technetium-tc-99m-medronate and Leukemia

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

The purpose of this study was to reveal the bone scan abnormalities in children with leukemia and to show the value of whole-body scanning in early and delayed phases.. From a database of all patients with a diagnosis of leukemia from January 1990 to April 2000, 12 children (9 male, 3 female; mean age, 8.0 y; age range, 4.7--13.2 y) were identified for whom the diagnosis of leukemia was suggested on the basis of bone scans obtained as part of the initial work-up for unexplained skeletal pain. Early and delayed whole-body bone scans and radiographs were reviewed retrospectively. Areas of abnormal uptake on early and delayed phases were categorized into locations: metaphysis--diaphysis--epiphysis (MDE), pelvis, ribs, spine, and others. MDE lesions included abnormalities in the metaphysis extending into the diaphysis for some length: metaphysis/diaphysis, metaphysis only, diaphysis only, epiphysis only, and the entire bone. Pelvic and spine lesions were further characterized as focal or diffuse.. Ten patients had lesions in 2 or more locations on both phases. Two patients had multiple lesions on the early scans but only rib lesions on the delayed scans. Lesions correlated with symptomatic sites in 8 patients on the delayed scans and in 11 patients on the early scans. The most common sites of abnormalities on the delayed scans were metaphyseal/diaphyseal, pelvis (focal), and ribs. The most common locations of lesions on the early scans were metaphyseal/diaphyseal, pelvis (diffuse or focal), and spine. More metaphyseal/diaphyseal lesions were seen on the early scans than on the delayed scans. Diffuse involvement of the pelvis and spine was seen only on the early phase. However, rib lesions were seen more frequently on the delayed scan.. Early whole-body imaging in conjunction with delayed whole-body scanning may enhance the diagnostic accuracy of bone scanning in the evaluation of children with skeletal pain of obscure etiology, such as that associated with leukemia.

Topics: Adolescent; Bone and Bones; Child; Child, Preschool; Diaphyses; Epiphyses; Female; Humans; Leukemia; Male; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Ribs; Spine; Technetium Tc 99m Medronate; Time Factors

Two patients with T-cell malignancy having radiographic manifestations of generalized and localized bone demineralization are reported. One, a 53-year-old man, had marked osteoporosis and severe hypercalcemia, but no clinical evidence of leukemia throughout his illness. At autopsy there was no definite evidence of bone involvement. Histologic proof was obtained from abdominal skin which revealed "adult T-cell leukemia/lymphoma (ATLL)." The second case, a 33-year-old man, complained of arthralgia in his hands and feet; radiographs showed severe localized demineralization and pathologic fractures. Specimens of his peripheral blood, cervical lymph nodes, and bone marrow revealed ATLL cells.

Topics: Adult; Bone and Bones; Deltaretrovirus; Humans; Leukemia; Male; Middle Aged; Minerals; Osteoporosis; Radiography; Radionuclide Imaging; Retroviridae Infections; Technetium Tc 99m Medronate

We report a case of adult T-cell leukemia with increased uptake in both lungs which was detected by a bone scan using 99mTc-MDP. This finding is thought to have been caused by the metastatic calcification which is associated with ectopic parathormone production.

Topics: Adult; Calcinosis; Diphosphonates; Humans; Leukemia; Lung Neoplasms; Male; Radionuclide Imaging; T-Lymphocytes; Technetium; Technetium Tc 99m Medronate

The 24 h-whole-body retention (WBR), determined by a whole-body counter, may be used to quantify exactly bone seeking properties of a radiopharmaceutical. The 24h-WBR of 99mTc-methylene-diphosphonate was determined in 200 patients and was found to be independent of kidney function if this function was normal or only slightly diminished. The 24h-WBR was slightly dependent on age since it decreased up to 20 years of age, reaching a minimum at 20-25 years, and then increased with increasing age. Normal values of 24h-WBR for individuals of more than 20 years of age were 31.8 +/- 5% of injected dose. Not more than two focal accumulations, i.e. skeletal metastases, failed to elevate the 24h-WBR significantly (p less than 0.1). However, a highly significant (p less than 0.001) difference to normals was found in patients with multiple metastases (24h-WBR: 38.2 +/- 7%), with diffuse osseous involvement as in primary hyperparathyroidism (24h-WBR: 49 +/- 11.7%, p less than 0.001) or with osteoporosis (24h-WBR: 45%). The 24h-WBR was found to be very sensitive in grading diffuse osseous involvement. This was shown in single-tumor patients by follow-up as the 24h-WBR in addition to bone scans was useful to describe progression or remission. Moreover, the 24h-WBR correlated closely with results of bone marrow biopsies in a small group of patients with malignancies of the lymphoreticular system.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Hyperparathyroidism; Leukemia; Lymphoma; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

Three leukemic patients showing minimal bone uptake of Tc-99m pyrophosphate but with good uptake of methylene diphosphonate are described.

Topics: Aged; Bone and Bones; Diphosphates; Diphosphonates; Female; Humans; Leukemia; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate