technetium-tc-99m-medronate and Osteosarcoma

The current standard of chemotherapy response evaluation holds the most important prognostic factor to be the histological assessment of the tumor necrosis of the excised lesion, but the major challenge is to find an early prognostic factor that will allow the adjuvant treatment regimen to be adjusted. The objective of this systematic review is to provide an up-to-date and unprecedented summary of the value of Technetium-methylene diphosphate or -hydroxymethylene diphosphate (Tc-MDP/HMDP) scintigraphy for the preoperative evaluation of osteosarcoma response to chemotherapy.. Studies evaluating the alteration ratio (percentage change of the Tc-99m -MDP/HMDP uptake between before and after neoadjuvant chemotherapy) to predict the histological response of osteosarcoma to chemotherapy were searched for in MEDLINE, EMBASE, and Web of Science. A meta-analysis of individual patient data (IPD) was performed to determine the optimal cut-off point from the receiver operating characteristic (ROC) curve. Additionally, aggregate data (AD) meta-analysis was performed to compare the value of Tc-MDP/HMDP scintigraphy with that of other quantitative modalities, such as dynamic magnetic resonance imaging (MRI), Tl scintigraphy, and F-FDG PET-CT.. Seven studies with 154 patients were included for the IPD meta-analysis. The optimal cut-off point of the alteration ratio was 31.0%. Five studies with 123 patients were considered for the AD meta-analysis. The pooled sensitivity and specificity were 0.76 (95% CI, 0.63-0.86) and 0.89 (95% CI, 0.79-0.95), respectively. There was a significant difference between the good and poor responders in terms of the diagnostic odds ratio. The summary ROC curve demonstrated that the area under curve (AUC) was 0.892, indicating excellent diagnostic accuracy.. Our findings have suggested that conventional Tc-MDP/HMDP scintigraphy remains as useful as recent quantitative modalities to predict the histological response of osteosarcoma to neoadjuvant chemotherapy.

Topics: Bone Neoplasms; Humans; Neoadjuvant Therapy; Osteosarcoma; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Osteosarcoma is a cancer characterized by formation of bone by malignant cells. Routine bone scan imaging with Tc-99m-MDP is done at diagnosis to evaluate primary tumor uptake and check for bone metastases. At time of relapse the Tc-99m-MDP bone scan also provides a specific means to assess formation of bone by malignant osteosarcoma cells and the potential for bone-seeking radiopharmaceuticals to deliver radioactivity directly into osteoblastic osteosarcoma lesions. This chapter will review and compare a bone-seeking radiopharmaceutical that emits beta-particles, samarium-153-EDTMP, with an alpha-particle emitter, radium-223. The charged alpha particles from radium-223 have far more mass and energy than beta particles (electrons) from Sm-153-EDTMP. Because radium-223 has less marrow toxicity and more radiobiological effectiveness, especially if inside the bone forming cancer cell than samarium-153-EDTMP, radium-223 may have greater potential to become widely used against osteosarcoma as a targeted therapy. Radium-223 also has more potential to be used with chemotherapy against osteosarcoma and bone metastases. Because osteosarcoma makes bone and radium-223 acts like calcium, this radiopharmaceutical could possibly become a new targeted means to achieve safe and effective reduction of tumor burden as well as facilitate better surgery and/or radiotherapy for difficult to resect large, or metastatic tumors.

Topics: Antineoplastic Agents; Bone Neoplasms; Humans; Lung Neoplasms; Molecular Targeted Therapy; Organometallic Compounds; Organophosphorus Compounds; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Radium; Technetium Tc 99m Medronate

A healthy elderly white man was admitted for right inguinal herniorrhaphy. Preoperative chest x-ray revealed a large mass in the lower lobe of the left lung. CT-directed needle biopsy was nondiagnostic. Technetium-99m methylene diphosphonate (99mTc-MDP) bone scan revealed intense soft-tissue activity in the lower left hemithorax with no evidence of abnormal activity in the osseous skeleton. Because of the degree of uptake in the lesion, a presumptive diagnosis of extraosseous osteogenic sarcoma was made. The patient had a left lower lobectomy and the lesion was diagnosed as an osteosarcoma of primary pulmonary origin.

Topics: Aged; Humans; Lung Neoplasms; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Technetium-99m-sestamibi (99mTc-MIBI) imaging is a well-established modality in oncologic investigations. The current study aimed to investigate whether any relationship could be found between 99mTc-MIBI uptake and local perfusion in malignant bone and soft-tissue tumours. It also aimed to compare 99mTc-MIBI images with those of technetium-99m-methylene diphosphonate (99mTc-MDP) bone scintigraphy with regard to the activity distribution pattern, intensity and lesion extension. The study group included 24 patients with various bone and soft-tissue tumours. Three-phase bone scintigraphy and 99mTc-MIBI studies were performed within the same week before any surgical and therapeutic intervention. Images were evaluated visually and quantitatively using regions of interest (ROIs) over the lesion and adjacent normal tissue. The 99mTc-MIBI study was positive with varying degrees of uptake (range, 1.4-5.3). The mean 99mTc-MIBI uptake and 99mTc-MDP blood-pool and osseous phase activity ratios were 2.5 +/- 0.5, 2.8 +/- 1.0 and 5.5 +/- 4.0, respectively. The correlation between the 99mTc-MIBI uptake and blood-pool ratios was 0.70 (P<0.05). While activity distribution patterns were in agreement in 99mTc-MIBI and blood-pool images in the majority of cases, 99mTc-MIBI better delineated tumour viability and extension in five cases. In conclusion, 99mTc-MIBI accumulation shows a reasonable correlation with blood-pool uptake assuming the presence of multifactorial mechanisms in addition to local hyperaemia. Better delineation of tumour outlines and cellular activity seems to be an advantage of 99mTc-MIBI scintigraphy which may be helpful in the evaluation of musculoskeletal tumours.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Regional Blood Flow; Sarcoma; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The response of osteosarcomas to preoperative chemotherapy as measured by quantitative 99mTc-diphosphonate scintigraphy was compared with the amount of tumor cell destruction found histologically in the resected specimens. 3-phase bone scintigraphy, with determination of tumor/non-tumor (T/NT) ratios, allowed accurate prediction of tumor response in 28 of 30 tumors (accuracy = 93%) after completion and in 10 of 12 osteosarcomas (83%) at the half-way stage of preoperative chemotherapy, when only those tumors were evaluated which showed convergent changes of T/NT ratios in the perfusion and the mineral phase. At the half-way stage, however, evaluation of chemotherapy effects was complicated in 12 of 23 osteosarcomas by diverging T/NT ratios. In contrast, quantification and mapping of the tumor plasma volume and 99mTc-diphosphonate clearance on parametric images predicted correctly the histological tumor response to chemotherapy in 10 of 11 tumors (91%) after completion and in all 11 cases (100%) at the half-way stage.

Topics: Adolescent; Adult; Altretamine; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone Neoplasms; Child; Cisplatin; Combined Modality Therapy; Cyclophosphamide; Dactinomycin; Doxorubicin; Follow-Up Studies; Humans; Methotrexate; Multicenter Studies as Topic; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

A 65-year-old man presented with abdominal bloating, pain, and nausea for 5 days. Abdominal CT revealed a heterogeneous mass with a large area of calcification, and rupture of the mass was seen around the capsulafibrosa. According to pathological examination after percutaneous puncture biopsy, the histopahological and immunohistochemical findings were suggestive of metastatic or primary hepatic osteosarcoma. Whole body bone scintigraphy demonstrated elevated 99mTc-MDP activity in hepatic mass, but no skeletal lesions. The diagnosis of primary hepatic osteosarcoma was finally confirmed. PET/CT showed hepatic mass with heterogeneous high-uptake, and multiple metastases in portacaval lymph nodes, lungs and the third thoracic vertebra were considered.

Topics: Aged; Bone Neoplasms; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Male; Osteosarcoma; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate

Osteosarcoma is a frequently occurring primary skeletal malignancy in the adolescent population. It arises from primitive mesenchymal bone forming cells and frequently involves long bones near the metaphyseal growth plate. Multiple imaging modalities are used for complete staging workup at the time of presentation; including magnetic resonance imaging (MRI) for local disease extent, computed tomography (CT) scan to rule out pulmonary metastasis, and bone scan to look for distant osseous metastases. We present the case of a young boy with osteosarcoma of left tibia, showing additional findings on MDP bone scan acquired for initial staging work up.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Osteosarcoma; Radiopharmaceuticals; Technetium; Technetium Tc 99m Medronate

Tc-99m methylene diphosphonate (MDP) bone scan is an effective tool for the evaluation of benign and malignant skeletal disorders. Hepatic uptake on bone scan is an unexpected finding and whenever present, the cause must be determined as the distinction between technical and pathological causes is important to direct further patient management. Identification of these abnormalities will decrease errors and provide cardinal clinical information. We present the image of a patient with Osteosarcoma of the left femur; who underwent bone scan for metastatic workup which showed diffuse hepatic uptake.

Topics: Bone Neoplasms; Humans; Osteosarcoma; Radiopharmaceuticals; Technetium Tc 99m Medronate; Terminally Ill

A 76-year-old woman with uterine cervical cancer 20 years ago received right total hip replacement 3 months ago for right hip avascular necrosis without specific intraoperative finding. She reported persistent right hip pain after falling from bed. Pelvic x-ray showed right pubic ramus fracture. To evaluate prosthesis loosening, 99mTc-MDP 3-phase bone scan was arranged, showing diffusely and heterogeneously increased vascularity and tracer perfusion over the right hip, with intensely and heterogeneously increased metabolism in the right iliac bone and hip. SPECT/CT showed nearby swelling of calcified muscles. After debridement and synovectomy, the pathologic report showed chondroblastic osteosarcoma.

Topics: Aged; Arthroplasty, Replacement, Hip; Bone Neoplasms; Female; Hip Prosthesis; Humans; Osteosarcoma; Prosthesis Failure; Technetium Tc 99m Medronate

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

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

The classification of thyroid nodules in children is often difficult, especially in pretreated patients with metastatic disease. In osteosarcoma patients, Tc-MDP SPECT/CT is used for primary and follow-up staging. Bone and soft tissue metastases can be revealed because of Tc-MDP imaging of osteoid-producing metastases. We present Tc-MDP SPECT-CT, CT, and ultrasound images of a highly suspicious calcified thyroid lesion in a 17-year-old boy with osteosarcoma. High uptake in Tc-MDP SPECT-CT provides diagnosis of thyroid metastasis of osteosarcoma, which was proven by histopathology.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Neoplasm Staging; Osteosarcoma; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Thyroid Neoplasms; Ultrasonography

Extraskeletal osteosarcomas are uncommon entities in clinical practice, which account for 1% to 2% of all soft tissue sarcomas. We here reported a case of multiple extraskeletal osteosarcomas and nuclear medicine imaging findings of this disease in Tc-MDP bone scan as well as F-FDG PET/CT.

Topics: Bone and Bones; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Humans; Middle Aged; Osteosarcoma; Positron Emission Tomography Computed Tomography; Technetium Tc 99m Medronate

We compared the usefulness of Tc-methyl diphosphonate (Tc-MDP) bone scintigraphy and F-fluorodeoxyglucose (FDG) for positron emission tomography/computed tomography (PET/CT) in predicting histologic response in patients with osteosarcoma receiving neoadjuvant chemotherapy (NAC).We retrospectively reviewed 62 patients with high-grade osteosarcoma who had received 2 cycles of NAC and surgery. All patients underwent Tc-MDP bone scintigraphy and F-FDG PET/CT before and after NAC. Tc-MDP uptake in the primary tumor was measured quantitatively as the maximum tumor-to-nontumor ratio (T/NTmax) and F-FDG uptake was measured as the maximum standardized uptake value (SUVmax), before and after NAC. The percent changes of T/NTmax (percent changes of the maximum tumor-to-nontumor ratio [Δ%T/NTmax]) and SUVmax (percent changes of the maximum standardized uptake value [Δ%SUVmax]) after NAC were calculated and the correlations between these parameters were evaluated. After surgery, the effects of NAC were graded histopathologically (good vs poor) and the optimum cut-off values of Δ%T/NTmax and Δ%SUVmax for predicting histologic response were assessed using the receiver operating characteristic (ROC) curve analysis.Δ%T/NTmax and Δ%SUVmax were positively correlated with each other (r = 0.494, P < .01). Based on the ROC curve analysis, both Δ%T/NTmax (area under the curve [AUC] = .772, P < .01) and Δ%SUVmax (AUC = .829, P < .01) predicted good histologic response. However, there was no significant difference between the AUCs of Δ%T/NTmax and Δ%SUVmax (P = .44). The sensitivity and specificity for predicting good histologic response were 83.3% and 75.0%, for the criterion Δ%T/NTmax <-12.5%, and 80.0% and 81.3% for the criterion Δ%SUVmax <-49.0%, respectively.The Tc-MDP bone scan and F-FDG PET scan are non-inferior to each other in predicting the histologic response of osteosarcoma treatments. The Tc-MDP bone scan and F-FDG PET scan showed respective advantages with differing features. Therefore, physicians should consider which scan is appropriate for their own institute based on the advantages of each scan and the circumstances of the institute.

Topics: Adolescent; Adult; Area Under Curve; Bone Neoplasms; Chemotherapy, Adjuvant; Female; Fluorodeoxyglucose F18; Humans; Male; Neoadjuvant Therapy; Osteosarcoma; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome; Young Adult

Topics: Adult; Diagnosis, Differential; Humans; Male; Muscle Neoplasms; Osteosarcoma; Pelvis; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate

A 36-year-old woman with a history of left above-knee amputation caused by tibial osteosarcoma 3 years ago underwent static Tc-MDP bone scintigraphy to evaluate osseous metastases. Although no lesion in the bone was identified, the images showed an intense activity in the region of the liver. This activity was also shown subsequently by F-NaF and F-FDG PET/CT imaging as a partially calcified lesion in the anterior segment of the right lobe of the liver. Solitary hepatic metastasis form osteosarcoma was suspected and further implied by follow-up studies.

Topics: Adult; Female; Fluorodeoxyglucose F18; Humans; Incidental Findings; Liver Neoplasms; Multimodal Imaging; Osteosarcoma; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

Osteosarcoma is the most frequent primary malignancy of bone, and usually metastasizes to the lung and bones, while other sites are rare. In most reported cases, soft tissue metastasis of osteosarcoma is unusual, and only develops in the advanced stages of the disease, especially following multiple recurrences. We present a patient with recently diagnosed osteosarcoma of the right femur, showing abdominal wall metastasis diagnosed by technetium-99m-methylene diphosphonate (99m Tc-MDP) whole body bone scintigraphy and confirmed histologically. The present case highlights the importance of whole body imaging of patients with osteosarcoma for detecting unusual sites of metastasis, especially in soft tissue organs.

Topics: Abdominal Neoplasms; Abdominal Wall; Female; Femoral Neoplasms; Humans; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Young Adult

We present a case of a 15-year-old boy with osteoblastic osteosarcoma of the left distal femur. The patient was referred to bone scan for initial staging. On planar bone scan, there is increased uptake of 99mTc-MDP (99mTc-methylene diphosphonate) in the left distal femur. There are also multiple sites of abnormal tracer uptake projecting to the thoracic cage, initially assumed to be localized in the ribs. SPECT/CT correctly identified them as pulmonary metastases. This case illustrates the potential advantages and utility of SPECT/CT imaging of skeletal bone scan in order to decide on the optimal treatment.

Topics: Adolescent; Diagnosis, Differential; Femur; Humans; Lung Neoplasms; Male; Osteosarcoma; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Whole Body Imaging

Florid reactive periostitis ossificans is a rare benign lesion usually affecting the tubular bones of the hands and feet, and its histological features may be confused with those of infection and osteosarcoma. We report a case with florid reactive periostitis ossificans of the femur showing increased tracer uptake on both Tc-MDP bone scan and F-FDG PET/CT mimicking a local recurrence in a 15-year-old patient with high-grade osteosarcoma.

Topics: Child; Diagnosis, Differential; Fluorodeoxyglucose F18; Humans; Male; Neoplasm Recurrence, Local; Osteosarcoma; Periostitis; Radionuclide Imaging; Technetium Tc 99m Medronate

We compared the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and (99 m)Tc-methylene diphosphonate bone scintigraphy (BS) for the detection of bone metastasis in osteosarcoma.. We retrospectively reviewed 206 patients with stage II-IV osteosarcoma treated with surgery and chemotherapy as well as at least one paired PET/CT and BS scan (defined as an examination). PET/CT and BS images were interpreted separately. When analyzing the diagnostic yield of a combination of PET/CT and BS (PET/CT+BS), an examination was considered positive if either PET/CT or BS scored positive. The final diagnosis was obtained from histological findings or clinical follow-up with imaging studies for at least 6 months. Diagnostic performances of PET/CT, BS, and their combinations were calculated.. Out of 833 examinations in 206 patients, 55 with 101 lesions in 38 patients were confirmed as bone metastases. The sensitivity, specificity, and diagnostic accuracy were 95, 98, and 98%, respectively, for PET/CT; 76, 97, and 96%, respectively, for BS; and 100, 96, and 97%, respectively, for PET/CT+BS in an examination-based analysis. Lesion-based analysis demonstrated that the sensitivity of PET/CT+BS (100%) was significantly higher than that of PET/CT (92%) or BS (74%) alone. BS detected significantly less bone metastases in the growth plate region than outside the growth plate region (22 vs. 77%).. PET/CT is more sensitive and accurate than BS for diagnosing bone metastases in osteosarcoma. The combined use of PET/CT and BS improves sensitivity.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Multimodal Imaging; Osteosarcoma; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

Osteosarcoma (OS) management requires a better understanding of tumor/bone interactions in vivo during disease progression. Using [(18)F]-FDG and [(99m)Tc]-HMDP imaging, we assessed a methodology for an in vivo quantitative characterization of an orthotopic model of osteolytic OS on the basis of (1) tumor proliferation, (2) tumor and bone metabolic activities, and (3) bone remodeling.. POS-1 tumor bearing mice were monitored in vivo over a 26-day period, with tumor and bone metabolic volumes (TMV and BMV, respectively) being determined from [(18)F]-FDG, bone remodeling from [(99m)Tc]-HMDP, and tumoral volume from micro- computed tomography scans.. From day 10, [(18)F]-FDG strongly accumulated within POS-1 tumor, with a tumor/muscle ratio of 3.7 ± 0.8. TMV and BMV increased as pathology progressed: TMV increased at early stage of pathology (from 56%) whereas BMV strongly increased (from 113%) during late stage. From [(99m)Tc]-HMDP imaging, bone remodeling features were evidenced within the distal region of tibia bearing the tumor, with a mean scintigraphic ratio of 1.36 ± 0.11 at day 12, that reached value of 2.53 ± 0.19 at day 26.. Our results validated the POS-1 orthotopic model as "OS imaging model," that could serve for evaluating in vivo therapies targeting tumor proliferation and/or bone remodeling in OS.

Topics: Animals; Bone Neoplasms; Bone Remodeling; Cell Growth Processes; Fluorodeoxyglucose F18; Male; Mice; Mice, Inbred C3H; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

The aim of this work was to report an unusual case of multiple soft tissue metastases of osteosarcoma detected using bone scan and confirmed by CT scan.. A 15-year-old patient with a history of osteogenic sarcoma presented with fatigue and loss of appetite in addition to a painless swelling of the distal left lower extremity. Bone scan and chest CT scan were performed for restaging purposes. The bone scan revealed multiple bone metastases and suspected tumor recurrence in the left lower extremity in addition to multiple extraosseous hot spots. The latter findings were assessed as ossified soft tissue metastases after considering the performed CT scan.. This case showed the double role of bone scan in osteosarcoma in simultaneously assessing the bone status and tumor spread in soft tissue. The benefit of a comparison of bone scan findings with other modalities was also demonstrated.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Osteosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

In a previous study using a rodent osteosarcoma-grafted rat model, in which cell-dependent mineralization was previously demonstrated to proportionally increase with growth, we performed a quantitative analysis of mineral deposit formation using (99m)Tc-HMDP and found some weaknesses, such as longer acquisition time and narrower dynamic ranges (i.e. images easily saturated). The recently developed near-infrared (NIR) optical imaging technique is expected to non-invasively evaluate changes in living small animals in a quantitative manner.. To test the feasibility of NIR imaging with a dual-channel system as a better alternative for bone scintigraphy by quantitatively evaluating mineralization along with the growth of osteosarcoma lesions in a mouse-xenograft model.. The gross volume and mineralization of osteosarcoma lesions were evaluated in living mice simultaneously with dual-channels by NIR dye-labeled probes, 2-deoxyglucose (DG) and pamidronate (OS), respectively. To verify these quantitative data, retrieved osteosarcoma lesions were then subjected to ex-vivo imaging, weighing under wet conditions, microfocus-computed tomography (μCT) analysis, and histopathological examination.. Because of less scattering and no anatomical overlapping, as generally shown, specific fluorescence signals targeted to the osteosarcoma lesions could be determined clearly by ex-vivo imaging. These data were well positively correlated with the in-vivo imaging data (r > 0.8, P < 0.02). Other good to excellent correlations (r > 0.8, P < 0.02) were observed between DG accumulation and tumor gross volume and between OS accumulation and mineralization volume.. This in-vivo NIR imaging technique using DG and OS is sensitive to the level to simultaneously detect and quantitatively evaluate the growth and mineralization occuring in this type of osteosarcoma lesions of living mice without either invasion or sacrifice. By possible mutual complementation, this dual imaging system might be useful for accurate diagnosis even in the presence of overlapping tissues.

Topics: Animals; Bone Neoplasms; Calcification, Physiologic; Diphosphonates; Feasibility Studies; Inositol; Mice; Mice, Hairless; Osteosarcoma; Pamidronate; Radiopharmaceuticals; Spectroscopy, Near-Infrared; Technetium Tc 99m Medronate; Transplantation, Heterologous

A rare case of osteogenic sarcoma (OGS) of the left humerus metastasizing to the right breast is presented. This lesion was detected by serendipitous observation on (99m)Tc-MDP skeletal scintigraphy that demonstrated a rounded focus just outside the skeletal outline of the right chest. The focus remained at a similar location on repeat postwash view. Clinical examination revealed a breast mass corresponding to the site of uptake, and a biopsy of this mass revealed it to be a metastasis of osteogenic sarcoma. The present case demonstrates a rare site of metastasis from OGS of the left humerus to the contralateral breast and hence is reported here as an unusual case vignette.

Topics: Adult; Bone Neoplasms; Breast Neoplasms; Female; Humans; Humerus; Incidental Findings; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Sensitivity and Specificity; Technetium Tc 99m Medronate

Local bone tumor excision followed by pasteurization and reimplantation is a unique technique of reconstruction for sarcoma patients. The long-term scintigraphic findings of pasteurized bone grafts in relation to clinical patients' data were reviewed retrospectively.. Twenty-two sarcoma patients (mean age, 24 years) done between April 2000 and January 2004 constituted the material of this study. One hundred and fifty-two 99 m TC-methylene diphosphonate (MDP) whole-body scans were reviewed. Initially, all autografts appeared as photon deficient areas. Diffusely increased bone uptake was present at the osteotomy sites within 4-6 months after surgery, the uptake of the grafted pasteurized bone was detected in 17 patients from about 6 months after surgery.. Of 22 patients, 11 (50%) showed higher uptake than the normal bone, 6 (27%) had uptake similar to the normal bone, while 5 (23%) had less uptake than the normal bone. Radiologically, 15 patients (68%) showed complete incorporation of graft and 5 patients (23%) had partial incorporation. Oncologically, 16 patients are disease free, while 6 died of disease. No local recurrence was detected at a mean of 59 months, while fracture (13.6%) eventually healed with bone grafting and revision of internal fixation, graft collapse (9%) (needed revision arthroplasty) and infection (9%), one cured and one converted to rotationplasty, were the major complications encountered. Significantly more mechanical complications were seen when tracer uptake suggestive of revascularization occurred; thus, revascularization and partial bone ingrowth are not sufficient conditions for lower mechanical complication rate.. The method of pasteurization of bone is a useful option for reconstruction after resection of malignant bone tumors.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Bone Transplantation; Child; Follow-Up Studies; Humans; Humerus; Middle Aged; Osteosarcoma; Plastic Surgery Procedures; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sarcoma; Sarcoma, Ewing; Technetium Tc 99m Medronate; Transplantation, Autologous; Young Adult

A 64-year-old woman presented with a painless breast mass. Tc-99m methoxyisobutylisonitrile scintigraphy of both breasts showed a local area of abnormal uptake in the left breast in 5 min and 2 h. A skeletal scan showed very intense concentration of activity in the primary breast tumor in the left breast. A left mastectomy and an axillary dissection were performed. The predominant histologic type of the mass was an osteosarcoma, and the diagnosis of a primary osteogenic sarcoma of the breast was made. Primary osteogenic sarcoma of the breast is rare and represents less than 1% of all primary breast malignancies.

Topics: Breast Neoplasms; Female; Humans; Middle Aged; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

Topics: Bone Neoplasms; Humans; Lung Neoplasms; Male; Middle Aged; Osteolysis; Osteosarcoma; Pleural Effusion, Malignant; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Technetium Tc 99m Medronate

A 25-year-old patient with osteosarcoma of the right distal femur underwent a bone scintigraphy with Tc-99m methylene diphosphonate (MDP). Whole-body bone scan revealed extensive metastatic disease in the abdominal region. Abdominal computerized tomography confirmed the presence of ascites and calcified masses on the greater omentum and peritoneal surfaces. Here we describe a case of unusual metastatic pattern of an osteosarcoma showing extensive intraabdominal metastases without prominent lung involvement after intensive chemotherapy.

Topics: Abdominal Neoplasms; Adult; Female; Femoral Neoplasms; Humans; Lung Neoplasms; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Rare Diseases; Technetium Tc 99m Medronate

The aim of this study was to assess early (15 min) and late 2 h) thallium-201 (201Tl) uptake in children with osteosarcoma and to compare these findings with magnetic resonance imaging (MRI) and technetium-99m methylenediphosphonate (99mTc MDP), with emphasis on evaluating tumor viability before and after chemotherapy. Fifteen patients with biopsy-proven osteosarcoma received standard preoperative chemotherapy with a combination of cisplatin, Adriamycin, and high-dose methotrexate. Their ages ranged between 7 and 18 years (median 14.5 years). All patients had 201Tl, 99mTc MDP, and MRI studies. Thallium scintigraphy was performed at 15 min and 2 h after IV injection of 92 MBq of thallium. Thallium uptake ratio was calculated by dividing the count density of the lesion (L) by that of the controlateral normal (N) area. The percent reduction of 201Tl uptake ratio (alteration ratio) was calculated by [100x(prechemotherapy L/N-postchemotherapy L/N)/prechemotherapy L/N]. Pathologic changes were graded on the basis of % tumor necrosis as defined histologically. Scintigraphic comparisons demonstrated a high-degree of correlation with late 201Tl alteration ration and poor correlation with both early 201Tl and 99mTc MDP alteration ratios. Late 201Tl images were superior to early 201Tl, 99mTc MDP, and MRI in predicting tumor response to chemotherapy as determined by % tumor necrosis (p<.01). The authors found that late 201Tl was an accurate test for evaluating the response to specific therapeutic regimens and it can be useful planning surgery or choosing alternative chemotherapeutic regimens.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Child; Cisplatin; Diagnostic Imaging; Doxorubicin; Drug Monitoring; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Methotrexate; Osteosarcoma; Radionuclide Imaging; Remission Induction; Technetium Tc 99m Medronate; Thallium Radioisotopes

Extraskeletal osteosarcoma is an extremely rare high-grade malignant soft tissue tumor, which accounts for approximately 4% of osteosarcomas and less than 1% of all soft tissue sarcomas. There have been reports describing the scintigraphic findings of this tumor, especially with Tl-201. We report a biopsy-proven case of extraskeletal osteosarcoma in which the bone and thallium scans were found to be useful in monitoring chemotherapy response. The Tc-99m HMDP bone scan revealed increased extraskeletal uptake in the tumor.

Topics: Bone Neoplasms; Humans; Male; Middle Aged; Muscle Neoplasms; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium; Thigh

Extraskeletal osteosarcoma is a rare malignant soft-tissue tumor. There are few reports describing the radiological findings of this tumor, especially concerning its MRI and scintigraphic appearance. We report a 58-year-old man with extraskeletal osteosarcoma in the thigh. Radiographs showed small foci of mineralization in the mass. The tumor showed low intensity on T1-weighted images and predominantly high intensity on T2-weighted images, and the tumor was heterogeneously well enhanced on Gd-DTPA-enhanced T1-weighted images. Bone scintigraphy showed extraskeletal uptake in the tumor, and thallium-201 scintigraphy revealed marked inhomogeneous accumulation.

Topics: Contrast Media; Gadolinium DTPA; Humans; Image Enhancement; Magnetic Resonance Imaging; Male; Middle Aged; Osteosarcoma; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thigh

Extraskeletal osteosarcoma (ExOs) is a rare, usually highly aggressive malignancy, which affects individuals beyond the fifth decade of life. ExOs prinicipally occurs as a soft tissue mass in a limb or retroperitoneum. We present the case of a 58-year-old man with a huge abdominal mass who underwent a complete range of clinical imaging investigations including computed tomography (CT), skeletal scintigraphy (BS) and positron emission tomography (PET). These exams showed a central calcified and ossified, strongly metabolic retroperitoneal tumour suggestive of an ExOs. This diagnosis was later confirmed by histopathology. To our knowledge, such a case has not previously been documented fully using radiological imaging correlated to modern nuclear medicine techniques such as PET.

Topics: Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Osteosarcoma; Positron-Emission Tomography; Radiopharmaceuticals; Retroperitoneal Neoplasms; Technetium Tc 99m Medronate

Two cases of primary pulmonary osteosarcoma are presented. In both cases, chest computed tomography revealed a calcified pulmonary mass and technetium-99m methylene diphosphonate bone scintigraphy showed intense uptake in the pulmonary mass. Primary pulmonary osteosarcoma was suspected on the basis of these radiographic findings. Microscopic examination of tumor specimens obtained by needle biopsy revealed histologic features of osteosarcoma, and this diagnosis was confirmed by postmortem examination of a second specimen in each case. Radiographic and histopathological findings enabled us to diagnose primary pulmonary osteosarcoma, which is one of the rarest types of cancer.

Topics: Aged; Biopsy, Needle; Diagnosis, Differential; Fatal Outcome; Humans; Lung Neoplasms; Male; Osteosarcoma; Radiography, Thoracic; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A 25-year-old woman presented with a disturbance in the opening of her mouth 5 months before admission. On admission, painful swelling of the right preauricular region was revealed. Computed tomography (CT) demonstrated a soft tissue density mass around the right condylar process of the mandible. Tc-99m hydroxymethylene diphosphonate (HMDP) bone scintigraphy and Ga-67 citrate scintigraphy showed avid uptake in the mass. The tumor was histologically identified as an osteoblastic osteosarcoma of the right mandible. There are few reports of Ga-67 citrate scintigraphy findings of osteoblastic osteosarcoma of the mandible. The accumulation patterns on Tc-99m HMDP bone scintigraphy and Ga-67 citrate scintigraphy are possibly characteristic of osteoblastic osteosarcoma of the mandible.

Topics: Adult; Arthralgia; Citrates; Female; Gallium; Humans; Mandibular Neoplasms; Osteoblastoma; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Temporomandibular Joint

Topics: Adult; Female; Humans; Neoplasm Recurrence, Local; Osteosarcoma; Radiopharmaceuticals; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Cervical Vertebrae; Humans; Image Enhancement; Male; Neck Pain; Osteosarcoma; Radiopharmaceuticals; Sensitivity and Specificity; Spasm; Spinal Neoplasms; Subtraction Technique; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Animals; Bone Neoplasms; Dog Diseases; Dogs; Female; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Glucose; Humans; Male; Osteosarcoma; Prognosis; Radiopharmaceuticals; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed

Topics: Adolescent; Bone Neoplasms; Humans; Leg; Male; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Whole-Body Counting

A 40-year-old woman presented with a known case of osteogenic sarcoma of the right leg and underwent below-the-knee amputation. The preoperative workup was negative for distant metastases, and the patient was followed regularly. Two years later she developed dyspnea and chest pain. Computed tomography revealed diffuse left lung metastases with pleural involvement and nodular metastases in the right lung. Tc-99m methylene diphosphonate whole-body bone scanning revealed the amputated right leg with a clean stump but with widespread metastases in the right thigh involving soft tissue and bone, and the pelvis, left femur, and skull. In addition, diffuse left lung metastases involving both parietal pleura and lung parenchyma were seen. Tc-99m methylene diphosphonate uptake has been observed in the soft tissue and lungs in patients with osteogenic sarcoma but is rarely observed in practice with this degree of aggressiveness.

Topics: Adult; Bone Neoplasms; Female; Humans; Lung Neoplasms; Osteosarcoma; Pleural Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

In patients with an osteosarcoma, the prognosis is still poor. The aim of the present study was to investigate whether routinely tested biochemical parameters or additional parameters on bone scintigraphy could be identified which can select prognostic subgroups at the time of diagnosis.. A retrospective study was performed in 115 consecutive patients (70 male, 45 female) (mean age: 25.6 years; range: 3.50-78.0 years) who were referred for bone scintigraphy prior to treatment from March 1986 to September 2000 because of a newly diagnosed osteosarcoma. All bone scans were reassessed for the intensity and pattern of uptake and a bone-scan index. All pre-treatment general, histological, biochemical, and scintigraphic data were correlated with clinical outcome during follow-up.. During follow-up 54 patients died. Tumour volume and GGT showed significance as independent variables for metastases. Patients with metastases demonstrated a significantly lower survival rate (23% 5-year survival) than patients without metastases (98% 5-year survival). Tumours of the humerus and femur had a significantly lower survival rate. With respect to significant biochemical parameters (ALP, GGT, ASAT), it was not possible to determine a cut-off value that could be used to differentiate between high- and low-risk patients. Additional parameters assessed on bone scintigraphy were not important for prognostic stratification.. The strongest predictor of survival in osteosarcoma is the presence or absence of metastasis. Some biochemical parameters have prognostic value, but they cannot be used for the unequivocal identification of subgroups. Additional scintigraphic parameters are irrelevant for prognostic stratification.

Topics: Adolescent; Adult; Aged; Biomarkers; Biopsy; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Osteosarcoma; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Survival Analysis; Technetium Tc 99m Medronate; Time Factors; Treatment Outcome

The purpose of this retrospective analysis was to evaluate the prognostic significance of both initial glucose metabolism as measured by (18)F-FDG PET and osteoblastic activity as measured by (99m)Tc-methylene diphosphonate (MDP) bone scintigraphy in osteosarcoma.. In 29 patients (18 male, 11 female; age range, 5-41 y) with primary osteosarcoma, (18)F-FDG uptake and (99m)Tc-MDP uptake were measured semiquantitatively (average and maximum tumor-to-nontumor ratios [T/NT(av) and T/NT(max), respectively]) using PET and bone scintigraphy at the time of diagnosis. After chemotherapy, the patients underwent surgery for their primary tumor, and the response was determined histologically. Cumulative overall survival and event-free survival were determined by clinical and imaging follow-up of 7-72 mo (median, 28 mo).. Clinical and imaging follow-up revealed that the disease relapsed or failed to achieve complete remission in 9 patients and that 6 patients died of the disease. Both overall and event-free survival were significantly better in patients with a low (18)F-FDG T/NT(max) (less than the median) than in patients with a high (18)F-FDG T/NT(max) (at least the median). The negative relationship of (18)F-FDG T/NT(av), (99m)Tc-MDP T/NT(max), and (99m)Tc-MDP T/NT(av) with overall and event-free survival did not reach a level of significance. (18)F-FDG uptake values correlated moderately and positively with (99m)Tc-MDP uptake values, but a level of significance was reached only between (18)F-FDG T/NT(max) and (99m)Tc-MDP T/NT(av).. The initial glucose metabolism of primary osteosarcoma as measured by (18)F-FDG PET using T/NT(max) provides prognostic information. High (18)F-FDG uptake correlates with poor outcome. Thus, (18)F-FDG uptake may be complementary to other well-known factors in judging the prognosis in osteosarcoma.

Topics: Adolescent; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Glucose; Humans; Male; Osteosarcoma; Prognosis; Radiopharmaceuticals; Retrospective Studies; Survival Rate; Technetium Tc 99m Medronate; Time Factors; Tomography, Emission-Computed

Topics: Adult; Female; Femoral Neoplasms; Humans; Lung Neoplasms; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

Metastatic osteosarcoma most commonly affects the lungs and other bones. Hepatic metastasis at the time of diagnosis is extremely rare. A 14-year-old boy with synovial sarcoma of the left popliteal fossa was treated with surgical resection, radiotherapy for microscopic residual disease, and 1 year of chemotherapy (vincristine, cyclophosphamide, dactinomycin, and doxorubicin). Approximately 10 years after the initial diagnosis, a secondary osteosarcoma developed in the left proximal tibia. Computed tomography at presentation showed bilateral pulmonary metastases and large ossified nodules in the liver that demonstrated abnormal avidity on 99mTc MDP bone scan indicating hepatic metastasis. Despite chemotherapy (cisplatin, ifosfamide, high-dose methotrexate, and dacarbazine), the patient died of progressive disease 4 months after the diagnosis of the second cancer. Hepatic metastasis was found at the time of diagnosis of a secondary osteosarcoma and manifested as ossified nodules. The risk of radiation-induced osteosarcoma should always be considered in decisions about treatment for soft-tissue sarcoma.

Topics: Adolescent; Fatal Outcome; Humans; Liver Neoplasms; Lung Neoplasms; Male; Neoplasms, Radiation-Induced; Neoplasms, Second Primary; Ossification, Heterotopic; Osteosarcoma; Radiopharmaceuticals; Radiotherapy; Sarcoma, Synovial; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Topics: Adolescent; Bone Neoplasms; Humans; Lung Neoplasms; Male; Neoplasm Recurrence, Local; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

A bone scan in a patient with proved osteogenic sarcoma of the tibia showed intense focal uptake in the gluteal region on the side of his cancer. This was proved to be a metastasis in the muscle.

Topics: Bone Neoplasms; Buttocks; Humans; Osteosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tibia

The aim of this study was to evaluate the value of three-phase dynamic bone scintigraphy (TPBS) in the assessment of the response of bone sarcomas to pre-operative chemotherapy and to correlate serial scintigraphic changes with histological findings. The study group comprised 27 patients (osteogenic sarcoma, n = 20; Ewing's sarcoma, n = 5; malignant fibrous histiocytoma, n = 2) with a mean age of 19.2 years. All patients received 99Tcm-methylene diphosphonate TPBS before and after pre-operative chemotherapy. Each phase of the imaging procedure was interpreted qualitatively and quantitatively. The percentage of tumour necrosis was analysed on resection materials following surgery. Histologically, 12 patients were non-responsive (tumour necrosis less than 90%) and 15 patients were responsive (tumour necrosis more than 90%). A decrease in the tumour blood flow ratio and extension were the most notable findings in the responders. The mean change in the tumour blood flow ratio following therapy was 58.7 +/- 8.3% and 19.9 +/- 26.6% (P < 0.005) in responders and non-responders respectively. The accuracy of three-phase imaging and static bone scintigraphy was 88% and 74% respectively. Since bone scintigraphy is a valuable technique owing to its ability to detect distant metastases in clinically early disease, TPBS should be helpful in monitoring therapy effects without any additional cost or radiation dose.

Topics: Adolescent; Adult; Antineoplastic Agents; Bone and Bones; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Data Interpretation, Statistical; Female; Histiocytoma, Benign Fibrous; Humans; Male; Middle Aged; Osteosarcoma; Radiopharmaceuticals; Regional Blood Flow; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, Emission-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

The aim of this work was to study and compare the usefulness of dynamic contrast-enhanced spin-echo MR imaging with high temporal resolution hydroxymethylene diphosphonate technetium-99 m skeletal angioscintigraphy in predicting the osteosarcoma histological response to neoadjuvant chemotherapy. Twelve patients with resectable osteosarcoma were prospectively monitored with dynamic MR imaging and skeletal scintigraphy before start of neoadjuvant chemotherapy, after two cycles of therapy and before surgery. Neoplasm signal intensity and activity intensity were plotted against time, and slopes were calculated for percentage increase over baseline values in the first minute. Stability and increase in slope values during or after chemotherapy were defined as a "radiological non-response". Changes in slopes were compared with the "histological response" (Huvos grading). At midpoint of the chemotherapy, these two imaging modalities failed in predicting final histological response. After the completion of the chemotherapy, these imaging modalities allowed the prediction of histological response with the same accuracy (91 %). In this series, dynamic MR imaging and technetium skeletal scintigraphy provide similar results regarding the prediction of final histological response during neoadjuvant chemotherapy; these results cannot be used to modify the therapeutic protocol at midpoint of chemotherapy; these imaging tools predict accurately the histological response at the end of chemotherapy. These latter results may permit anticipation of the adjuvant chemotherapy strategy during decalcification procedures in resected osteosarcoma and thus to monitor chemotherapy in non-surgical osteosarcoma.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Contrast Media; Female; Gadolinium DTPA; Heterocyclic Compounds; Humans; Magnetic Resonance Imaging; Male; Organometallic Compounds; Osteosarcoma; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Antineoplastic Agents; Biopsy; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Female; Humans; Male; Middle Aged; Neoplasm Staging; Osteosarcoma; Preoperative Care; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sarcoma, Ewing; Sensitivity and Specificity; Technetium Tc 99m Medronate; Time Factors

To apply postprocessing techniques to register three-dimensional TI-201 bone SPECT datasets with MRI. This may provide more accurate anatomic-functional correlation when localizing active tumors.. Three-dimensional datasets were constructed from previously acquired MRIs using routine imaging protocols. Registration software was used to coregister the TI-201 SPECT studies and the MRIs in three dimensions.. Adequate TI-201 uptake in muscles and soft tissues along with relatively low accumulation in tendons and joint spaces provided adequate landmarks for visually aligning SPECT and MRI datasets. MR abnormalities were more extensive because of surrounding reactive tissue, and more focal TI-201 uptake could be demonstrated within the region of MR signal abnormality, allowing the focal metabolically active tissue to be distinguished from adjacent edema.. Image registration of SPECT and anatomic imaging (CT or MRI) is used routinely to evaluate functional abnormalities within the brain. This technique has now been applied to the combination of TI-201 SPECT and MR data for evaluating bone lesions and may provide additional anatomic information for localizing functional abnormalities. This may be valuable for defining targets for biopsy, planning surgical treatment, and using minimally invasive therapies.

Topics: Bone Neoplasms; Feasibility Studies; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Osteosarcoma; Radiopharmaceuticals; Retrospective Studies; Software; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

We prospectively compared the ability of two techniques--bone scintigraphy with single-photon emission computed tomography (SPECT) of the chest and CT of the chest--to reveal potential osteosarcoma metastases of the lung.. Our study included 27 patients with osteosarcoma who prospectively underwent both bone scintigraphy with SPECT of the chest and CT of the chest. The imaging results were compared with outcome or pathologic analysis of any lung lesions found.. Eight (30%) of the 27 patients had pulmonary metastases. Four of these eight patients had positive results on both CT studies and bone SPECT studies, with additional lesions detected with bone SPECT in two of these four patients. The other four patients with pulmonary metastases had positive results on CT studies, whereas the results of bone SPECT studies remained negative. The results of bone SPECT studies were negative in the 19 patients without pulmonary metastases. CT, however, showed abnormalities in seven (37%) of the 19 patients, which were eventually attributed to benign conditions.. Negative results on a bone SPECT study of the chest should not be used to exclude the possibility of lung metastases. However, if the results are positive, a bone SPECT study can be used to confirm abnormalities seen on CT scans and may also reveal subtle lesions missed on CT scans.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Female; Humans; Lung Neoplasms; Male; Middle Aged; Osteosarcoma; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Sensitivity and Specificity; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Adult; Breast Neoplasms; Female; Humans; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Local malignant bone tumor excision followed by high-dose extracorporeal irradiation (300 Gy) and subsequent reimplantation is a unique technique for treatment of primary bone and cartilage tumors. The long-term scintigraphic findings of irradiated bone autografts in relation to clinical patient data were reviewed retrospectively.. Thirty-seven patients (12 women, 25 men; age range 13.0-66.7 yr; average age 29.1 yr) were studied. Postsurgical anatomopathological diagnoses included osteosarcoma, 20 patients; chondrosarcoma, 7 patients; and other less-frequent primary osteogenic tumors, 10 patients. Three hundred ninety 99mTc-methylene diphosphonate (MDP) whole-body scans performed between 3 mo and 18.3 yr (mean 6.5 yr) after treatment were reviewed.. The 10-yr actuarial survival rate was 78%. After a mean period of 19.4 mo, 6 patients developed a local recurrence, and MDP scintigraphy detected the recurrence in 4. Distant metastases developed in 11 patients (30%), of which 10 were nonosseous. Initially, all autografts appeared as photon-deficient areas. Diffusely increased bone uptake was present at osteotomy sites and at articulating surfaces contiguous with autografts within the first few months after surgery. Of all 25 patients with adequate follow-up, 7 showed persistent decreased uptake up to 129 mo after surgery. The other patients developed partial tracer uptake after 19.6 mo, on average. In 6 patients, scintigraphic images consistent with complete revascularisation were noted later (mean 31.5 mo). Local, sometimes multiple, complications were noted in 22 patients, mainly mechanical graft-related (15) or infections (11). Scintigraphic sensitivity for mechanical complications was 100%. Significantly more fractures and collapses were seen when partial tracer uptake suggestive of revascularisation occurred. Altered bone stress gave rise to focal and diffuse scintigraphic abnormalities, often in the spine and lower extremities. In recent literature, similar clinical complication patterns are found for massive allografts.. Skeletal scintigraphy is a sensitive technique for evaluating long-term follow-up of massive grafts to treat primary malignant bone tumors. Revascularisation and partial bone ingrowth are not sufficient conditions for a lower complication rate.

Topics: Adult; Bone Neoplasms; Bone Transplantation; Chondrosarcoma; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Osteosarcoma; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Survival Rate; Technetium Tc 99m Medronate; Time Factors; Transplantation, Autologous

We quantitatively analyzed images of 99mTc-HMDP bone scintigraphy in 34 bone sarcomas before and after preoperative chemotherapy. The isotopic uptake was calculated as tumor-to-background ratio (TBR), and the changes in TBR before and after chemotherapy were calculated as the alteration ratio. The histological effect of preoperative chemotherapy was classified in 4 grades, according to Huvos. We defined good scintigraphic responders as cases having decreased uptake after chemotherapy, with an alteration ratio > or = 60%. There was a positive correlation (Rho = 0.76, p < 0.001) between the histological effect and the alteration ratio. Of the 17 good histological responders, 13 showed a good scintigraphic response. The average alteration ratio in 17 cases with good response (68%) was higher than that in 17 cases showing poor response (-9.9%) (p < 0.001). 3 patients with pathologic fractures and 1 with primarily normal uptake showed false negative findings. The sensitivity of this method was 100% and the specificity was 81%.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Female; Histiocytoma, Benign Fibrous; Humans; Image Processing, Computer-Assisted; Leg; Male; Neoadjuvant Therapy; Osteosarcoma; Radionuclide Imaging; Sarcoma; Sarcoma, Ewing; Sensitivity and Specificity; Technetium Tc 99m Medronate; Treatment Outcome

Topics: Adult; Bone Neoplasms; Humans; Lung Neoplasms; Male; Osteosarcoma; Radiopharmaceuticals; Ribs; Solitary Pulmonary Nodule; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

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

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

Topics: Adolescent; Adrenal Gland Neoplasms; Bone Neoplasms; Humans; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

We present the findings on 201Tl and 99mTc-MDP scintigraphy in three patients suffering from heterotopic ossification (two patients presenting with myositis ossificans and one patient presenting with juxta-articular ossification in combination with myositis ossificans). Since resection of the lesions has to be delayed until stabilization, 99mTc-MDP is often used as a parameter of lesional activity, although it is not optimal. For this clinical problem, we evaluated 201Tl scintigraphy as a marker of metabolic activity. In addition to the well-documented uptake of 99mTc-MDP, marked accumulation of 201Tl was observed in all heterotopic ossification sites. Hence, our results support the use of 201Tl scintigraphy in the therapeutic management and monitoring of conditions associated with ectopic ossification. On the other hand, although myositis ossificans is sometimes clinically, radiographically and even histologically confused with extraosseous osteogenic sarcoma, 201Tl accumulation may not be a helpful factor in the differential diagnosis due to the presence of tracer accumulation in both disorders.

Topics: Adult; Diagnosis, Differential; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Muscle, Skeletal; Myositis Ossificans; Ossification, Heterotopic; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Thallium Radioisotopes

Focal and diffuse hepatic uptake of bone-seeking radiopharmaceuticals may be due to a variety of conditions including tumors and radiopharmaceutical impurity. However, uptake in the gallbladder is unusual with currently used skeletal agents. Three patients (aged 10, 15, and 16 years) underwent routine whole-body bone scans during a course of intensive chemotherapy with VP-16 and ifosphamide. Images showed intense gallbladder and faint liver uptake. No patient had symptoms of cholecystitis. Radiopharmaceutical quality control revealed no impurities. Repeat bone scans after completion of chemotherapy showed no liver or gallbladder uptake. The authors conclude that this finding represents altered distribution induced by the chemotherapy regimen, and should not be misinterpreted as intrinsic liver or gallbladder disease.

Topics: Adolescent; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bone and Bones; Bone Neoplasms; Child; Etoposide; Female; Gallbladder; Humans; Ifosfamide; Liver; Male; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tissue Distribution

Thirty-seven patients with newly diagnosed or treated sarcomas had 47 sets of sequential thallium scans (TS) followed by three-phase bone scan (TPBS) on the same day. The diagnosis in all patients was verified by biopsy (n = 40) or long-term follow-up studies (n = 7). The sensitivity, specificity, and accuracy of TS and TPBS in detecting sarcomatous lesions was calculated: TS sensitivity was 88%, specificity 69%, and accuracy 83%; blood flow (BF) and blood pool (BP) sensitivity was 91%, specificity 54%, and accuracy 81%; delayed bone scan (DB) sensitivity was 88%, specificity 38%, and accuracy 74%. In 17 studies the flow and blood pool parts of the TPBS and TS demonstrated the soft tissue component of sarcomas, which would have been missed if only the delayed bone scan had been performed. The TS lesion to normal tissue ratio alone was not very helpful in differentiating sarcomas from benign conditions because some benign lesions are highly cellular and vascular while some malignant lesions, such as chondrosarcoma, have poor vascularity and a less cellular chondroid matrix. However, when the thallium ratio was correlated with similar ratios calculated from the BP image, it was found that if the TS lesion to normal tissue ratio exceeded the BP lesion to normal tissue ratio (12 patients), the specificity for detecting sarcomatous lesions was 100%. Nevertheless, the reverse was not true. The positive predictive value of this observation was 100% and the negative predictive value was 37%.

Topics: Adolescent; Adult; Aged; Bone and Bones; Bone Neoplasms; Child; Chondrosarcoma; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes

Topics: Aged; Bone and Bones; Humans; Male; Osteosarcoma; Pleural Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Topics: Bone and Bones; Breast Neoplasms; Female; Humans; Mammography; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Intratibial injection in nude rats of 1 x 10(6) OHS, MHMX, and LOX human tumor cells resulted in each case in progressively growing bone tumors. When the diameter of the affected leg had increased by 2-3 mm, the animals were examined for uptake of 99mTc-methylenediphosphonate. The OHS osteosarcoma tumors caused sclerotic lesions with high and uniform isotope uptake, and the MHMX unclassified sarcoma showed a mixed pattern with both sclerotic and lytic areas, whereas the LOX melanoma caused lytic bone lesions with low uptake of the radionuclide. These findings were compared with the results of analogous investigations previously performed in the patients from whom the tumor lines originated. Striking similarities in both the morphology and the scintigraphic images were observed between corresponding tumors in rats and humans, with results supporting the clinical relevance of the model systems. When the LOX model was used for therapy experiments, doxorubicin had no effect on the growth of the tibial tumors, which in the control group appeared after a latency of 13.5 days. The alkylating agent mitozolomide increased the median tumor-free latency to 47 days in 7 rats, and 5 animals did not develop tumors within the observation period of 60 days. Doxorubicin was ineffective also against the OHS tumor, whereas ifosfamide and the radionuclide 89Sr-chloride showed significant antitumor activity. The disease-free latency increased from 20 days, in the control animals, to 45 and 28.5 days, respectively, in the 2 treated groups, in which 2 of 7 and 2 of 10 rats were without tumors at 60 days. The data demonstrate that the tibial models discriminated between the action of the different therapeutic agents, and suggest that they may be useful in selecting compounds with clinical activity against skeletal tumors.

Topics: Animals; Bone Neoplasms; Cell Line; Doxorubicin; Female; Femur; Ifosfamide; Male; Melanoma, Amelanotic; Osteosarcoma; Radionuclide Imaging; Rats; Rats, Nude; Sarcoma; Strontium; Technetium Tc 99m Medronate; Tibia; Transplantation, Heterologous; Tumor Cells, Cultured

The prognosis of localized osteogenic sarcoma (OS) has improved considerably since the introduction of neoadjuvant chemotherapy. However, there is a subset of patients who do not show full benefit from neoadjuvant chemotherapy because of chemoresistance. The early identification of poor responders to chemotherapy during neoadjuvant therapy remains difficult. In order to evaluate the role of bone scintigraphy we report our experience of dynamic technetium-99m hydroxymethylene diphosphonate bone scintigraphy in 19 cases of paediatric osteogenic sarcomas. Before the beginning of chemotherapy, a dynamic scan was recorded during 30 min followed by static images at 3 h. The procedure was repeated halfway through the course of chemotherapy (6th week). Histological grading of the response to chemotherapy was carried out in the 12th week, showing nine good responses and ten poor responses. Factor analysis of dynamic structures (FADS) applied to dynamic scans allowed us to identify three factors termed vascular, "soft tissue" and osseous factors. The effect of chemotherapy on each factor was evaluated. Using FADS we were able to detect all the poor histological responders with the combination of vascular and osseous factors. Six out of nine good histological responders were also classified as scintigraphic responders. FADS applied to dynamic bone scans allowed us to identify at an early stage all the poor histological responders to neoadjuvant chemotherapy. This method may have clinical relevance for the therapeutic strategy in patients with OS.

Topics: Adolescent; Antineoplastic Agents; Bone Neoplasms; Chemotherapy, Adjuvant; Child; Factor Analysis, Statistical; Female; Humans; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

To evaluate previously described radiologic prognostic factors in extremity osteosarcoma.. In 47 pediatric patients, available images were evaluated for seven prognostic factors at diagnosis and seven additional factors after preoperative chemotherapy. These factors were correlated with histopathologic response and clinical outcome. The association of histopathologic response and outcome was also evaluated.. Metastases at presentation and a > 20-cm-diameter soft-tissue mass were predictive of a poor outcome but occurred in few patients. Factors most predictive of < 90% tumor necrosis after chemotherapy included an increase or no change in soft-tissue mass size and increased bone destruction. Although a significant relationship (P < .05) was found between histopathologic response and outcome, no factors predictive of histopathologic response were also predictive of outcome. The accuracy of pathologic response in predicting outcome was 66%.. Radiologic studies are of only limited use in predicting which patients with extremity osteosarcoma will have a poor response to chemotherapy or a poor outcome, and are not useful in predicting a good response or outcome.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child; Child, Preschool; Diagnostic Imaging; Female; Femoral Neoplasms; Follow-Up Studies; Humans; Humerus; Magnetic Resonance Imaging; Male; Osteosarcoma; Prognosis; Salvage Therapy; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tibia; Tomography, X-Ray Computed

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

Although the radiopharmaceuticals used for bone scintigraphy are of very high quality, the search for an "ideal" agent continues. To optimise the detectability of bone lesions, we analysed 244 different 99mTc-labeled phosphonates in animal experiments. In osteosarcoma-carrying rats 99mTc-labeled 1-Hydroxy-3-methyl-phosphinic-1, 1-propanediphosphonic acid (HMPD) was shown to produce the best lesion/normal bone ratio. 99mTc-MDP was used as reference. The ratio was found to be 1.28 for 99mTc-HMPD. The transferability of our results in animals to the situation in man was studied in 10 patients with bone metastases. There was for 99mTc-HMPD an improvement of the lesion/normal bone ratio by more than 60% but also an additional reduction of the soft tissue contrast by about 40%. 15% of the metastases were detected by scintigraphy using 99mTc-HMPD only and not with 99mTc-MDP. The new agent should make possible a better and earlier discrimination of bone lesions in the scintigram.

Topics: Aged; Aged, 80 and over; Animals; Bone Neoplasms; Diphosphonates; Female; Humans; Male; Middle Aged; Neoplasm Transplantation; Organophosphorus Compounds; Organotechnetium Compounds; Osteosarcoma; Radionuclide Imaging; Rats; Rats, Sprague-Dawley; Sarcoma, Experimental; Technetium Tc 99m Medronate; Tissue Distribution

Three patients with osteosarcoma of the femur developed abnormal radiopharmaceutical uptake in the bones of the contralateral leg. This uptake was not due to metastases. The histology in one patient, the form of the lesion and the disappearance of the abnormal uptake without treatment in the other two, indicated that the uptake was probably due to stress fractures. Changes in weight bearing and walking in the normal leg as a result of the osteosarcoma in the other leg could have been the cause of the stress fractures. It should be recognized that new abnormal uptake on bone scintigraphy in patients with osteosarcoma of the leg may not necessarily indicate metastasis. It may be caused by a stress fracture and disappears after rest.

Topics: Adult; Bone Neoplasms; Child; Female; Femur; Fibula; Fractures, Stress; Humans; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Tibial Fractures

Topics: Adult; Bone Neoplasms; Female; Humans; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; 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

The authors retrospectively reviewed the Tc-99m medronate scan findings in six patients who had no evidence of metastatic disease following en bloc resection of a primary osteosarcoma and subsequent limb reconstruction using allograft bone. Persistently increased radionuclide uptake was noted at the junction between the host bone and the graft, while the graft cortical bone showed persistently decreased activity. Radionuclide uptake at the periphery of the graft varied. Over time the youngest patient in the series had increasingly normal scan findings.

Topics: Adolescent; Adult; Bone Neoplasms; Bone Transplantation; Child; Child, Preschool; Histiocytoma, Benign Fibrous; Humans; Leg; Osteosarcoma; Radionuclide Imaging; Retrospective Studies; Sarcoma, Ewing; Technetium Tc 99m Medronate; Time Factors

There is given a report about first clinical experiences in the partial cryodevitalization of the mandible. 3 tumor-bearing patients were treated. The resection of the mandible was not necessary. The process of revitalisation was observed by bone scanning.

Topics: Bone Regeneration; Carcinoma, Squamous Cell; Cryosurgery; Follow-Up Studies; Humans; Mandible; Mandibular Neoplasms; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

The effect of preoperative chemotherapy (PCT) on the uptake of 99mTc-labeled diphosphonates into tumor bone was quantitatively assessed from serial scan studies of 30 osteosarcomas and correlated with the histomorphological changes determined from the surgical specimens. The parametric images of the tumor blood pool and labeled methylene diphosphonate (99mTc-MDP) plasma clearance by the tumor bone enabled a sensitive distinction to be made preoperatively between a good (greater than 90% tumor cell destruction) and a poor (less than 90% tumor cell destruction) tumor response. Overall accuracy in presurgical prediction of tumor regression was found to be 88% and 96% for the blood pool and 99mTc-MDP clearance measurements, respectively (P less than or equal to 0.0004). In addition, it proved possible to localize resisting areas of viable tumor up to 1.0 cm in diameter. Even at the half-way stage of PCT, a poor response could be reliably predicted (overall accuracy 91% and 100%, respectively; P less than or equal to 0.011). Therefore, 99mTc-MDP parametric imaging is a highly sensitive and specific modality for an objective and accurate assessment of tumor regression during PCT of osteosarcoma.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bone Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Extremities; Female; Humans; Male; Osteosarcoma; Predictive Value of Tests; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Humans; Necrosis; Osteosarcoma; Preoperative Care; Radionuclide Imaging; Remission Induction; Technetium Tc 99m Medronate

Bone scintigraphy was performed as part of an initial diagnostic evaluation of 70 dogs admitted with primary bone tumors during a 2-year period. Tumors involved major long bones of the appendicular skeleton and included 62 osteosarcomas, 6 fibrosarcomas, and 2 chondrosarcomas. All dogs were free of radiographically detectable pulmonary metastases. Bone scintigraphy was not of value in distinguishing among various types of primary tumors. One dog with an ulnar chondrosarcoma had a scintigraphically detectable occult osseous metastasis or synchronous primary tumor, and 1 dog with osteosarcoma had a scintigraphically detectable lymph node metastasis. Pulmonary metastases were not detected scintigraphically. Of the 70 dogs, 44.3% had areas of increased isotope uptake associated with nonneoplastic disease processes.

Topics: Animals; Bone Neoplasms; Chondrosarcoma; Dog Diseases; Dogs; Female; Fibrosarcoma; Lung Neoplasms; Lymphatic Metastasis; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Bone Neoplasms; Female; Humans; Osteosarcoma; Pleural Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

The advent of improved chemotherapy has changed the natural course of osteosarcoma. The role of bone scintigraphy in the workup of metastatic osteosarcoma is being re-evaluated. Extra-osseous osteogenic sarcoma metastases, particularly pulmonary metastases, are known to accumulate bone-avid agents. In this case, there is also uptake by noncalcified metastases to the brain and to soft tissues of the leg and arm which has not been previously reported. Correlation with computed tomography and magnetic resonance imaging is made.

Topics: Adult; Bone Neoplasms; Brain Neoplasms; Humans; Lung Neoplasms; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adult; Female; Femoral Neoplasms; Femur; Humans; Knee Joint; Osteoma, Osteoid; Osteosarcoma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Aged; Bone and Bones; Female; Humans; Lumbosacral Region; Lung Neoplasms; Osteosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Tc-99m MDP bone scintigraphy is widely used for initial staging and subsequent follow-up of patients with osteosarcoma. Two unusual cases are presented here, one with diffuse pleural metastases and one with diffuse peritoneal metastases. In one case, an abnormal bone scan was the first indication of metastatic disease. Both the metastatic pattern of osteosarcoma and the indications for bone scintigraphy are reviewed.

Topics: Adolescent; Adult; Femoral Neoplasms; Humans; Male; Osteosarcoma; Peritoneal Neoplasms; Pleural Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Extraosseous soft tissue metastases from osteosarcoma occasionally accumulate Tc-99m MDP. The authors present a case of osteogenic sarcoma of the femur with a pulmonary metastasis detected by bone imaging with radiographic correlation including CT and magnetic resonance imaging. The implication of the detection of osseous and extraosseous metastasis in these patients by bone imaging is discussed. The changing role of bone imaging in the initial workup and follow-up of patients with osteogenic sarcoma is reviewed in light of the change in course and prognosis of the disease as a result of recent advances in adjuvant chemotherapy.

Topics: Adult; Femoral Neoplasms; Humans; Lung Neoplasms; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

The soft tissue uptake of 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) due to subcutaneous injections of heparin calcium is reported in two patients with osteosarcoma. This uptake occurs in an unusual site, i.e. the shoulders and the anterior and posterior compartments of the upper arms.

Topics: Adolescent; Arm; Femoral Neoplasms; Heparin; Humans; Injections, Subcutaneous; Male; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

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

Bone scintigraphy was performed in 17 patients with previously known lung metastases of osteosarcoma. 99Tcm-MDP uptake was observed in all primary bone lesions but lung metastatic lesions were positive in only six patients (35%). 99Tcm-MDP uptake by lung metastases was significantly correlated with bone and osteoid formation in the metastatic lesions and preoperative serum ALPase values. These clinical observations were confirmed by using nude mice transplanted with human lung metastatic osteosarcoma. 99Tcm-MDP scintigraphy appears to be useful for detecting lung metastases of osteosarcoma only in a selected group of patients.

Topics: Adolescent; Adult; Animals; Bone Neoplasms; Female; Humans; Lung Neoplasms; Male; Mice; Mice, Nude; Middle Aged; Neoplasm Transplantation; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Transplantation, Heterologous

Topics: Adolescent; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Eosinophilia; Follow-Up Studies; Histiocytoma, Benign Fibrous; Humans; Osteoma, Osteoid; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

An investigation to correlate histologic changes in 12 osteosarcoma specimens from patients undergoing chemotherapy was performed using functional images of regional 99mTc methylene diphosphonate (MDP) plasma clearance rates assessed from dynamic bone scintigraphies taken during chemotherapy. Residual tumor cell viability was determined by microscopic examination of multiple thin sections from surgical specimens and quantitated by histomorphometry. Regions that showed decreases in 99mTc MDP plasma clearance of more than 20% were associated with areas of necrotic tumor, and regions that showed absent decline or increasing clearance rates were associated with high residual cell viability and incomplete response to chemotherapy. Therefore, functional bone scintigraphy allows an objective presurgical assessment of tumor response to chemotherapy.

Topics: Adolescent; Adult; Antineoplastic Agents; Bone Neoplasms; Cell Survival; Female; Humans; Male; Metabolic Clearance Rate; Osteosarcoma; Radionuclide Imaging; Regional Blood Flow; Technetium Tc 99m Medronate

To determine how often stress fractures occur in patients who have undergone surgery for osteosarcoma of a lower limb and to characterize such lesions, 156 bone scans obtained in 43 such patients were reviewed for bone stress. Of 43 patients who had undergone amputation or limb-preserving procedures, 42 (98%) had abnormalities on scintiscans attributable to bone stress; 31 had focal or mixed focal and diffuse lesions. Bones most commonly involved were those of the contralateral leg, pelvis, ipsilateral leg, and arms. Focal and mixed lesions seemed to be associated with increased work load on the limb involved. Findings indicated that the more active the patient, the more severe the bone stress. Because of their distribution, appearance, and intensity of tracer uptake, most stress-related lesions were readily distinguishable from bony metastases on scintiscans. Questionable lesions should be evaluated further with other imaging methods.

Topics: Adolescent; Adult; Amputation, Surgical; Bone Neoplasms; Child; Female; Follow-Up Studies; Fractures, Bone; Humans; Leg Injuries; Male; Osteosarcoma; Radionuclide Imaging; Stress, Mechanical; Technetium Tc 99m Medronate

Topics: Bone Neoplasms; Child; Humans; Humerus; Mediastinal Neoplasms; Osteosarcoma; Pericardium; Radionuclide Imaging; Technetium Tc 99m Medronate

In 16 patients with a long bone osteosarcoma treated after the therapy regimen of COSS 80/82 (Cooperative Osteosarcoma Study) the tumour response to preoperative chemotherapy was assessed by conventional roentgenograms (plain films, tomograms, angiograms). The histological grade of regression determined in the operative specimen was used as a reference for the extent of tumour devitalisation. By their different typical roentgenological course the osteosarcomas with a very good and those with a rather poor response could be correctly identified (100%). On following the clinically used differentiation between "good responders" (histological grades I to III) and "poor responders" (grades IV to VI) the corresponding classification of these tumours by roentgenograms and functional scintigraphic imaging was found to be correct in 94% of the cases. The coincidence of the correct as well as the false results in both radiological methods was as high as 100% if those osteosarcomas showing only a "medium response" in their roentgenograms were added to the clinical group of good responders. There were no fundamentally discrepant results obtained by each of the two radiological techniques. With the combined workup of the roentgenological and the scintigraphic material any incorrect preoperative estimation of tumour regression with a harmful influence on therapy (date and type of surgery, mode of postoperative chemotherapy) could be avoided.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Combined Modality Therapy; Female; Humans; Male; Osteosarcoma; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

Hospital records of 27 children with osteogenic sarcoma were reviewed in an effort to define the usefulness of skeletal scintigraphy in the initial evaluation and follow-up of their disease. Serial bone scans as well as plain radiographs, linear tomograms, and computed tomograms were evaluated for evidence of bone or lung metastases. Eighteen patients developed lung metastases and three developed bone metastases. Seven patients demonstrated uptake of tracer in lung metastases, however, the lesions were all easily identifiable by radiographic means. All bone metastases were detected by scintigraphy, in one instance prior to radiographic abnormality. In no cases were bone metastases known to occur in the absence of lung metastases. None of the bone scans performed for routine follow-up purposes resulted in altered therapy for the patient. We propose that skeletal scintigraphy is useful in the initial metastatic work up of osteogenic sarcoma, and may be helpful in some patients with specific indications during their follow-up, but is less valuable when there is no clinical suspicion for bone metastases.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; Etidronic Acid; Female; Humans; Lung Neoplasms; Male; Organotechnetium Compounds; Osteosarcoma; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate

A 64-year-old man with right knee pain had uptake of Tc-99m MDP in the area as well as in the greater trochanter. Both sites were shown to contain osteogenic sarcoma. There was resection of the bone. Eight months later, radiogallium uptake was avid in the nearby soft tissue, indicating tumor spread.

Topics: Femoral Neoplasms; Humans; Male; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium Tc 99m Medronate

During preoperative chemotherapy regional 99mTc-MDP clearance by tumor and healthy bone as well as tumor blood flow were determined in 13 patients with osteosarcoma. The results were compared to histologic regression grades. After good response (tumor vitality less than 10%) tumor blood flow normalized and regional 99mTc-MDP clearance decreased by 66% (range 56-82%). After poor response to chemotherapy (tumor vitality greater than 10%) tumor blood flow remained increased, whereas regional 99mTc-MDP clearance was unchanged or increased except in one patient. After 4-7 weeks of chemotherapy tumor viability was accurately assessed in 8 of 9 patients (89%) by means of regional 99mTc-MDP clearance. Tumor viability could be evaluated also by simple tumor/non-tumor ratios. A decrease of 99mTc-MDP clearance by more than 20% indicated an effective chemotherapy with a specificity of 80%. After 10-13 weeks of chemotherapy the specificity was improved including the results of tumor blood flow determination.

Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Bone and Bones; Bone Neoplasms; Child; Cisplatin; Cyclophosphamide; Dactinomycin; Diphosphonates; Drug Evaluation; Female; Humans; Male; Osteosarcoma; Preoperative Care; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

A clinically and radiographically unsuspected ossified renal metastasis from a primary osteogenic sarcoma was identified by computed tomography (CT) and radionuclide bone scan. These imaging modalities play an important adjunctive role in the evaluation and follow-up of patients with primary osteogenic sarcoma.

Topics: Adolescent; Diphosphonates; Female; Femoral Neoplasms; Humans; Kidney Neoplasms; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone Neoplasms; Diphosphonates; Female; Humans; Ilium; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Thoracic Neoplasms

Sequential gallium scans were performed in 37 patients with newly diagnosed osteogenic sarcoma. High gallium uptake was found more often in males in the 10 to 19 age group and in femoral lesions. High uptake was also seen in patients who had predominantly osteoblastic or mixed changes on radiographs and in those who had a soft tissue mass. Following chemotherapy, significant decrease of tumor to nontumor ratio occurred in the patients who responded to treatment as shown by a Grade III or IV response on histologic examinations at the time of en bloc resection. It is concluded that semiquantitative gallium scintigraphy is useful in monitoring therapeutic response in patients with osteogenic sarcoma.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Female; Femoral Neoplasms; Gallium Radioisotopes; Humans; Male; Osteosarcoma; Prognosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors

In 87 patients with proved diagnosis and a normal or pathologic bone scan (BS) in addition a bone marrow scan (BMS) was performed using a 99mtechnetium-labelled microcolloid. The analysis of scintigraphic findings included those obtained by other investigations shows that in these selected patients a false normal or false positive interpretation would have been resulted in 18% performing the BS only. Both methods BS and BMS were capable of diagnosing the correct stage of disease in all patients. The results indicate an augmentation of diagnostic facilities by the BMS in diseases affecting bone or bone marrow.

Topics: Adult; Bone and Bones; Bone Diseases; Bone Marrow; Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Hodgkin Disease; Humans; Lung Neoplasms; Male; Middle Aged; Myeloproliferative Disorders; Osteomyelitis; Osteosarcoma; Plasmacytoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Diphosphonates; Humans; Knee Joint; Male; Osteosarcoma; Radionuclide Imaging; Synovial Fluid; Technetium; Technetium Tc 99m Medronate; Tibia

We describe a patient with osteosarcoma of the breast with intense uptake by the primary tumour of 99m Tc-methylene diphosphonate on bone scan. This appearance on bone scan strongly suggests a diagnosis of osteosarcoma, and has diagnostic and therapeutic implications which are discussed.

Topics: Breast Neoplasms; Diphosphonates; Female; Humans; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Skeletal scintigraphy of a distal femoral osteosarcoma revealed a band of soft-tissue uptake in the medial thigh extending to the groin, which corresponded to direct perivascular tumor extension.

Topics: Adult; Diphosphonates; Femoral Neoplasms; Humans; Male; Osteosarcoma; Radionuclide Imaging; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate; Thigh

An intratibially transplantable osteogenic sarcoma in rats, that regularly disseminates osteogenic metastases in the lung, is described. The tumor take rates exceeded 90% 30 days after transplantation. Pulmonary metastases were diagnosed in about 99% of the animals, while metastases in the kidneys (14%), lymph nodes (13%) and liver (3%) occurred less frequently. The mean survival time of untreated animals varied between 36 and 48 days, depending on the age at transplantation. Histologic and scintigraphic findings are reported.

Topics: Animals; Bone Neoplasms; Cell Line; Diphosphonates; Female; Femoral Neoplasms; Lung Neoplasms; Lymphatic Metastasis; Male; Neoplasm Transplantation; Osteosarcoma; Radiography; Radionuclide Imaging; Rats; Rats, Inbred Strains; Technetium; Technetium Tc 99m Medronate; Tibia; Time Factors

Topics: Child; Diphosphonates; Female; Femoral Neoplasms; Humans; Osteosarcoma; Pleural Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

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

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

Topics: Adolescent; Bone Neoplasms; Diphosphonates; Humans; Humerus; Male; Osteosarcoma; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

99mTc-methylene diphosphonate (MDP) bone scintigraphy demonstrated localization in an intracranial metastasis of osteogenic sarcoma. This unusual case suggests that bone scintigraphy may have diagnostic value in the early diagnosis of metastatic ossifying lesions.

Topics: Adult; Brain Neoplasms; Diphosphonates; Femoral Neoplasms; Humans; Male; Occipital Lobe; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

A 5-year-old girl presented with a rapidly growing osteosarcoma of the proximal right tibia. The radiographically osteoblastic lesions appeared as a "cold" on the 99mTc-MDP bone scan. Possible explanations for this unusual finding on the bone scan are discussed.

Topics: Bone Neoplasms; Child, Preschool; Diphosphonates; Female; Humans; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Tibia

Topics: Aged; Angiography; Bone Neoplasms; Child; Diphosphonates; Female; Humans; Male; Osteosarcoma; Technetium; Technetium Tc 99m Medronate; Thermography; Tomography, X-Ray Computed; Ultrasonography

Topics: Bone and Bones; Bone Neoplasms; Diphosphonates; Fibula; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Osteosarcoma; Pulmonary Embolism; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Whole body distribution and accumulation of radionuclide for diagnostic purpose such as 99mTc-MDP (methylene diphosphonate), 67Ga-citrate (67Ga) and 201Tl-chloride (201Tl) in implanted osteosarcoma of human origin were evaluated by macroautoradiography of Balb/c nude mouse. 3H-thymidine of which uptake has a close relation to growth pattern of tumors was used for a partner of target nuclide in double tracer technique to examine the distribution characteristics. Separated distribution pattern of coupled nuclides was imaged by a difference both of half life and energy of radiation between radionuclides. The distribution pattern of each target nuclide and 3H-thymidine were compared to clarify distribution characteristics respectively in specimen. 67Ga and 201Tl were taken around the tumor and the mode of their distribution was identical to that of 3H-thymidine. Uptake of 67Ga in tumor was much higher. 99mTc-MDP accumulated in the central zone of the tumor and its pattern was quite different from that of 3H-thymidine. From above result it was demonstrated that the accumulation mechanism of 67Ga, 201Tl and 99mTc-MDP are quite different in the tumor each other. So we concluded that our method of double tracer technique was useful for evaluation of distribution pattern of radionuclides for diagnostic purpose.

Topics: Animals; Autoradiography; Bone Neoplasms; Diphosphonates; Gallium Radioisotopes; Half-Life; Male; Mice; Mice, Nude; Osteosarcoma; Sarcoma, Experimental; Technetium; Technetium Tc 99m Medronate; Thallium; Thymidine; Tritium

The localization of 99mTc-methylene diphosphonate (99mTc-MDP) in mouse osteosarcoma was studied using a skeletal scintigraphic method and macro- and microautoradiographic methods. On the skeletal scintigraph, the tumor showed a high uptake of 99mTc-MDP and its concentration was about 20 times as high as the value seen in the muscular tissue. The macroautoradiography showed high activity in the tumor bone region and little activity in the nonossified region. On the microautoradiography, the activity of 99mTc-MDP was localized in the mineralized matrix of tumor bone and was almost nil in the nonmineralized matrix (osteoid) and the tumor cells. These findings indicate that the mineralization of the tumor bone matrix plays an important role in 99mTc-MDP uptake in osteosarcoma.

Topics: Animals; Diphosphonates; Male; Mice; Mice, Inbred C3H; Neoplasm Transplantation; Osteosarcoma; Radionuclide Imaging; Sarcoma, Experimental; Technetium; Technetium Tc 99m Medronate

The pathologic specimens of 18 osteosarcomas of long bones were examined to correlate histologic abnormalities with abnormalities seen on preoperative 99mTc pyrophosphate or methylene diphosphonate bone scans. Seven scans accurately represented the extent of the tumor. Eleven scans disclosed increased activity extending beyond the radiographic abnormalities. In eight of these, there was no occult tumor extension and in the other three, the scan activity did not accurately portray the skip metastases that were present. Therefore, these 11 scans demonstrated the falsely extended pattern of uptake beyond the true limits of the tumors. Pathologic slides were available for 10 of the 11 areas of bone that exhibited extended uptake. In two instances, there was no pathologic abnormality. In the other eight cases we found marrow hyperemia, medullary reactive bone, or periosteal new bone. This is the first description of these histologic abnormalities of medullary bone in areas of extended uptake on radionuclide bone scans.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Diphosphates; Diphosphonates; Female; Femoral Neoplasms; Humans; Male; Osteosarcoma; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

Topics: Adult; Bone and Bones; Bone Neoplasms; Child; Chondroma; Chondrosarcoma; Diagnosis, Differential; Diphosphates; Diphosphonates; Female; Humans; Infant; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate

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

Employing ROI-technique, a ratio Q was obtained from relating accumulation of 99mTc-MDP at the site of the bone lesion (n = 150) with that of contralateral non-involved osseous areas. Values of Q were correlated with histologic tumor diagnosis, its dignity and frequency. Values of Q of greater than 3.0 were found in 95% of all sarcomas, in 100% of the osteosarcomas but in only 3.8% of all benign bone tumors. Values ranging from 1.0 to 1.2 were exclusively measured in benign tumors (e.g., in 52% of juvenile bone cysts and in 67% of non-ossifying fibromas). Since the threshold--separating benign from malignant lesions--at Q = 3.0 was blurred by tumorlike lesions, metastases and especially by Paget's disease, this method does not precisely predict dignity. However, this method may complement radiographic evaluation with low values supporting the diagnosis of a benign lesion. The combined findings of radiography and these rations gained by nuclear imaging may help determine the pathway of a patient through further diagnosis and treatment.

Topics: Bone Neoplasms; Chondroma; Diphosphonates; Femur; Humans; Osteosarcoma; Radionuclide Imaging; Radius; Technetium; Technetium Tc 99m Medronate; Tibia

The results of 99mTc-methylene diphosphonate 99mTc-MDP scintigraphy in 37 osteosarcoma patients were evaluated. In 11 of 12 patients with pulmonary metastases these were demonstrated by the scintigram. In 2 of these 11 patients the lung metastases could be shown earlier by scintigraphy than by X-ray tomography. Uptake of 99mTc-MDP appeared to be correlated with the formation of osteoid by the tumor. 99mTc-MDP scintigraphy demonstrated metastases not only in the lungs and the skeleton, but also in the lymph nodes and soft tissues. 99mTc-MDP whole-body scintigraphy should be used routinely for the early detection of osteosarcoma metastases.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Child, Preschool; Diphosphonates; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Infant; Lung Neoplasms; Male; Middle Aged; Osteosarcoma; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Time Factors; Tomography, X-Ray

A prospective investigation of two different radionuclide imaging techniques for the skeleton--technetium-99m phosphonate and gallium-67 citrate--was carried out prior to biopsy in fifty-five patients with primary bone tumors of the extremities and limb girdles. The study showed that the technetium-99m phosphonate scans were not useful in separating benign from malignant lesions or in defining reliably the local extent of malignant tumors. Gallium scans were more accurate in delineating the local extent of malignant tumors and may provide better indentification of benign tumors.

Topics: Bone Neoplasms; Chondrosarcoma; Diphosphonates; Etidronic Acid; Gallium Radioisotopes; Humans; Organotechnetium Compounds; Osteosarcoma; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate