technetium-tc-99m-medronate and Sarcoma

Primary sarcoma of bone is a rare entity but nevertheless a significant cause of mortality in children and adolescents. The focus of the preoperative evaluation is to set up a histological diagnosis, define local tumor extent and develop a therapy regimen. In addition to patient history and clinical findings a radiograph in two orthogonal planes is still of great importance. MRI plays a major role in the further clarification of the diagnosis, while CT is valuable in the diagnosis of tumors of the axial skeleton as well as in systemic staging. A PET-CT can be performed to obtain an overview of further tumor sites. Open bone biopsy is the final diagnostic step and should be carried out at the institution where the definitive treatment will be performed. Complications such as fracture, neural lesions and spread of tumor cells are relatively rare if the biopsy is performed appropriately; however, patients should be instructed to strictly avoid weight-bearing on the affected extremity.

Topics: Adolescent; Angiography; Biopsy; Biopsy, Needle; Bone Neoplasms; Child; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Multimodal Imaging; Neoplasm Grading; Neoplasm Seeding; Neoplasm Staging; Positron-Emission Tomography; Radionuclide Imaging; Sarcoma; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Mazabraud's syndrome, though uncommon, is reported increasingly frequently. It represents an entity readily recognisable radiologically on MR imaging. Awareness of the syndrome, particularly when the myxoma is solitary, can prevent misdiagnosis of intramuscular myxomas (especially when large) as malignant mesenchymal tumors containing myxoid tissue. We review the 34 cases previously reported in the literature and include a recent case from our center.

Topics: Adult; Diagnosis, Differential; Femur; Fibrous Dysplasia, Polyostotic; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Muscle Neoplasms; Myxoma; Radiopharmaceuticals; Ribs; Sarcoma; Syndrome; Technetium Tc 99m Medronate; Thigh; Tomography, X-Ray Computed

The TNM staging system is a modus for diagnosis and treatment in which T is the extent of the tumor involvement, N is lymph node involvement, and M is the metastases; this system is supplemented with a histologic malignancy grade. Staging systems identify specific prognostic factors with which to predict clinical outcome. Staging systems are useful for assigning treatment priorities, determining the role of adjuvant therapies, and evaluating clinical investigations. Unfortunately, no universally accepted staging system for soft-tissue sarcomas exists. This is related to the relatively low incidence of sarcomas, the unique and unpredictable behavior of sarcomas, significant disagreement regarding histogenesis and grading, and lack of consensus regarding the value of various prognostic factors. In adults, the two most commonly used staging systems are those developed by the American Joint Committee on Cancer and by Enneking. In children, the Intergroup Rhabdomyosarcoma Study and the International Union Against Cancer have described the systems most commonly used. These systems for soft-tissue sarcomas rely on an ability to accurately determine both the local and distant extent of disease. Advances in the field of computed tomography and magnetic resonance imaging have made this possible. It is likely that a staging system based upon a more sophisticated understanding of the basic biology of sarcomas will become available.

Topics: Adult; Biopsy; Child; Clinical Protocols; Humans; Incidence; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Invasiveness; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Rhabdomyosarcoma; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Treatment Outcome

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

A 24-year-old woman with left hip pain for 4 months was admitted. Radiographs of the left hip showed a radiolucent lesion in the proximal femur. The lesion demonstrated hypointensity on T1-weighted and high intensity on T2-weighted fat saturated images. Tc-MDP bone scan and F-FDG PET/CT illustrated intense radiotracer accumulation at the osteolytic lesion. Postoperative pathology confirmed a low-grade myofibroblastic sarcoma (LGMS). LGMS is a rare neoplasm, which often occurred in the head and neck region. Our case suggested that LGMS should be considered in the differential diagnosis of proximal femur lesion on Tc-MDP bone scan and F-FDG PET/CT.

Topics: Bone and Bones; Female; Fluorodeoxyglucose F18; Humans; Myofibroblasts; Neoplasm Grading; Positron Emission Tomography Computed Tomography; Sarcoma; Technetium Tc 99m Medronate; Young Adult

Many children with sarcomas undergo whole body 2-deoxy-2-((18)F)fluoro-D-glucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and technetium methylene diphosphonate ((99)Tc-MDP) studies. It is unknown whether the combination of both tests results in more accurate detection of bone lesions than (18)F-FDG- PET/CT alone.. (99)Tc-MDP bone and (18)F-FDG PET/CT scans were each read by 2 "blinded" observers and then reviewed side-by-side by 3 readers. Bone lesions were graded qualitatively on a 5-point scale (from benign to malignant). Clinical and imaging follow-up (n = 21) and bone biopsy results (n = 8) served as reference standard.. A total of 39 paired (99)Tc-MDP and (18)F-FDG-PET/CT studies (cases) performed at a mean interval 4 ± 7 days, were performed on 29 patients (mean age 12 ± 5 y). Of these, 21 patients (72%) had bone sarcoma, whereas 8 patients (28%) had soft tissue sarcoma. By patient and case-based analysis, (18)F-FDG PET/CT had an accuracy of 100%. Tc-MDP had accuracies of 90% and 82% by patient and case-based analysis. The combined interpretation had an accuracy of 97%.. In this study, (99)Tc-MDP bone imaging does not provide an added diagnostic value for bone involvement over (18)F-FDG-PET/CT.

Topics: Adolescent; Bone Neoplasms; Child; Child, Preschool; Diagnostic Imaging; Female; Fluorodeoxyglucose F18; Humans; Image Interpretation, Computer-Assisted; Male; Multimodal Imaging; Positron-Emission Tomography; Radionuclide Imaging; Retrospective Studies; Sarcoma; Sensitivity and Specificity; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Bone and Bones; Disease Progression; Fluorodeoxyglucose F18; Giant Cell Tumor of Bone; Humans; Knee; Male; Middle Aged; Positron-Emission Tomography; Sarcoma; 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: Aged, 80 and over; Buttocks; Humans; Low Back Pain; Male; Radionuclide Imaging; Radiopharmaceuticals; Sarcoma; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

This report describes a case of bone involvement by epithelioid sarcoma, which on imaging had the appearance of a primary intraosseous lesion of the scapula. The tumor initially presented as a subcutaneous nodule which was mistakenly diagnosed as "fibrosis" following initial resection. The lesion recurred locally and after several resections presented with several ulcerated subcutaneous nodules, at which time all imaging studies were performed. The patient was treated with en bloc upper humeral interscapulothoracic resection and shoulder reconstruction. Two years after the operation the patient is alive without local recurrence or metastasis.

Topics: Adult; Bone Neoplasms; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Sarcoma; Scapula; Shoulder; Soft Tissue Neoplasms; Technetium Tc 99m Medronate

Pasteurized autogenous bone graft sterilized at a low temperature (60 degrees C) is one option for reconstruction after resection of bone and soft tissue tumors. The purpose of this investigation was to assess the normal and abnormal radiographic and scintigraphic findings of pasteurized intercalary autogenous bone graft after resection of bone and soft tissue sarcomas.. This was a retrospective evaluation of the radiography and bone scintigraphy findings in patients after treatment of bone and soft tissue sarcomas using an intercalary pasteurized autogenous bone graft.. Among 10 consecutive patients, eight had intercalary grafts, and they constitute the subjects of this study. All available radiography and bone scintigraphy findings were reviewed for the healing process and the possibility of complications.. Healing and incorporation of the graft were observed in five patients during the follow-up, but the other three did not heal satisfactorily. Rapid incorporation of pasteurized autogenous bone graft can be demonstrated by means of radiography and bone scintigraphy.

Topics: Adolescent; Adult; Aged; Bone Neoplasms; Bone Transplantation; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Retrospective Studies; Sarcoma; Soft Tissue Neoplasms; Sterilization; Technetium Tc 99m Medronate; Transplantation, Autologous; Treatment Outcome

The incidence of bone metastases in soft tissue sarcoma (STS) patients seems to be low but has not been studied separately. In this study, the authors aimed to determine the value of routine radionuclide bone scanning in preoperative staging of STS patients.. Preoperative bone scans were evaluated retrospectively in 109 consecutive patients (median age, 44 years; range, 1-86) with intermediate or high grade STS. Scans were scored in 3 categories: 1, metastases very likely; 2, equivocal; and 3, normal or benign lesions.. Category 1 scans were found in 8 of 109 patients (7%); in all 8 patients, bone metastases were confirmed. Six of these eight patients reported pain, and all had additional lung, bone marrow, or lymph node metastases. The highest rate (17%) was found in the rhabdomyosarcoma subgroup (n = 18). Category 2 (equivocal) scans were present in 12 of 109 patients (11%), in all of which bone metastases were excluded through additional investigations. Category 3 (normal) scans were found in 81%. Bone metastases were at least as frequent as lung metastases (4%) and were the single site of systemic disease in 4%. The rate of bone metastases was 55% in patients with bone pain versus 2% in patients without pain.. Bone metastases in primary STS patients are rare (7%) yet in this study at least as frequent as lung metastases. The low rate in asymptomatic patients versus the high rate in symptomatic patients supports the use of bone scanning in symptomatic patients only. The yield of routine bone scanning is low.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Marrow; Bone Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Pain; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Rhabdomyosarcoma; Sarcoma; Technetium Tc 99m Medronate

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

Focal soft-tissue accumulation of bone-seeking radiopharmaceuticals has many causes but is usually less intense than skeletal activity. Extraskeletal new bone formation, as seen in myositis ossificans and extraskeletal osteosarcoma, represents an exception where markedly increased uptake can be seen. Technetium-99m-MDP uptake in primary breast carcinoma has been recently investigated using scintamammographic techniques to differentiate malignant from benign lesions. The mechanism of uptake remains unclear but is likely multifactorial and nonspecific. We present a case of primary breast carcinoma with florid 99mTc-MDP activity relative to normal bone. Tumor histopathology in this patient demonstrates malignant new bone formation as the likely mechanism for the marked radiotracer avidity.

Topics: Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Metaplasia; Middle Aged; Ossification, Heterotopic; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate

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

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

Topics: Adult; Buttocks; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

This study attempts to characterize thallium-201 (201TI) uptake in patients with bone and soft-tissue sarcoma and to compare these findings with gallium-67 (67Ga) and bone scintigraphy with emphasis on evaluating tumor viability before and after chemotherapy. Thirty-eight patients with surgically-proven sarcomas were evaluated. All patients had gallium and thallium studies. Nineteen patients underwent pre- and post-chemotherapy thallium and evaluation. Seven patients also had technetium-99m-MDP (99mTc-MDP) bone scintigraphy comparisons. Pathologic changes pre- and postchemotherapy were graded on the basis of %tumor necrosis as defined histologically. Scintigraphic comparisons demonstrated a high degree of correlation with 201TI and poor correlation with 99mTc-MDP. Thallium-201 was superior to 99mTc-MDP and 67Ga in predicting tumor response to chemotherapy as determined by %tumor necrosis determined histologically. Gallium was superior to Tc-MDP in predicting response to chemotherapy. However, both 67Ga and 99mTc-MDP appear to be affected by factors other than tumor activity.

Topics: Adolescent; Adult; Antineoplastic Agents; Bone Neoplasms; Citrates; Citric Acid; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate; Thallium Radioisotopes

Two cases of alveolar soft part sarcoma were examined with gallium-67 citrate (67Ga), technetium-99m-methylenediphosphate (99mTc-MDP) and technetium-99m(V)-dimercaptosuccinic acid (Tc(V)-DMS) to compare the sensitivity of these three radiopharmaceuticals. All scintigrams were positive with primary tumor, and images with Tc(V)-DMS were the best. Skull metastasis could be also detected by all agents, but scintigrams with lung metastases were negative. In scintigraphic evaluation of alveolar soft part sarcoma, Tc(V)-DMS may be a better agent than 67Ga or 99mTc-MDP.

Topics: Adult; Citrates; Citric Acid; Humans; Male; Organotechnetium Compounds; Radionuclide Imaging; Sarcoma; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Topics: Adolescent; Bone Neoplasms; Female; Humans; Liver Neoplasms; Radionuclide Imaging; Sarcoma; Technetium Tc 99m Medronate

In a prospective study of forty-five patients, we evaluated the usefulness of bone and gallium scintigraphy prior to definitive surgery for a soft-tissue sarcoma in an extremity. Bone scintigraphy provides a baseline for staging and often reveals periosteal invasion that is not detected by routine radiographs. Blood-pool scintigraphy with bone tracers is very sensitive for a diagnosis of malignant disease. Gallium scintigraphy appeared to be a reliable preoperative indicator of malignant disease of soft tissue (sensitivity, 85 per cent; specificity, 92 per cent) and was useful for detecting the infrequent occult, non-pulmonary metastasis. Combined gallium and bone scintigraphy with blood-pool imaging provided a reliable prediction of the presence or absence of a malignant lesion in patients with a soft-tissue mass in an extremity. We recommend that bone and gallium scintigraphy be routinely used in the initial clinical staging of soft-tissue sarcomas.

Topics: Adolescent; Adult; Aged; Bone and Bones; Child; Diphosphonates; Etidronic Acid; Female; Gallium Radioisotopes; Humans; Male; Middle Aged; Neoplasm Invasiveness; Neoplasm Metastasis; Organotechnetium Compounds; Radionuclide Imaging; Sarcoma; Soft Tissue Neoplasms; Technetium; Technetium Tc 99m Medronate

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

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

Our experiences with more than 2000 bone scintigrams in 803 tumour patients underline the high ranking of skeletal scintigraphy in oncology. Among our patients--who, as a matter of fact, represented a selected material--the rate of false negative scintigraphs was less than 1%. The incidence mentioned in literature is between 1 and 3% (6, 11, 38, 41). By balanced and differentiated assessment of bone scintigrams and analogous x-ray films (plain radiographs, spot-film radiographs, if necessary x-ray tomograms), taking into consideration storage anomalies in respect of localization, form and storage intensity, false-positive results can be reduced to a minimum; as a matter of fact, we believe that in oncology patients the quota of false-positive results can be reduced to less than 3%. In tumour patients, the question as to whether there are any bone metastases, can be correctly answered with a probability of about 96% by means of skeletal scintigraphic imaging and the analogous x-ray film as a complementary examination. The bone scintigram is excellently suited for effecting malignoma staging. It is, in fact, superior to all other methods. Skeletal scintigraphic imaging enables the identification of metastases earlier than any other method. It is the most sensitive primary search method which can be utilized for on-target application of x-ray diagnostic methods. Both solitary and multiple osseous metastases can be accurately localized by scintigraphy. The early identification of skeletal metastases in skeletal regions with endangered stability, is particularly important, since an impending spontaneous fracture can be prevented by osteosynthesis or local radiation therapy. Changes in the growth of metastases under radiation and/or chemotherapy can be reliably observed by scintigraphic follow-ups, and can be assessed to determine whether there is a continued growth or a remission. If scintigram and x-ray film are employed side by side--a procedure which is imperative during first examination and later with specific courses of the disease, the low grade specificity of scintigraphy is largely compensated by the x-ray method.

Topics: Bone Neoplasms; Breast Neoplasms; Diagnosis, Differential; Diphosphonates; Female; Fractures, Spontaneous; Hodgkin Disease; Humans; Lung Neoplasms; Male; Plasmacytoma; Prostatic Neoplasms; Radionuclide Imaging; Ribs; Sarcoma; Skull Neoplasms; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate