technetium-tc-99m-medronate and Multiple-Myeloma

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

Over the past 5 years, we have encountered 6 cases of diffuse pulmonary uptake of 99m-Tc bone-scanning agents (incidence, 0.04%). To assess the significance of this phenomenon, we reviewed all of the cases reported since 1974 (Including our series, a total of 32 cases). Three groups can be discerned, the first consisting of 24 patients without radiological calcifications in the lungs and with hypercalcemia of different origins (mostly hyperparathyroidism). Of the eight autopsies performed in this group, seven revealed extensive calcifications in alveolar walls and lung vessels; the other autopsy showed no calcification at all and only bronchopneumonic lesions. The second group consists of 6 patients in chronic dialysis. The last group consists of 2 patients having diffuse pulmonary alveolar microlithiasis with extensive radiologic calcifications. The mechanism of lung uptake of 99m-Tc bone-imaging agents is probably the same as that of bone uptake (chemisorption on hydroxyapatite crystals), although other uptake mechanisms have also been discussed. Bone scintigraphy can be useful in the detection of early pulmonary calcifications, which have been associated with impaired pulmonary function and, due to their size, are generally not detected by X-ray.

Topics: Adenoma; Adult; Aged; Bone Diseases; Calcinosis; Female; Humans; Hypercalcemia; Lung Diseases; Male; Middle Aged; Multiple Myeloma; Parathyroid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Vitamin D

Technetium-99m 2-methoxyisobutylisonitrile (99mTc-MIBI) is a lipophilic agent that has been proposed as a useful tracer for the detection of disease sites in patients with multiple myeloma (MM). We performed a prospective study to determine the potential of 99mTc-MIBI imaging for the evaluation of the extent of primary disease in patients with advanced stage MM, compared with skeletal survey and bone scintigraphy. Twenty patients with advanced stage MM at initial diagnosis underwent whole-body 99mTc-MIBI imaging, together with contemporaneous skeletal survey and bone scintigraphy. The findings of 99mTc-MIBI imaging were correlated with the results of skeletal survey and bone scan. All 99mTc-MIBI scans were positive for the presence of active MM, whereas skeletal surveys were positive in 18 patients (90%) with osteolytic lesions. Bone scintigraphy demonstrated MM in only 15 patients (75%). In two patients with no detectable lesions on skeletal survey, 99mTc-MIBI imaging revealed uptake in the spine, corresponding to the abnormalities seen on magnetic resonance imaging (MRI). With respect to the localization of bone lesions, 99mTc-MIBI imaging was superior to bone scintigraphy in 15 patients (75%) and had concordant results with bone scintigraphy in four (20%). 99mTc-MIBI imaging is a very sensitive imaging modality for the identification of the extent of disease in patients with advanced MM. It is clearly superior to bone scintigraphy and complements the results of skeletal survey by finding additional disease sites. Hence, in active MM patients, 99mTc-MIBI imaging has the potential to detect bone marrow disease that cannot be detected by skeletal survey and bone scintigraphy.

Topics: Adult; Aged; Aged, 80 and over; Bone Marrow Neoplasms; Bone Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Neoplasm Staging; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole-Body Counting

The objectives of this study were to investigate the role of whole-body 201Tl-chloride scintigraphy in comparison with bone scintigraphy in the detection of bone marrow involvement in patients with multiple myeloma and to assess the follow-up evaluation using 201Tl-chloride. Twenty-one patients with untreated multiple myeloma were evaluated. 201Tl-chloride images were acquired 10 min (early) and 2 h (delayed) after the injection of 111 MBq 201Tl-chloride. Bone images were acquired 3 h after the intravenous injection of 740 MBq 99mTc-hydroxymethylene diphosphonate (HMDP). The 201Tl-chloride scan patterns were classified as normal, diffuse (presence of bone marrow), focal (localized areas of uptake) and diffuse+focal. The bone scan patterns were classified as normal and abnormal. Eight of the 21 patients also underwent 201Tl-chloride scintigraphy after chemotherapy for the evaluation of the therapeutic response. On the early 201Tl-chloride image, two patients showed a normal, 13 a diffuse, two a focal and four a diffuse + focal pattern. On the delayed 201Tl-chloride image, nine patients showed a normal, six a diffuse, four a focal and two a diffuse + focal pattern. Bone scintigraphy showed an abnormal accumulation in only five of the 21 patients. Of the eight patients who underwent follow-up 201Tl-chloride studies, the abnormal diffuse pattern was changed to a normal pattern on post-treatment scintigraphy in three, and the degree of abnormal 201Tl-chloride accumulation decreased in comparison with the pre-treatment scan in three. These six patients were considered to be in clinical remission. In the two remaining patients, the degree of abnormal 201Tl-chloride accumulation increased in comparison with the pre-treatment scan, and they were considered to be in clinical progression. 201Tl-chloride scintigraphy is a non-invasive tool, which may be more useful than bone scintigraphy for the diagnosis of multiple myeloma, and may be helpful in the follow-up of multiple myeloma.

Topics: Aged; Antineoplastic Agents; Bone and Bones; Bone Marrow; Bone Marrow Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thallium; Tomography, Emission-Computed; Treatment Outcome; Whole-Body Counting

Conventional skeletal radiography and bone scan have certain limitations in the initial evaluation of bone and bone marrow lesions in multiple myeloma (MM). In this study we investigated the value of bone marrow immunoscintigraphy (BMIS) using anti-granulocyte monoclonal antibody (AGA) for the diagnosis of bone involvement of MM, in comparison with bone scan and skeletal radiography. Whole-body BMIS using technetium-99m-labelled AGA was performed in 22 MM patients (15 male, 7 female) and the imaging findings compared with those of skeletal radiography and (99m)Tc-methylene diphosphonate bone scan. The findings of bone marrow aspiration and serum biochemical findings were also compared with BMIS findings. Abnormal findings of BMIS were defined as presence of a focal photon defect in the axial skeleton or expansion of peripheral bone marrow. A total of 124 focal lesions were detected in 19 subjects (86%) by skeletal radiography, bone scan or BMIS. BMIS detected 92 lesions (74%) in 19 subjects, whereas skeletal radiography detected 58 focal lesions (47%) in 14 and bone scan 40 lesions (32%) in 11. Fifty-one (41%) of the 124 lesions were only seen on BMIS. Spine and pelvic lesions were better visualised by BMIS, whereas skull lesions were better seen with skeletal radiography, and bone scan detected more lesions in the ribs. Marrow expansion was noted in 15 subjects (68%) on BMIS, and its grade correlated with marrow cellularity and myeloma cell percentage in bone marrow aspirates ( P=0.0055 and P=0.0541, respectively). BMIS revealed abnormal lesions in one of three stage II patients and 17 out of 19 stage III patients. The number of lesions of the thoracolumbar vertebrae on BMIS was correlated with cellularity ( P=0.0393), but not with myeloma cell percentage ( P=0.1262). These findings suggest that the results of BMIS with (99m)Tc-labelled AGA correlate with clinical stage, and thus reflect the functional status of bone marrow in MM patients. BMIS might be useful for the detection of bone involvement of MM when skeletal radiography or bone scan is inconclusive, especially for vertebral lesions.

Topics: Adult; Aged; Antibodies, Monoclonal; Bone Marrow; Female; Granulocytes; Humans; Male; Middle Aged; Multiple Myeloma; Neoplasm Staging; Radiography; Radioimmunodetection; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Statistics as Topic; Technetium; Technetium Tc 99m Medronate

Tc-99m Methylene Diphosphonate (MDP) bone scintigraphy has been used for the assessment of benign as well as malignant skeletal conditions. Non-osseous radiotracer uptake on bone scan is an unusual finding. It is usually performed for metastatic bone disease, and is generally not an indication in multiple myeloma, as osteolytic lesions typically show no radiotracer uptake. Despite this, substantial number of multiple myeloma patients undergo bone scintigraphy due to their presentation imitating a metastatic bone disease. We describe a case of multiple myeloma, where extra osseous uptake in lung and diffuse hepatic, has been noted on bone scan.

Topics: Bone and Bones; Bone Diseases; Humans; Multiple Myeloma; Radiopharmaceuticals; Technetium Tc 99m Medronate

A 69-year-old man with a history of low back pain for more than 4 months underwent Tc-MDP bone scan to determine the cause of the symptoms. In addition to the osseous lesions, significant activity in the stomach wall was noted. However, a subsequent F-NaF PET/CT only revealed bone lesion without increased activity in the stomach wall. The cause of the back pain was eventually confirmed due to multiple myeloma.

Topics: Aged; Fluorine Radioisotopes; Humans; Male; Multiple Myeloma; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sodium Fluoride; Stomach; Technetium Tc 99m Medronate

Topics: Gastric Mucosa; Humans; Multiple Myeloma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Amyloidosis is a rare disorder characterized by variable extracellular accumulation of a complex substance consisting of proteinaceous fibrils (amyloid fibrils) and nonfibrillar glycoprotein or amyloid P component. We present a case of a primary systemic amyloidosis associated with multiple myeloma in a 48-year-old woman whose Tc-MDP SPECT/CT study revealed extraosseous periarticular uptake in amyloid deposits with no abnormal focal tracer uptake in the bone.

Topics: Amyloidosis; Bone and Bones; Female; Humans; Immunoglobulin Light-chain Amyloidosis; Middle Aged; Multimodal Imaging; Multiple Myeloma; Plaque, Amyloid; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Multiple myeloma (MM) is a plasma cell neoplasm with skeletal destruction which could also spread to extramedullary regions. Common diagnostic imaging modalities include skeletal radiography, computed tomography (CT), magnetic resonance imaging (MRI). Recently, PET/CT is proposed as an ideal tomographic tool for diagnosis and follow-up, but impending factors includes high cost, limited availability of cameras and radiotracers. Bone scan and gallium scan are usually considered of limited clinical value. Herein, we present a 66-year-old Taiwanese man with MM, who was hospitalized to our hospital for bone pain control. Bone and gallium scintigraphies were obtained for bone pain and infection workup. However, unexpected features of discordant osseous uptake with high gallium-to-bone uptake ratio and extramedullary gallium uptake were noted which both indicated poor prognosis of MM. The patient then passed away due to rapid disease progression. In conclusion, although gallium and bone scintigraphies are considered less sensitive for MM, combined use may be a good alternative for 18F-FDG PET/CT in evaluation of disease extent and prognosis, especially in high-risk patients or with suspicion of disease progression.

Topics: Aged; Bone and Bones; Citrates; Gallium; Humans; Male; Multiple Myeloma; Prognosis; Radiography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed

A 66-year-old woman with congestive heart failure suspected to have multiple myeloma underwent bone scintigraphy. The bone scintigraphy using technetium-99m hydroxymethylene-diphosphonate showed the following interesting findings: absent skeletal uptake; increased gastrointestinal, myocardial, and soft tissue uptake; migration of radionuclide to bilateral pleural effusions. Histopathological examination revealed that the patient suffered from AL-type amyloidosis associated with multiple myeloma. Extraosseous uptake is often observed on bone scintigraphy in amyloidosis patients, but in many cases skeletal uptake is preserved. The simultaneous presentation of these findings is rare.

Topics: Aged; Amyloidosis; Female; Humans; Multiple Myeloma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Favorable vertebroplasty outcomes reflect accurate preoperative identification of vertebral fracture targets, operator proficiency, and assiduous fracture aftercare. Conventional teaching is that nuclear bone scintigraphy is not helpful in the management of osteolytic myeloma bone disease. Nuclear bone scintigraphy in two patients with multiple myeloma and vertebral fracture pain convincingly identified the fracturing vertebral level and provided confidence that synchronous vertebral fractures were not missed, whereas neither had been appreciated by either radiography or magnetic resonance imaging.

Topics: Aged; Bone Neoplasms; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Positron-Emission Tomography; Predictive Value of Tests; Preoperative Care; Radiopharmaceuticals; Spinal Fractures; Technetium Tc 99m Medronate; Thoracic Vertebrae; Vertebroplasty

Dentists need to be aware of the relationship between malignancies and paresthesia or complete loss of sensation in a jaw segment. In particular, dentists should be aware of numb chin syndrome (NCS) and its clinical manifestations, as well as the limitations of using panoramic radiographs to detect the causative malignancy.. The authors report two cases of paresthesia in the mental region. No lesions were readily apparent on the patients' panoramic radiographs. To exclude the presence of disease in the mandible that could have been responsible for the NCS, the authors obtained computed tomographic (CT) images. They identified metastases to the mandible from primary malignant tumors elsewhere in the body.. To prevent misdiagnosis of NCS, dentists need to be aware of the clinical manifestations of NCS, the need for CT imaging, the shortcomings of panoramic radiographs and the value of obtaining detailed and accurate medical and dental histories from patients.

Topics: Aged; Chin; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Hypesthesia; Male; Mandibular Neoplasms; Multiple Myeloma; Paresthesia; Prostatic Neoplasms; Radiography, Panoramic; Radiopharmaceuticals; Syndrome; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 76-year-old man with previous sigmoid colon resection for adenocarcinoma had low back pain for 2 months. Whole-body bone scintigraphy showed multiple focal Tc-99m methylene diphosphonate (MDP)-avid lesions in both rib cages and 3 lumbar vertebrae, indicating metastases. F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging was performed for further evaluation of this possible metastatic disease and demonstrated the lumbar and costal metastases and several hypermetabolic areas in the pelvic bones, multiple thoracic vertebrae, both shoulders, and the right femur. Histopathologic examination of the right-sided iliac crest, however, revealed multiple myeloma.

Topics: Aged; Colonic Neoplasms; Humans; Male; Multiple Myeloma; Neoplasms, Multiple Primary; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

It is important to recognize osteonecrosis of the jaws in patients treated with bisphosphonates because an early diagnosis can make a significant difference to the outcome of the disease. The aim of this study is to describe the radiological features of bisphosphonate osteonecrosis (BON) in order to aid its prompt recognition.. A conventional radiograph, a computed tomograph (CT), a magnetic resonance image (MRI) and a 99Tc(m)-MDP 3-phase bone scan were carried out for 11 patients with BON. The main imaging findings of osteonecrosis are described.. Conventional radiography and CT displayed osteolytic lesions with the involvement of cortical bone. MRI demonstrated the characteristic features of osteonecrosis and the oedema of soft tissues. Both CT and MRI were very useful in defining the extent of the lesions. 99Tc(m)-MDP three-phase bone scan was the most sensitive tool to detect the osteonecrosis at an early stage.. 99Tc(m)-MDP three-phase bone scans who could be used as a screening test to detect subclinical osteonecrosis in patients who have received bisphosphonates. CT scans and MRI are useful in defining the features and extent of osteolytic lesions.

Topics: Aged; Aged, 80 and over; Bone Density Conservation Agents; Bone Neoplasms; Diphosphonates; Female; Humans; Imidazoles; Jaw Diseases; Magnetic Resonance Imaging; Male; Middle Aged; Multiple Myeloma; Osteonecrosis; Radiography, Panoramic; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Zoledronic Acid

Topics: Bone Diseases, Infectious; Citrates; Female; Gallium; Humans; Middle Aged; Multiple Myeloma; Pressure Ulcer; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole-Body Counting

The authors present a case of multiple myeloma with intense hepatic and splenic uptake on Tc-99m HDP bone scan and discuss its clinical implications and possible uptake mechanisms. Tc-99m MIBI and Tc-99m sulfur colloid were used to demonstrate bone marrow involvement and focal lesions of multiple myeloma.

Topics: Bone and Bones; Humans; Liver; Male; Middle Aged; Multiple Myeloma; Radiopharmaceuticals; Spleen; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Bone Neoplasms; Diagnosis, Differential; Humans; Ilium; Male; Middle Aged; Multiple Myeloma; Plasmacytoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Technetium 99m-2-methoxyisobutylisonitrile (Tc-99m MIBI) is a lipophilic agent that accumulates preferentially within living malignant cells due to the higher transmembrane electrical potential as a consequence of the higher metabolic rate than in the surrounding normal cells. It has been effectively used to detect malignant tumors at diagnosis and follow-up and has been reported to be useful in detecting disease lesions in multiple myeloma. We studied 28 consecutive patients with multiple myeloma at diagnosis to determine the value of Tc-99m MIBI in comparison with Tc-99m methylene diphosphonate (MDP), conventional X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI). We found 26 patients with obvious osteolytic lesions in X-rays, 22 patients with positive Tc-99m MIBI scans, and 15 patients with positive Tc-99m MDP scans. There was no coincidence of the positive lesions in the two scans, while in two patients the osteolytic areas were positive in the Tc-99m MDP scans, and in one case the osteolytic area was positive in the Tc-99m MIBI scan. The intensity of Tc-99m MIBI scans correlated with disease activity as determined by lactate dehydrogenase (LDH) (p<0.05), C-reactive protein (CRP) (p<0.01), beta2-microglobulin (p<0.05), and serum ferritin (p<0.01). We believe that Tc-99m MIBI scintigraphy can detect bone marrow lesions in myeloma patients that cannot be detected by other imaging methods and that it can be useful especially in solitary myeloma to exclude other involved sites. In addition, it could be a prognostic factor related to disease activity and multidrug resistance. We believe that a multicenter study is needed to evaluate the usefulness of this agent.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Prospective Studies; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Bone scintigraphy is not usually performed in multiple myeloma (MM), as marrow deposits characteristically show no tracer uptake. However, metastatic bone disease often mimics MM both clinically and biochemically, resulting in a substantial number of MM patients undergoing bone scintigraphy. Variable appearances in these cases have been reported, ranging from normal to a superscan, the latter a result of massive tracer uptake within bone. Soft tissue uptake has been documented, often when MM is complicated by secondary amyloidosis. This usually results in mainly solid organ uptake of tracer. We report a case of MM where massive soft tissue uptake occurred, primarily within muscles, with very little isotope elsewhere.

Topics: Aged; Aged, 80 and over; Fatal Outcome; Humans; Hypercalcemia; Male; Multiple Myeloma; Muscle, Skeletal; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Tissue deposits of amyloid may lead to various clinical symptoms and signs, depending on the site of deposition. In addition, a specific subtype of amyloidosis, AL protein type, is associated with multiple myeloma. Two cases representing contrasting examples of altered radiopharmaceutical biodistribution in myeloma and amyloidosis are presented and discussed, with a bone tracer depicting the heart and a heart tracer depicting the bones.

Topics: Aged; Amyloidosis; Bone and Bones; Bone Neoplasms; Cardiomyopathies; Heart; Humans; Male; Multiple Myeloma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

Eighteen bone marrow transplanted multiple myeloma patients had imaging studies on 24 occasions with radiography as well as bone and bone marrow scintigraphy within 2 months. Twelve of the radionuclide bone marrow studies were performed with Tc-99m human serum albumin colloid and 12 were performed with a Tc-99m tagged monoclonal antigranulocyte antibody. The total detection rate of bone marrow lesions increased by 5% when the findings on bone marrow scintigraphy were combined with the findings and at radiography bone scintigraphy. For lesions in the spine and sacrum, the increase was 25% and 33% respectively, including patients with focal radiotherapy. Peripheral red bone marrow expansion was noted in 17 patients. In a comparison of Mab and Tc-99m HSA colloid imaging, Mab resulted in a higher bone marrow to soft tissue uptake and to a much smaller part of the skeleton being obscured by liver and spleen uptake. It is concluded that bone marrow imaging is valuable for showing red bone marrow distribution. It thereby shows possible sites for malignant lesions; it also shows that Mab imaging is superior to Tc-99m HSA colloid imaging in bone marrow transplanted multiple myeloma patients.

Topics: Adult; Antibodies, Monoclonal; Bone and Bones; Bone Marrow; Bone Marrow Transplantation; Bone Neoplasms; Female; Follow-Up Studies; Granulocytes; Humans; Liver; Male; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Radiography; Radioimmunodetection; Radiopharmaceuticals; Sacrum; Spine; Spleen; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

To compare conventional radiography and bone scintigraphy in relation to clinical outcome in bone marrow transplant multiple myeloma patients.. A total of 70 radiographies and 70 bone scintigraphies were compared in 35 patients.. The skull, the extremities, the iliac and public bones were better assessed with radiography. For new vertebral lesions and for lesions in the ribs and sternum, bone scintigraphy proved superior. For the sacrum, the methods were equal. When bone scintigraphy was used as a complement to radiography, 4% more pathological sites were found. No patient had both a normal radiography and a pathological bone scintigraphy, but 5 patients had both a normal bone scintigraphy and a pathological radiography. The results of the radiological examinations did not always correlate with the clinician's grading of the patient's disease. The radiological examinations had no prognostic value for the 7 patients examined on several occasions.. The ability of conventional radiography and bone scintigraphy to disclose myeloma lesions varies, depending on location and size of the lesions. Radiography should remain the primary examination modality also for bone marrow transplant multiple myeloma patients. Bone scintigraphy can serve as a complement for investigating unexplained pain, e.g. caused by lesions in vertebrae or ribs.

Topics: Adult; Aged; Bone and Bones; Bone Marrow Transplantation; Combined Modality Therapy; Diphosphonates; Female; Follow-Up Studies; Humans; Male; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Prognosis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To determine whether dynamic registration at bone and bone-marrow scintigraphy produces additional information compared to subsequent static registrations of bone-marrow transplants in multiple myeloma patients.. In a prospective study, 8 dynamic bone and 6 dynamic bone-marrow scintigraphies were performed in 10 patients. The dynamic scintigraphies were compared with conventional radiography, MR images, and static scintigraphies of bone and bone marrow.. No additional information was revealed by the dynamic registration method; on the contrary, 4 of the 8 known lesions were not discerned at dynamic registration. An incidental observation was that the time-activity curves of both radiopharmaceuticals had a specific pattern.. Dynamic registration at bone and bone-marrow scintigraphy was not useful for detecting disease in multiple myeloma lesions.

Topics: Adult; Bone and Bones; Bone Marrow; Bone Marrow Transplantation; Female; Humans; Male; Middle Aged; Multiple Myeloma; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Medronate

The authors present a patient with Fanconi syndrome who demonstrated poor renal uptake of Tc-99m DMSA and high urinary concentration of the tracer. Tc-99m DTPA imaging was normal and the creatinine clearance was only minimally decreased. These findings suggest that Tc-99m DMSA may be accumulated in the kidney by glomerular filtration and subsequent tubular reabsorption. A Tc-99m MDP bone scan showed faint renal uptake, as well as diffuse high skeletal uptake, particularly in the spine, demonstrating that the metabolic bone disease associated with Fanconi syndrome can be one of the causes of poor renal visualization on a bone scan.

Topics: Bone and Bones; Fanconi Syndrome; Female; Glomerular Filtration Rate; Humans; Kidney; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Strontium-89 is an effective agent for palliation of pain due to bony metastases from breast and prostate carcinoma. As a functional analog of calcium, 89Sr is taken up by bone in areas of osteoblastic activity. Since patients with multiple myeloma frequently have osteolytic metastases, 89Sr might not be considered to be a therapeutic option. However, metastases which appear osteolytic by radiographs may demonstrate osteoblastic activity on bone scans. Consequently, the bone scan may be used to identify a subset of patients with osteolytic metastases who may benefit from 89Sr treatment. This report describes a patient with severe rib pain due to multiple myeloma whose chest radiograph showed multiple lucent lesions throughout the bones of the chest wall but whose bone scan showed marked osteoblastic activity. The patient was treated with 89Sr and received substantial pain relief. Bone scans may be useful in selecting myeloma patients or other cancer patients with osteolytic radiographic lesions who may benefit from 89Sr therapy.

Topics: Bone and Bones; Bone Neoplasms; Female; Follow-Up Studies; Humans; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Strontium Radioisotopes; Technetium Tc 99m Medronate

We have encountered two cases of bone tumors with high 18F-fluorodeoxyglucose (FDG) uptake and negative 99mTc-HMDP bone scintigraphy, including a patient with myeloma and a patient with a metastatic bone tumor from esophageal cancer. Bone scintigraphy with a 99mTc-phosphate complex reflects osteoblastic activity in the bone tissue surrounding the tumor, whereas the accumulation of FDG is associated with the metabolic activity of the tumor itself. An FDG-PET study can therefore be used as a complementary study for the detection and follow-up of bone tumors when a 99mTc-phosphate bone scintigram is negative.

Topics: Adult; Bone Neoplasms; Deoxyglucose; False Negative Reactions; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multiple Myeloma; Ribs; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Amyloidosis; Bone and Bones; Female; Humans; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate; Tongue

A pentavalent 99mTc-dimercaptosuccinic acid (DMSA) scan was performed on a patient with multiple myeloma without amyloidosis. A high accumulation of the tracer was found in numerous tumors. We believe that the accumulation of DMSA is unrelated to amyloidosis and that the DMSA scan may have potential for the staging of tumors in patients presenting with multiple myeloma.

Topics: Bone Neoplasms; Female; Humans; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Radionuclide bone imaging using Tc-99m phosphates may show accumulation of activity in amyloid deposits. While many sites of amyloidosis have been detected with bone imaging, many reports center on cardiac amyloidosis. The case reported here demonstrates accumulation of Tc-99m MDP in amyloidosis involving the skin and muscle, including the tongue.

Topics: Aged; Amyloidosis; Humans; Male; Multiple Myeloma; Muscles; Radionuclide Imaging; Skin; Technetium Tc 99m Medronate; Tongue

Topics: Adult; Anemia; Citrates; Citric Acid; Female; Fever of Unknown Origin; Gallium Radioisotopes; Humans; Multiple Myeloma; Proteinuria; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Female; Humans; Male; Middle Aged; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Uptake of Tc-99m MDP by extraskeletal tissues is a rare, serendipitous finding during bone scanning studies. It can be clinically correlated with the presence of hypercalcemia in association with renal failure, as may occur in multiple myeloma. While the precise mechanism of non-osseous uptake of MDP is not certain, it may represent metastatic calcification based upon histological examination. A critical calcium-phosphate ion product appears to be requisite for deposition within soft tissues, and all cases in the literature for which data were available exceeded this ion product value. While MDP bone scanning is not generally useful in the diagnosis or staging of multiple myeloma, these findings may indicate secondary effects of the disease. The authors report the first case of liver, spleen, and lung uptake by MDP in a patient with hypercalcemia secondary to multiple myeloma, with a review of the literature.

Topics: Aged; Bone and Bones; Female; Humans; Hypercalcemia; Liver; Lung; Multiple Myeloma; Radionuclide Imaging; Spleen; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Bone and Bones; Gallium Radioisotopes; Humans; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

Bone lesions with a ring-shaped appearance (the doughnut sign) have been encountered during routine reporting of bone scintigrams performed on patients with multiple myeloma. Such a ring-shaped appearance has been revealed in four (8%) of the last 50 bone scintigrams performed on patients with myeloma at the Royal Marsden Hospital. In contrast, a review of the last 300 bone scintigrams performed on patients with bone metastases failed to reveal any such ring-shaped appearance. Examination of the case notes and radiographs of the multiple myeloma patients did not reveal any correlation between the presence of the ring-shaped appearances and the histology, biochemistry, treatment, or course of the disease nor were any specific radiographic features noted. Three of the four patients have had local radiotherapy to the sites of the lesions. We conclude that the ring-shaped appearance on bone scintigrams is usually related to myelomatous bone lesions, particularly following local radiotherapy to these lesions. The reason for this appearance in three of the four scintigrams may be the stimulation of vascularity and osteoblastic activity around the periphery of the myelomatous lesions by the response of the lesions to radiotherapy.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Male; Multiple Myeloma; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Female; Humans; Hypercalcemia; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone and Bones; Bone Marrow; Female; Humans; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

Abnormal accumulation of Tc-99m MDP in the lungs and stomach was observed in a patient with multiple myeloma and refractory hypercalcemia. There was no roentgenographic evidence of calcification. At postmortem examination, the presence of amyloid deposits was confirmed in both organs, while the corresponding metastatic calcification was demonstrated only in the gastric mucosa. It seems likely that, in our case, soft-tissue localization of bone-seeking agent was attributable to the presence of amyloid deposits rather than metastatic calcification. No cases showing the combined occurrence of amyloid deposition and metastatic calcification in soft-tissues have previously been demonstrated to concentrate bone-seeking agent.

Topics: Amyloidosis; Humans; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

A case of nonsecretory multiple myeloma is presented. Radiological findings and bone marrow examination provided the diagnosis. Bone scintigraphy showed metastatic pulmonary calcification, thus demonstrating the potential superiority to any other routine diagnostic modality in detection of visceral calcification.

Topics: Adult; Biopsy; Bone Marrow; Calcinosis; Humans; Lung Neoplasms; Male; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Bone Marrow; Diagnosis, Differential; Humans; Male; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

The kidneys were evaluated on [99mTc]phosphonate bone scans using 35 studies from 23 individuals with multiple myeloma; these images were compared with those from 50 controls. In each case, the kidneys could be visualized and calculation was made of the renal:skeleton ratio. Two myeloma patients showed an elevated renal:skeleton ratio. One was due to reduced vertebral uptake of [99mTc]phosphonate following therapeutic radiation. In the second case, the elevated ratio was related to renal uptake of the tracer (independent of urinary retention), and was consistent with nephrocalcinosis. No significant correlation between the renal:skeleton ratio and the degree of hypercalcemia, proteinuria, or renal impairment was found. We conclude that bone scintigraphy represents a safe, simple means of demonstrating renal presence and activity in multiple myeloma patients. However, calculation of the renal:skeleton ratio is not directly helpful in clarifying the events of calcium metabolism.

Topics: Bone and Bones; Humans; Hypercalcemia; Kidney; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

We present a case of multiple myeloma in which pulmonary calcification was clinically shown by bone scintigraphy and subsequently confirmed at autopsy. It is suggested that, in patients with myeloma, radionuclide bone scanning may be of value for differentiating deposits in the lung due to calcification from those due to other types of pulmonary infiltration revealed by chest X-rays. A thorough review of the relevant literature is presented.

Topics: Bone and Bones; Calcinosis; Humans; Hypercalcemia; Lung Diseases; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Diphosphonates; Humans; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Skull; Skull Neoplasms; Technetium; Technetium Tc 99m Medronate

Fifty patients with bone primary tumors (multiple myeloma, osteogenic sarcoma, Ewing's sarcoma, giant cell tumor, and others) were studied gammagraphically after injecting 555 MBq of 99mTc-MDP. Eighty per cent of the cases were found in long bones, specially femur and tibia. These two bones were the preferent localization of osteosarcomas. Ewing's neoplasms were mostly diaphysial and osteoclastomas epiphysial.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Female; Femur; Fibrosarcoma; Giant Cell Tumors; Humans; Male; Middle Aged; Multiple Myeloma; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tibia

In the diagnosis of multiple myeloma (MM), the radiological skeletal survey (RSS) was proven to be most useful for the detection of bone lesions. Since 1961, a new technique radioisotopic bone scan (RIBS), for the detection of such lesions, using 85Sr and 99mTc, has been shown to be highly sensitive for the detection of skeletal metastases of epithelial tumors. We have studied 30 patients with plasma cell dyscrasia (PCD) by both methods and concluded that RSS is clearly superior to RIBS in PCD. As RIBS detected less than 50% of the lesions demonstrated by RSS there seems to be no indication for a routine RIBS in the initial work-up of patients suspected to have PCD. However, due to the fact that RIBS is useful for the detection of new bone formation it has a certain value in the localization of pathological fractures in MM, mainly in vertebral compression.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Diphosphonates; Fractures, Spontaneous; Humans; Middle Aged; Multiple Myeloma; Osteoporosis; Pelvic Bones; Plasmacytoma; Radiography; Radionuclide Imaging; Ribs; Skull; Spinal Injuries; Spine; Technetium; 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

A case is described of reversible, intense gastric uptake of 99mTc-MDP in the fundal region of a patient with myeloma, while very little transient pulmonary fixation was seen. The significance of this unusual finding in terms of relevant blood chemistry, results of gastric biopsies, which failed to show metastatic calcification, and the drugs administered is discussed.

Topics: Aged; Bone Neoplasms; Diphosphonates; Gastric Mucosa; Humans; Male; Multiple Myeloma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Tc-99m labeled dimethyl-amino-diphosphonate (DMAD) was compared with methylene diphosphonate (MDP) in five healthy volunteers and 28 patients with a variety of bony afflictions. Although the normal bone uptake of DMAD is less than MDP, the lesion-to-normal bone ratio is significantly higher with DMAD. All 71 lesions detected with MDP were also seen with DMAD. However, 10 lesions were disclosed with DMAD that were not seen with MDP. These lesions tended to have low grade concentrations of the radiopharmaceutical and were detected with DMAD by virtue of the lower normal bone uptake rather than higher lesion uptake.

Topics: Adult; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Humans; Kidney Neoplasms; Lung Neoplasms; Middle Aged; Multiple Myeloma; Organotechnetium Compounds; Osteitis Deformans; Osteomyelitis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone Neoplasms; Diphosphonates; False Negative Reactions; Female; Humans; Male; Middle Aged; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Radiography and scintigraphy were correlated in 70 patients with recently diagnosed, untreated multiple myeloma, including 59 with and 11 without primary lytic bone lesions. A site-by-site comparison showed that scintigraphy was more sensitive than radiography in only 18% of cases, whereas radiography was more sensitive in 38% (p less than 0.001). Patients whose bone scan was as sensitive or more so than the radiograph ("hot" myeloma) had more active disease than those with the "cold" form. Remission was indicated by significant regression or disappearance of scintigraphic abnormalities in 90% of cases. The authors conclude that scintigraphy is not helpful in detecting myelomatous bone lesions, but does have prognostic value for diagnosis and chemotherapy: a positive bone scan indicates initial or residual activity.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Diphosphates; Diphosphonates; Female; Humans; Male; Middle Aged; Multiple Myeloma; Prospective Studies; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Bone Neoplasms; Diphosphonates; Female; Humans; Middle Aged; Multiple Myeloma; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Amyloidosis; Dimethyl Sulfoxide; Diphosphonates; Female; Humans; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A patient with multiple myeloma complicated by hypercalcemia is presented. During the state of an elevated calcium phosphate product a transient diffuse accumulation of Tc 99m MDP in the liver was demonstrable, whereas the demonstrated metastatic calcifications of the kidneys persisted after therapeutic reduction of the elevated ion product. This points to a difference in the formation of calcium phosphate precipitations in these organs. Accumulation of Tc 99m labelled bone seeking agents in the liver must not always mean severe liver damage or amyloidosis or tumour manifestation. An altered serum calcium phosphate balance has to be taken into account when interpreting scintigrams performed with bone seeking radiopharmaceuticals.

Topics: Bone and Bones; Calcium Phosphates; Diphosphonates; Humans; Liver; Male; Middle Aged; Multiple Myeloma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Twenty-one patients with multiple myeloma were examined in close time relation with skeletal X-ray survey and bone scanning using technetium diphosphonate. Results indicate that X-ray is superior to bone scan in detecting myelomatous bone lesions. Approximately twice as many lesions were detected by X-ray as by bone scan. An exception to this general finding is the lumbar spine and rib cage, in which the two methods are equally reliable. Thus, a negative bone scan does not exclude the possibility of a myelomatous bone lesion.

Topics: Bone Neoplasms; Diphosphonates; Etidronic Acid; Humans; Multiple Myeloma; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate