technetium-tc-99m-medronate and Osteitis-Deformans

Topics: Acquired Hyperostosis Syndrome; Bone Neoplasms; Face; Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Hyperplasia; Infections; Mandibular Condyle; Maxilla; Osteitis Deformans; Periodontitis; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sjogren's Syndrome; Technetium Tc 99m Medronate; Technology, Dental; Temporomandibular Joint Disorders; Tomography, X-Ray Computed

Traditionally, incisional bone biopsy has been required in order to establish and confirm a diagnosis of Paget's disease (Osteitis deformans) of the mandible and/or maxilla. This article presents a case report of a patient who refused such biopsy. The patient was referred with a three year history of intermittent mandibular pain, accompanied by occasional swelling of the adjacent soft tissues. Although several health professionals had been consulted, no diagnosis had been established. Furthermore, an incisional biopsy had apparently been performed in the area of the left mandible, as reported by the patient, with no conclusive results. On examination, the patient refused all proposed repeat biopsy, but did agree to a full laboratory workup which included: routine blood studies; nuclear medicine bone studies of total body regions including the head and neck, followed by sialography of the submandibular salivary glands. A definitive diagnosis of Paget's disease was reported on 99-m-MDP-technetium bone scans of the mandible. The patient was subsequently treated with the appropriate medication which resulted in a remission of the disease over the three year follow-up period. The histopathological diagnosis was never confirmed because of the patient's repeated refusal to be biopsied.

Topics: Female; Gallium Radioisotopes; Humans; Mandibular Diseases; Middle Aged; Osteitis Deformans; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Familial expansile osteolysis is an exceedingly rare autosomal dominant bone dysplasia, which can have overlapping features with Paget disease and expansile skeletal hyperphosphatasia. We present a novel case of familial expansile osteolysis evaluated on 99mTc-MDP bone scan with correlative radiographs and CT.

Topics: Humans; Osteitis Deformans; Osteolysis; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Alkaline Phosphatase; Humans; Hypercalcemia; Hyperparathyroidism, Primary; Male; Middle Aged; Osteitis Deformans; Pelvic Bones; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Vitamin D Deficiency

Paget's disease of bone is a common metabolic bone disease in most of the European countries. The disease has distinct geographical distribution being rare in Asia. We report Paget's disease in a 70 years old Pakistani male who presented with history of pain in right leg with difficulty in walking for the last 5 months. Plain X-ray raised suspicion of Paget's disease of bone. Technetium-99m MDP bone scan showed involvement of multiple bones. Bone biopsy confirmed the diagnosis. This case illustrates that Paget's disease of bone does exist in Pakistan.

Topics: Aged; Alendronate; Alkaline Phosphatase; Biopsy; Bone Density Conservation Agents; Humans; Male; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Treatment Outcome

Paget disease of bone (PDB) and hyperparathyroidism (HPT) are metabolic osseous disorders which affect ≥2% of the population. As these diseases may share clinical, radiographic, biochemical, and histopathologic features, knowledge of their phenotypic overlap may provide diagnostic utility and improve clinical outcome. Scant information is available in the dental literature regarding patients concurrently affected with both pathologies. We present an unusual case report of a 63-year-old woman coaffected with primary HPT, attributed to a functional oxyphilic parathyroid adenoma, and PDB. Bone scintigraphy revealed pagetoid lesions of the skull, humeral head, spine, sacrum, and hemipelvis. Salient craniofacial features noted were bony involvement of the calvarium and midface, resulting in extensive maxillary overgrowth, hearing loss, telecanthus and consequent visual impairment, nasal deformity, and leontiasis ossea. The patient underwent a partial parathyroidectomy and bisphosphonate administration was to be initiated upon extraction of the remaining dentition.

Topics: Adenoma; Female; Humans; Hyperostosis; Hyperostosis Frontalis Interna; Hyperparathyroidism, Primary; Hypertelorism; Maxillary Diseases; Middle Aged; Nose Deformities, Acquired; Osteitis Deformans; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The prevalence of Paget's disease of bone (PDB) is unknown in peninsular Southern Italy, although an elevated clinical severity of the disease was reported in patients from Campania.. This study was performed to evaluate the epidemiological and genetic characteristics of PDB in a rural area of Calabria, the southernmost region in the Italian peninsula.. We examined 1068 consecutive pelvic radiographs of patients older than 40 yr referred for any reason to the "Spinelli" Hospital, Belvedere Marittimo, from January 1st 2004 to December 31st 2006. In subjects with radiological findings of pelvic PDB, a 99m Technetium methylene diphosphonate bone scan and the sequence analysis of the sequestosome 1 (SQSTM1) gene were subsequently performed.. In the examined geographic area, the crude radiographic prevalence of pelvic PDB was 0.74% (8/1068; male:female 5:3, mean age 71.6 ± 13.1 yr) whereas the estimated overall prevalence of PDB between 0.82% and 1.21%. PDB patients from Calabria showed clinical characteristics similar to those reported in patients from Campania. The disease was also frequently complicated by osteoarthritis and the right side of the body was more affected than the left. The SQSTM1 gene analysis revealed the presence of a novel missense mutation (M401V) in exon 8 in one subject with a familial and aggressive form of PDB.. The study results confirmed that patients with PDB from rural districts of Southern Italy show an earlier onset and an increased clinical severity of the disease that appears mostly independent from the presence of germinal SQSTM1 mutations.

Topics: Adaptor Proteins, Signal Transducing; Adult; Age of Onset; Aged; Bone and Bones; Female; Humans; Italy; Male; Middle Aged; Mutation; Osteitis Deformans; Prevalence; Radiography; Radionuclide Imaging; Sequestosome-1 Protein; Technetium Tc 99m Medronate

Topics: Aged; Bone Neoplasms; Carbon Radioisotopes; Cell Proliferation; Choline; Diagnosis, Differential; Femur; Humans; Inflammation; Lumbar Vertebrae; Lymphatic Metastasis; Male; Osteitis Deformans; Pelvic Bones; Positron-Emission Tomography; Prostatectomy; Prostatic Neoplasms; Reference Values; Sacrum; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tibia; Tomography, X-Ray Computed; Whole Body Imaging

Topics: Adult; Female; Fingers; Humans; Middle Aged; Osteitis Deformans; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Paget's disease of bone (PDB) is reportedly declining in prevalence and severity, with increasing numbers of monostotic cases. Some accounts suggest that these findings are more evident in women, and that monostotic disease is unexpectedly frequent at certain sites. We have studied whether birth date or gender is associated with the number of sites affected and with the distribution of sites in monostotic disease and, by reviewing 100 follow-up 99Tc(m) methylene diphosphonate (MDP) scans, whether additional sites appear after initial diagnosis. Scintigraphic scans from 171 male (age 40-91 years) and 179 female (44-88 years) consecutive referrals with PDB were reviewed. Patients were analysed by referral date (1982-1992 and 1993-2001), and by their median date of birth (before (PRE21) and after (POST21) 1921). Mean age of pre-1993 patients was 69 years and 75 years for referrals after 1993. Younger patients had more monostotic disease (POST21 vs PRE21 subjects (47% vs 28%)), with a more marked trend in females (52% vs 25%), and POST21 females had fewer polyostotic sites than males (p<0.05), whereas the number in PRE21 males and females was similar. Monostotic females, but not males, showed an excess of tibial involvement. The spine was less involved in monostotic disease. Follow-up scans in 100 patients revealed no new sites. The incidence of monostotic disease has doubled over the last 30 years, but diminishing site involvement appears to be more marked in females. The lesser involvement at the axial sites in monostotic disease may lead to overestimation of the decline in PDB based on abdominal radiographs.

Topics: Adult; Age Factors; Age of Onset; Aged; Aged, 80 and over; Bone and Bones; Cervical Vertebrae; Chi-Square Distribution; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteitis Deformans; Prevalence; Radionuclide Imaging; Radiopharmaceuticals; Sex Factors; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tibia

Paget's disease of bone is characterized by alterations in skeletal metabolism, affecting a single or multiple bones. Paget's is usually confined to an individual bone and typically does not spread or extend across joints. A patient with an unusual pattern of disease is presented together with quantitative assessment of the tracer kinetics pre- and posttreatment.. A 75-year-old lady patient presented to her general practitioner in May 2002 with a history of lethargy. Clinical examination was unremarkable and further investigations such as blood tests (alkaline phosphatase levels), Tc-99m MDP bone scan, biopsy, and CT scan were carried out.. Alkaline phosphatase levels were greater than 2000 IU/L (Normal: 31-116 IU/L). The Tc-99m MDP bone scan showed strikingly increased uptake in the central skeleton involving the thoracic vertebrae and the adjoining ribs. The bone biopsy was inconclusive. CT scan revealed symmetrical expansion of the ribs with bridging osteophytes across the ribs and spine. The patient was treated with risedronate and quantitative analysis of the pre- and posttherapy bone scans showed reduced plasma clearance in the pagetic bones.. This case illustrates an unusual distribution of bone lesions in Paget's disease, which we think could be due to the result of degenerative disease leading to bridging and allowing direct extension of disease from one bone to another.

Topics: Aged; Bone and Bones; Female; Humans; Kinetics; Metabolic Clearance Rate; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Bone and Bones; Bone Density; Humans; Lumbar Vertebrae; Male; Osteitis Deformans; Osteoporosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

An 85-year-old woman who had an invasive ductal carcinoma of the breast and elevated alkaline phosphatases (420 U/L) was referred for Tc-99m MDP bone scintigraphy for initial evaluation of skeletal metastases. Bone symptoms were limited to chronic pain in both knees. A bone scan revealed pagetoid findings in both calcanei. Feet and toes on plain x-rays of the calcaneus were unremarkable. Findings were stable in the 2-year follow up, excluding other potential diagnosis as extensive metastases or stress fractures.

Topics: Aged, 80 and over; Calcaneus; Female; Humans; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Arthralgia; Bone Diseases, Metabolic; Bone Neoplasms; Diagnosis, Differential; Erdheim-Chester Disease; Female; Hip Joint; Humans; Middle Aged; Muscle Neoplasms; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Osteolytic lesions seen on plain radiographs can be caused by various disorders of the bones such as simple bone cyst, aneurysmal bone cyst, plasmacytoma, giant cell tumor, eosinophilic granuloma and tuberculosis. We studied prospectively Tc-99m-methylene diphosphonate bone scan findings in osteolytic lesions seen radiologically and followed them to histopathology. Interestingly, the scans in these patients helped to show if the lesions were monoostotic or polyostotic and, in some cases, ruled out malignant or infective etiology.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Osteitis Deformans; Osteolysis; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tuberculosis, Osteoarticular

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Calcaneus; Female; Humans; Osteitis Deformans; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Monostotic Paget's disease of the patella was detected with Tc-99m MDP and Tl-201 scans. Diffuse intense uptake of MDP in the left patella was observed on the blood-pool and late phases of the bone scan. Tl-201 imaging was performed to differentiate a malignant process and showed diffuse marked accumulation at the same site. Semiquantitative analysis of the patella region on both Tc-99m MDP and Tl-201 scans did not support a diagnosis of cancer. Radiographs showed the features of Paget's disease of the bone. Findings of a pathologic evaluation were compatible with the diagnosis of osteitis deformans. This case represents the unusual skeletal involvement of monostotic Paget's disease of the bone in the patella. Tl-201 accumulation in the Paget's lesion was suggested to be caused by increased metabolic activity of the lesion but was not indicative of a malignant process.

Topics: Aged; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Osteitis Deformans; Patella; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thallium Radioisotopes

Topics: Aged; Humans; Male; Osteitis Deformans; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Ulna

Topics: Aged; Bone and Bones; Gout; Humans; Male; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Aged; Humans; Male; Osteitis Deformans; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Skull; Technetium Tc 99m Medronate

Topics: Aged; Bone and Bones; Humans; Male; Osteitis Deformans; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thumb

Interest in the assessment of activity of Paget's disease has increased since the advent of effective therapies. The aim of this study was to develop a quantitative method for the scintigraphic assessment of Paget's disease activity in bone. Twenty patients with Paget's disease were studied prospectively. A scintigraphic visual activity index, together with a quantitative activity index that reflects both the extent and activity of the disease, was obtained for each patient. The quantitative activity index is calculated as the sum of the activity (geometric mean measured from the anterior and posterior views) for all affected bones divided by a reference obtained in non-affected bone. To evaluate the validity of the scintigraphic methods, several biochemical markers of bone turnover were assessed: serum total alkaline phosphatase and serum propeptide aminoterminal of type I procollagen (PINP) as markers of bone formation; urinary hydroxyproline and urinary N-terminal cross-linked telopeptide of type I collagen (NTx) as markers of bone resorption. The visual and quantitative scintigraphic indices were highly correlated (r = 0.78, P < 0.0001). The highest correlations between the biochemical markers and the quantitative activity index were found for PINP (r = 0.69, P < 0.001), which was the most sensitive marker of bone formation, and for urinary NTx (r = 0.63, P < 0.005), which was the most sensitive marker of bone resorption. In conclusion, quantitative evaluation of bone scintigraphy allows easy and objective assessment of Paget's disease activity and it may be useful in evaluating the effectiveness of therapies.

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Remodeling; Collagen; Collagen Type I; Evaluation Studies as Topic; Female; Humans; Hydroxyproline; Male; Middle Aged; Osteitis Deformans; Peptide Fragments; Peptides; Procollagen; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Alkaline Phosphatase; Bone and Bones; Humans; Osteitis Deformans; Radionuclide Imaging; Radiopharmaceuticals; Skull; Technetium Tc 99m Medronate

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

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

The authors present the case of a patient with recurrent hyperparathyroidism who was shown on thallium-technetium subtraction scintigraphy, ultrasound, and magnetic resonance imaging to have recurrent parathyroid tissue in the right side of the neck. The thallium scan also showed intense uptake centrally in the chest, mimicking an intrathoracic adenoma. This was subsequently shown on plain films and a radionuclide bone scan to be due to Paget's disease of the sternum. This case illustrates the value of a combined imaging strategy in preventing an unnecessary thoracotomy after a false-positive nuclear medicine scan.

Topics: Adenoma; Aged; Choristoma; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Magnetic Resonance Imaging; Neck; Osteitis Deformans; Parathyroid Glands; Parathyroid Neoplasms; Radiopharmaceuticals; Recurrence; Sternum; Subtraction Technique; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thoracic Diseases; Tomography, Emission-Computed, Single-Photon; Ultrasonography

Topics: Bone and Bones; Colon, Sigmoid; Diagnosis, Differential; Fecal Impaction; Humans; Osteitis Deformans; Pelvic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Rectum; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Bladder; Whole-Body Counting

Topics: Aged; Female; Humans; Metacarpus; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate

Scintigraphy using Tc-99m MDP and Tl-201 was performed in a patient with polyostotic Paget's disease and sarcomatous degeneration in the right iliac bone. Tc-99m MDP imaging showed abnormal uptake in both types of lesions. Tl-201 imaging showed increased uptake in the sarcomatous lesion and absent uptake in pagetic lesions. This result supports the idea that Tl-201 scintigraphy may have a potential role to play in the differentiation of Paget's disease from malignancy. To the authors' knowledge, Tl-201 has never been reported for the detection of sarcomatous change of pagetic bone.

Topics: Bone and Bones; Bone Neoplasms; Female; Humans; Ilium; Middle Aged; Osteitis Deformans; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Thallium Radioisotopes

Bisphosphonates have marked affinity for bone that makes them useful in both the treatment and imaging of bone lesions. Bone scintigraphy is very sensitive for the detection of bone metastases, which can cause life-threatening hypercalcemia requiring emergency treatment. This prospective study was done to determine whether intravenous administration of pamidronate, a second-generation bisphosphonate used to treat hypercalcemia, affects the affinity of the radiopharmaceutical 99m technetium-labeled hydroxymethylene bisphosphonate (99mTc-HMDP) for bone and bone lesions. Six patients with metastatic bone disease and five with Paget's disease of bone had a 99mTc-HMDP bone scan before and two to four days after an intravenous infusion of pamidronate. The number and activity of metastatic bone lesions were unchanged after pamidronate, even when the second bone scan was done only 24 hours after the pamidronate infusion. Our data suggest that emergency treatment of life-threatening hypercalcemia by intravenous pamidronate does not decrease the sensitivity of subsequent bone scanning done to detect bone metastases.

Topics: Aged; Bone Neoplasms; Diphosphonates; Female; Humans; Hypercalcemia; Infusions, Intravenous; Male; Middle Aged; Osteitis Deformans; Pamidronate; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

The pagetic bones in the active phase of the disease with brisk lysis and sclerosis manifest intense tracer uptake on planar bone and SPECT images. Intense tracer uptake, however, can occur also in infections, dysplasias and metastases. Pinhole bone scintigraphy has been shown to portray specific diagnostic signs in a number of skeletal diseases. In an effort to identify useful bone scan signs, we prospectively carried out 99mTc-oxidronate pinhole bone scintigraphy of the skull, vertebrae, ribs, humerus, sacrum and ilium in two patients with Paget's disease of the bone. The pinhole bone scintigraphy findings correlated with radiographic, CT and MRI findings and in the vertebra with the pathological study. Interestingly enough, pinhole bone scintigraphy revealed intense tracer uptake preferentially in the bone cortex and the rim of the affected bones. Thus, the cranial inner table, humeral cortex and vertebral endplates and rims were the seats of characteristic tracer uptake, respectively creating a scintigraphic version of the radiographic "cotton wool" sign, "casket" sign and "picture frame" sign. The pagetic lesions in the sacrum and ilium also showed intense cortical and rim uptake. Correlation of pinhole bone scintigraphy with radiography, CT and MRI indicated that such cortical or rim uptake is characteristic of Paget's disease.

Topics: Bone and Bones; Diagnostic Imaging; Female; Humans; Male; Middle Aged; Osteitis Deformans; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Female; Humans; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Sphenoid Bone; Technetium Tc 99m Medronate

Topics: Bone and Bones; Female; Humans; Middle Aged; Osteitis Deformans; Periodontal Diseases; Radiography, Panoramic; Radionuclide Imaging; Technetium Tc 99m Medronate

Paget's disease of bone is a disorder of bone remodeling in which excessive production of structurally abnormal bone occurs, with the primary and fundamental abnormality residing in the osteoclast. To evaluate further the jeopardized bone marrow in Paget's disease, the authors studied 29 skeletal lesions by means of conventional bone imaging and antigranulocyte antibody bone marrow imaging in eight consecutive patients affected by Paget's disease. Bone scans showed abnormal tracer uptake in the 29 skeletal sites (11 pelves, 10 vertebrae, 5 extremities, 2 skulls, and 1 rib). Antigranulocyte antibody bone marrow scans showed decreased uptake of radiopharmaceutical in 16 (55%) of those 29 areas (8 pelves, 7 vertebrae, and 1 rib). Lesions appeared to be more extensive on bone scans than on bone marrow scans. It was concluded that antigranulocyte bone marrow scans may show focal defects in hematopoietic bone marrow in patients with Paget's disease. Paget's disease affects the cortical bone more severely than the bone marrow.

Topics: Aged; Bone and Bones; Bone Marrow; Female; Humans; Male; Middle Aged; Osteitis Deformans; Radioimmunodetection; Technetium Tc 99m Medronate

Topics: Aged; Bone Transplantation; Humans; Ilium; Male; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibia; Tibial Fractures

Topics: Aged; Anemia; Bone and Bones; Erythrocyte Transfusion; Female; Humans; Injections, Intravenous; Iron-Dextran Complex; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate; Tissue Distribution

Topics: Aged; Diphosphonates; Female; Humans; Male; Middle Aged; Osteitis Deformans; Pamidronate; Radionuclide Imaging; Technetium Tc 99m Medronate; Whole-Body Counting

Acquisitions of 360 degrees are usually performed for bone single photon emission computed tomography (SPECT). However, the spine is a peripheral and median structure, it therefore seemed interesting to compare the 360 degrees and the posterior 180 degrees SPECT images. In a phantom study and in 25 adult patients, the 360 degrees SPECT images were compared with the posterior 180 degrees images obtained during the same acquisition: the posterior 180 degrees images are at least equivalent to the 360 degrees images. With a reduction in the examination time, SPECT could become easier to perform, especially in patients suffering from back pain.

Topics: Adult; Aged; Aged, 80 and over; Back Pain; Female; Follow-Up Studies; Gamma Cameras; Humans; Male; Middle Aged; Models, Structural; Osteitis Deformans; Spinal Diseases; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

99Tcm-methylene diphosphonate (MDP) global skeletal uptake (4 h GSU) was determined by quantitative measurement of activity on bone scan images 4 h after injection in whole skeleton regions of interest (ROI) in 16 normal subjects, in five patients with hypertrophic pulmonary osteoarthropathy (HPO) and in 12 with Paget's disease. Values were correlated with those of whole body retention (24 h WBR), and serum bone gla protein (BGP), i.e. osteocalcin, alkaline phosphatase (AP) and type 1 procollagen (P1CP). They were 40% higher in HPO than in the normal controls, while in Paget's disease they increased more in polyostotic than in monostotic patients. A statistically significant difference was noted between 4 h GSU and 24 h WBR values in the two groups of patients compared with the controls. Of the bone metabolism markers, serum AP and P1CP were higher in the patients and positively correlated with their enhanced 4 h GSU values, whereas BGP was always within the normal range. This method may thus be regarded as a useful way of simultaneously determining bone 99Tcm-MDP uptake and altered bone turnover sites, especially in patients with systemic bone disease.

Topics: Adult; Aged; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Diseases; Female; Humans; Male; Middle Aged; Osteitis Deformans; Osteoarthropathy, Secondary Hypertrophic; Osteocalcin; Procollagen; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Diagnosis, Differential; Humans; Male; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Aged; Humans; Male; Osteitis Deformans; Radionuclide Imaging; Skull; Technetium Tc 99m Medronate

Glucose phosphate (GP) labelled with 99mTc was used to obtain scintigraphic images of bone lesions in one group of patients (n = 28) and of lung tumors in another (n = 35). All bone lesions detected by 99mTc-MDP were also demonstrated by 99mTc-GP; all lung tumors except 4 were detected by 99mTc-GP, the failure rate being about the same as that for 67Ga. The use of 99mTc-GP is preferable to that of 99mTc-MDP because the former does not accumulate in normal bone; the advantage of 99mTc-GP over 67Ga lies in its better physical characteristics and in the fact that the result of the study is available within a few hours rather than three days.

Topics: Adolescent; Adult; Aged; Bone Cysts; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Female; Glucosephosphates; Humans; Hyperparathyroidism; Lung Neoplasms; Male; Middle Aged; Organotechnetium Compounds; Osteitis Deformans; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Comparison between the plasma levels of intravenously injected technetium 99m hydroxy methylene [corrected] diphosphonate (99mTc-HMDP) and chromium 51 ethylene diamine tetra-acetic acid (51Cr-EDTA) reflects the uptake of diphosphonate into bone (the diphosphonate space). This can be used as an index of skeletal function in metabolic bone disease. In a series of 49 patients with Paget's disease the diphosphonate space (DPS) correlated well with other indicators of disease activity such as alkaline phosphatase and urinary hydroxyproline levels. The DPS is a good predictor of the volume of skeletal involvement as estimated from bone images. The DPS also provides a sensitive indicator of response to treatment with intravenously administered bisphosphonate. The DPS is simple to perform and is a useful adjunct to routine bone imaging.

Topics: Alkaline Phosphatase; Bone and Bones; Chromium Radioisotopes; Edetic Acid; Humans; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate

The effectiveness of the 24-hour whole body retention of Tc-99m MDP in monitoring disease activity was evaluated in 58 patients with Paget's disease of bone. Patients had baseline 24-hour retention studies, bone scans, radionuclide bone blood-flow studies, and alkaline phosphatase and OH-Proline level measurements. Increased retention of Tc-99m MDP was present in 88% (51/58) of individuals while alkaline phosphatase and OH-Proline were respectively elevated in 100% (58/58) and 64% (35/55) of patients. Forty-seven examinations were further obtained to evaluate changes in retention with therapy. Retention correctly reflected response to treatment in 89.3% of follow-ups versus 85.1% with alkaline phosphatase (n = 47). It was accurate in 90.9% of patients versus 75% for OH-Proline (n = 44). We conclude that the retention study, while not absolutely correlative with Pagetic activity, still is useful in grading the condition. It is a simple additional step that monitors the global severity of lesions localized on bone scans.

Topics: Aged; Bone and Bones; Female; Humans; Male; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate; Time Factors

Serial radionuclide bone scans (n = 96) of 40 patients with Paget's disease were studied and tracer uptake graded using a four-point subjective scale. In nine patients studied without treatment the serial scan appearance improved in some, remained unchanged in others and deteriorated in yet others. Similarly individual lesions demonstrated increased, decreased or unchanged tracer uptake. One lesion disappeared without treatment but no new lesions developed. After treatment with aminohydroxypropylidene bisphosphonate (APD) or ethanehydroxy bisphosphonate (EHDP) the overall scan appearance improved in the majority of patients treated (n = 34), but individual lesions demonstrated increased (n = 20), unchanged (n = 79) or decreased uptake (n = 86). The mean reduction in tracer was 32% and 20 lesions reverted to normal intensity. The site of the lesion or the initial intensity of tracer uptake did not influence response to therapy. New lesions developed in five patients after therapy. There was variable correspondence between scintigraphic changes and biochemical parameters of response. From our study we conclude that serial bone scans must be used with caution when interpreting the response of Paget's disease to therapy.

Topics: Aged; Aged, 80 and over; Diphosphonates; Etidronic Acid; Female; Humans; Male; Middle Aged; Osteitis Deformans; Pamidronate; Radionuclide Imaging; Retrospective Studies; Scotland; Technetium Tc 99m Medronate

Topics: Aged; Humans; Male; Osteitis Deformans; Patella; Radionuclide Imaging; Technetium Tc 99m Medronate

A continuous bone remodelling takes place throughout life at different turnover speed according to age, physiological and pathological conditions. The evaluation of bone turnover may be of value for a prognostic and therapeutical assessment. Calcium bone exchange may be considered a suitable marker of bone turnover; for this reason 47Ca or 45Ca kinetics may be used; these methods have been employed in the past. Labelled diphosphonates, and in particular 99Technetium-methylene-diphosphonate (99TcmDP) are simpler and safer, because these substances are strongly and almost completely stored in bone and not absorbed by the soft tissue; for this reason they are used at the present time. The evaluation of blood levels and 24 hrs urinary elimination of 99TcmDP is used to measure whole bone diphosphonate retention (WBR). This parameter is positively correlated with other markers of bone turnover such as alkaline phosphatase (AP), osteocalcin (OC), urinary hydroxyproline (HOP). A bicompartmental analysis schedule of 99TcmDP distribution has been proposed some years ago and therefore applied by our group, based on the mathematical evaluation of serum concentration at different times and urinary elimination of the label given intravenously. This method provides the possibility to calculate not only WBR but also total body retention (TBR) and a constant (Kbh) which reflects the influx speed of the tracer in the bone. Kbh probably represents a more sensitive index of bone turnover than WBR. It presents a better correlation with AP and OC values and also shows some (statistically less significant correlations with some indices of bone remodelling obtained by histomorphometry on bone biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Bone and Bones; Calcium-Binding Proteins; Humans; Hydroxyproline; Middle Aged; Osteitis Deformans; Osteocalcin; Osteoporosis; Technetium Tc 99m Medronate

A 72-year-old woman with Paget's disease underwent therapy with EHDP for 5 years. A Tc-99m MDP bone scan demonstrated an unusual image in the right femur. The upper one third of the femur was thickened, bowed, and had diffuse and mild uptake. This corresponded to radiographic findings of mixed or chronic Paget's disease. A long area of intense and homogenous uptake was found immediately distal, and with a sharp demarcation. Alterations typical of the lytic phase of Paget's disease were seen on radiographs. The overall lesion in this patient thus demonstrated two distinct patterns, both radiographically and on bone imaging. It is conjectural whether this was related to the chronic use of a diphosphonate in therapy.

Topics: Aged; Etidronic Acid; Female; Femur; Humans; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Clobetasol; Drug Hypersensitivity; Erythema Multiforme; Female; Humans; Middle Aged; Osteitis Deformans; Technetium Tc 99m Medronate; Vasculitis

Paget's disease of the bone occasionally transforms into sarcomatous tumors such as osteosarcoma. While Paget's disease demonstrates markedly increased uptake of bone scanning radiopharmaceutical, osteosarcomas complicating this condition often show decreased uptake. An unusual scan appearance of the osteosarcoma is presented in which the tumor showed intense uptake of the tracer on the bone scan. The extent of the sarcoma as delineated by the bone scan corresponded closely to the size of the lesion as seen on computerized tomography and magnetic resonance imaging and was confirmed at surgery.

Topics: Aged; Aged, 80 and over; Humans; Male; Osteitis Deformans; Osteosarcoma; Radionuclide Imaging; Skull; Skull Neoplasms; Technetium Tc 99m Medronate

We present a 93-year-old man with prostatic carcinoma whose 99mTc-HMDP skeletal images showed multiple areas of abnormally increased radioactivity in the bone and virtual absence of renal activity. These findings were interpreted as representing multiple skeletal metastases. When correlated with concurrent radiographs, the abnormalities were found to be due to Paget's disease. Multiple areas of bone involvement are not rare in Paget's disease. We reemphasize that an abnormal bone scintigram should always be correlated with regional radiographs to rule out conditions other than malignancy.

Topics: Aged; Aged, 80 and over; Bone Neoplasms; Diagnosis, Differential; Humans; Male; Osteitis Deformans; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Bone scintigraphy using 99mTc-MDP was performed on 2 patients with Paget's disease of bone before and after the treatment with a synthetic eel calcitonin analogue [Asu1,7)-eel calcitonin, ECT] at a dose of 40 U per day. All pagetic lesions showed markedly the increased accumulation of the radionuclide. The uptake ratio, defined as the count rate of 99mTc-MDP over each bone lesion to that over the control bone, was calculated. The response to the calcitonin therapy was evaluated with the uptake ratio of the radionuclide. The uptake ratio decreased markedly within the first 3 months of the treatment, in association with a palliation of bone pain, while the serum alkaline phosphatase activities which had been within the normal range or slightly high before the treatment did not show any significant change or did not reflect a clinical feature (e.g. bone pain) with the treatment. Thus, the uptake ratio on the bone scintigram seemed to offer the most sensitive and most reliable information for the evaluation of calcitonin treatment of Paget's disease of bone.

Topics: Aged; Bone and Bones; Calcitonin; Drug Evaluation; Humans; Male; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate

A 48-year-old man with a ten-year history of corticosteroid-dependent asthma and a previous fracture of the right humerus after minimal trauma was referred for a dual photon absorptiometry (DPA) study to assess the degree of osteoporosis. The DPA study revealed a large discrepancy in bone mineral density (BMD) between the right and left hips. A Tc-99m MDP bone scan and an anteroposterior frog-leg radiograph demonstrated changes typical of Paget's disease in the sacrum, pelvis, and femurs. This case is an example of how underlying bone disease may artificially elevate bone mineral density, and demonstrates the value of performing BMD tests on both hips and the necessity for correlative bone scans and radiographs in selected cases.

Topics: Bone and Bones; Femur; Humans; Lumbar Vertebrae; Male; Middle Aged; Minerals; Osteitis Deformans; Osteoporosis; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate

Paget's disease of bone can occur in up to 4% of the population over forty. Most of these patients are asymptomatic, and will have more than one bone involved. The monostotic presentation of the disease is much less common, but not rare. Monostotic Paget's disease involving the mandible, however, is very unusual. Only six cases have been reported since 1945, and bone imaging did not play a significant role in the diagnoses of these reports. A patient with proven Paget's disease of the mandible presented with a rather dramatic "bearded" image on a bone scan.

Topics: Female; Humans; Mandibular Diseases; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate

In a study designed to evaluate the radionuclide images in patients with gout, six (23%) of the 26 patients had clear evidence of Paget's disease of bone by technetium Tc 99m medronate imaging. A reference population consisting of 333 technetium Tc 99m medronate bone scans ordered for other reasons was reviewed, and only seven scans (2.1%) were found to have evidence of Paget's disease. This difference was found to be highly significant. All cases of Paget's disease were confirmed by independent radiologic evaluation. We conclude that there is a significant association between Paget's disease and gout, the basis for which is not yet known.

Topics: Aged; Aged, 80 and over; Gout; Humans; Male; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Medronate; Uric Acid

Topics: Aged; Humans; Male; Muscle Spasticity; Osteitis Deformans; Paralysis; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Diphosphonates; Female; Fractures, Spontaneous; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Brain; Diphosphonates; Humans; Male; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Skull; Technetium; Technetium Tc 99m Medronate

Topics: Aged; False Negative Reactions; Hip Prosthesis; Humans; Male; Osteitis Deformans; Prosthesis Failure; Radionuclide Imaging; Technetium Tc 99m Medronate

This is a comprehensive review of 85 patients who had bone sarcoma associated with Paget disease and who were seen at Memorial Sloan-Kettering Cancer Center between 1927 and 1982. There was an almost equal distribution of tumors in the axial and the appendicular skeletons. The pelvis, humerus, femur, and skull were the tumor sites in 80% of cases. The tumors were bulky large soft tissue masses. Lytic lesions were more common than sclerotic lesions. Mixed lytic and sclerotic lesions were much less common than either single type. Periosteal reaction was uncommon and found in less than 7%. Methylene diphosphonate scans of the bone often showed a cold area that was associated with marked increase in uptake on the gallium scan. Angiography, which was performed in 13 patients, was useful, but CT was much more helpful in showing the soft tissue mass as well as the extent of bony disease. Only three patients in this study survived for five years. Present chemotherapy protocols were disappointing in the treatment of this highly lethal tumor.

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

A method is described for the quantitation of total skeletal activity during bone scans. The method requires a single plasma sample only, taken at the time of imaging. The ratio of % injected dose of 51Cr EDTA to that of 99Tcm MDP is calculated from this sample following combined injection of the two radiopharmaceuticals. The 51Cr EDTA level corrects for the glomerular filtration of 99Tcm MDP. Using this method, which only requires a gamma counter, significant differences from normal controls have been shown in patients with osteomalacia, renal osteodystrophy, Paget's disease and hypercalcaemia. The method provides routine quantitative data to add to the imaging information in the bone scan.

Topics: Adult; Aged; Bone and Bones; Bone Diseases, Metabolic; Chromium Radioisotopes; Chronic Kidney Disease-Mineral and Bone Disorder; Diphosphonates; Edetic Acid; Humans; Hypercalcemia; Metabolic Clearance Rate; Middle Aged; Osteitis Deformans; Osteomalacia; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

We did 27 bone scintiscans in 20 patients, 15 of whom had Paget's disease. Early variations of isotopic activity were analyzed in the pagetic bone, and in normal bone and muscle tissue using 3 parameters: A1 or the period of maximum activity obtained when the isotope was first injected into the circulation, A2 or the isotopic activity at 30 minutes, and P or slope of the curve in the change of activity between 15 and 30 minutes. These scintigraphic parameters, which seem to reflect the importance of the vascular phase (parameter A1) and of the metabolic activity of the bone (parameter A2/A1 and P) proved to be a good guide in following the course of Paget's disease. In 6 patients with Paget's disease who were treated with calcitonin (5 cases) or by etidronate disodium (1 case), we compared the changes in these isotopic parameters with the clinical and laboratory findings before and after treatment. We were able to note a good correlation between the clinical course of the illness and the scintiscans in most cases.

Topics: Adult; Bone and Bones; Calcitonin; Diphosphonates; Etidronic Acid; Female; Humans; Male; Middle Aged; Osteitis Deformans; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Twenty-four symptomatic patients with symptoms of active Paget's disease of bone were evaluated, during the course of their therapy, a total of 71 times (24 baseline and 47 follow-up examinations) by serial alkaline phosphatase levels (AP), Tc-99m MDP bone scans, and radionuclide blood-flow studies. The flow study correlated with disease activity in all of the baseline studies and in at least 85% of the follow-up studies. In five patients (seven follow-up studies) the changes in local blood flow correctly anticipated the eventual rise or fall of AP. In comparison with the bone scan, the changes in blood flow preceded the bone-scan alterations or were more reliable indicators of disease activity in 12 of the 13 follow-up studies in which the results of the two examinations disagreed. We conclude that the radionuclide flow study provides useful additional clinical information in the management of Paget's disease.

Topics: Alkaline Phosphatase; Bone and Bones; Calcitonin; Diphosphonates; Drug Therapy, Combination; Etidronic Acid; Follow-Up Studies; Humans; Hyperemia; Osteitis Deformans; Plicamycin; Radionuclide Imaging; Regional Blood Flow; Technetium; Technetium Tc 99m Medronate

Topics: Adult; Aged; Bone and Bones; Diphosphonates; Female; Humans; Male; Middle Aged; Osteitis Deformans; Regional Blood Flow; 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

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

Increased patellar uptake on bone scans is seen quite commonly but the possible or probable etiologies of this finding have not been previously well described. A review of 100 consecutive bone scans showed that the incidence of bilateral "hot" patellae is 15%. Identified etiologies include osteoarthritic degenerative disease (35%), fracture, possible metastatic disease, bursitis, Paget's disease, and osteomyelitis. The value of careful history, physical examination, and radiographs is stressed.

Topics: Adult; Arthritis, Infectious; Bone and Bones; Bursitis; Diphosphonates; Female; Humans; Male; Middle Aged; Osteitis Deformans; Osteoarthritis; Osteomyelitis; Patella; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A case of advanced Paget's disease was successfully treated with Didronel. All indicators of disease activity have been in remission for two years post-therapy. Although sequential radiographs obtained before and after treatment showed slight changes that might have reflected a reparative process, bone scintigraphs revealed more prominent changes, so that radionuclide bone imaging could well be considered as the follow-up imaging study of choice after treatment of Paget's disease.

Topics: Bone and Bones; Diphosphonates; Etidronic Acid; Follow-Up Studies; Humans; Male; Middle Aged; Osteitis Deformans; Radiography; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Diseases; Bone Neoplasms; Diphosphonates; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Kinetics; Liver Cirrhosis; Middle Aged; Osteitis Deformans; Osteomalacia; Osteoporosis; Technetium; Technetium Tc 99m Medronate