technetium-tc-99m-medronate and Primary-Myelofibrosis

99mTc-MDP bone scan was performed in a 49-year-old woman with breast cancer. Whole-body bone scan showed multiple foci of increased MDP activity in the bone and intense splenic 99mTc-MDP uptake. Initial bone marrow aspiration in multiple locations yielded no blood cells. A subsequent bone marrow biopsy in the left anterior superior iliac spine showed myelofibrosis in addition to the known bone metastasis.

Topics: Biological Transport; Female; Humans; Middle Aged; Primary Myelofibrosis; Radionuclide Imaging; Spleen; Technetium Tc 99m Medronate

Topics: Adult; Antitubercular Agents; Bone and Bones; Humans; Male; Primary Myelofibrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tuberculosis

Tc-99m bone scintigraphy is widely used for evaluation of osseous spread of malignant tumors.. A 60-year-old man had multiple areas of increased uptake on a bone scan in a pattern considered characteristic for extensive metastatic disease. However, a primary neoplasm could not be identified. Finally, acute myelofibrosis--a rare, fatal myeloproliferative syndrome--was diagnosed.. To avoid delays and extensive diagnostic procedures, acute myelofibrosis should be considered in the differential diagnosis of bone scans showing multiple hot spots. In such cases, a diagnosis can be made on an a tissue sample.

Topics: Acute Disease; Adrenal Cortex Hormones; Antineoplastic Agents; Biopsy; Bone Neoplasms; Diagnosis, Differential; Fatal Outcome; Humans; Interferon alpha-2; Interferon-alpha; Male; Middle Aged; Primary Myelofibrosis; Radionuclide Imaging; Radiopharmaceuticals; Recombinant Proteins; Technetium Tc 99m Medronate

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

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

Topics: Biopsy; Bone Marrow; Breast Neoplasms; Carcinoma; Female; Humans; Middle Aged; Myocardial Ischemia; Primary Myelofibrosis; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi

The authors describe the radiographic-scintigraphic features of an unusual craniotubular dysplasia characterized by diffuse osteopenia with bone expansion and a "ground glass" appearance, markedly increased skeletal turnover, myelofibrosis, hypophosphatemia, and pigmented "coast-of-Maine" patches. This syndrome, termed panostotic fibrous dysplasia, is distinct from previously reported disorders.

Topics: Adolescent; Bone Diseases, Metabolic; Fibrous Dysplasia of Bone; Humans; Male; Phosphates; Primary Myelofibrosis; Radiography; Radionuclide Imaging; Syndrome; Technetium Tc 99m Medronate

A patient with secondary myelofibrosis associated with prostatic cancer gained hematologic remission after hormone therapy. Before treatment, a bone scan with Tc-99m MDP showed diffuse, increased uptake in the axial skeleton without visualization of the appendicular skeleton; a bone marrow scan with In-111 chloride revealed decreased uptake in the central marrow. Following hormone therapy, a bone scan showed an almost normal distribution with visualization of the appendicular skeleton and bone marrow scan indicating improved uptake of the central marrow. Radionuclide bone and bone marrow imaging was thus useful not only in diagnosing secondary myelofibrosis but also in evaluating the effects of therapy.

Topics: Aged; Bone and Bones; Diethylstilbestrol; Humans; Male; Primary Myelofibrosis; Prostatic Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate

Acute myelofibrosis is a rare hematologic malignancy which usually follows a rapidly progressive, fatal course. A case of acute myelofibrosis and severe focal bone pain is described showing bone scan and plain radiograph findings. A biopsy of one of the abnormal bony areas revealed malignant cells, necrosis and fibrosis, and abnormal, exuberant new bone formation, which may account for what is seen on the radiographic and radionuclide studies. The etiology and optimal management of this rare and often rapidly fatal disease remain to be defined.

Topics: Acute Disease; Adult; Humans; Male; Primary Myelofibrosis; Radiography; Radionuclide Imaging; Technetium Tc 99m Medronate