotoxicosis, and 10 patients with chronic renal failure. The precision was 4.8% and 2.7%, respectively, and the two methods were highly significantly correlated (r = 0.99, SEE = 2.9%, p less than 0.001). In addition, urinary 99mTc-MDP excretions at 0 h-4 h (UE4) and 0 h-8 h (UE8) after injection were calculated in 49 subjects. The estimation of WBR from UE4 or UE8 was considerably poorer than from UE (for UE4: r = -0.83, SEE = 8.7%, and for UE8: r = -0.90, SEE = 6.8%) and the precision of UE4 and UE8 was 7.2% and 7.8%, respectively, and greater than those of both UE and WBR. It is concluded that the UE bone turnover measurement may become a simple, radiation dose-saving method to diagnose and monitor the treatment of metabolic bone diseases.

Topics: Adult; Bone and Bones; Female; Humans; Kidney Failure, Chronic; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyrotoxicosis

A rare case of extensive dermal uptake of Tc-99m MDP associated with renal failure is reported. The mechanism of Tc-99m MDP uptake in such examples of metastatic calcification is not proved, but may relate to adsorption onto hydroxyapatite crystals. This phenomenon is useful in demonstrating distribution of nonvisceral metastatic calcification.

Topics: Adult; Calcinosis; Female; Humans; Kidney Failure, Chronic; Liver; Liver Cirrhosis; Polycystic Kidney Diseases; Radionuclide Imaging; Skin; Skin Diseases; Technetium Tc 99m Medronate

Topics: Bone and Bones; Diphosphonates; Humans; Kidney Failure, Chronic; Lung; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Ribs; Technetium; Technetium Tc 99m Medronate

Using compartmental analysis techniques, we modeled the biodistribution of Tc-99m(Sn)methylene diphosphonate in humans on a computer, and by selectively perturbing appropriate rate constants, we simulated changes in contrast between bone and soft tissue in a number of systemic disorders. The model predicts low contrast in patients with moderate to marked edema, obesity, congestive heart failure or decreased cardiac output states and high contrast with as little as 25% increase in bone avidity for the tracer. In acute renal failure without fluid-volume imbalance, image contrast should be normal. The model predicts greater contrast shortly after injection in patients with increased cardiac output, skeletal blood flow, or bone avidity; images made at these times would be indistinguishable. These simulations are in keeping with reports in the literature of bone images and bone-to-soft tissue ratios in many of these conditions, suggesting that modeling studies could play an important role image interpretation.

Topics: Acute Kidney Injury; Aged; Blood Circulation; Bone and Bones; Bone Development; Cardiac Output; Computers; Diphosphonates; Edema; Humans; Kidney Failure, Chronic; Middle Aged; Radiographic Image Enhancement; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technology, Radiologic

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: Adult; Aged; Alkaline Phosphatase; Bone and Bones; Calcium; Diphosphonates; Humans; Kidney Failure, Chronic; Middle Aged; Phosphorus; Radionuclide Imaging; Renal Dialysis; Technetium; Technetium Tc 99m Medronate; Time Factors

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphonates; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Kinetics; Liver Cirrhosis; Middle Aged; Osteitis Deformans; Osteomalacia; Osteoporosis; Technetium; Technetium Tc 99m Medronate