technetium-tc-99m-medronate and Sarcoma--Ewing

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

Ewing's sarcoma is a highly malignant neoplasm of bones which accounts for the 10% of primary bone malignancies. Primary Ewing's sarcoma of skull vault is very rare and constitutes 1-6% of all Ewing's sarcomas. We present a case of a primary and a radiation-induced skull Ewing's sarcoma. The symptoms, neuroimaging findings and the treatment for these cases are reviewed. Both children were operated with favorable outcome.

Topics: Adolescent; Astrocytoma; Brain Neoplasms; Facial Nerve Diseases; Facial Paralysis; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Neoplasms, Radiation-Induced; Particle Accelerators; Petrous Bone; Radiopharmaceuticals; Sarcoma, Ewing; Skull Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

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

Topics: Adolescent; Biopsy; Bone Neoplasms; Chronic Disease; Diagnosis, Differential; Genetic Testing; Humans; In Situ Hybridization, Fluorescence; Joint Diseases; Knee Joint; Male; Pain, Intractable; Positron-Emission Tomography; Sarcoma, Ewing; Technetium Tc 99m Medronate; Thigh; Tomography, X-Ray Computed

Cervical spinal Ewing's sarcomas are rare and cause problems in diagnosis. We present an unusual case of a primary extraosseous Ewing's sarcoma arising from the spinal cord. An 18-year-old woman with fever, headache and back pain lasting one month was admitted to the hospital. Whole body bone scintigraphy was performed with 1110 MBq technetium-99m methylenediphosphonate. Scintigraphy clearly showed abnormal technetium-99m methylenediphosphonate accumulation in the level of the 5th and 6th cervical vertebrae. Magnetic resonance imaging could also confirm this examination finding. After the scintigraphic study, the patient underwent surgery. Pathological diagnosis of the operation specimen was Ewing's sarcoma.

Topics: Adolescent; Back Pain; Cervical Vertebrae; Female; Fever of Unknown Origin; Headache; Humans; Neoplasms, Unknown Primary; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma, Ewing; Spinal Neoplasms; Technetium Tc 99m Medronate

Bone and gallium scans have been shown to be useful in imaging Ewing's sarcoma. Here we report on a case of recurrent Ewing's sarcoma with multiple skeletal metastases demonstrated by the FDG-PET whole body scan, while the bone scan revealed fewer lesions and a non-remarkable finding was found on the gallium scan. The following pathologic examination showed bone marrow involvement. This case demonstrated that the FDG-PET could detect more lesions of metastatic Ewing's sarcoma than bone and gallium scans, especially for those with bone marrow involvement.

Topics: Adult; Bone Neoplasms; Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Male; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, Emission-Computed

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: 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

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; Facial Asymmetry; Humans; Male; Ophthalmoplegia; Sarcoma, Ewing; Skull Neoplasms; Sphenoid Bone; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

The objective of this study was to determine the value of magnetic resonance (MR) imaging in diagnosing local recurrence of Ewing sarcoma. We retrospectively reviewed radiographs, Tc99m-methylene diphosphonate (MDP) skeletal scintigraphy, computed tomography scans, and MR studies of 11 patients who had local recurrences of osseous Ewing sarcoma following initial responses to chemotherapy and local radiation. The MR images were compared to those of a control group of nine patients who had no evidence of relapse. T1- and T2-weighted MR images identified 9 of the 11 recurrences. Computed tomography was diagnostic in 4 of 6 cases evaluated, Tc99m-MDP bone scintigraphy in 4 of 11 cases, and plain radiographs in 2 of 10. MR findings at relapse included changes in signal intensity, increased extent of abnormal marrow signal on T1- and T2-weighted images, and identification of a new soft tissue mass. These findings suggest that MR imaging is valuable in the routine follow-up of primary osseous Ewing sarcoma.

Topics: Adolescent; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Magnetic Resonance Imaging; Male; Neoplasm Recurrence, Local; Radionuclide Imaging; Retrospective Studies; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adolescent; Bone Neoplasms; Femoral Neoplasms; Humans; Male; Radiography; Radionuclide Imaging; Sarcoma, Ewing; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

Eighty-nine Technetium-99m-MDP scans performed between January 1987 and June 1990 at the Leicester Royal Infirmary were reviewed with regard to the indication, patient outcome and value of the scans in the patients' management. The significant finding was the value of a normal scan in the management of children with chronic pain.

Topics: Acute Disease; Adolescent; Bone and Bones; Bone Diseases; Bone Neoplasms; Child; Child, Preschool; Chronic Disease; Humans; Infant; Medical Audit; Osteomyelitis; Pain; Radionuclide Imaging; Sarcoma, Ewing; Synovitis; Technetium Tc 99m Medronate

Multifocal bone involvement was seen on bone scintigraphy in a young woman being examined for a suspected bone lesion noted on pelvic radiographs. Biopsy of the third lumbar vertebral body demonstrated a vascular lesion. The tumor was resected and a bone graft was performed. The patient was followed with serial scans to assess the viability of the bone graft and course of the disease. This report analyzes the scintigraphic characteristics of this rare tumor and emphasizes the importance of bone scintigraphy in the diagnosis, treatment, and follow up of this condition.

Topics: Adult; Bone Neoplasms; Female; Follow-Up Studies; Humans; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

A primary Ewing's tumor in the mandible is reported, and the diagnostic imaging features of this lesion are discussed. Modalities used included panoramic and plain films, computed tomography, and 99mTc-MDP scintigraphy.

Topics: Adolescent; Diagnosis, Differential; Humans; Male; Mandibular Neoplasms; Radiography, Panoramic; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Bone Neoplasms; Female; Humans; Osteosarcoma; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

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

A 3 1/2-year-old boy had thigh pain and a leg mass. Bone scanning demonstrated intense uptake within the involved femur, but no uptake within the soft tissues or evidence of metastatic spread. Radiographs and CT scanning showed a large soft tissue mass and periosteal reaction suggestive of Ewing's sarcoma. Following chemotherapy, the patient had an apparently good clinical response. However, bone scanning showed uptake that was more intense and extensive than it was before therapy. Plain films and CT showed that the uptake was evidence of soft tissue calcification and that the mass had shrunk. This is an unusual example of the flare response to therapy because the apparent progression of the disease on bone scanning was caused by extraskeletal uptake.

Topics: Antineoplastic Combined Chemotherapy Protocols; Calcinosis; Child, Preschool; Femoral Neoplasms; Humans; Male; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate

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

Topics: Adolescent; Angiography; Bone Neoplasms; Humans; Male; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Thumb; Tomography, X-Ray Computed

The immediate Tc-99m MDP image of a neoplastic right wrist mass in a 10-year-old boy demonstrated intense focal accumulation that suggested a very vascular tumor, but delayed images showed only slightly increased activity in the mass. A Tc-99m labeled RBC study was performed to permit whole-body blood pool imaging for other vascular lesions, and it did not demonstrate an increased blood volume in the mass. Biopsy showed the tumor to be a Ewing's sarcoma, probably of soft tissue origin. The sarcoma was not very vascular. The intense immediate accumulation of Tc-99m MDP in this case may be attributed to increased microvascular permeability.

Topics: Biopsy; Blood Volume; Bone and Bones; Bone Neoplasms; Capillary Permeability; Child; Diagnosis, Differential; Erythrocytes; Humans; Male; Microcirculation; Radionuclide Imaging; Sarcoma, Ewing; Technetium Tc 99m Medronate; Ulna

This is a retrospective analysis of bone scans in 72 patients with Ewing's sarcoma. Sites of primary disease were found to be evenly distributed among the axial skeleton and the proximal and distal extremities. Primary disease sites in the axial skeleton were more frequently associated with metastases. Fifty-three of these patients had their first scans done at presentation; among them, 25 were found to have metastases. Unsuspected metastases were picked up in 28 of all the patients. Metastases at presentation were seen to be associated with a poorer prognosis.

Topics: Adolescent; Adult; Bone and Bones; Bone Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Diphosphonates; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Radionuclide Imaging; Sarcoma, Ewing; Technetium; Technetium Tc 99m Medronate; Time Factors

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; Biopsy; Bone Neoplasms; Diphosphonates; False Negative Reactions; Female; Humans; Radionuclide Imaging; Sacrum; Sarcoma, Ewing; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Eleven patients with untreated primary Ewing sarcoma were studied with intravenously administered 13N-labeled L-glutamate. Seven were repeatedly scanned during chemotherapy using this agent and 99mTc-methylene diphosphonate (99mTc-MDP). The untreated primary tumor was distinctly visualized with 13N-L-glutamate in all cases; the distribution of 13N label in the tumor sometimes differed from that of 99mTc. A kinetic study showed rapid uptake of 13N by tumor tissue. Repeat scans following therapy indicated that 13N-L-glutamate and 99mTc-MDP uptake showed changes consistent with histological findings following subsequent surgery. 13N uptake often decreased more markedly than 99mTc uptake during chemotherapy, but metastatic lesions were not visualized with 13N-L-glutamate. Tumor imaging with this labeled amino acid may be of value in assessing the response of primary Ewing sarcoma to chemotherapy.

Topics: Adolescent; Adult; Bone Neoplasms; Child; Diphosphonates; Female; Glutamates; Glutamic Acid; Humans; Male; Middle Aged; Nitrogen Radioisotopes; Radionuclide Imaging; Sarcoma, Ewing; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate