technetium-tc-99m-medronate and Lymphoma

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

To assess the value of (99m)Tc-MDP bone scintigraphy in the staging of primary bone lymphoma.. Thirteen staging scintigrams of patients with biopsy proven primary bone lymphoma were reviewed. The number and location of involved sites of disease were documented in each case.. Seven out of 13 scintigrams (54%) demonstrated a single site of bone involvement. Six cases (46%) showed multifocal disease, including clinically silent weight-bearing sites.. Bone scintigraphy is a valuable tool in the staging of primary bone lymphoma. It detects multifocal involvement which alters prognosis and possibly treatment. Clinically silent involvement of weight-bearing sites may be detected allowing prophylactic treatment if required.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Humans; Image Enhancement; Lymphoma; Male; Neoplasm Staging; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Bone marrow necrosis (BMN) is a relatively uncommon clinicopathologic entity with diverse etiology. We describe a case of BMN in a 11 1/2 year old male child with an underlying non Hodgkin's lymphoma T-cell type. With the help of 99m Tc-MDP (methylene diphosphonate) bone scan we were able to find out the etiologic factor in this case.

Topics: Biopsy, Needle; Bone and Bones; Bone Marrow; Child; Combined Modality Therapy; Humans; Lymphoma; Male; Necrosis; Radiography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Although extraosseous accumulations of 99mTc phosphate complexes are phenomena which can often be seen, no case showing extraosseous accumulation to brain tumor on SPECT has been reported. We report here two cases of primary brain tumor showing extraosseous accumulation of 99mTc phosphate in bone SPECT. 201Tl SPECT also showed increased 201Tl uptake by the tumor. Comparing bone SPECT with 201Tl SPECT, the regions of abnormality of both SPECTs were very similar in the case of glioblastoma, but in the case of malignant lymphoma the region showing intense uptake of 99mTc-MDP was smaller than that on 201Tl SPECT. It was revealed that bone SPECT is more useful in the assessment of extraosseous accumulation to a primary brain tumor than conventional bone scintigraphy.

Topics: Aged; Brain Neoplasms; Diphosphonates; Female; Glioblastoma; Humans; Lymphoma; Male; Middle Aged; Radiopharmaceuticals; Skull; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Radioisotope bone scanning is frequently used in staging malignancies. However, false-positive results are common, and biopsy is usually required. In the absence of plain radiographic abnormalities or local symptoms, localization of the area of abnormal tracer activity at the time of open rib or sternum biopsy may be difficult. It often requires resection of a large portion of one or more ribs or the sternum to assure that biopsy of the target area was performed. In this setting, a small gamma probe underwent evaluation as an aid to precise intraoperative localization of increased tracer activity in the target bone.. Ten patients with asymptomatic suspected osseous chest metastases by radioisotope bone scanning but with normal plain radiographs underwent open biopsy of 13 ribs and 1 sternum. Six to 12 hours before operation, each received an intravenous injection of 28 mCi of technetium-99m oxidronate. The hand-held, pencil-sized gamma probe in a sterile sleeve was used to localize the area of greatest activity in the target bone, once the bone was exposed through a small incision. Biopsy of a 3-cm length of rib or portion of sternum was performed. In the first two rib biopsies, an intraoperative radiograph with a radiopaque marker on the rib confirmed that the correct rib was selected for biopsy. Intraoperative radiographs were not done on later cases.. The mean ratio of hot spot activity on the targeted rib to background counts on adjacent ribs was 1.65 +/- 0.22 (range, 1.35 to 2.05), and the difference was easily discernible intraoperatively. The ratio of hot spot activity on the sternum was somewhat lower (1.22), but the target area was still easy to detect. An abnormal diagnosis to account for the increased tracer activity was found in each of the 13 ribs and 1 sternal biopsy in all 10 patients: metastatic squamous cell carcinoma (1 rib), metastatic prostatic adenocarcinoma (1 rib), lymphoma (2 ribs), localized hypercellular marrow (1 rib), medullary fibrosis/Paget's disease of the bone (2 ribs), localized fibrosis/granulation tissue (1 rib), enchondroma (3 ribs), and chondroma (2 ribs, 1 sternum). The difference in background counts to hot spot activity was best with injection of the tracer 6 hours before operation.. The intraoperative use of gamma counting is an easy, highly accurate aid (100% sensitivity) to localize areas of abnormal radioisotope uptake in suspected asymptomatic rib and sternal metastases. Use of this technique obviates the need to obtain intraoperative localizing radiographs to confirm accurate rib identification, thereby decreasing operative time.

Topics: Adenocarcinoma; Adult; Aged; Biopsy; Bone Marrow Diseases; Bone Neoplasms; Carcinoma, Squamous Cell; Chondroma; Contrast Media; Female; Fibrosis; Gamma Cameras; Granulation Tissue; Humans; Injections, Intravenous; Intraoperative Care; Lymphoma; Male; Middle Aged; Osteitis Deformans; Primary Myelofibrosis; Prostatic Neoplasms; Radiography, Interventional; Radiology, Interventional; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Sensitivity and Specificity; Sternum; Technetium Tc 99m Medronate

The objective of this study was to compare Tc-99m MDP bone and Ga-67 scans for the therapeutic response to bone lymphoma in 40 patients. The authors retrospectively compared 40 Tc-99m MDP bone scans and 20 Ga-67 scans before therapy, 29 bone scans and 13 Ga-67 scans during the therapy, and 33 bone scans and 15 Ga-67 scans after therapy. Tc-99m MDP and Ga-67 whole body scans were obtained within 2 weeks of each study and were graded visually (grades 1-4) in which grade 3 means similar count density to that of normal iliac alar activity on bone scans and normal liver activity on Ga-67 scans, respectively. The findings of lesion improvement during and after therapy were found in 66.0% (19 of 29) and 72.7% (24 of 33) with Tc-99m MDP bone scans, 84.6% (11 of 13) and 86.7% (13 of 15) with Ga-67 scans, respectively. The mean grades of Tc-99m MDP uptake were 3.06 before, 2.34 during, and 1.75 after therapy. The mean grades of Ga-67 uptake were 3.22 before, 1.42 during, and 1.30 after therapy. Ga-67 scans appear to be more reliable than Tc-99m MDP bone scans in evaluating the therapeutic response of bone lymphoma.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Female; Gallium Radioisotopes; Humans; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Adult; Humans; Lymphoma; Magnetic Resonance Spectroscopy; Male; Radiography; Radionuclide Imaging; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate

The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.

Topics: Adult; Aged; Bone Marrow; Bone Neoplasms; Breast Neoplasms; False Negative Reactions; False Positive Reactions; Female; Hodgkin Disease; Humans; Lymphoma; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; 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

Three cases (rhabdomyosarcoma, lymphoma, and metastatic malignant melanoma) of unexpected increased uptake of methylenediphosphonate labelled by technetium 99m sodium pertechnetate (99mTc-MDP) are described. The possible mechanisms of the extraosseous tumoral accumulation of 99mTc-MDP in these malignancies are discussed. The usefulness of this method for the diagnosis, localization, and follow-up of some extraosseous tumors is evaluated.

Topics: Adult; Diphosphonates; Female; Humans; Lymphoma; Male; Melanoma; Middle Aged; Radionuclide Imaging; Rhabdomyosarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

The role of modern techniques of 99mTc methylene diphosphonate bone imaging in the management of lymphoma patients was assessed by comparing results of 107 bone scans in 16 patients with Hodgkin's disease, and 45 patients with non-Hodgkin's lymphoma to simultaneous radiologic, clinical, and histopathologic features as well as to subsequent disease course. The sensitivity and specificity were both greater than or equal to 0.96 in both Hodgkin's disease and non-Hodgkin's lymphoma and the overall accuracy by site was 98%. The scan proved to be useful in the definition and follow-up of skeletal lymphomatous disease in both symptomatic and asymptomatic patients, and defined abnormalities which were not predicted by either serum alkaline phosphatase activity or the presence of bone marrow involvement. In no patient, however, did the bone scan result by itself alter either initial staging or estimates of extent of disease at the time of relapse. Bone scanning, therefore, cannot be recommended as a screening procedure in patients with lymphoma; rather, this test is best reserved for the definition and follow-up of skeletal metastases in patients with active, concomitant, extraosseous disease.

Topics: Bone Neoplasms; Diagnostic Errors; Female; Follow-Up Studies; Hodgkin Disease; Humans; Lymphoma; Male; Middle Aged; Neoplasm Staging; Radiography; Radionuclide Imaging; 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

Topics: Bone and Bones; Diphosphonates; Female; Humans; Kidney; Lymphoma; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Urine