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

Metastatic pulmonary calcification (MPC) is rarely reported in primary hyperparathyroidism, especially MPC develops quickly. We report such a case here with a literature review.. A 41-year-old woman presented with cough and dyspnea. Data from clinical, radiological, pathological, technetium (. Rapidly progressive MPC tends to be misdiagnosed as many primary pulmonary diseases.

Topics: Adenoma; Adult; Calcinosis; Disease Progression; Female; Humans; Hyperparathyroidism, Primary; Image-Guided Biopsy; Lung Diseases; Parathyroid Neoplasms; Parathyroidectomy; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Tomography, X-Ray Computed; Treatment Outcome

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

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

The purpose of this study was to assess the relationship between (99m)Tc-MIBI and (99m)Tc-MDP bone scintigraphy and clinical or pathological variables, including preoperative serum PTH levels and tumor diameter, in patients with newly diagnosed PHPT.. Dual-phase (99m)Tc-MIBI planar scintigraphy was performed in 244 patients with PHPT. Of these patients, 155 underwent (99m)Tc-MDP bone scintigraphy to detect bone changes before parathyroidectomy. Factors influencing (99m)Tc-MIBI scintigraphy and (99m)Tc-MDP bone scintigraphy detection rate were assessed using univariate and multivariate logistic regression analysis; optimal cutoff values for predicting positive (99m)Tc-MIBI and (99m)Tc-MDP bone scintigraphy were evaluated using ROC analysis.. Among 244 patients, 174 (71.31 %) patients with 181 foci had a positive (99m)Tc-MIBI planar scintigraphy; delayed neck and thorax SPECT/CT could identify and locate the (99m)Tc-MIBI lesions but could not find more lesions than planar scintigraphy. 70 (28.69 %) patients had a negative (99m)Tc-MIBI planar scintigraphy. Tumor diameter, serum PTH level and symptoms were statistically significant predictive factors in predicting positive (9m)Tc-MIBI scintigraphy both univariate and multivariate logistic regression analyses. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.03 cm and 127.60 ng/L, respectively. Among 155 patients with bone scintigraphy, (99m)Tc-MDP bone scintigraphy showed positive finding in 80 (51.61 %) patients and negative finding in 75 patients. Univariate logistic regression analysis showed that patient age, sex, tumor diameter and PTH level (≥150 ng/L) were statistically significant in predicting positive (99m)Tc-MDP bone scintigraphy. Multivariate logistic regression analysis showed both tumor diameter and PTH ≥ 150 ng/L were statistically significant in predicting positive (99m)Tc-MDP bone scintigraphy. The optimal thresholds for tumor diameter and serum PTH by ROC analysis were 1.96 cm and 163.85 ng/L, respectively.. The utility of delayed neck and thorax SPECT/CT over dual-phase (99m)Tc-MIBI planar scintigraphy is that it can identify and locate a parathyroid tumor in about more than 70 % of patients in PHPT and provide the assistance for surgical planning. These studies also suggest that (99m)Tc-MIBI scintigraphy and (99m)Tc-MDP bone scintigraphy are closely correlated with tumor diameter and PTH; which may show negative results when tumor diameter is small and serum PTH level is low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Child; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Primary; Male; Middle Aged; Multivariate Analysis; Neck; Parathyroid Hormone; Parathyroid Neoplasms; Predictive Value of Tests; Retrospective Studies; ROC Curve; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thorax; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome; Vitamin D; Young Adult

Topics: Bone and Bones; Calcinosis; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

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

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

Topics: Bone and Bones; Humans; Hyperparathyroidism; Male; Middle Aged; Osteolysis; Parathyroid Glands; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Whole Body Imaging

Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.

Topics: Adenoma; Bone and Bones; Fatal Outcome; Female; Humans; Hyperparathyroidism; Middle Aged; Pain; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Severity of Illness Index; Technetium Tc 99m Medronate

Topics: Adenocarcinoma, Papillary; Bone Neoplasms; Clavicle; Female; Humans; Middle Aged; Parathyroid Neoplasms; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Sternum; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium; Whole-Body Counting

Topics: Adenoma; Bone and Bones; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Parathyroid carcinoma is a rare cause of hyperparathyroidism and metabolic osteopathy. The authors report a patient with parathyroid carcinoma who underwent 99mTc-Sestamibi parathyroid and 99mTc-MDP bone scanning. These techniques showed the parathyroid lesion and typical features of severe metabolic osteopathy respectively. The bone scan performed at only four months after surgery showed near complete resolution.

Topics: Bone and Bones; Bone Diseases, Metabolic; Carcinoma; Contrast Media; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Time Factors

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

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

An unusual case of multiple brown tumors due to parathyroid carcinoma is reported. The patient presented with lower leg pain. Plain radiographs demonstrated multiple lytic lesions of the lower legs and a Tc-99m MDP bone scan depicted multiple areas of increased uptake suggesting skeletal metastases. Tc-99m sestamibi tumor scintigraphy showed multiple sites of tumor uptake in bones and a large area of increased uptake with a cystic component in the right lower pole of the thyroid gland. An open biopsy from the right tibial lesion revealed a brown tumor. A large parathyroid carcinoma with a necrotic cyst was removed. After parathyroidectomy and right thyroid lobectomy, the patient became free of bone pain and serum PTH levels normalized. A 9-month follow-up Tc-99m MDP bone scan demonstrated less intense uptake in the pelvis, tibia, and fibulae. Nine-month follow-up tumor imaging with Tc-99m MIBI revealed disappearance of the preoperative uptake of multiple brown tumor.

Topics: Adult; Bone Diseases; Bone Neoplasms; Carcinoma; Female; Follow-Up Studies; Granuloma, Giant Cell; Humans; Hyperparathyroidism; Leg; Osteitis Fibrosa Cystica; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thyroid Gland; Thyroidectomy; Whole-Body Counting

A 59-yr-old man with chronic renal failure was admitted for evaluation of generalized skeletal pain and frontal bone mass, which was lytic on radiography. Bone scintigraphy demonstrated several foci of moderately increased uptake, without involvement of the skull mass. Radiographs of these lesions were compatible with brown tumors. Serum parathormone level was elevated and CT demonstrated a lower right cervical mass, consistent with parathyroid tumor. Following the removal of the mass and decrease in parathormone levels, the patient suffered from a prolonged period of hypocalcemia and his bone pain worsened. Repeat bone scintigraphy showed an increase in the number and intensity of the areas of focal uptake, consistent with hungry bone syndrome. This flare-up phenomenon is due to an increase in bone metabolism and is an uncommon finding following parathyroidectomy for primary hyperparathyroidism.

Topics: Bone and Bones; Bone Diseases, Metabolic; Carcinoma; Humans; Hyperparathyroidism; Hypocalcemia; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Technetium Tc 99m Medronate

Metastatic calcification within soft tissue, such as the lung and stomach, is associated with hyperparathyroidism, chronic renal failure, hemodialysis, metastatic neoplasm and hypervitaminosis D. Bone scanning agents variably accumulate within these extraskeletal metastatic calcifications. We report a patient with primary hyperparathyroidism whose bone scan revealed abnormal uptake in the liver, lung, stomach and parathyroid gland followed by complete resolution of extraskeletal uptake less than 1 wk after parathyroidectomy.

Topics: Adenoma; Aged; Bone and Bones; Calcinosis; Female; Humans; Hypercalcemia; Hyperparathyroidism; Parathyroid Neoplasms; Parathyroidectomy; Radionuclide Imaging; Technetium Tc 99m Medronate

We describe herein a case of parathyroid carcinoma accompanied with metastatic calcification identified by technetium-99m methylene diphosphonate (Tc-99m MDP) scintigraphy in the lungs, kidneys and stomach. Parathyroid carcinoma remains a rare disorder despite the increased prevalence of primary hyperparathyroidism. Metastatic calcification is noted infrequently even in primary hyperparathyroidism and it may cause respiratory failure. Tc-99m MDP scintigraphy three months after surgery showed a complete disappearance of Tc-99m uptake in the stomach and an obvious reduction in the kidneys but no significant change in the lungs, indicating metastatic calcification can be reversibly reabsorbed. This case indicates that the adequate excision of parathyroid carcinoma as well as the early detection of metastatic calcification by Tc-99m MDP are obligatory.

Topics: Calcinosis; Carcinoma; Female; Humans; Hypercalcemia; Kidney Neoplasms; Lung Diseases; Middle Aged; Neoplasm Invasiveness; Parathyroid Neoplasms; Radionuclide Imaging; Respiratory Insufficiency; Stomach Diseases; Technetium Tc 99m Medronate

Topics: Alendronate; Bone and Bones; Bone Neoplasms; Clodronic Acid; Diphosphonates; False Negative Reactions; Female; Humans; Hypercalcemia; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Adenoma; Adult; Bone Neoplasms; Diagnosis, Differential; Female; Humans; Hyperparathyroidism; Osteitis Fibrosa Cystica; Parathyroid Neoplasms; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate

It is generally agreed that the Technetium-Thallium Subtraction Scan is a reliable method for locating abnormal parathyroid glands in patients with clinical and biochemical evidence of parathyroid hyperactivity. This report illustrates the value of scintigraphy in diagnosis and in the subsequent surgical management of a patient with primary hyperparathyroidism.

Topics: Adenoma; Adult; Bone and Bones; Female; Humans; Hyperparathyroidism; Parathyroid Neoplasms; Radioisotopes; Radionuclide Imaging; Subtraction Technique; Technetium Tc 99m Medronate; Thallium

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

Topics: Adenoma; Bone and Bones; Diphosphonates; Humans; Male; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate

Intense diffuse uptake of Tc-99m-labeled methylene diphosphonate was seen in both lungs of a patient submitted to surgery for a primary parathyroid adenoma. Five scans performed over the 3 yr following the operation showed persistence of lung uptake despite restoration of normal blood calcium concentration. Mild chronic renal failure caused by the hypercalcemia also persisted postoperatively. The present case confirms that pulmonary uptake of bone tracer can occur asymptomatically when both hypercalcemia and renal failure are present. Lung uptake of a bone tracer probably reflects tissue deposition of hydroxyapatite rather than of amorphous structures. Correction of the hypercalcemia failed to resolve the abnormal scan pictures.

Topics: Adenoma; Bone and Bones; Diphosphonates; Female; Humans; Hypercalcemia; Kidney Failure, Chronic; Lung; Middle Aged; Parathyroid Neoplasms; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate