technetium-tc-99m-medronate and Liver-Neoplasms

Topics: Female; Hemangiosarcoma; Humans; Liver; Liver Neoplasms; Middle Aged; Phosphates; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Bone scanning is the most frequent type of radionuclide examination performed. We present a case of reduced uptake on a bone scan thought to be due to etidronate therapy. Other causes of this phenomenon are reviewed.

Topics: Aged; Back Pain; Bone and Bones; Etidronic Acid; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

The aim of this prospective study is to evaluate the diagnostic and prognostic usefulness of F-18 sodium fluoride (NaF) positron emission tomography-computed tomography (PET-CT) relative to Tc-99m methylene diphosphonate (MDP) planar bone scintigraphy with no CT (BS) for hepatocellular carcinoma (HCC) patients with suspicious bone metastasis.. Both Tc-99m MDP BS and F-18 NaF PET-CT were performed for 34 consecutive Taiwanese HCC patients (five female and 29 male; mean age, 61.0+/-12.0 years) within a time span of 1 month (mean: 11.3+/-10.4 days). The accuracies of BS and PET-CT were determined by comparing their results with the finalized clinical data in a lesion-by-lesion manner.. According to the pathological and/or follow-up results, the accuracy for detecting metastatic bone lesions by Tc-99m MDP BS is 75.4% and that by F-18 NaF PET-CT is 95.7%, respectively. F-18 NaF PET-CT is significantly more accurate than Tc-99m MDP BS (P=0.0001). Furthermore, there is a significant correlation between the presence of F-18 NaF PET-CT-positive bone lesions and the survival time of HCC patients. On the other hand, the diagnostic results from BS are not correlated with the survival time of these HCC patients.. F-18 NaF using PET-CT system has significantly better sensitivity and specificity than conventional Tc-99m MDP BS in detecting metastatic HCC bone lesions that are predominantly osteolytic. The diagnostic result of PET-CT also serves as a more effective prognostic indictor for HCC patients.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Hepatocellular; Female; Fluorine Radioisotopes; Follow-Up Studies; Humans; Liver Neoplasms; Male; Middle Aged; Positron-Emission Tomography; Prognosis; Prospective Studies; Sodium Fluoride; Survival Analysis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In order to evaluate the diagnostic reliability of somatostatin receptor scintigraphy (SRS) in patients treated with somatostatin analogs, ten patients with metastatic neuroendocrine tumors were investigated before and during continuous treatment. Different somatostatin analogs were used for therapy: five patients received octreotide (Sandostatin, Sandoz, Switzerland) and five were treated with BIM 23014 (Lanreotide, Ipsen Biotech, France) within the scope of a clinical phase II study. The SRS findings were analyzed in terms of biodistribution of the labeled somatostatin analog and tumor visualization comparing the two studies in each patient. Whereas liver, spleen, and kidney uptake were decreased during octreotide treatment and increased on lanreotide therapy, tumor accumulation was intensified in all but one patient. Our results suggest that the diagnostic value of SRS is not necessarily restricted during treatment with somatostatin analogs. Indeed, tumor visualization may even be enhanced in this therapeutic setting.

Topics: Adult; Aged; Antineoplastic Agents; Biomarkers, Tumor; Carcinoid Tumor; Female; Humans; Indium Radioisotopes; Liver Neoplasms; Male; Metabolic Clearance Rate; Middle Aged; Octreotide; Pentetic Acid; Peptides, Cyclic; Radionuclide Imaging; Receptors, Somatostatin; Somatostatin; Technetium Tc 99m Medronate; Tissue Distribution

A 65-year-old man presented with abdominal bloating, pain, and nausea for 5 days. Abdominal CT revealed a heterogeneous mass with a large area of calcification, and rupture of the mass was seen around the capsulafibrosa. According to pathological examination after percutaneous puncture biopsy, the histopahological and immunohistochemical findings were suggestive of metastatic or primary hepatic osteosarcoma. Whole body bone scintigraphy demonstrated elevated 99mTc-MDP activity in hepatic mass, but no skeletal lesions. The diagnosis of primary hepatic osteosarcoma was finally confirmed. PET/CT showed hepatic mass with heterogeneous high-uptake, and multiple metastases in portacaval lymph nodes, lungs and the third thoracic vertebra were considered.

Topics: Aged; Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Osteosarcoma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Primary hepatic angiosarcoma was diagnosed in a 59-year-old woman who presented an arthralgia of limbs and dry cough for 6 weeks. Physical examination revealed digital clubbing. A Tc-MDP bone scintigraphy showed diffusely increased uptake along the cortical margins of long bones, suggesting hypertrophic osteoarthropathy.

Topics: Female; Hemangiosarcoma; Humans; Liver Neoplasms; Middle Aged; Osteoarthropathy, Secondary Hypertrophic; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone is the third most common site of metastasis from hepatocellular carcinoma (HCC), the first two being the lung and lymph nodes, respectively. Metastatic HCC has been reported in the vertebrae, ribs, pelvis, and femur, which are more common sites of bone metastases. We present a case of HCC with metastasis to the distal tibia, fibula, and small bones of the feet as the only sites of bone metastasis, along with a brief literature review.

Topics: Ankle; Bone Neoplasms; Carcinoma, Hepatocellular; Foot; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 36-year-old woman with a history of left above-knee amputation caused by tibial osteosarcoma 3 years ago underwent static Tc-MDP bone scintigraphy to evaluate osseous metastases. Although no lesion in the bone was identified, the images showed an intense activity in the region of the liver. This activity was also shown subsequently by F-NaF and F-FDG PET/CT imaging as a partially calcified lesion in the anterior segment of the right lobe of the liver. Solitary hepatic metastasis form osteosarcoma was suspected and further implied by follow-up studies.

Topics: Adult; Female; Fluorodeoxyglucose F18; Humans; Incidental Findings; Liver Neoplasms; Multimodal Imaging; Osteosarcoma; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Nonosseous uptakes are occasionally found on bone scintigraphy. Most of them are easily explained by current pathophysiological mechanisms (metastatic calcifications, metabolic process, or extravascular accumulation of radiopharmaceutical) or current artifacts. Other unusual findings are still unexplained. We report 1 didactic case of incidental gallbladder uptake on bone scan. Additional single-photon emission computed tomography-computed tomography (SPECT/CT) imaging was performed to better characterize abnormal location. The significance of this serendipitous uptake is not clearly established. This finding could be due to altered distribution induced by the chemotherapy regimen and is not the result of intrinsic gallbladder disease.

Topics: Artifacts; Bone and Bones; Female; Gallbladder; Humans; Liver Neoplasms; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Selective Internal Radiation Therapy (SIRT) is a new and effective locoregional anticancer therapy for colorectal cancer patients with liver metastases. Markers for prediction of therapy response and prognosis are needed for the individual management of those patients undergoing SIRT.. Blood samples were prospectively and consecutively taken from 49 colorectal cancer patients with extensive hepatic metastases before, three, six, 24 and 48 h after SIRT to analyze the concentrations of nucleosomes and further laboratory parameters, and to compare them with the response to therapy regularly determined 3 months after therapy and with overall survival.. Circulating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), C-reactive protein (CRP) and various liver markers increased already 24 h after SIRT. Pretherapeutical levels of CYFRA 21-1, CEA, cancer antigen 19-9 (CA 19-9), asparate-aminotransferase (AST) and lactate dehydrogenase (LDH) as well as 24 h values of nucleosomes were significantly higher in patients suffering from disease progression (N = 35) than in non-progressive patients (N = 14). Concerning overall survival, CEA, CA 19-9, CYFRA 21-1, CRP, LDH, AST, choline esterase (CHE), gamma-glutamyl-transferase, alkaline phosphatase, and amylase (all 0 h, 24 h) and nucleosomes (24 h) were found to be prognostic relevant markers in univariate analyses. In multivariate Cox-Regression analysis, the best prognostic model was obtained for the combination of CRP and AST. When 24 h values were additionally included, nucleosomes (24 h) further improved the existing model.. Panels of biochemical markers are helpful to stratify pretherapeutically colorectal cancer patients for SIR-therapy and to early estimate the response to SIR-therapy.

Topics: Adult; Aged; Biomarkers, Tumor; Cohort Studies; Colorectal Neoplasms; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Multivariate Analysis; Nucleosomes; Predictive Value of Tests; Prognosis; Prospective Studies; Radiopharmaceuticals; Survival Analysis; Technetium Tc 99m Medronate

Topics: Biological Transport; Breast Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Technetium-99m methylene diphosphonate (Tc-99m MDP) whole-body bone scintigraphy (BS) has been widely used for detecting bone metastases. The aim of this study is to investigate the diagnostic accuracy of BS in detecting skeletal metastases for hepatocellular carcinoma (HCC) patients. In addition, the anatomic distribution of the metastatic bone lesions and the prognoses of the HCC patients are also analyzed.. We retrospectively reviewed BS results of 179 consecutive HCC patients from January 2005 to December 2006 in our institution. The false negative (FN) rate, sensitivity, and specificity of BS were evaluated by patient-based and region-based analyses.. A total of 59 patients (33.0%) were confirmed of bone metastases. A total of 25 of these 59 patients (46.3%) had at least one lesion categorized as BS FN, and the bone metastatic status for 10 patients (17.0%) was underestimated by BS. The most observed metastatic site was spine while the most observed sites with FN of BS were the lower extremity. In total, there were 122 metastatic regions and 33 regions (27.0%) were FN of BS. Patients without any metastases survived significantly longer than any of other groups with metastases.. High FN rate of Tc-99m MDP BS in detecting metastatic bone lesions for HCC patients was observed. In our opinion, careful history taking, meticulous examination, and a high index of suspicion are important for HCC patients with unexplained progressive pain in the musculoskeletal system. Even with negative results from Tc-99m MDP BS, the possibility of skeletal metastases cannot be indiscriminately excluded.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Hepatocellular; False Negative Reactions; Female; Humans; Kaplan-Meier Estimate; Liver Neoplasms; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adrenal Gland Neoplasms; Carcinoma, Hepatocellular; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Middle Aged; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 55-year-old woman presented with multiple calvarial cavernous hemangiomas manifesting as right frontal swelling. Craniography and computed tomography showed an osteolytic lesion. Magnetic resonance imaging demonstrated multiple intraosseous lesions, and radioisotope bone scintigraphy identified even more numerous lesions. Total resection of the right frontal lesion and cranioplasty was performed. Histological examination confirmed the lesion as a cavernous hemangioma. Computed tomography of the abdomen revealed multiple hepatic lesions, which might be cavernous hemangiomas. Cavernous hemangioma is a rare bony tumor that should be considered in the differential diagnosis of skull tumors. A patient with multiple cavernous hemangiomas should undergo systemic examination to look for latent lesions, and regular follow-up examinations.

Topics: Craniotomy; Female; Frontal Bone; Hemangioma, Cavernous; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Middle Aged; Plastic Surgery Procedures; Radionuclide Imaging; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome

Neuroblastoma is the third most common malignancy of childhood. 131I-MIBG scintigraphy must be performed in patients with neuroblastoma at the time of staging. The aim of this study is to identify the role of 131I-MIBG scintigraphy in neuroblastoma patients in correlation with other diagnostic modalities for staging of the disease.. Twenty six patients provisionally diagnosed by clinical and imaging criteria to have neuroblastoma were included. On histopathologic verification 5 of these 26 patients were rediagnosed as non-neuroblastoma. Each patient had imaging by ultrasound, CT and/or MRI. In all cases, 131I-MIBG scintigraphy was performed, among them 15 patients had additional 99mTc-MDP bone scan.. The outcome demonstrated that CT and MRI were able to detect lesions in 19 out of 21 patients; while in 2 patients no lesions were detected. 131I-MIBG showed active lesions in 16 out of the above 19 patients, while in 3 patients 131I-MIBG was negative. There were no false positive result by 131I-MBG scan. Accordingly, 131I-MIBG is able to detect neuroblastora lesions with an overall sensitivity of 84.2%, specificity of 100% and an accuracy of 85.7%. Detection of primary lesions by 131I-MIB was significantly better than 99mTc-MDP bone scanning (92.31% vs. 61.54% respectively) (P < 0.05). For skeletal metastases, 131I-MIBG scan has a higher ability to detect more lesions than 99mTc-MDP bone scan (P = 0.023).. 131I-MIBG scintigraphy has an excellent ability to discriminate between neuroblastonia and other small round cell paediatric tumours. 131I-MIBG was found to be significantly superior to conventional bone scanning in revealing both primary and metastatic osseous lesions.

Topics: 3-Iodobenzylguanidine; Adolescent; Adrenal Gland Neoplasms; Bone Marrow Neoplasms; Brain Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Iodine Radioisotopes; Liver Neoplasms; Male; Mediastinal Neoplasms; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Retroperitoneal Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

A 35-year-old man with a history of medullary carcinoma of the thyroid underwent a whole-body bone scan for chest wall pain. Extensive irregular radionuclide uptake was observed in hepatic metastases in both lobes, later confirmed on CT scan. A case of technetium-99m MDP uptake in hepatic metastases from medullary carcinoma of the thyroid is presented and the literature is reviewed.

Topics: Adult; Carcinoma, Medullary; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Neoplasms

The aim of the study was to determine the value of radioisotope bone scans in the preoperative staging of patients with hepatopancreatobiliary (HPB) cancer.. Bone scanning was performed as part of a routine staging protocol in 402 consecutive patients with HPB cancer over a period of 5 years. Patients with positive bone scans underwent coned radiography, computed tomography with review on bone windows, or a bone biopsy. Bone scans were reviewed along with staging investigations, surgical and histological findings. Patients were followed for a minimum of 6 months.. There were 171 patients with colorectal liver metastases, 106 with suspected pancreatic cancer, 47 with hepatocellular cancer, 52 with gallbladder cancer or cholangiocarcinoma, and 26 with other types of HPB cancer. Bone scans were negative in 377 patients (93.8 per cent) and positive in 25 patients (6.2 per cent). Of the 25 positive scans, 16 were falsely positive as a result of degenerative bone disease. Of nine patients with a true-positive bone scan, four had locally irresectable disease and four distant metastases. In only one patient did the bone scan result alone influence the decision to resect the HPB cancer. Overall sensitivity was 100 per cent, specificity 95.9 per cent, positive predictive value 36.0 per cent and negative predictive value 100 per cent.. Bone scanning should not be included in the routine staging protocol for HPB cancer.

Topics: Aged; Biopsy, Needle; Bone Neoplasms; Cholangiocarcinoma; Colorectal Neoplasms; Female; Gallbladder Neoplasms; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Staging; Pancreatic Neoplasms; Preoperative Care; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, Spiral Computed

Topics: Aged; Bone and Bones; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Peritoneal Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Rupture; Technetium Tc 99m Medronate

Topics: Adenocarcinoma; Duodenal Neoplasms; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Bicycling; Bone Neoplasms; Buttocks; Carcinoma, Hepatocellular; Cumulative Trauma Disorders; Humans; Incidental Findings; Liver Neoplasms; Male; Middle Aged; Occupational Diseases; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Injuries; Technetium Tc 99m Medronate

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

Recent advances in the treatment of hepatocellular carcinoma (HCC) have prolonged patient survival. However, the number of patients with bone metastases identified during follow-up examinations has increased. Tc-99m Sn-N-pyridoxy-5-methyltryptophan (Tc-99m PMT) has been reported to accumulate at a high rate in HCC lesions and bone metastases. In the patient described here, whole-body scintigraphy showed accumulation of DTPA galactosyl human serum albumin (Tc-99m GSA) and Tc-99m PMT in bone metastases from HCC. The authors suggest that asialoglycoprotein receptors may be present in bone metastases from well-differentiated HCC. Tc-99m GSA whole-body imaging can be used to detect bone metastases from HCC and to evaluate hepatic reserve.

Topics: Albumins; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tryptophan

Metastatic osteosarcoma most commonly affects the lungs and other bones. Hepatic metastasis at the time of diagnosis is extremely rare. A 14-year-old boy with synovial sarcoma of the left popliteal fossa was treated with surgical resection, radiotherapy for microscopic residual disease, and 1 year of chemotherapy (vincristine, cyclophosphamide, dactinomycin, and doxorubicin). Approximately 10 years after the initial diagnosis, a secondary osteosarcoma developed in the left proximal tibia. Computed tomography at presentation showed bilateral pulmonary metastases and large ossified nodules in the liver that demonstrated abnormal avidity on 99mTc MDP bone scan indicating hepatic metastasis. Despite chemotherapy (cisplatin, ifosfamide, high-dose methotrexate, and dacarbazine), the patient died of progressive disease 4 months after the diagnosis of the second cancer. Hepatic metastasis was found at the time of diagnosis of a secondary osteosarcoma and manifested as ossified nodules. The risk of radiation-induced osteosarcoma should always be considered in decisions about treatment for soft-tissue sarcoma.

Topics: Adolescent; Fatal Outcome; Humans; Liver Neoplasms; Lung Neoplasms; Male; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Ossification, Heterotopic; Osteosarcoma; Radiopharmaceuticals; Radiotherapy; Sarcoma, Synovial; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Clavicle; Humans; Ilium; Liver Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Pyrrolidines; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Scapula; Skull; Technetium Tc 99m Medronate; Tetracycline

Topics: Bone and Bones; Bone Neoplasms; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Necrosis; Pancreatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The authors evaluated the utility of hepatobiliary scintigraphy for tissue characterization of extrahepatic metastases from hepatocellular carcinoma (HCC) using Tc-99m N-pyrydoxyl-5-methyltriptophane (Tc-99m PMT).. We examined 13 patients with HCC (29 extrahepatic metastases and 3 benign bone lesions) and 5 patients with other cancers (15 extrahepatic metastases). Thirty minutes to 6 hours after intravenous administration of Tc-99m PMT, planar (all 47 lesions) and SPECT (42 lesions) images were obtained. Accumulation of Tc-99m PMT in the lesion was evaluated visually by comparing bone scintigraphy, computed tomography, magnetic resonance imaging, or all of these.. Findings were positive in 12 of 13 patients with HCC and extrahepatic metastases (16 of 29 on planar imaging and 21 of 26 on SPECT). Findings in all three benign bone lesions and 15 metastatic lesions from non-HCC primary lesions were negative (0 of 18 on planar imaging, 0 of 16 on SPECT). There were no false-positive findings in these lesions. Lesion-by-lesion sensitivity, specificity, accuracy, and positive and negative predictive values were 55%, 100%, 72%, 100%, and 58% by planar imaging and 81%, 100%, 88%, 100%, and 76% by SPECT, respectively.. Because of the high specificity and reasonable sensitivity, Tc-99m PMT appears to be useful for the differential diagnosis of extrahepatic metastases from HCC. SPECT improves the detectability of small or faint accumulation in metastases from HCC.

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Liver Neoplasms; Male; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed, Single-Photon; Tryptophan

We present the bone scintigrams of two patients, which demonstrate diffuse extraosseous uptake of a bone agent in metastatic masses in the liver, one from a primary lung tumor and one from a primary breast tumor. The bone imaging agent did not localize in the brain metastases in these patients. CTs of the abdomen in both patients showed massive metastases in the liver with multiple areas of tumor necrosis. The CT of the abdomen of the breast cancer patient showed multiple small hepatic calcifications. Autopsy revealed massive tumor necrosis with calcifications in the enlarged liver. In routine bone scintigraphy, diffuse uptake of bone agents in the liver of a patient with a known malignancy should be considered suggestive of massive hepatic metastases.

Topics: Adenocarcinoma; Adult; Aged; Bone and Bones; Breast Neoplasms; Carcinoma, Small Cell; Female; Humans; Liver; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone scintigraphy was performed on a woman 2 y and 10 mo after surgery for rectal cancer. Intense extra-bone accumulations of 99mTc-HMDP were visible in an aortic atherosclerosis lesion and in a metastatic liver tumor. Uptake in the metastatic lesion was confirmed by x-ray CT. Uptake in the aortic lesion was shown as typical calcification by x-ray CT.

Topics: Aged; Aged, 80 and over; Arteriosclerosis; Bone and Bones; Female; Humans; Liver Neoplasms; Postoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Rectal Neoplasms; Technetium Tc 99m Medronate

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.

Topics: Bone Neoplasms; Carcinoid Tumor; Follow-Up Studies; Humans; Indium Radioisotopes; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms, Unknown Primary; Octreotide; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Photons; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Shoulder; Spinal Neoplasms; Sternum; Technetium Tc 99m Medronate; Thoracic Neoplasms

A patient with initial complaints of leg pain and difficulty walking was found to have a large right tibial metastatic tumor and poorly differentiated adenocarcinoma of the lung. Findings from total-body bone scintigraphy include a large area of increased uptake in the proximal half of the right tibia with a photon-deficient area medially, and focal areas of uptake in a right rib, in the femoral neck and the left ileum. An irregular area of increased uptake in the left lung mass was shown by thoracic bone SPECT. This is an unusual case of a tibial metastasis as the first clinical presentation of bronchogenic adenocarcinoma.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Femoral Neoplasms; Femur Neck; Humans; Ileal Neoplasms; Ileum; Liver Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate; Tibia; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Whole-Body Counting

Topics: Bone and Bones; Calcinosis; Child; Female; Humans; Liver Neoplasms; Neuroectodermal Tumors, Primitive; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Lymphangiomatosis is an extremely rare congenital disorder affecting visceral organs and/or the skeletal system. In bone is is usually characterized by multiple lytic lesions with a lacelike pattern and sclerotic margins of various thickness. In this case report we demonstrate the rare sclerotic variant of lymphangiomatosis. We report the development of predominantly sclerotic lesions at different sites by serial radiographs with a long-term follow-up, and show the MRI findings of lymphangiomatosis of the spine.

Topics: Adult; Bone Neoplasms; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lymphangioma; Magnetic Resonance Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors

Topics: Adult; Bone Neoplasms; Brain Neoplasms; Glioblastoma; Humans; Liver Neoplasms; Lung Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Female; Gallium Radioisotopes; Humans; Kidney Neoplasms; Liver Neoplasms; Lymph Nodes; Lymphoma, B-Cell; Radionuclide Imaging; Splenic Neoplasms; Technetium Tc 99m Medronate

Localization of skeletal tracer in a neuroblastoma primary is common but localization in extraskeletal metastatic sites has not received recognition. Tc-99m MDP concentration in hepatic or pulmonary metastases was noted in three of ten patients with such metastases. Lesion size appears to be important for demonstrating these metastases with Tc-99m MDP. This was particularly true for hepatic metastases, which were identified only when they were 5 cm or greater in diameter.

Topics: Bone and Bones; Calcinosis; Child; Child, Preschool; Contrast Media; Female; Follow-Up Studies; Gadolinium; Humans; Image Enhancement; Infant; Infant, Newborn; Liver Neoplasms; Lung Neoplasms; Magnetic Resonance Imaging; Male; Neoplasm Staging; Neuroblastoma; Radiography, Thoracic; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

A 51-year-old man was found to have hepatic metastasis from colon carcinoma. Bone scintigraphy with 99mTc-hydroxymethylene diphosphonate showed a ringlike accumulation corresponding to the hepatic mass, which was without calcification on computed tomography. Treatment with chemotherapeutic agents was started. After 4 months, computed tomography showed that the mass was smaller than before and that the margin was calcified. The extraosseous accumulation of the radionuclide may be evidence supporting earlier speculation on calcification that could not yet be detected by computed tomography.

Topics: Antineoplastic Combined Chemotherapy Protocols; Bone and Bones; Calcinosis; Cisplatin; Colonic Neoplasms; Fatal Outcome; Fluorouracil; Humans; Liver Neoplasms; Male; Middle Aged; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

Topics: Adult; Bone and Bones; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Kidney Neoplasms; Liver Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Spherocytosis, Hereditary; Spleen; Splenectomy; Technetium Tc 99m Medronate

A case of hepatocellular carcinoma metastatic to the mandible is described. The patient reported swelling, pain, and trismus after a pathologic fracture. After a systematic examination with the use of 99mTc-methylene diphosphonate, 67Ga-citrate, and 99mTc-pyridoxyl-5-methyl triptophan scintigraphy the primary focus was discovered in the right lobe of the liver. The focus was confirmed by computed tomography and magnetic resonance imaging. The histopathologic diagnosis of hepatocellular carcinoma was made from a biopsy specimen of the mandibular lesion.

Topics: Carcinoma, Hepatocellular; Fatal Outcome; Gallium Radioisotopes; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Male; Mandibular Neoplasms; Middle Aged; Organotechnetium Compounds; Pyridoxal; Radiography, Panoramic; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Tryptophan

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Citrates; Citric Acid; Gallium Radioisotopes; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Carcinoma, Mucoepidermoid; Humans; Liver Neoplasms; Male; Middle Aged; Parotid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Hemangioma; Humans; Liver Neoplasms; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Thallium Radioisotopes; Ultrasonography

After establishing the diagnosis of carcinoma in the head and neck, routine examinations comprise chest x-ray, bone scan and abdominal ultrasound and are often initiated to exclude or confirm metastatic disease. Data are few on the frequency of metastases at the time of initial diagnosis and reliability of bone scanning and sonography to detect metastases. The aim of the present retrospective study was to define criteria for the use of these latter two methods of examination. The medical records of 382 patients with squamous cell carcinoma who were examined for the first time were analyzed during a four-year period. Bone scanning was performed on 360 patients, but suspect scintigraphic evidence of bone metastasis could be confirmed in only one patient. Only three of 367 patients undergoing abdominal ultrasound were found to have hepatic metastases. Reasons for a practical use of these two methods of examination are discussed.

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; Diagnosis, Differential; Diagnostic Imaging; Head and Neck Neoplasms; Humans; Liver Neoplasms; Magnetic Resonance Imaging; Neoplasm Staging; Otorhinolaryngologic Neoplasms; Prognosis; Technetium Tc 99m Medronate; Ultrasonography

Although bone scintigraphy with 99mTc-MDP is a sensitive diagnostic method to detect bone metastasis, it is not specific for malignancy. A radioactive substance which accumulates specifically into metastatic lesions should be of value. 123I-IMP and bone scintigraphy with 99mTc-MDP were consecutively performed in patients with vertebral bone metastases from hepatocellular carcinoma and lumbar spondylosis deformans in a 7-day interval or shorter. The intensity of uptake was compared. Eighteen of the 20 metastatic lesions (90%) were classified as increased uptake areas in 123I-IMP scintigraphy. MDP-scintigraphy disclosed 16 metastatic lesions (80%), 9 as "hot" lesions (56%) and 7 as "cold" lesions (44%). 123I-IMP scintigraphy was negative in all 12 lesions of lumbar spondylosis deformans. Compared to MDP-scintigraphy, 123I-IMP scintigraphy was more sensitive in detecting vertebral bone metastases of hepatocellular carcinoma with smaller rates of false-positive and false-negative findings.

Topics: Amphetamines; Carcinoma, Hepatocellular; Female; Humans; Iodine Radioisotopes; Iofetamine; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

There have been few studies and case-reports of bone metastases from hepatocellular carcinoma. To determine the characteristics of these metastases, we retrospectively studied 22 patients in whom the diagnosis was established either on the basis of concomitant occurrence of malignant bone lesions and hepatocellular carcinoma in the absence of other detectable malignant disease (n = 15) or on the basis of histological evidence of bone metastasis from an hepatocellular carcinoma (n = 7). There were 21 males and one female. Mean age was 62.5 years. Most patients (88.2%) had chronic alcohol abuse. The bone metastases occurred as the first manifestation of the liver cancer in half the cases (11/22). Time interval between onset of bone symptoms and admission was less than one month in 6 of 11 patients; mean interval was 7.4 weeks. Hepatomegaly was found upon initial physical evaluation in 9 of 11 patients. Pain was the main symptom of bone disease (18/22). Palpable bone masses were found in 6 of 22 patients. Purely osteolytic lesions were seen on roentgenograms in every case; rupture of the cortex and spread to adjacent soft tissues were common findings. The radionuclide bone scan was normal in four of 12 patients. An advanced primary hepatic tumor was found in 84.2% of cases. Histologic examination of bone specimens established the diagnosis of metastasis from a hepatocellular carcinoma in 7 of 9 patients (77.8%). Severe bleeding occurred during one of the nine biopsy procedures. Patients were given symptomatic treatment. Systemic chemotherapy was used in five patients, unsuccessfully. Median survival was three months.

Topics: Bone Neoplasms; Carcinoma, Hepatocellular; Female; Humans; Liver Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Osteolysis; Radiography; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Eleven patients who underwent nuclear medicine bone scanning were reviewed to determine the incidence of bone scan abnormalities associated with hepatoblastoma. Of these, six patients had abnormal bone scan findings--four with focal involvement. Correlating plain radiographs and/or follow-up nuclear bone scans were available for three of these four. All plain films indicated the presence of osteoporosis. Follow-up scans showed improvement or resolution of abnormalities. None of the patients had documented metastatic bone disease. While there has been no prior reported association, the authors attribute the abnormal bone scan findings to a paraneoplastic syndrome of osteoporosis associated with this primary tumor. They conclude that bone scanning is not routinely indicated in the initial diagnostic staging of hepatoblastoma.

Topics: Bone Neoplasms; Child; Child, Preschool; Female; Hepatoblastoma; Humans; Infant; Liver Neoplasms; Male; Osteoporosis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adenocarcinoma, Mucinous; Aged; Colonic Neoplasms; Humans; Liver Neoplasms; Male; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The diagnostic value of N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) scintigraphy was evaluated in 12 patients with 20 bone metastases from hepatocellular carcinoma, in comparison with 99mTc-methylene diphosphonate (99mTc-MDP) bone scintigraphy. Sixteen lesions (80%) were detected by 123I-IMP scintigraphy, whereas four lesions (two lesions in the rib and two lesions after a radiation of 40 Gy) were missed. Of 16 lesions demonstrated as areas of increased uptake in 123I-IMP scan, only eight (50%) showed an increased pattern of uptake in 99mTc-MDP bone scintigraphy. In conclusion, 123I-IMP is a promising radiopharmaceutical for the detection of bone metastases from hepatocellular carcinoma.

Topics: Amphetamines; Bone and Bones; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Iodine Radioisotopes; Iofetamine; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

We describe the case of a man with known prostatic carcinoma and bone metastases who was admitted with jaundice and hepatomegaly. A bone scan showed uptake of diphosphonate by the liver and ultrasound suggested the presence of diffuse metastatic disease. Liver biopsy revealed foci of carcinoma cells in the portal tracts which exhibited positive cytoplasmic staining for prostate-specific antigen, thus confirming the presence of metastatic prostatic adenocarcinoma.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Humans; Liver Neoplasms; Male; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Carcinoma, Hepatocellular; Hepatorenal Syndrome; Humans; Kidney Cortex; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Considerable accumulation of Tc-99m HMDP was noted in a huge splenic mass in a 62-year-old man with hepatocellular carcinoma. An autopsy revealed a massive hemorrhage within the splenic metastasis. The splenic uptake of the radionuclide corresponded to the marked deposition of hemosiderin.

Topics: Carcinoma, Hepatocellular; Hemorrhage; Hemosiderin; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spleen; Splenic Diseases; Splenic Neoplasms; Technetium Tc 99m Medronate

Both biodegradable emboli and pharmacological agents can enhance regional therapy for hepatic targeting. Using a rat model with similar haemodynamic characteristics to human colorectal liver tumour and a radio-labelled marker of similar molecular weight to Adriamycin, we have combined the two approaches to see if the effect was addictive. Following induction of liver tumour in male hooded rats by intrahepatic injection of HSN sarcoma cells, the relative distribution of marker, 99mTc methylene diphosphonate (MDP), was studied in three groups given the following by injection into the hepatic artery. (1) Saline (Control) + MDP; (2) Degradable Starch Microspheres (DSM) + MDP; and (3) Angiotensin II + DSM + MDP. Both Degradable Starch Microspheres alone (P less than 0.001) and Degradable Starch Microspheres + Angiotensin II (P = 0.003) significantly increased the retention of marker in liver and tumour at 1 min following injection, with a 12-fold improvement over controls, but the tumour:liver ratio was unaltered. By 90 min the MDP levels in normal hepatic parenchyma had returned to control values. There was relatively less washout with significant retention in tumour tissue in both DSM (P = 0.03) and combination treated animals (P = 0.001), with a significantly improved (P = 0.001) tumour to liver ratio (5.22:1) in combination treated animal relative to those treated with DSM alone.

Topics: Angiotensin II; Animals; Colonic Neoplasms; Drug Carriers; Liver Neoplasms; Male; Microspheres; Neoplasm Metastasis; Radionuclide Imaging; Rats; Rats, Inbred Strains; Rectal Neoplasms; Sarcoma, Experimental; Starch; Technetium Tc 99m Medronate

Topics: Ascites; Carcinoma, Hepatocellular; Humans; Hydrothorax; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

A 99mTc-MDP scan was done on a patient with liver metastases from a medullary thyroid carcinoma who, in addition, had a familial history of multiple endocrine neoplasm, type 2. The scan revealed accumulation in several areas of calcified liver metastases.

Topics: Adult; Calcinosis; Carcinoma; Female; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Bone and Bones; Carcinoma, Hepatocellular; Child, Preschool; Humans; Liver; Liver Neoplasms; Male; 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: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

The clinical records of 94 patients with regionally advanced melanoma (nodal disease or regional satellites) were reviewed to determine the value of preoperative bone and liver imaging. Of 68 bone scans obtained, none were suggestive of metastases. of 97 liver imaging studies (computed tomography, scintiscan, or sonography) in 88 patients, only two were found to have demonstrable metastases. Liver enzyme elevation was present in both of these patients. Bone and liver imaging in the absence of signs or symptoms of dissemination by history, physical examination, chest x-ray, and enzyme determination for regionally advanced melanoma appears to be of little value unless the patient is involved in a protocol study.

Topics: Alkaline Phosphatase; Bone Neoplasms; Female; Humans; Liver Neoplasms; Male; Melanoma; Middle Aged; Radionuclide Imaging; Skin Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

The scintigraphic features of malignant epithelioid hemangioendothelioma of the liver have not been previously documented. In particular, there are no reports on the nature of gallium uptake in these rare tumors. The case reported is a young woman with primary hepatic epithelioid hemangioendothelioma. Metastatic disease in the skull was detected on a Tc-99m MDP bone scan. A Ga-67 study demonstrated that this tumor was not gallium avid.

Topics: Adult; Bone and Bones; Female; Gallium Radioisotopes; Hemangioendothelioma; Humans; Liver Neoplasms; Radiography; Radionuclide Imaging; Skull Neoplasms; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone and Bones; Female; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Carcinoma, Small Cell; Female; Humans; Liver Neoplasms; Lung Neoplasms; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Bone Diseases; Female; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Examination for liver and bone metastases was performed in 30 women suffering from carcinoma of the uterus and in 27 with cervical and 37 with ovarian carcinoma. Scintigraphy was the examination method of choice in bone metastases and computed tomography in liver metastases. Bone metastases were not seen in any patient in the stages I to IV with carcinoma of the cervix and ovarian carcinoma. Bone metastases were found in one patient in stage III and in one in stage IV with carcinoma of the uterus. Liver metastases were found in four patients in stages III and IV with carcinoma of the uterus and in five patients with ovarian carcinoma.

Topics: Bone Neoplasms; Female; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Ovarian Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Uterine Cervical Neoplasms; Uterine Neoplasms

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

Seventy children (3.7 +/- 3.3 y) with definitely confirmed diagnosis of neuroblastoma had 115 whole body scans carried out 24 h after injection of 3.7 MBq/kg of I-123 mIBG (83 scans) or 0.7 MBq/kg of I-131 mIBG (17 scans) or 0.9 to 4.5 GBq of I-131 mIBG (15 post-therapeutic scans). The scans were interpreted as positive in the presence of any non-physiological uptake area or of any bone uptake of the tracer, even at the level of the metaphyseal complex. For the primary tumour, the sensitivity of mIBG scans was 73%. Ten false negative patients had an overlap of the tumour with the bladder or heart images (4 cases) or with positive metastatic images (6 cases: liver, spine). Three false negative patients had neuroblastomas which did not secrete catecholamines. The specificity of mIBG was 94%. In our opinion, mIBG scans have a complementary role to assess the activity of post-therapeutic remnants. For the detection of hepatic and lymph node metastases, the sensitivity was about 50% and the specificity was 100%. The standard used for the detection of bone marrow metastases was the cytological and histological examination of 10 bone marrow aspirations and one or more biopsies (CHBMS). The sensitivity of mIBG scans was 90% and the specificity 68%. However, reviewing the data from the 16 false positive scans, we found 11 definitely proven bone metastases, 3 biological relapses and 2 cases of delayed abnormal CHBMS supporting the positivity of the mIBG scans, raising the specificity to 100%. Tc-99m diphosphonate bone scans had a sensitivity of 78% and a specificity of 51%. We suggest that positive mIBG scans may save other procedures since our data do not support false positive detection of bone or bone marrow metastases. In contrast, patients with negative mIBG findings should be further explored.

Topics: 3-Iodobenzylguanidine; Bone and Bones; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Humans; Infant; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Lymphatic Metastasis; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Focal uptake of 99mTc-MDP was seen in a case of hepatoblastoma. The focal uptake corresponded to an area of calcification on CT, which was shown histologically to consist of osteoid with mineralization. The mechanism of uptake by the tumor in this case is likely to be the same as for skeletal uptake.

Topics: Calcinosis; Carcinoma, Hepatocellular; Humans; Infant; Liver Neoplasms; Male; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

To determine the frequency with which liver metastases are visualized on bone scintigraphy, 425 pairs of liver and bone scans, performed within one month of each other, were reviewed. Sixty-three of the 425 liver scans showed metastases. Of these 63, five cases of carcinoma of the colon and six cases of carcinoma of the lung also visualized by Tc-99m MDP scintigraphy. This represented 46% of colon metastases and 15% of lung metastases detected on liver scan. Liver metastases from other primary tumors were not detected on bone scan, but the numbers for these tumors were small. The liver metastases which were detected on bone scan were significantly larger than those which were not. The literature was reviewed and the primary and secondary tumors of liver with uptake of Tc-99m phosphate compounds listed.

Topics: Bone and Bones; Humans; Liver Neoplasms; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Female; Humans; Liver Neoplasms; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Female; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Liver Neoplasms; Male; Middle Aged; Radiography; Radionuclide Imaging; Ribs; Spinal Neoplasms; Technetium Tc 99m Medronate

The scintigraphic findings on sulfur colloid liver-spleen imaging, Tc-99m labeled RBC blood pool imaging, and Tc-99m MDP bone imaging in four patients with infantile hemangioendothelioma are described. Thirteen radionuclide studies were performed, with serial sulfur colloid images obtained in three patients, allowing interval assessment of liver size and tumor involvement. Findings of Tc-99m MDP uptake in the livers of two patients with hemangioendothelioma and diffuse increase in hepatic RBC labeled blood pool activity in one patient also are reported.

Topics: Child, Preschool; Erythrocytes; Female; Hemangioendothelioma; Humans; Infant; Infant, Newborn; Liver Neoplasms; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

To evaluate the significance and frequency of skeletal imaging agent localization in hepatic metastases from colonic carcinoma, scintigrams from 54 patients were retrospectively studied. Of 54 patients, 22 had hepatic metastases, and skeletal metastases were present in seven of 54. Six of the seven patients with skeletal metastases had concurrent hepatic deposits. Two patterns of bone agent localization in liver metastases occurred: diffuse and mild (10 patients) and ringlike in appearance (two patients). Twelve of the 22 patients had localization of skeletal imaging agent in hepatic metastases and extensive or large liver lesions. Concurrent serum calcium values for nine of 12 patients were reviewed; none had a high level of serum calcium. Among available plain films and /or CT scans of the abdomen for 21 of the 22 patients, only one patient with extensive colonic metastases had multiple calcifications shown on CT but not seen in plain films. The data indicate a high frequency of hepatic metastases in colon carcinoma (22/54, 40%) and a high frequency of skeletal imaging agent localization in the hepatic colonic metastases (12/22, 54.5%). Once skeletal metastases are observed, there are almost always hepatic metastases present (6/7). There was no relation between elevated serum calcium values and bone agent localization in hepatic deposits. The relation between skeletal imaging agent localization or radiographic calcifications and histopathology of colonic carcinoma was inconclusive. The presence of bone agent localization in a 99mTc hydroxymethylene diphosphonate (HMDP) bone study indicates colonic hepatic metastases that are substantially widespread and/or bulky.

Topics: Aged; Calcium; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Technetium Tc 99m Medronate

Data on 1,601 patients with node-positive operable breast cancer who were randomized in four different prospective adjuvant therapy trials were analyzed to evaluate the role of routine bone scans and the alkaline phosphatase value at regular intervals in screening for bone involvement. Bone scan was a prerequisite for randomization and was repeated within the first 12 months in 90% (1,441) of the patients. Abnormal or doubtful scan findings had to be verified by x-ray examination. The repeated scan results were normal in 1,263 (87.8%) patients, doubtful but with no radiologic evidence of bone metastasis in 161 (11%), and abnormal (radiologically confirmed) in 17 (1.2%). After a median observation of 4 years bone metastases as the first relapse developed in 136 (8.5%) patients. This occurred in 87 of 1,263 (6.9%) of the patients with normal repeated scan results and in 18 of 161 (11.2%) of those with doubtful repeated scan findings. Based on the results of the first repeated scan, early detection of a first recurrence in bone might have been possible for 2.4% of the population. Serum alkaline phosphatase levels were also without clinical use. Bone scan in the observation of patients with operable breast cancer should be performed only as dictated by the clinical situation.

Topics: Alkaline Phosphatase; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Female; Follow-Up Studies; Humans; Liver Neoplasms; Risk; Technetium Tc 99m Medronate; Tomography, Emission-Computed

A cavernous hemangioma of the liver presented as an area of increased activity on an isotope bone scan. A review of the literature fails to reveal any previous reports of this phenomenon.

Topics: Bone and Bones; Erythrocytes; Female; Hemangioma, Cavernous; Humans; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Diffusely increased radioactivity in the thoracoabdominal region (lower thorax and/or upper abdomen) occasionally has been observed when performing Tc-99m phosphonate bone studies. To assess the significance of activity in this finding, 1100 bone scintigrams were reviewed and the clinical data and other diagnostic imaging procedures were evaluated in these cases. With the exclusion of Tc-99m sulfur colloid liver-spleen scans 18 patients were found to have mild but diffuse increased radioactivity in the thoracoabdominal region either on the right or left. Clinical findings in these cases with abnormal uptakes were pleural effusions (six cases), hepatic colonic metastases (six cases), splenic metastases from bronchogenic carcinoma (one case), abdominal and peritoneal colonic metastases (one case), a massive metastatic squamous cell carcinoma (from lung) in the right lower chest (one case), and defective radiopharmaceuticals (three cases). Since the defective radiopharmaceuticals contained 5% of hydrolyzed reduced Tc-99m colloid by thin-layer chromatography, each of three patients received approximately 740 mu Ci of Tc-99m sulfur colloid. Factors to be considered in the interpretation of diffuse thoraco-abdominal activity from a bone agent should include splenic or hepatic metastases, a Tc-99m sulfur colloid splenic or hepatic metastases, a Tc-99m sulfur colloid study within the previous 24 hours, pleural effusion, faulty radiopharmaceuticals, and abdominal and peritoneal colonic metastases.

Topics: Abdomen; Aged; Bone and Bones; Colonic Neoplasms; Humans; Liver Neoplasms; Male; Pleural Effusion; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Thorax

Topics: Aged; Carcinoma, Hepatocellular; Humans; Liver; Liver Neoplasms; Male; 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

Abnormal accumulation of Tc-99m MDP in two metastatic lesions of the liver was observed in a patient with resected colon carcinoma. Single-photon emission computed tomography (SPECT) revealed characteristic marginal accumulation of Tc-99m MDP in both of those metastatic lesions. X-ray CT showed the corresponding marginal calcification in one of the metastases, but no apparent calcification was observed in the other lesion. Two months later, however, the latter also became calcified on x-ray CT. These findings suggest that the accumulation of Tc-99m MDP in the present case is strongly related to the calcium deposition and that Tc-99m MDP may accumulate in a calcified metastatic lesion before the calcification appears on x-ray CT.

Topics: Calcinosis; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver Neoplasms; Middle Aged; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

A 37-year-old woman presented with a neck mass that proved to be medullary thyroid carcinoma by histologic and immunoperoxidase examinations. Serum calcitonin values were greatly elevated (over 100,000 pg/ml). There were widespread metastases in bone and liver. As the peripheral lesions showed only slight response to chemotherapy and local radiation therapy, potential use of radioiodine was studied. The bone lesions showed uptake of both Tc-99m MDP and radioiodide (I-131). Metastatic lesions were similar to the primary tumor in terms of histology, presence of calcitonin, and absence of thyroglobulin. Hence, the patient had a medullary thyroid carcinoma that took up radioiodide in its metastases. Two large oral doses of radioiodide (over 100 mCi each) did not significantly alter the serum calcitonin values, although there was a slight response in the activity of bone lesions. The whole body turnover of radioiodide was rapid (T 1/2 = 0.7 days). Upon oral administration of lithium carbonate, whole-body radioiodide turnover slowed slightly (T 1/2 = 1 day). If this effect were reflected in greater tumor retention of radioiodide (slower release), then agents that block radioiodide egress might have a role to play in therapy.

Topics: Adult; Bone Neoplasms; Calcitonin; Carcinoma; Combined Modality Therapy; Diphosphonates; Female; Humans; Iodine Radioisotopes; Lithium; Lithium Carbonate; Liver Neoplasms; Radionuclide Imaging; Sodium Iodide; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

A patient in whom metastatic medullary thyroid cancer was diagnosed underwent a scintigraphic examination using [131I]MIBG. Multiple hot lesions and diffuse hepatic uptake were noted corresponding to bone and liver metastases. Iodine-131 MIBG may prove to be useful for scintigraphic localization and for the treatment of medullary thyroid cancer as in pheochromocytoma and neuroblastoma.

Topics: 3-Iodobenzylguanidine; Diphosphonates; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Carcinoma, Hepatocellular; Diphosphonates; Female; Gallium Radioisotopes; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Carcinoma; Colloids; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver Neoplasms; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

The role of ultrasonography, computed tomography (CT), and radioisotopic scanning in the staging of bilharzial bladder cancer has not been reported previously. Forty patients with invasive bladder cancer seen at the King Faisal Specialist Hospital and Research Centre between January 1978 and June 1981 underwent complete preoperative workup for staging of their tumors prior to radical cystectomy. The preoperative radiologic investigations included excretory urography (IVP), ultrasonography (US), CT of the pelvis, and liver and bone scans. The results of these investigations were compared with the operative and pathologic staging. Ninety-three percent of the patients with bilharzial cancer had evidence of ureteric obstruction on IVP compared with 22% of the nonbilharzial cancer patients. The presence of ureteric obstruction in these patients did not correlate with the stage of the disease with 83% of the patients with superficial tumors (T1 and T2) having hydroureteronephrosis. Ultrasonography and CT had an 83% accuracy in the staging of superficial tumors. Stage T3 tumors were understaged in 14% of the cases. Ultrasonography did not differentiate Stages T3 and T4 tumors while CT scan differentiated these two stages in 57% of the cases. Bone scan failed to reveal evidence of metastatic disease in any of the bilharzial cancer patients. Liver scan was suspicious for liver metastases in two patients with bilharzial cancers in whom open liver biopsy revealed only hepatic bilharziasis. Of all the radiographic studies, US or preferably CT scan seem to be of some value in the staging of bilharzial tumors localized to the bladder. Bone and liver scans are probably of no cost effective benefit.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Diphosphonates; Humans; Liver Neoplasms; Middle Aged; Neoplasm Staging; Prognosis; Radionuclide Imaging; Schistosomiasis; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography; Urinary Bladder Neoplasms; Urography

Topics: Diphosphonates; Female; Humans; Liver Neoplasms; Melanoma; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Bone and Bones; Bone Neoplasms; Diphosphonates; Humans; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A total of 2530 consecutive bone scans were examined to evaluate the number and the type of soft tissue neoplasms detected with bone-seeking phosphonates. Sixty-eight primary or secondary soft tissue neoplasms of 63 patients accumulated 99mTc -methylene diphosphonate and 2 accumulated 99mTc -diphosphonate, and one metastasis was seen as a nonactive 'cold' focus in the urinary bladder. The localization of tumors was: 19 in the lung, 15 in the liver, 11 in the kidney, 10 in the peritoneal cavity or ascites, 5 in the large bowel, 4 in the vascular or lymphatic system, 3 in the connective tissue or muscles, 2 in the ovary, 1 in the urinary bladder, and 1 in the brain. Our results differ in many respects from those reported in the literature. The causes of the differences are discussed.

Topics: Abdominal Neoplasms; Adenocarcinoma; Adolescent; Adult; Aged; Bone and Bones; Carcinoma, Small Cell; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver Neoplasms; Lung Neoplasms; Lymphoma, Non-Hodgkin; Middle Aged; Ovarian Neoplasms; Radionuclide Imaging; Retroperitoneal Neoplasms; Soft Tissue Neoplasms; Technetium; Technetium Compounds; Technetium Tc 99m Medronate

A patient with adenocarcinoma of the prostate presented with right upper quadrant abdominal pain and weight loss. Liver biopsy revealed hepatic metastases from prostate carcinoma. A bone scan demonstrated marked uptake of Tc-99m MDP within the hepatic metastases.

Topics: Adenocarcinoma; Bone and Bones; Diphosphonates; Humans; Liver Neoplasms; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Carcinoma, Hepatocellular; Diphosphonates; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A case of hepatocellular carcinoma demonstrating intense uptake of Tc-99m methylene diphosphonate (MDP) is described. This is one of three cases seen by the authors who suggest that hepatoma be considered along with other previously described entities when there is localized accumulation of a bone-scanning agent in the liver.

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Diphosphonates; Female; Humans; Liver; Liver Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Two cases of bone radiotracer uptake by primary hepatic malignancies of childhood hepatocellular carcinoma and hepatoblastoma and their metastases are presented. These cases are illustrative of a previously unreported cause of extraosseous uptake of bone seeking radionuclide.

Topics: Carcinoma, Hepatocellular; Child; Diphosphonates; Humans; Infant; Liver Neoplasms; Male; Peritoneal Neoplasms; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

The case of a 66-year-old man with mucinous adenocarcinoma of the rectum with metastases to the liver is presented. Several mechanisms of accumulation of MDP are identified and correlated with CT scan findings.

Topics: Adenocarcinoma, Mucinous; Aged; Colonic Neoplasms; Diphosphonates; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adenocarcinoma; Adult; Carcinoma, Small Cell; Diphosphonates; Female; Humans; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Carcinoma, Squamous Cell; Child, Preschool; Diphosphonates; Female; Histiocytoma, Benign Fibrous; Humans; Liposarcoma; Liver Neoplasms; Lung Neoplasms; Male; Middle Aged; Neoplasm Recurrence, Local; Radionuclide Imaging; Rectal Neoplasms; Rhabdomyosarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate; Thigh

Between 1978 and 1980, 33 patients with cervical cancer, 40 patients with ovarian cancer, and 28 patients with uterine cancer underwent clinical diagnostic staging. Fifty-four patients had bone scans, and 101 patients received liver scans as a part of their staging work-up. No positive bone scan results were found. Eight of 33 patients with Stage IV disease had positive liver scan results consistent with hepatic metastases. Only 1 of 69 patients with Stage I-III disease had a positive test for metastases. While these numbers are small, the authors conclude that bone and liver scanning in asymptomatic patients with early stage gynecologic cancers may not be warranted as staging procedures.

Topics: Bone and Bones; Bone Neoplasms; Diphosphonates; Female; Genital Neoplasms, Female; Humans; Liver; Liver Neoplasms; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Time Factors

Staging bone scans or skeletal surveys were obtained of 97 patients with endometrial carcinoma. Of the 77 patients with Stage I or II disease, no metastases were identified at staging. Three patients in the entire series demonstrated bony metastases; all of these metastases were detectable by radionuclide bone scan and radiographic bone survey. Eighty-nine patients were examined with radionuclide liver/spleen scanning at the time of staging. Four of the 89 initial scans were interpreted as demonstrating hepatocellular disease, and all four patients had abnormal liver function studies. Only one patient demonstrated a possible hepatic metastasis at initial diagnosis. This patient also had abnormal liver function studies. Based on these results, bone surveys and radionuclide bone scans are not indicated as screening procedures in endometrial carcinoma. It is suggested that screening for liver metastases in patients with endometrial carcinoma is not warranted in patients with normal liver function studies.

Topics: Bone Neoplasms; Carcinoma; Diphosphates; Diphosphonates; Female; Humans; Liver Neoplasms; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Uterine Neoplasms

Accumulation of 99mTc-methylene diphosphonate was observed in liver metastasis resulting from stomach carcinoma. This accumulation was located around the lesion on an emission-computed tomogram. This has not been previously reported.

Topics: Adult; Diphosphonates; Humans; Liver Neoplasms; Male; Stomach Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Aged; Colonic Neoplasms; Diphosphonates; Female; Humans; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A case is described in which Tc-99m methylene diphosphonate concentrated in a hepatic metastasis from esophageal squamous cell carcinoma. We observed radiopharmaceutical concentration in the hepatic metastases, which was probably related to the presence of necrosis with calcification.

Topics: Bone and Bones; Calcium; Carcinoma, Squamous Cell; Diphosphonates; Esophageal Neoplasms; Humans; Liver; Liver Neoplasms; Male; Middle Aged; Spleen; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed