technetium-tc-99m-medronate and Neoplasm-Metastasis

In recent years tomographic hybrid scanners have been quickly introduced in nuclear medicine: single-photon emission computed tomography (SPECT)-CT and positron emission tomography (PET)-CT.- Both SPECT-CT and PET-CT techniques provide a higher diagnostic accuracy than conventional (non-tomographic, non-hybrid) bone scintigraphy (bone scan).- Differences between 99mTc hydroxymethylene diphosphonate (HDP) SPECT-CT or 99mTc methylene diphosphonate (MDP) SPECT-CT and 18F-fluoride PET-CT bone scanning relate to image quality, technique, availability, quantification possibilities, radiation dosimetry and financial cost.- Indications for these techniques will especially lie in the field of more accurate detection of skeletal metastases than with bone scans, patients with unexplained musculoskeletal pain, the diagnostic stage after conventional X-ray and/or MRI, and quantification of bone metabolism.

Topics: Bone Density; Bone Neoplasms; Costs and Cost Analysis; Fluorine Radioisotopes; Humans; Multimodal Imaging; Neoplasm Metastasis; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Artifacts; Axilla; Biopsy; Breast Diseases; Breast Neoplasms; Carcinoma; Carcinoma, Ductal, Breast; Chemotherapy, Adjuvant; Drug Resistance, Multiple; Drug Resistance, Neoplasm; False Positive Reactions; Female; Forecasting; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Mammography; Middle Aged; Multicenter Studies as Topic; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Organophosphorus Compounds; Organotechnetium Compounds; Patient Selection; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Ultrasonography

The TNM staging system is a modus for diagnosis and treatment in which T is the extent of the tumor involvement, N is lymph node involvement, and M is the metastases; this system is supplemented with a histologic malignancy grade. Staging systems identify specific prognostic factors with which to predict clinical outcome. Staging systems are useful for assigning treatment priorities, determining the role of adjuvant therapies, and evaluating clinical investigations. Unfortunately, no universally accepted staging system for soft-tissue sarcomas exists. This is related to the relatively low incidence of sarcomas, the unique and unpredictable behavior of sarcomas, significant disagreement regarding histogenesis and grading, and lack of consensus regarding the value of various prognostic factors. In adults, the two most commonly used staging systems are those developed by the American Joint Committee on Cancer and by Enneking. In children, the Intergroup Rhabdomyosarcoma Study and the International Union Against Cancer have described the systems most commonly used. These systems for soft-tissue sarcomas rely on an ability to accurately determine both the local and distant extent of disease. Advances in the field of computed tomography and magnetic resonance imaging have made this possible. It is likely that a staging system based upon a more sophisticated understanding of the basic biology of sarcomas will become available.

Topics: Adult; Biopsy; Child; Clinical Protocols; Humans; Incidence; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Rhabdomyosarcoma; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome

Skeletal metastases of bone sarcomas are indicators of poor prognosis. Various imaging modalities are available for their identification, which include bone scan, positron emission tomography/CT scan, MRI, and bone marrow aspiration/biopsy. However, there is considerable ambiguity regarding the best imaging modality to detect skeletal metastases. To date, we are not sure which of these investigations is best for screening of skeletal metastasis.. Which staging investigation-18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT), whole-body MRI, or 99mTc-MDP skeletal scintigraphy-is best in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in detecting skeletal metastases in patients with osteosarcoma and those with Ewing sarcoma?. A prospective diagnostic study was performed among 54 of a total 66 consecutive osteosarcoma and Ewing sarcoma patients who presented between March 2018 and June 2019. The institutional review board approved the use of all three imaging modalities on each patient recruited for the study. Informed consent was obtained after thoroughly explaining the study to the patient or the patient's parent/guardian. The patients were aged between 4 and 37 years, and their diagnoses were proven by histopathology. All patients underwent 99mTc-MDP skeletal scintigraphy, 18F-FDG PET/CT, and whole-body MRI for the initial staging of skeletal metastases. The number and location of bone and bone marrow lesions diagnosed with each imaging modality were determined and compared with each other. Multidisciplinary team meetings were held to reach a consensus about the total number of metastases present in each patient, and this was considered the gold standard. The sensitivity, specificity, PPV, and NPV of each imaging modality, along with their 95% confidence intervals, were generated by the software Stata SE v 15.1. Six of 24 patients in the osteosarcoma group had skeletal metastases, as did 8 of 30 patients in the Ewing sarcoma group. The median (range) follow-up for the study was 17 months (12 to 27 months). Although seven patients died before completing the minimum follow-up, no patients who survived were lost to follow-up.. With the number of patients available, we found no differences in terms of sensitivity, specificity, PPV, and NPV among the three staging investigations in patients with osteosarcoma and in patients with Ewing sarcoma. Sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 67% (4 of 6 [95% CI 22% to 96%]) and specificities were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 78% (14 of 18 [95% CI 52% to 94%]), respectively, in patients with osteosarcoma. In patients with Ewing sarcoma, sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 88% (7 of 8 [95% CI 47% to 100%]), 88% (7 of 8 [95% CI 47% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and specificities were 100% (22 of 22 [95% CI 85% to 100%]), 95% (21 of 22 [95% CI 77% to 100%]), and 95% (21 of 22 [95% CI 77% to 100%]), respectively. Further, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and the NPVs were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 88% (14 of 16 [95% CI 62% to 98%]), respectively, in patients with osteosarcoma. Similarly, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (7 of 7 [95% CI 59% to 100%]), 88% (7 of 8 [95% CI 50% to 98%]), and 80% (4 of 5 [95% CI 28% to 100%]), and the NPVs were 96% (22 of 23 [95% CI 78% to 100%]), 95% (21 of 22 [95% CI 77% to 99%]), and 84% (21 of 25 [95% CI 64% to 96%]), respectively, in patients with Ewing sarcoma. The confidence intervals around these values overlapped with each other, thus indicating no difference between them.. Based on these results, we could not demonstrate a difference in the sensitivity, specificity, PPV, and NPV between 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy for detecting skeletal metastases in patients with osteosarcoma and Ewing sarcoma. For proper prognostication, a thorough metastatic workup is essential, which should include a highly sensitive investigation tool to detect skeletal metastases. However, our study findings suggest that there is no difference between these three imaging tools. Since this is a small group of patients in whom it is difficult to make broad recommendations, these findings may be confirmed by larger studies in the future.. Level II, diagnostic study.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Humans; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Staging; Osteosarcoma; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sarcoma, Ewing; Sensitivity and Specificity; Technetium Tc 99m Medronate; Whole Body Imaging; Young Adult

Topics: Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Hypercalcemia; Neoplasm Metastasis; Paraneoplastic Syndromes; Parathyroid Hormone-Related Protein; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

We presented a 61-year-old man's surprising Tc-MDP whole-body blood pool superscan pattern with early unexpected generalized bone uptake. He complained of weakness and undesired weight loss with anemia and elevated erythrocyte sedimentation rate. As a malignancy workup in a patient without obvious suspicious origin, a whole-body Tc-MDP bone scan was requested. This unusual tracer distribution on blood pool imaging was very similar to the whole-body delayed scan except for visible kidneys.

Topics: Bone Neoplasms; Gated Blood-Pool Imaging; Humans; Male; Middle Aged; Neoplasm Metastasis; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Metastatic calcification relates to abnormal calcification resulting from hypercalcaemia in otherwise normal tissues. Hypercalcaemia can occur secondary to chronic renal failure, hyperparathyroidism, hypervitaminosis D, and metastatic neoplasms. Specific symptoms are often lacking, but calcification may be a marker of disease severity and its chronicity. We present cases with different patterns of soft tissue calcification on Tc99m MDP bone scan.

Topics: Aged; Bone Neoplasms; Breast Neoplasms; Calcinosis; Carcinoma; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thoracic Wall

Malignant transformation of giant cell tumour of the bone is extremely rare. In addition, bone transformation in giant cell tumour may occur in different phases. With conventional X-rays, CT scans or MRIs, it may be challenging to distinguish among different phases of bone transformation, normal bone, soft tissue disease and bone disease (benign vs malignant lesions) and changes in multiple organs such as lung, liver and lymph nodes unless every lesion is biopsied, which is not practical. Molecular imaging with different isotopes (Tc-99m phosphonate, 2-deoxy-2-(

Topics: Adult; Bone Neoplasms; Cell Transformation, Neoplastic; Diagnosis, Differential; Female; Fluorodeoxyglucose F18; Giant Cell Tumor of Bone; Humans; Molecular Imaging; Neoplasm Metastasis; Osteosarcoma; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Rare Diseases; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

In this report, we present a case of liver uptake seen on a bone scan that was due to diffuse metastatic disease from breast carcinoma. We discuss possible etiologies for the uptake and offer an algorithm to narrow the differential diagnosis.

Topics: Algorithms; Biological Transport; Bone and Bones; Breast Neoplasms; Female; Humans; Liver; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Technetium Tc 99m Medronate

Prostate cancer (PCa) is increasingly being diagnosed in China. Early detection of bone metastases (BM) is critical in the management of patients with high-risk PCa. The aim of this study is to establish a screening model to determine if bone scan should be performed for BM in Chinese patients at the time when PCa is diagnosed.. The study included 488 patients who were diagnosed with PCa between 2009 and 2011 at a single center. All patients received bone scans using technetium (99m)Tc methylene diphosphonate at the initial staging. If the bone scan finding was equivocal, computed tomography or magnetic resonance imaging was performed to confirm the diagnosis. Age, prostate-specific antigen (PSA) at diagnosis, clinical stage assigned according to the TNM 2002 staging system and biopsy Gleason score were collected in all patients. Multivariate logistic regression analysis was performed to identify statistically significant covariates and then receiver operating characteristic (ROC) curves were generated to identify optimal cut-off values. Using these cut-off values, a formula was devised to calculate an index value for BM screening at diagnosis. The model was cross-validated using the leave-one-out method.. Of the 488 patients, 65 patients (13.3%) had BM. The area under the ROC curve was 0.87 (95% confidence interval 0.83-0.94). The sensitivity of the cut-off point was 87.7% and the specificity was 73.1%. Bone scan is needed for all cT4 PCa patients, however, it is also advisable for cT1-T3 PCa patients who have a biopsy Gleason score ≤3 + 4 and a PSA >132.1, and for cT1-T3 patients having a Gleason score of ≥4 + 3 and PSA >44.5.. The regression model may help determine if bone scan is needed to detect BM from PCa at the time of diagnosis. The model was generated upon a single center experience. Further validation is needed in future studies.

Topics: Adult; Aged; Aged, 80 and over; Asian People; Bone and Bones; Bone Neoplasms; China; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multivariate Analysis; Neoplasm Grading; Neoplasm Metastasis; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Regression Analysis; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

We report a case of Q fever demonstrated on (99m)Tc methylene diphosphonate bone scan and fluorodeoxyglucose (FDG) PET/CT. A 66-year-old man with newly diagnosed, low-grade prostate cancer presented with abdominal and bone pain. Bone scan revealed multiple lesions suspicious for prostate cancer metastases. Because of liver abnormalities on noncontrast CT, an FDG PET/CT was performed and demonstrated FDG-avid sclerotic bone lesions, infiltrative liver disease, and retroperitoneal adenopathy. This appearance, thought unusual for low-grade prostate cancer, prompted extensive clinical evaluation for several months. Liver and iliac bone biopsies showed noncaseating granulomas without neoplasia. Extensive serologic evaluation eventually demonstrated elevated Q fever titers.

Topics: Aged; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms; Q Fever; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole Body Imaging

Sodium fluoride (NaF) is a bone-seeking positron-emitting tracer with high sensitivity and specificity for detection of osseous lesions, particularly osteolytic lesions. We believe that NaF positron emission tomography (PET)/computed tomography (CT) scans can provide a more thorough and conclusive evaluation of bone diseases than conventional Technetium-99m-methylene diphosphonate bone scans. Understanding both normal and pathologic patterns is important for the evaluation and interpretation of these studies. Thus, an atlas of NaF positron emission tomography/computed tomography bone scans demonstrating benign, pathologic, and malignant osseous lesions as well as extraosseous lesions will be invaluable in the correct interpretation and diagnosis of osseous lesions.

Topics: Aged; Bone and Bones; Female; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Metastasis; Osteolysis; Positron-Emission Tomography; Sodium Fluoride; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Whole Body Imaging

Schmorl's node (SN) is a common entity characterized by protrusion of intervertebral disc material through a break in the subchondral end plate of a vertebral body. They can show increased 99mTC methylene diphosphonate uptake on bone scintigraphy mimicking metastasis and can be symptomatic. Differentiation of SN from metastasis is essential for appropriate patient management. Here, we present a case where increased 99mTC methylene diphosphonate uptake in a dorsal vertebra was found to be because of SN by using single-photon emission computed tomography-computed tomography.

Topics: Adult; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Neoplasm Metastasis; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

We observed an unusually increased scrotal uptake as an interesting finding in some patients with prostate cancer who were scanned for any possible metastatic disease. This study was designed to investigate the significance of this incidental finding in the technetium-99m methylene diphosphonate scintigraphies.. The study population consisted of 104 patients with biopsy-proven prostate cancer (group I), 55 male patients with other cancers (group II), 30 male patients with nonmalignant diseases (group III) and finally 15 patients with benign prostate hypertrophy (group IV). The square-shaped regions of interest are placed centrally on the scrotum and then on the lateral femoral soft tissue. Then the simple ratios of the scrotal and femoral soft tissue mean counts (S/Bg) were calculated. The statistical significance of differences among the groups in terms of scrotal uptake was determined.. Group I showed increased scrotal uptake relative to the other groups. The mean uptake ratios (S/Bg±standard deviation) were 3.49±1.42 in group I, 2.89±0.70 in group II, 2.87±0.75 in group III, and 2.91±0.60 in group IV. This ratio was significantly higher in patients with prostate cancer than the normal group (P=0.024), the group with benign prostate hypertrophy (P=0.004), and the patients with other cancers (P=0.004).. Our results showed that technetium-99m methylene diphosphonate bone scintigraphy, as a routine for detecting metastatic disease or performed for other purposes, could give clues for a hidden prostate cancer. Then, in elderly male patients, we strongly recommend that it is wise to keep one's eye on scrotal activity when bone scans are read and where there is any doubt, take appropriate regions of interest to make quantitative evaluations.

Topics: Biological Transport; Bone and Bones; Humans; Incidental Findings; Male; Middle Aged; Neoplasm Metastasis; Prostate-Specific Antigen; Prostatic Neoplasms; Radionuclide Imaging; Scrotum; Technetium Tc 99m Medronate

This investigation was undertaken to evaluate the significance of solitary bony abnormalities on bone scintigrams of children with known or suspected malignancy. A total of 215 bone scans were performed in 183 children in order to look for possible metastasis over a 10-year period. Forty-nine scans (22.8%) were found to have single lesions, of which 18 were due to uptake at the primary site and were excluded from further consideration. Of the remaining 31 lesions, 13 (41.9%) were confirmed as metastases, 17 lesions were proved to be benign, and 1 indeterminate. Solitary hot spots in children with known or suspected malignancy are common and therefore have to be taken seriously due to their higher malignant potential.

Topics: Adolescent; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Humans; Infant; Infant, Newborn; Neoplasm Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Medronate

We report the case of a 72-year-old man with prostate cancer, in whom Tc-99m MDP bone scintigraphy revealed a "superscan" pattern, except in a dorsal vertebra, which appeared photopenic. A low-dose SPECT/CT acquisition demonstrated that the lack of tracer uptake corresponded to a blastic lesion with no lytic component. Surprisingly, the cold vertebra appeared as an "ivory vertebra" on the CT part of the SPECT/CT acquisition. In the present case, the photopenic appearance is thought to be due to a concomitant blastic lesion and spine infarct.

Topics: Aged; Bone and Bones; Disease Progression; Humans; Male; Neoplasm Metastasis; Phenotype; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Whole Body Imaging

A 51-year-old woman on peritoneal dialysis for chronic renal failure secondary to diabetic and nonsteroidal anti-inflammatory drug nephropathy was referred for a Tc-99m MDP bone scan to assess firm subcutaneous plaques in the sacral and gluteal regions. This showed extensive superficial tracer localization in the subcutaneous tissues as well as visceral tracer activity in the myocardium, lungs, stomach, and kidneys. These findings were typical for calciphylaxis (calcific uremic arteriolopathy), a form of metastatic calcification encountered in patients with chronic renal failure that is characterized by subcutaneous soft tissue calcification, painful ulcerations, high morbidity, and mortality. Treatment with sodium thiosulfate resulted in dramatic scintigraphic improvement.

Topics: Bone and Bones; Calcinosis; Calciphylaxis; Female; Humans; Ischemia; Kidney Failure, Chronic; Middle Aged; Necrosis; Neoplasm Metastasis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thiosulfates; Tissue Distribution

Chronic pain is one of the most frequent and distressing symptoms in patients suffering from bone metastases due to malignant disease. Besides pharmacological therapy using analgesics according to the WHO scheme and local surgical or radiotherapeutic treatment options, systemic radionuclide therapy is available, particularly for patients with multilocular metastatic disease. This palliative pain treatment is almost free of severe side effects and is thus indicated as a complementary therapy as part of an interdisciplinary approach in pain treatment. Moreover, preliminary data indicate a favorable cost:utility ratio. Positive clinical effects with marked reduction of pain are described in 70-80% of patients with breast or prostate cancer. However, complete analgesia is uncommon and, thus, most patients require analgesic treatment during the further course of their disease.

Topics: Aged; Bone Neoplasms; Female; Humans; Male; Neoplasm Metastasis; Neoplasms; Pain; Prostatic Neoplasms; Radiography; Radioisotopes; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Child; Humans; Intellectual Disability; Male; Muscles; Myositis Ossificans; Neoplasm Metastasis; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Accumulation of bone seeking radiopharmaceuticals in soft tissue of the chest has many causes. We report two cases of 99m-Tc-HMDP uptake respectively in the lung, in a patient with localized amyloidosis, and on diaphragmatic metastasis of a PNET. Mechanisms of such uptake are discussed.

Topics: Adult; Amyloidosis; Bone and Bones; Diaphragm; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neuroectodermal Tumors, Primitive; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Patients with skeletal metastases from hormone-refractory prostate cancer have shown variable responses to high-activity therapy with (186)Re-HEDP and peripheral stem cell support. In this paper, we report on the use of a novel technique to compare sequential planar images acquired post-(186)Re-HEDP therapy administration with pretherapy diagnostic (99m)Tc-MDP scans, to evaluate the turnover of the radiopharmaceutical in normal and abnormal bone. It was found that the activity in normal (i.e., disease-free) segments of the spine demonstrates a faster effective decay than that of the metastases, with the latter showing only physical decay. This study showed, for the first time, a detailed correlation in the behavior of the (99m)Tc-MDP and (186)Re-HEDP images, encouraging the possibility of using the pretherapy 99mTc-MDP scan for estimations of absorbed doses to be delivered by prescribed activities of (186)Re-HEDP.

Topics: Bone and Bones; Bone Neoplasms; Etidronic Acid; Humans; Image Processing, Computer-Assisted; Male; Neoplasm Metastasis; Organometallic Compounds; Prostatic Neoplasms; Radioimmunodetection; Radioisotopes; Radiopharmaceuticals; Software; Technetium Tc 99m Medronate; Time Factors; Whole-Body Counting

Diffuse metastatic visceral calcification is rare in breast cancer. We report on a 57-year-old woman with breast cancer and hypercalcemia who had diffuse metastatic visceral calcifications on lungs, myocardium, stomach, and thyroid on a (99m)Tc-methylene diphosphonate bone scan. Visceral calcifications were completely resolved 6 months after successful anticancer and zoledronic acid treatments. Bone scanning offers a useful diagnostic tool for both identifying visceral calcification and assessing the response to therapy in chemosensitive malignities with hypercalcemia such as breast cancer.

Topics: Antineoplastic Agents; Bone and Bones; Breast Neoplasms; Calcification, Physiologic; Calcium; Diphosphonates; Female; Heart Neoplasms; Humans; Imidazoles; Lung Neoplasms; Middle Aged; Neoplasm Metastasis; Stomach Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms; Time Factors; Zoledronic Acid

Poorly differentiated insular thyroid carcinoma is classified as a separate entity among other tumors of the thyroid gland. Its histological pattern and clinical course are regarded as intermediate between well-differentiated and anaplastic thyroid cancer. The authors report Tc-99m pertechnetate, Tc-99m MDP and radioiodine imaging features in a 33-year-old male patient with metastatic insular carcinoma of the thyroid. The extent of involvement was almost identical in all three studies. Insular carcinoma of the thyroid was shown by biopsy, and the patient received a cumulative dose of 14,800 MBq (400 mCi) radioactive I-131. Other radionuclide imaging agents are also reviewed.

Topics: Adult; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Palliative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Thyroid Neoplasms; Treatment Outcome

The potential targeting of therapeutic bisphosphonate conjugates to bone metastatic lesions was evaluated in vivo in mice. A bisphosphonate conjugate with 5-fluorouracil was synthesized as a potential chemotherapy agent, and a bisphosphonate conjugate with diethylenetriaminepentaacetic acid (DTPA) was prepared as a potential carrier of cytotoxic radionuclides. The compounds are hypothesized to be able to deliver either high doses of radiation or a high concentration of chemotherapy agents at sites of increased osteoclastic activity in patients with bony metastases while exhibiting minimal toxicity to normal tissues. Tissue distribution studies with the 99mTc-labeled bisphosphonate conjugates with DTPA and 5-fluorouracil showed rapid blood clearance and excretion of unbound activity, clearance from most tissues, and substantial retention of the bisphosphonates in bone. For the DTPA conjugate, activity in the bone represents 13.6% of the total injected dose at 8 hours following injection, representing 54.3% of the total whole-body activity at this time period. Under the same conditions, the 5-fluorouracil conjugate showed a 17.1% bone uptake at 60.2% of the whole-body activity. This normal bone uptake predicts that high concentrations of conjugates are expected to be achieved at sites of bone metastatic disease. Chemotherapy and radiotherapy studies with these compounds in animal models of metastatic bone cancer are underway.

Topics: Animals; Antimetabolites, Antineoplastic; Bone Neoplasms; Diphosphonates; Female; Fluorouracil; Humans; Mice; Mice, Inbred BALB C; Models, Chemical; Neoplasm Metastasis; Neoplasm Transplantation; Neoplasms, Experimental; Pentetic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Pentetate; Time Factors; Tissue Distribution

To document the varied radiological features before, during, and after treatment of non-Central Nervous System Primitive Neuroectodermal Tumours (PNETs), which are rare tumours of childhood.. Thirty-three children with PNETs have been treated at our institution between 1990 and 1999. Full radiological and clinical follow-up was obtained in 29 (17 females, 12 males). Imaging was retrospectively reviewed, with particular attention to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).. Age range at diagnosis was 0-16 years old (mean 4.4 years). There were five main sites of tumour: head and neck (n = 7), scapula/axilla (n = 2), chest (n = 11), abdomen (n = 3), and spinal/paraspinal (n = 6). Overall mortality was 62%. Tumours of the scapula or paraspinal region appear to show better survival than other sites. Of 23 patients who had Tc99m-methylene diphosphonate (MDP) bone scans at diagnosis, four patients showed widespread distant metastases, seven showed focal increased uptake in an adjacent bone only, and 12 had normal examinations. CT was performed in 25 patients and MRI in 20, both at diagnosis and follow-up. Average size of tumours at presentation was 4.5 cm in the paraspinal, head and neck and scapular regions and 7.5 cm in the chest and abdomen. Tumours were typically of soft tissue density on CT with the larger (>5 cm) masses tending to be more heterogeneous in character. The lesions were slightly higher signal than muscle on T1-weighted (T1W) MRI and all masses were heterogeneous on T2W sequences. Calcification was uncommon (n = 6) and generally sparse. Tumours tended to displace adjacent soft tissue structures such as vessels and bronchi rather than invade or encase them. Tumours rarely crossed the midline. Local or bony invasion was seen in 12 patients at diagnosis. Metastases were identified in the lung (n = 5), pleura (n = 2), brain (n = 4), bone (n = 4), lymph nodes (n = 2), liver (n = 2), subcutaneous tissues (n = 2), kidney (n = 1) and peritoneum (n = 1).. Imaging characteristics of non-CNS PNETs are described. Tumours tend to displace rather than encase adjacent structures; local invasion occurred in 43%. Tumour calcification is uncommon. Poor prognostic features included the presence of distant metastases at diagnosis (all four patients with distant metastases at diagnosis died), but even patients without metastatic disease have a relatively poor prognosis.

Topics: Abdominal Neoplasms; Adolescent; Child; Child, Preschool; Disease-Free Survival; Female; Head and Neck Neoplasms; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neuroectodermal Tumors, Primitive, Peripheral; Prognosis; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Neoplasms; Tomography, X-Ray Computed

Topics: Adult; Age of Onset; Antibodies; Bone Marrow; Bone Marrow Neoplasms; Bone Neoplasms; Granulocytes; Humans; Male; Neoplasm Metastasis; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

To describe scintigraphic characteristics of bone allografts used in limb salvage reconstruction after resection of lower extremity osteosarcoma.. The authors reviewed 85 skeletal scintigrams of 20 pediatric patients followed up for 0.5-5.7 years after resection of lower extremity osteosarcoma and allograft reconstruction. Uptake in the allograft and adjacent host tissues was assessed visually.. Lack of tracer uptake in the allografts was seen in 99% of the studies and a faint rim of tracer localization outlining the allograft's periphery was seen in 95% of the studies. Increased uptake was noted at the allograft-host bone junction in 78% of the studies. Uptake was increased in the joint surfaces of native bones articulating with allografts (97% of studies), including the patella (93% of studies) when the knee was involved. These findings were stabilized as time passed.. Cadaveric bone allografts have a characteristic scintigraphic appearance in this selected patient group that reflects the physiology of their incorporation process.

Topics: Adolescent; Bone Neoplasms; Bone Transplantation; Child; Female; Femur; Follow-Up Studies; Humans; Male; Neoplasm Metastasis; Osteosarcoma; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia

The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma.. Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex.. Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 +/- 0.32) and NSCLC (1.43 +/- 0.19) tumour types did not show statistical difference (p > 0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases.. Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Topics: Bone Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Humans; Injections, Intravenous; Lung Abscess; Lung Neoplasms; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A correct staging of clinically localized prostate cancer should nowadays consist of: digital rectal examination (DRE) (+/- -transrectal ultrasound [TRUS]) bone scan abdominal computed tomography or body coil magnetic resonance imaging (+/- laparoscopic lymph node dissection according to the PSA level) endorectal surface coil MR imaging (if available) The above-mentioned methods are discussed with preference to the new technology of endorectal surface coil magnetic resonance imaging (E-MRI) of the prostate.

Topics: Aged; Bone and Bones; Humans; Laparoscopy; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Ultrasonography

Topics: Carcinoma, Renal Cell; Female; Humans; Kidney; Kidney Neoplasms; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Humans; Male; Neoplasm Metastasis; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Parameters that predict tumor aggressiveness or response to therapy are potentially useful in selecting the most appropriate treatment. In theory, the biologic aggressiveness of an untreated bone tumor may be reflected in bone scan parameters. The purpose of this study was to assess the usefulness of bone scintigraphy as a predictive indicator of subsequent metastasis in 25 dogs with primary osteosarcoma. Dogs received radiotherapy and/or intra-arterial cisplatin prior to limb-sparing surgery. Quantitative bone scintigraphy of the tumor was performed prior to treatment (25 dogs) and following treatment but prior to limb-sparing surgery (22 dogs). All dogs developed metastasis at a median time of 202 days (range, 41-444 days) after initiation of treatment. A statistically significant relationship was identified between time to metastasis and: (1) the radiographic tumor area, (2) the pretreatment ratio of mean counts per pixel in tumor-to-adjacent nontumor bone (T/NTT), and (3) the pre:post-treatment T/NTT. Larger tumor area and high pretreatment tumor activity were associated with earlier metastasis. Tumors characterized by greater decreases in scintigraphic uptake after treatment were associated with earlier metastasis. These data suggest that osteosarcomas with high pretreatment mean counts per pixel signify aggressive tumors subject to early metastasis.

Topics: Animals; Bone Neoplasms; Cisplatin; Combined Modality Therapy; Dogs; Infusions, Intra-Arterial; Neoplasm Metastasis; Neoplasm Recurrence, Local; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

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

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

Neuroblastoma is a potentially curable childhood malignancy with survival rates of 20% reported even in advanced disease. Technetium-labelled methylene diphosphonate (Tc99m-MDP) scanning is well established as a method of assessing bone disease. We report four patients, with advanced neuroblastoma in complete or partial remission, in whom new abnormalities on bone scintigraphy were due to benign lesions. Correct management depends on the precise diagnosis of such lesions.

Topics: Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neuroblastoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Based upon the rapid early renal excretion of bone imaging radiopharmaceuticals, we performed a prospective study to determine the use of combining renal evaluation with routine bone scans in 79 consecutive patients with prostate cancer. The radionuclide renal scintigraphy consisted of a 1-minute sequence of 2.5-second frames with a bolus injection of 99mtechnetium-methylene diphosphonate followed by a series of 2-minute images for 24 minutes. Whole body bone scans were performed after a 3-hour delay. All patients had at least 1 confirmatory study with excretory urography (62), ultrasonography (49) or computerized tomography (30). Results were interpreted independently and compared. Ten studies were normal. Radionuclide renal scintigraphy was able to identify 45 of 49 cortical abnormalities (90 per cent) with a false positive rate of 4 per cent. Accuracy of renal cyst detection was only 47 per cent (15 of 32 cases). All acutely obstructed kidneys were identified correctly by radionuclide renal scintigraphy (5 of 5 cases). Of 12 chronically obstructed kidneys 8 (67 per cent) were identified correctly. The 4 missed kidneys were small and nonfunctioning, and they were diagnosed correctly as such but obstruction as the etiology of nonfunction was unidentifiable by radionuclide renal scintigraphy. The false positive rate of obstructive diagnosis by radionuclide renal scintigraphy was 24 per cent (4 of 17 cases). These findings demonstrate that renal evaluation combined with routine bone scanning is an effective screening procedure for renal complications of prostate cancer; no significant abnormalities were missed. The procedure is entirely free of morbidity and does not add to the radiation dose from the bone scan. Furthermore, it is cost-effective, since it avoids the routine need for 2 separate procedures at followup of patients with prostate cancer.

Topics: Bone and Bones; False Positive Reactions; Humans; Male; Neoplasm Metastasis; Prospective Studies; Prostatic Neoplasms; Radioisotope Renography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

We have been among the first authors to point out that false negative cases could be observed with 131I-MIBG scintigraphy for neuroblastoma. We have observed until now ten of such false negative cases, 7 with primary tumor and 3 with bone metastases. Fifty 131I-MIBG scans were performed in 35 children with histologically proven neuroblastoma (24 grade IV) and compared to bone scans, CT and NMR images, ultrasound and clinical results. The visualization of the primary tumor shows a higher sensitivity with MIBG (79%) than with bone scans (47%) and a 100% specificity with each method. MIBG and bone scans, for bone metastases, are similar in the sensitivity (87.5%) but MIBG is much more specific (100%) than bone scan (81%). These results clearly confirm the superiority of MIBG scan for detection of primary tumor as well as bone metastases. However, MIBG is not always the most appropriate investigation, as shown by 11 observed pitfalls. Ten false negative cases have been observed and must be considered: in five out of 10 cases, bone scans performed with 99m Tc-HMDP made the diagnosis (3/7 cases of primary tumor and 2/3 cases of bone metastases). Moreover, one case was not usable due to a large digestive uptake. Our aim is to understand the reasons of the false negative by a meticulous analysis of every single case. The optimal procedure for neuroblastoma diagnosis, extent and follow up clearly seems to be the following strategy: MIBG scan must be firstly performed; in case of non-demonstrative scan the bone scan, which is complementary, will greatly contribute to the diagnosis.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Male; Neoplasm Metastasis; Neuroblastoma; Technetium Tc 99m Medronate; Tomography, Emission-Computed; Tomography, X-Ray Computed

Whole body retention (WBR) of 99mTc labeled methylene diphosphonate (MDP) has been shown to significantly differentiate various clinical stages of prostate cancer. Whole body measurements, when performed at 5 min and 24 h after i.v. administration of 99mTc-MDP, allows for the calculations of percentage whole body retention (% WBR) after one day. The latter can be expressed relative to either the anterior or posterior projection, or in combination as the geometric mean value. In an attempt to better describe the clinical course of prostate cancer patients with bone metastases we have refined the % WBR calculations to include a normalization factor. The latter consists of the mean 24-h value of WBR's as obtained from 10 prostate cancer patients without bony metastases as determined by bone scintigram. These values were determined for each projection to be: anterior = 26.5 +/- 4.7%, posterior = 37.5 +/- 7.4%, and geometric mean = 31.5 +/- 5.7%. The % WBR is then divided by the normalization factor of choice and expressed as (% WBR)N. These data are used to better express 99mTc MDP 24-h whole body retentions when following the clinical course of patients with metastatic carcinoma of the prostate. Caution should be exercised when interpreting these data when metabolic bone pathology is present. A false negative (% WBR)N value will result if an infiltration of the 99mTc-MDP occurs during administration.

Topics: False Negative Reactions; False Positive Reactions; Humans; Male; Neoplasm Metastasis; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Seventy-nine cases with known carcinoma of the lung or breast who underwent both bone marrow aspiration and Tc-99m MDP bone scintigraphy were reviewed. The bone images were assessed for the presence of the pattern of bone marrow expansion which is visualized by diffuse increased metaphyseal activity, particularly evident at the knees, ankles, and elbows. This pattern was found to be an insensitive marker for the presence of marrow metastases (sensitivity 15%). The specificity of the finding was 86%. When diffuse increased metaphyseal activity is present on a Tc-99m MDP bone scan in a patient with malignant disease, the possibility of bone marrow metastases should be pursued by marrow aspiration and biopsy.

Topics: Biopsy, Needle; Bone and Bones; Bone Marrow; Bone Neoplasms; Breast Neoplasms; False Positive Reactions; Humans; Lung Neoplasms; Neoplasm Metastasis; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Medronate

Topics: Abdominal Muscles; Adenocarcinoma; Humans; Kidney Failure, Chronic; Kidney Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Postoperative Care; Technetium Tc 99m Medronate

In a patient with synovial sarcoma, routine bone survey showed no abnormality, while bone marrow scintigraphy with Tc-99m sulfur colloid revealed a defect in the fifth lumbar vertebra. At surgery, tumorous invasion was noted in the fifth lumbar vertebra and the surrounding tissues. It was suggested that the bone marrow scintigraphy was particularly useful in the detection of tumorous invasion into the bone marrow at the early stage before the destruction of skeletal tissue.

Topics: Adolescent; Bone Marrow; Diphosphonates; Foot Diseases; Humans; Lumbar Vertebrae; Male; Neoplasm Metastasis; Radionuclide Imaging; Sarcoma, Synovial; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

In a prospective study of forty-five patients, we evaluated the usefulness of bone and gallium scintigraphy prior to definitive surgery for a soft-tissue sarcoma in an extremity. Bone scintigraphy provides a baseline for staging and often reveals periosteal invasion that is not detected by routine radiographs. Blood-pool scintigraphy with bone tracers is very sensitive for a diagnosis of malignant disease. Gallium scintigraphy appeared to be a reliable preoperative indicator of malignant disease of soft tissue (sensitivity, 85 per cent; specificity, 92 per cent) and was useful for detecting the infrequent occult, non-pulmonary metastasis. Combined gallium and bone scintigraphy with blood-pool imaging provided a reliable prediction of the presence or absence of a malignant lesion in patients with a soft-tissue mass in an extremity. We recommend that bone and gallium scintigraphy be routinely used in the initial clinical staging of soft-tissue sarcomas.

Topics: Adolescent; Adult; Aged; Bone and Bones; Child; Diphosphonates; Etidronic Acid; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis; Organotechnetium Compounds; Radionuclide Imaging; Sarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

Immune-deprived mice bearing HX99 human breast carcinoma xenografts were injected with a radiolabelled monoclonal antibody, LICR-LON-M8 (M8), to investigate the dependence of tumour localization on (i) tumour site and (ii) antibody radiolabel. No significant difference was found in the degree of localization of radio-iodinated M8 in subcutaneous, renal or intracranial xenografts, but a highly significant improvement in HX99 localization by M8 was recorded using an 111indium-DTPA conjugate of the antibody (111In-DTPA-M8), related to its rapid tumour uptake and blood pool clearance. Radio-iodinated or 111In-labelled M8 was given to 29 patients with breast cancer, 7 with primary tumours and 22 with metastases. Tumour localization was assessed by (i) examination of surgical specimens and (ii) antibody scans, which were compared with conventional X-rays and 99mTc-methylene diphosphonate (MDP) bone scans. Radiolabelled M8 localized preferentially in all primary tumours (radioactivity tumour: normal breast = 6.2 +/- 1.4 [mean +/- s.e.]). All ten patients with skeletal metastases had positive 111In-DTPA-M8 scans, but the correlation with X-rays and MDP scans showed a regional variation. Radio-iodinated M8 failed to identify metastases in any site. The favourable biodistribution of 111In-DTPA-M8 has led to the clear localization of breast carcinomas in patients and mice. In future such reagents may rationalize the clinical management of breast cancer.

Topics: Animals; Antibodies, Monoclonal; Breast Neoplasms; Diphosphonates; Evaluation Studies as Topic; Female; Humans; Indium; Iodine Radioisotopes; Mice; Mice, Inbred BALB C; Mice, Inbred CBA; Neoplasm Metastasis; Neoplasm Transplantation; Organ Specificity; Pentetic Acid; Radiography; Radioisotopes; Radionuclide Imaging; Scintillation Counting; Technetium; Technetium Tc 99m Medronate; Transplantation, Heterologous

A retrospective analysis of 104 chest radionuclide angiography (CRNA) studies establishes the utility of this procedure in the evaluation of pulmonary malignancies and benign masses. Remarkable abnormalities in the perfusion of the lungs were identified in 36 (58%) of 62 cases that were not predictably normal or predictably abnormal form the clinical setting. While 60 of these 62 cases involved malignancy being evaluated for metastases, only 21 (34%) had metastases identified by radionuclide bone or liver-spleen scintigraphy. In addition to diagnosis of superior vena cava obstruction, the CRNA may have a more frequent application as an adjunct to routine scintigraphic studies directed to the identification of metastatic disease.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Diphosphonates; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid; Vena Cava, Superior

Seven patients with Paget's disease, mimicking the radiographic appearance of metastatic disease, are illustrated. This disorder may simulate metastases if the simultaneous processes of bone resorption and new bone formation are not apparent, especially if there is no evidence of bone enlargement. Additional confusion may arise if the lesion is monostotic, has an unusual location, or occurs in a patient with known or suspected malignant disease.

Topics: Adult; Aged; Bone Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Osteitis Deformans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

The intensity of parenchymal brain lesions was compared using Tc-99m pertechnetate and Tc-99m phosphate. The following conclusions were made: 1. If the Tc-99m phosphate intensity is greater than the intensity of the Tc-99m pertechnetate scan, and the patient is evaluated within four weeks of ictus, the lesion is a CVA (P less than .001). 2. If the Tc-99m phosphate intensity is less than or equal to the intensity of the Tc-99m pertechnetate scan, and the patient is evaluated within four weeks of ictus, the parenchymal lesion is not a CVA (P less than .001). 3. If the evaluation takes place longer than six weeks after ictus, then no evaluation about the nature of the lesion can be made based upon uptake of Tc-99m phosphate and Tc-99m pertechnetate.

Topics: Adult; Brain Neoplasms; Diphosphonates; Glioblastoma; Glioma; Humans; Male; Middle Aged; Neoplasm Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The value of radioisotope bone scanning at the time of presentation and serially during follow-up has been evaluated in 55 patients with biopsy-proven osteogenic sarcoma. Many of the patients studied were treated with adjuvant chemotherapy. Bone metastases were detected at presentation in only one patient and in a second patient, proximal extension of the primary tumor not evident on radiographs was demonstrated by the radioisotope technique. During fellow-up, 20 patients experienced bone metastases and each had an abnormal bone scan. Eleven of these patients were asymptomatic for bone metastases at the time the scan became abnormal. Seven patients experienced bone metastases as their first site of tumor recurrence. The detection rate for soft tissue metastases was low, but the scan indicated stump recurrence in three patients. Although the yield is small, bone scanning is justified at presentation be cause the results may profoundly after the management. During follow-up, routine bone cans are indicated in all patients, whether they have symptoms or not.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Diphosphates; Diphosphonates; Female; Humans; Male; Middle Aged; Neoplasm Metastasis; Osteosarcoma; Prognosis; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

The correlation between prostaglandin E (PgE) and scintigrams of bone (Tc-99m MDP) and bone marrow (Tc-99m SC) was investigated in normal and VX-2-bearing rabbits. PgE in plasma of normal rabbits was 486.2 +/- 185.7 pg/ml (n = 86) and the maximum-to-minimum (max/min) ratio was 1.85 +/- 0.26 at 4 wk after tumor implantation. In rabbits with VX-2 transplanted into femoral muscles, PgE was in the normal range unless the tumor invaded bone. PgE did not increase significantly in rabbits when the tumor was transplanted into the marrow cavity. When tumor invaded bone, PgE increased markedly (to 1335 +/- 584 pg/ml). Elevation of PgE did not necessarily coincide with the appearance of positive bone scans. PgE in an indomethacin-treated group was not higher than in the untreated group. There was no significant difference between the two groups regarding the time of appearance of abnormal bone scans. However, when the number of transplanted cells in the bone marrow was reduced, the treatment with indomethacin delayed the increase in tracer uptake in the affected bone and resulted in a photon-deficient area. Indomethacin may suppress the local acceleration of calcium metabolism.

Topics: Animals; Bone and Bones; Bone Marrow; Bone Neoplasms; Calcium; Diphosphonates; Indomethacin; Mitomycins; Neoplasm Metastasis; Neoplasm Transplantation; Neoplasms, Experimental; Prostaglandins E; Rabbits; Radioimmunoassay; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate