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

Previous reports have indicated a relatively high incidence of distant metastases in patients with nasopharyngeal carcinoma (NPC), one of the most common sites being the skeleton. Although bone scintigraphy offers the advantage of whole-body imaging in patients with cancer by providing useful information about disease spread, its value in patients with NPC is not well defined because of cost-effectiveness considerations. In this study, we assessed the value of follow-up bone scintigraphy for the evaluation of skeletal metastases in patients with different stages of NPC. Between 1994 and 2001, 230 patients with histologically proven NPC were admitted to the Department of Radiation Oncology. Out of 230 patients, 171 were examined for skeletal metastases with bone scintigraphy prior to therapy and at 1 year intervals. Bone scintigraphy detected increased uptake in 29 patients, which was reported as suggestive of metastases or equivocal. Twenty-six of these were true-positive, confirmed by radiography or clinical follow-up. Bone pain was present in 67% of these patients and serum lactate dehydrogenase and alkaline phosphatase were elevated in 35% and 37%, respectively. The incidence of bone metastases correlated with the extent of lymph node involvement, which were detected after a median time of 10.5 months following the diagnosis of the primary disease. No correlation was observed between the metastatic status and local T stage, histological differentiation age or gender of the patient. We can therefore recommend that bone scintigraphy be used in determining the presence of bone metastases, but its utilization should be preserved for those with nodal involvement.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Neoplasms; Child; Female; Follow-Up Studies; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Prevalence; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Risk Assessment; Sensitivity and Specificity; Technetium Tc 99m Medronate

Bone metastasis occurs frequently in nasopharyngeal carcinoma (NPC) patients. The aim of this study was to compare the clinical value of 18F-FDG PET/CT with that of 99mTc-MDP planar bone scintigraphy (PBS) for detecting bone metastasis in NPC patients.. Thirty-five histologically proven NPC patients were enrolled in this retrospective study. They underwent both 18F-FDG PET/CT and PBS within 7 days in our department. In a lesion-based analysis, the skeletal system, excluding the head, was divided into four regions: the spine, the pelvis, the thorax, and the appendix. Bone metastasis was considered to be present by either biopsy or clinical follow-up for at least 6 months. PET/CT and PBS were compared by McNemar's paired-sample test.. A total of 50 lesions were confirmed to be malignant (spine 27, thorax 11, pelvis 8 and appendix 4). Although PET/CT was found to be more sensitive on lesion level than PBS (sensitivity 70.0 versus 42.0%; P=0.044), there were still 14 metastatic (28.0%) lesions that could be detected by PBS while negative in PET/CT imaging. In a patient-based analysis, fifteen (42.9%) of 35 eligible patients were found to have bone metastasis. The sensitivity, specificity and accuracy of PET/CT was 60.0% (9/15), 100% (20/20) and 82.9% (29/35); as for PBS, it was 66.7% (10/15), 85.0% (17/20) and 77.1% (27/35), respectively. There was no statistical difference between PET/CT and PBS (P>0.05).. PBS, as a conventional imaging, should be used as an important complement for detecting bone metastasis in NPC patients.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma; Female; Fluorodeoxyglucose F18; Humans; Image Interpretation, Computer-Assisted; Male; Middle Aged; Multimodal Imaging; Nasopharyngeal Carcinoma; Nasopharyngeal Neoplasms; Positron-Emission Tomography; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Young Adult

To investigate the value of the additional skull lateral static imaging in whole-body bone imaging (WBI) vs CT for evaluation of skull base invasion in patients with nasopharyngeal carcinoma.. A total of 405 patients with pathologically confirmed NPC underwent WBI with additional static imaging of the left and right skull as well as CT examination of the nasopharynx and skull base within one week before the radiotherapy.. The concordance rates between WBI and CT for positive and negative diagnosis were 29.48% and 76.05% in these cases, respectively, with the total concordance rate of 81.23%. The concordance rates between skull lateral static imaging with visual judgment and CT examination for positive and negative diagnosis were 67.95% and 74.07%, respectively, showing a total concordance rate of 87.16%. Skull lateral static imaging with semi-quantitative analysis and CT examination showed concordance rates for positive and negative diagnosis of 75.64% and 74.07%, respectively, with a total rate of 88.64%. In 27 patients with negative diagnosis by CT but a positive one in skull lateral static imaging with semi-quantitative analysis, 9 had a positive diagnosis by magnetic resonance imaging.. Skull lateral static imaging can be of value in the diagnosis of skull base invasion in NPC patients and may serve as an effective means for screening skull base invasion in NPC.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Neoplasm Invasiveness; Radionuclide Imaging; Skull; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging; Young Adult

It is an evaluation of radionuclide bone scanning in detecting bone metastasis in the patients with nasopharyngeal carcinoma after radiotherapy.. The bone scanning was performed in 78 patients with nasopharyngeal carcinoma after radiotherapy.. Bone metastasis were detected in 47 patients out of 78, including 46 squamous cell carcinoma and 1 undifferentiated carcinoma.. Radionuclide bone imaging is useful for diagnosing, treating and prognosing of nasopharyngeal carcinoma.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Radiography; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Plain radiographs, computed tomography (CT), and more recently magnetic resonance imaging (MRI) are used routinely to stage carcinoma of the nasopharynx. Tc-99m methylene diphosphonate (MDP) SPECT is seldom used for local staging of the disease.. Plain radiographs and CT were used to stage squamous carcinoma of the nasopharynx in a 50-year-old man with a left XII nerve palsy.. Findings of the plain radiographs were normal, whereas the CT scan revealed a nonhomogenous hyperdense mass in the nasopharynx but intact underlying bone. Given the symptoms, a Tc-99m MDP planar scan was ordered and showed no enhanced uptake, but SPECT images obtained at the same time revealed markedly increased focal radiotracer uptake in the region of the tumor, indicating osseous involvement.. Possible bony invasion with a nasopharyngeal carcinoma may be better shown with MDP SPECT than with planar isotope bone scans, plain radiographs, or CT.

Topics: Adult; Carcinoma, Squamous Cell; Cranial Nerve Diseases; Humans; Hypoglossal Nerve; Male; Nasopharyngeal Neoplasms; Radiopharmaceuticals; Skull Base Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adult; Carcinoma; Enteral Nutrition; Heart; Humans; Lung; Male; Nasopharyngeal Neoplasms; Nutrition Disorders; Radionuclide Imaging; Radiopharmaceuticals; Stomach; Technetium Tc 99m Medronate; Thyroid Gland; Tissue Distribution; Uremia

The aims of this study were to determine the incidence of hypertrophic pulmonary osteoarthropathy (HPO) in nasopharyngeal carcinoma (NPC) and assess its clinical significance. Altogether, 407 NPC patients were reviewed retrospectively. HPO was identified by 99Tcm-methylene diphosphonate bone scans and related clinical and radiographic evidence. Pulmonary metastases, bony metastases and titre of anti-Epstein Barr virus (EBV) immunoglobulin were assessed in patients with and without HPO. The patients had a mean (+/- S.D.) age of 50.4 +/- 12.4 (range 17-73) years. HPO was found in 27 of the 407 (6.6%) NPC patients, among whom 13 (48%) had pulmonary metastases. HPO preceded lung metastases by 7-22 months (14.4 +/- 6 months) in 7 (52%) patients. Six patients had overt lung metastases at the time of the bone scan. No significant difference was found in anti-EBV immunoglobulins between the patients with or without HPO, nor in the incidence of bony metastases between these two groups of patients. HPO should be regarded as an early sign of pulmonary metastases.

Topics: Adolescent; Adult; Aged; Antibodies, Viral; Bone Diseases; Bone Neoplasms; Child; Herpesvirus 4, Human; Humans; Hypertrophy; Lung Diseases; Lung Neoplasms; Middle Aged; Nasopharyngeal Neoplasms; Osteoarthropathy, Secondary Hypertrophic; Radionuclide Imaging; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate

The diagnostic contribution of single-photon emission tomography (SPET) to the detection of bone lesions of the skull base was explored in 200 patients with nasopharyngeal carcinoma (NPC). Comparison of SPET with planar bone scintigraphy showed that SPET improved the contrast and better defined the lesions in 107 out of the 200 patients. Comparison of SPET with X-ray computed tomography (CT) showed that SPET did not miss the lesions detected by CT while CT missed 49% of the lesions detected by SPET. The only false-positive lesion with SPET was detected in the mastoid bone. SPET detected skull base lesions in all of the 35 patients with cranial nerve involvement, while CT missed eight and planar bone scintigraphy missed four. The findings suggest that SPET should be included in the routine check-up examinations of patients with NPC.

Topics: Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Sensitivity and Specificity; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

SPECT of the skull was performed on twelve patients with histologically proven nasopharyngeal carcinoma using newly developed three detectors SPECT system (Toshiba GCA 9300A) mounted with fan-beam collimators, for the purpose of early detection of skull base involvement of the disease. This SPECT system has extremely improved resolution with FWHM of 8 mm in the center, and it provides clear tomographic images of the skull which has anatomically complex structure. SPECT image was taken 3 hours after injection of 740 MBq (20 mCi) of 99mTc-MDP following whole body skeletal survey. In twelve patients with confirmed nasopharyngeal carcinoma, 8 patients showed positive findings on SPECT. Three of SPECT positive patients also showed destructive findings on CT. Other five positive patients did not show destructive findings on CT at their initial examinations, but in three of them CT findings turned to positive later. SPECT was superior to CT in early detection of skull base involvement. We believe that SPECT of the skull is a diagnostic tool for early detection of skull base involvement of nasopharyngeal carcinoma.

Topics: Adult; Aged; Carcinoma; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Neoplasm Invasiveness; Skull; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

One hundred thirty-two new patients with nasopharyngeal carcinoma and no evidence of distant metastases were evaluated for bone metastases with bone scanning. Forty-four patients had abnormal hypercaptation. These abnormal findings were considered related to benign diseases in 39 patients after correlating clinical examinations and skeletal radiographs. The remaining five patients had positive bone scanning which was suggestive of bone metastasis. There were 13 patients who developed symptomatic bone metastases over a follow-up period of 0.2-41 months. In three of these, the bone metastases corresponded to the sites of abnormal hypercaptation in the initial positive bone scanning. In view of the low sensitivity and specificity of bone scanning in this setting, routine bone scanning for staging nasopharyngeal carcinoma is not recommended. But in the research setting, baseline scanning is useful to make subsequent scanning more valuable, and it reduces false-positive results.

Topics: Bone and Bones; Bone Neoplasms; Carcinoma; Evaluation Studies as Topic; Female; Hong Kong; Humans; Incidence; Male; Middle Aged; Nasopharyngeal Neoplasms; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

One hundred and forty-three patients (Group 1) with histologically proven nasopharyngeal-carcinoma (NPC) had bone scintigraphy with 99Tcm methylenediphosphonate (MDP) or dihydroxypropanediphosphonate (DPD) within 2 months of the initial diagnosis. A further 162 patients (Group 2) had bone scans during the course of follow-up if there were symptoms of bone pain or evidence of metastases at other sites. Twenty-three per cent (33/143) of the newly diagnosed NPC patients (Group 1) had evidence of bone metastases. Of these 143 patients, 101 were T0-T2, 16 were T3 and 25 were T4. Thirty-six patients had no neck nodes (NO), 44 were N1, 25 N2 and 38 N3. Of the 162 patients in Group 2, 96 (59%) had a positive bone scan. The commonest sites for bony metastases from NPC were the spine, ribs, pelvis and lower limbs in order of frequency. There is a highly significant association with the nodal stage but no association with the UICC T staging which is not adequate in nasopharyngeal carcinoma. In our part of the world, bone metastases from NPC are a common cause of an abnormal bone scan.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Nasopharyngeal Neoplasms; Neoplasm Metastasis; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Medronate

Of 628 patients with extra-osseous malignancies diagnosed by surgery and/or pathology, 207 (33.0%) were identified as having skeletal metastasis by bone imaging. There was statistical significant difference in the incidence of metastasis in in different malignancies (P less than 0.02). The metastatic rates of nasopharyngeal, lung, prostate and breast cancers were higher than gastrointestinal, kidney, and other malignancies. There was significant differences in the different sites of skeletal metastasis (P less than 0.01). They were thorax, spine, pelvis, limbs and skull in order of incidence. Solitary metastatic rate was 15.9%. Biopsy is advised for patients suspected to have metastatic disease but with only one single "hot spot" in skeletal imaging, particularly in the rib.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Humans; Lung Neoplasms; Male; Nasopharyngeal Neoplasms; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

A five year review of 224 Tc-99m methylene diphosphonate (MDP) scintiscans of 194 patients with proven nasopharyngeal carcinoma revealed evidence of craniofacial asymmetry in 73.7 per cent. In virtually all instances tracer accumulation corresponded to the side of the primary lesion, cervical node enlargement and or cranial nerve dysfunction. It was concluded that the high frequency of asymmetric ipsilateral MDP accumulation about the face may be attributed to one or all of the following; tumour extension into contiguous structures, localised inflammatory or necrotic changes or even tracer uptake by the tumour itself.

Topics: Bone Neoplasms; Carcinoma, Squamous Cell; Facial Bones; Humans; Nasopharyngeal Neoplasms; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

Topics: Adult; Aged; Carcinoma, Squamous Cell; Female; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Prognosis; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed