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

Skeletal metastases are one of the major clinical problems for the oncologist. Over the last several decades bone scintigraphy has been used extensively in detecting bone involvement since it can provide information about disease location, prognosis and the effectiveness of treatment. Bone scan offers the advantage of total body examination, and images bone lesions earlier than other techniques. In this paper the main clinical problems related to the most common applications of bone scan in breast, prostate, lung cancer and other tumours are discussed. The experience carried out at the National Cancer Institute of Milan by using bone SPECT to detect single bone metastases is reported. One hundred and eighteen patients with bone metastases (from different tumour types: breast, lung, prostate, lymphomas, etc.) were studied by planar scintigraphy, SPECT and other radiological modalities (CT, MRI or X-rays). The overall performances of bone SPECT were sensitivity: 90.5% (19/21), specificity 92.8% (90/97), positive predictive value 73% (19/26), negative predictive value 97.8% (90/92), accuracy 92.4% (109/118). Considering breast cancer, the most frequent pathology in our series, and the lumbar spinal tract, the most common skeletal segment involved, the figures of merit of SPECT were: sensitivity 100% (4/4), specificity 95.3% (41/43), positive predictive value 66.7% (4/6), negative predictive value 100% (41/41), accuracy 95.7% (45/47). In conclusion bone SPECT showed very good performances, in particular improving the predictive value of planar scan in the diagnosis of vertebral metastases.

Topics: Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Male; Predictive Value of Tests; Prostatic Neoplasms; Radiopharmaceuticals; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

The purpose of this study was to compare the diagnostic accuracy of whole-body MRI (WB-MRI) and bone scintigraphy (BS) for the screening of bone metastases for the first time in a large and homogeneous patient collective with breast cancer in a systematic and controlled study.. 213 breast cancer patients were evaluated for bone metastases under randomized, double-blinded and prospective conditions at two hospitals. All participants were examined by WB-MRI and BS over an average period of four days. The examinations were performed separately at two different locations. The WB-MRI protocol included T 1-TSE and STIR sequences. WB-MRI and BS were reviewed independently by experienced radiologists and nuclear medicine specialists in a consensus reading.. In 66 % of cases bone metastases were excluded by both procedures, and bone metastases were detected concordantly in 2 % of cases. In 7 % of cases there were discrepant results: in 7 cases BS was false-positive when WB-MRI was negative. In 5 / 7 cases BS was negative when WB-MRI identified bone metastases. In 89 % of cases BS was uncertain when WB-MRI was true-negative. In 17 % of cases WB-MRI showed important (non-) tumor-associated findings. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for WB-MRI were 90 %, 94 %, 82 %, 98 % and 99 % and for BS those were 40 %, 81 %, 36 %, 91 % and 93 %.. It could be demonstrated that WB-MRI is superior to BS for detecting bone metastases in breast cancer patients. These results should be considered for the next version of the S 3 guideline "Diagnosis, Therapy and Follow-Up of Breast Cancer".

Topics: Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Breast Neoplasms, Male; Double-Blind Method; Female; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging

Single photon emission computed tomography (SPECT) images provide many details of the anatomical structure. Also about bone scintigraphy, there are many reports of the improvement of diagnosis by SPECT images. Although SPECT is useful, it requires much time. So to perform SPECT for all cases is difficult in the clinical situation. Recently, due to technical improvements in gamma cameras, we can get SPECT images in a short time. We examined diagnosis of solitary hot spots of thoracic spine in cancer patients using short-time SPECT. And we considered whether short-time SPECT contributes to the precise diagnosis of the lesion.. We performed bone scintigraphy image acquisition and both planar and short-time SPECT of the chest. Short-time SPECT was acquired in 6 minutes. We selected 36 cases with malignancy, whose bone scintigraphy demonstrated a solitary accumulation hot spot in the thoracic spine. Three experienced radiologists in nuclear medicine and 4 beginners diagnosed the images. They interpreted planar, short-time SPECT and maximum intensity projection (MIP) view of the chest of each case. The observers' response data were analyzed with receiver operating characteristic (ROC) curve analysis.. Of the three types of images, the Az (the area under ROC curve) values of short-time SPECT were the highest in all the observers except for only one beginner. Compared with experienced observers, beginners scored lower Az values of short-time SPECT. MIP images were constructed using SPECT data, but the Az values of MIP images were not higher than those of planar images. As to diagnosis, beginners tended to interprete most of the accumulations as metastatic lesions.. Short-time SPECT can be helpful to some degree, but to provide greater benefit, the observers require considerable exercise and experience.

Topics: Adult; Aged; Aged, 80 and over; Bone Cysts; Female; Humans; Image Enhancement; Male; Middle Aged; Observer Variation; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors; Tomography, Emission-Computed, Single-Photon

Because of the discrepant findings on regional bone mineral density (BMD) in stage IV patients with bone metastases due to prostate cancer, we decided to evaluate BMD of lumbar spines in 30 prostate cancer patients with lumbar spine metastases. These measurements of BMD in lumbar spines were compared with 30 stage IV prostate cancer patients without lumbar spine metastases.. Before BMD measurements, the bone scan with technetium-99m labeled diphosphonate was carried out in all of the men to evaluate lumbar spine metastases. Dual energy x-ray absorptiometry was used to measure BMD in the lumbar spines.. There was no difference of age, height, weight, and body mass index between the two group patients. However, significantly higher BMD of the lumbar spines in the 30 patients of prostate cancers with lumbar spine metastases was found (p value <0.05).. Our results show that patients of prostate cancers with lumbar spine metastases demonstrated by Tc-99m MDP bone scan have increased BMD in the lumbar spines, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by Tc-99m MDP bone scan.

Topics: Absorptiometry, Photon; Aged; Bone Density; Bone Neoplasms; Carcinoma; Humans; Lumbar Vertebrae; Male; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate

To compare single photon emission computed tomography (SPECT) with planar whole body bone scan (WBBS) in diagnosis of solitary vertebral lesion in non-skeletal malignancies in terms of diagnostic accuracy.. Cross-sectional study.. Nuclear Medical Centre, Armed Forces Institute of Pathology, Rawalpindi, July 2014 to June 2016.. After fulfilling the inclusion and exclusion criteria and taking written informed consent, 74 patients of various extra-skeletal malignancies were enrolled in the study. Patients were injected with 740 MBq of 99mTc-methylene diphosphonate (MDP) intravenously. WBBS images were acquired in anterior and posterior projections 3 hours after injection. SPECT images of the desired vertebral region were acquired subsequently along with low dose CT. All the images were read by two experienced nuclear medicine physicians. Lesions were diagnosed as definitely benign, indeterminate/equivocal and definitely malignant separately on WBBS and SPECT. With SPECT/CT as gold standard, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were calculated.. For planar WBBS, sensitivity was 91.43%, NPV was 86.96%, specificity was 51.28% and PPV remained 62.75%. For SPECT, sensitivity and NPV were 100%, specificity was 92.31% and PPV remained 92.11%. Accuracy remained 70.27% and 95.95% for planar WBBS and SPECT, respectively.. SPECT imaging significantly increases the specificity (p <0.05) of ⁹⁹ᵐTc-MDP skeletal scintiscanning and accurately diagnoses the equivocal lesions as compared to planar images.

Topics: Adult; Aged; Cross-Sectional Studies; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Radiopharmaceuticals; Sensitivity and Specificity; Single Photon Emission Computed Tomography Computed Tomography; Spinal Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging

Prostate cancer (PC) is the second most common malignancy in men. According to International agency for research on cancer,4552 new cases of PC were registered in 2018 in Pakistan.Although majority of cases are confined to prostate on initial presentation, there is a high tendency for advanced PC to metastasize to bone. Metastatic lesions are typically osteoblastic rather than osteolytic. Therefore, these are easily identified by Technetium labeled Methylene Diphosphonate (Tc99m-MDP) uptake on Whole body Bone Scan (BS). Hybrid scanning offers anatomic details for differentiation between aggressive or non-aggressive lesions. Most common axial sites include pelvic bones and spine. Metastases to appendicular skeleton is rare and uncommon . We present a case of 62-years-old male with PC. Follow-up WBS, showed interval development of multiple sites of skeletal metastases. SPECT-CT scan acquired for characterization of atypical site of abnormal MDP uptake in appendicular skeleton, which showed features suggesting skeletal metastasis.

Topics: Adenocarcinoma; Bone Neoplasms; Fibula; Humans; Ilium; Male; Middle Aged; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

MINI: Bone scan remains the modality of choice for the screening of bone metastases. This study demonstrated the diagnostic value of bone scan in detecting bone metastases limited to the cervical spine in oncological patients remains uncertain due to the moderately high false-negative diagnostic rate.. A retrospective cohort, radiographic study.. To assess the diagnostic accuracy of bone scintigraphy (BS) for the detection of cervical spine metastases in oncological patients.. BS remains the modality of choice for the screening of bone metastases, because of its feasibility in whole-body scanning and its widespread availability at low cost. Current practice guidelines for patients with malignant diseases recommend BS imaging as the primary screening method for detecting both axial and appendicular skeletal metastases.. Of 481 patients, 242 were diagnosed with cervical spinal metastases from a primary cancer. The BS findings of these patients, evaluated by nuclear medicine physicians, were assessed with respect to their usefulness for detecting cervical spine metastases. Magnetic resonance imaging findings, evaluated by radiologists, were used as the reference standards. The diagnostic value of BS was compared between subgroups according to the order in which the diagnostic procedures (magnetic resonance imaging and BS) were completed, the presence of pathological fractures, the location of the primary malignancy, and the number of cervical metastases.. The sensitivity of BS in the detection of cervical spine metastases was 59.1%, with a 40.9% rate of false-negative diagnoses; the specificity was 94.6%, with a 5.4% rate of false-positive diagnoses. The sensitivity tended to be higher in the presence of pathological fractures (72.1% in cases with a fracture vs. 3% in cases without a fracture) and a greater number of lesions (r = 0.921). Neither the order in which the diagnostic examinations were performed nor the location of the primary cancer, except for those in the stomach and liver, appeared to affect the diagnostic accuracy of BS.. Considering the moderately high false-negative diagnostic rate obtained in the present study, BS alone cannot accurately diagnose metastases in the cervical spine in oncological patients.. 3.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Child; Child, Preschool; Cohort Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging; Young Adult

The bone scan index (BSI) is calculated from a whole-body bone scan image; it shows the tumor burden in bone as a percentage of total skeletal mass. It has been used to determine the prognosis and to assess treatment effects; however, little has been reported on whether the BSI calculated using a two-dimensional image can accurately evaluate the three-dimensional spread in tumor volume. We investigated the relationship between tumor volume and BSI using Monte Carlo simulation (MCS). We simulated a gamma camera and constructed a voxel phantom based on an anthropomorphic phantom computed tomography (CT) image and gamma rays emitted from each part according to technetium-99m-labeled methylene diphosphonate (

Topics: Bone Neoplasms; Humans; Image Processing, Computer-Assisted; Monte Carlo Method; Phantoms, Imaging; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Tumor Burden; Whole Body Imaging

To compare the diagnostic accuracy of the following imaging techniques in the detection of spine metastases, using magnetic resonance imaging (MRI) as a reference: whole-body bone scintigraphy (WBS) with technetium-99m-MDP, [18F]-sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and [(18) F]-fluoromethylcholine (FCH) PET/CT.. The study entry criteria were biopsy-proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days of informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion-based analysis. The primary target variable was bone lesion (malignant/benign) and the 'gold standard' was MRI.. A total of 50 men were recruited between May 2009 and March 2012. Their mean age was 73 years, their median PSA level was 84 ng/mL, and the mean Gleason score of the tumours was 7.7. A total of 46 patients underwent all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men: 363 malignant and 163 non-malignant according to MRI. Sensitivity, specificity, positive and negative predictive values and accuracy were: WBS: 51, 82, 86, 43 and 61%; NaF-PET/CT: 93, 54, 82, 78 and 81%; and FCH-PET/CT: 85, 91, 95, 75 and 87%, respectively.. We found that FCH-PET/CT and NaF-PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. The present results call into question the use of WBS as the method of choice in patients with hormone-naïve prostate cancer.

Topics: Aged; Aged, 80 and over; Choline; Humans; Male; Multimodal Imaging; Positron-Emission Tomography; Prospective Studies; Prostatic Neoplasms; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Metastases and benign conditions of spine are common, however, the diagnoses of imaging modalities in the nature of spinal lesions are difficult, especially for the solitary lesions in spine. This study aims to retrospectively evaluate the diagnostic value of single photon emission computed tomography (SPECT)/spiral computed tomography (CT) in assessing indeterminate spinal solitary lesion of patients without certain medical history of malignancies.. A total of 48 patients (28 male, 20 female, average 54.9 ± 14.8 years) without malignant history but with a solitary lesion of spine on the Tc-99m-methylene diphosphonate planar scintigraphy, were enrolled in this study. SPECT/spiral CT was simultaneously performed on the abnormal lesions of the spine. SPECT alone and SPECT/spiral CT images were independently analyzed and interpreted by two experienced nuclear medicine physicians. Finally, the indeterminate spinal single lesion was confirmed with pathological results. The agreements of the SPECT and SPECT/spiral CT diagnoses with the pathology were evaluated using a weighted kappa score, respectively.. Among 48 patients, the pathological results revealed 37.5 % (18/48) benign and 62.5 % (30/48) malignant lesions. For SPECT alone, 6 of 18 benign cases and 28 of 30 malignant conditions were correctly diagnosed. For SPECT/spiral CT, 9 of 18 benign and 29 of 31 malignant lesions were exactly judged. For these patients without malignant history, the diagnostic accuracy, specificity, positive predictive value, and negative predictive value of SPECT and SPECT/spiral CT in assessing abnormal spinal solitary lesion were 70.8 % (34/48) vs 79.2 % (38/48), 33.3 % (6/18) vs 50.0 % (9/18), 70.0 % (28/40) vs 76.3 % (29/38), 75.0 % (6/8) vs 90.0 % (9/10), respectively. Moreover, the kappa scores for the agreement of SPECT alone and SPECT/spiral CT with the pathological confirmation were 0.300 and 0.512, respectively (both P < 0.005).. Compared with SPECT imaging, hybrid SPECT/spiral CT imaging improves the diagnostic accuracy and specificity in evaluating indeterminate spinal solitary lesion of patients without certain malignant history. Moreover, based on whole-body bone scan with high sensitivity, cheap price, widespread and time-saving use, SPECT/spiral CT is a good imaging modality for the diagnosis and evaluation of the nature of solitary lesion in spine.

Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Spiral Computed; Tomography, X-Ray Computed; Young Adult

Early diagnosis of spinal metastases is of key importance in further therapeutic management.. The aim of the study was to assess the reliability of single-photon emission computed tomography (SPECT) or SPECT and computed tomography (SPECT/CT) in the diagnosis of solitary hot nodules in the spine identified by scintigraphy.. In this retrospective study, 70 patients with neoplastic disease and a solitary nodule detected in the spine were analyzed. Using a SPECT/CT γ-camera, the type and site of the foci in the vertebra were analyzed. Bone scintigraphy, SPECT, and CT were performed. Reliability of the results was assessed depending on the applied technique.. In malignant lesions, increased isotope uptake was observed in the vertebral body with the posterior arch (89%), the body and both arches (67%), and the body alone (14%). In benign lesions, increased uptake was observed in the body area or in the joint area. Using SPECT, 25 of 27 cases (93%) of foci were properly classified as malignant. Using SPECT/CT, malignant lesions were observed in 26 of 27 cases (96%). Using SPECT, 19 of 43 cases were identified as benign (44%), and using SPECT/CT, 31 of 43 were identified as benign (72%). The agreement between SPECT and SPECT/CT was higher for malignant lesions (89%) than for benign lesions (67%). The use of CT in SPECT/CT examinations allowed to change the SPECT diagnosis of malignant lesions to that of benign lesions in 50% of the cases.. The criteria used in the diagnosis of solitary nodules in the spine direct the diagnosis largely towards noncancerous lesions. Reliability of positive assessment was significantly lower than that of negative one - 51% in SPECT and 68% in SPECT/CT. A hybrid SPECT/CT camera is more reliable than SPECT alone in the assessment of spinal lesions.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, Spiral Computed

The aim of this study was to explore the distribution features of metastatic bony lesions in prostate cancer.. Bone scans with 99mTc-methylene diphosphonate were performed in 144 patients with pathologically proven prostate cancer, and distribution regularity of metastatic bony lesions was analyzed retrospectively.. A total of 2000 lesions of bone metastasis were detected in 102 patients, 28.9% of which were distributed in the ribs, 14.8% in thoracic vertebrae, 13.8% in the ilium, and 8.0% in the lumbar vertebrae. The distribution of metastatic bony lesions was correlated with the total number of lesions. The proportion of metastatic lesions of vertebrae and pelvis was up to 84.5% (49/58) in fewer bone metastases. The proportion gradually decreased with an increase in the total number of lesions, but the proportion of the bony lesions, except for the vertebrae and pelvis, gradually increased with an increase in the total number of lesions. Ninety-nine percent (903/912) of metastatic bony lesions, except for the vertebrae and pelvis, coexisted with metastasis of vertebrae or pelvis, whereas only 1.0% (9/912) of those were detected in no metastasis of the vertebrae and pelvis; their difference was significant (χ2=876.4, P=0.000). About 98.8% (571/578) of metastatic costal lesions coexisted with vertebrae metastasis, but only 1.2% (7/578) of these were detected in no metastasis of vertebrae; their difference was significant (χ2=550.3, P=0.000). The difference between left body and right body was not significant (χ=1.3, P=0.249).. Metastatic bony lesions of prostate cancer are located mainly in the vertebrae and pelvis in the early stage. The distribution of metastatic bony lesions is not only characterized by spreading to left body and right body randomly, but also presents the tendency of developing with orderliness to a certain extent in the whole body.

Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Humans; Ilium; Lumbar Vertebrae; Male; Middle Aged; Prostatic Neoplasms; Radiopharmaceuticals; Retrospective Studies; Ribs; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

Schmorl's node (SN) is a common entity characterized by protrusion of intervertebral disc material through a break in the subchondral end plate of a vertebral body. They can show increased 99mTC methylene diphosphonate uptake on bone scintigraphy mimicking metastasis and can be symptomatic. Differentiation of SN from metastasis is essential for appropriate patient management. Here, we present a case where increased 99mTC methylene diphosphonate uptake in a dorsal vertebra was found to be because of SN by using single-photon emission computed tomography-computed tomography.

Topics: Adult; Breast Neoplasms; Diagnosis, Differential; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Neoplasm Metastasis; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The purpose of this study was to investigate the incremental value and diagnostic impact of SPECT/CT in patients who had a solitary spinal lesion on a bone scan.. A prospective study was performed on 80 patients (50 with known cancer) who underwent (99m)Tc-methylene diphosphonate whole-body planar bone scintigraphy and had a solitary spinal lesion. These lesions were then further evaluated using SPECT/CT.. Lesions were localized to the vertebral body in 38 patients (47.5%), pedicle in 15 (18.8%), facet joint in 15 (18.8%), transverse process in 2 (2.5%), spinous process in 2 (2.5%), lamina in 3 (3.8%), and end plates in 5 (6.2%). Although the specificity of planar bone scans was excellent (100%), sensitivity was only 6.1% but increased to 78.8% after the addition of SPECT/CT. The results provide evidence of a substantial incremental increase in diagnostic accuracy using SPECT/CT over planar imaging alone for patients in whom a solitary spinal lesion is noted.. The addition of SPECT/CT significantly reduced the number of false-negative results and increased the number of true-positive results. SPECT/CT also reduced the number of equivocal reports. A definitive diagnosis was given for most patients, indicating improved diagnostic confidence with the addition of SPECT/CT, compared with planar imaging alone, in patients with solitary spinal lesions.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Cancers that metastasize to the cauda equina are uncommon. Only seventeen cases were reported. Those from pulmonary squamous cell carcinoma was never been published to our knowledge.. A 79-year-old male patient presented with low back pain since 1 year and severe sacral pain irradiating to the left leg, paraparesis, urinary dysfunction and leg weakness since one week.. Preoperative magnetic resonance images of the lumbar spine showed an intradural spinal mass in L2-3 with infiltration of the cauda equina; the lesion measured 13 mm craniocaudally and 11 mm anteroposteriorly, and thus occupied the majority of the intrathecal space at that level. The magnetic resonance images, surgical treatment, and related pathophysiology are reviewed.. The majority of cauda equina tumors are primary tumors, and metastases are very rare. Especially old patients with intradural mass and rapidly progressive cauda equina syndrome should be evaluated for a primary malignancy to avoid an unnecessary spinal operation.

Topics: Aged; Bone and Bones; Carcinoma, Squamous Cell; Humans; Immunohistochemistry; Lumbar Vertebrae; Lung Neoplasms; Magnetic Resonance Imaging; Male; Polyradiculopathy; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Spinal Stenosis; Technetium Tc 99m Medronate

The objective of this study was to compare the diagnostic value obtained using single-photon emission computed tomography (SPECT)/spiral computed tomography (CT) with Tc-99m methylene-diphosphonate with that obtained using SPECT alone in patients with spinal lesions.. This was a retrospective study of 56 patients who underwent planar whole-body scintigraphy because of bone pain or osseous lesions that had been detected by other imaging techniques, or for the investigation of bone metastasis in patients with extraskeletal malignancies. Only patients who had hot spots detected in their spine and who had undergone single-photon emission computed tomography/computed tomography (SPECT/CT) imaging were included. One lesion from each patient was resected or biopsied for pathological diagnosis, and lesions for which a pathological diagnosis could be made were included in this study. Single-photon emission computed tomography (SPECT) and SPECT/CT images were independently interpreted by two experienced nuclear medicine physicians who had not been involved in the selection of data for the study. The physicians were aware of patients' sex, age, history of histologically confirmed extraskeletal malignancy, and whole-body scintigraphy results, but were unaware of the results of other investigations, such as X-ray, MRI, and laboratory tests. SPECT images were analyzed first, followed by SPECT/CT images. Each lesion was graded on a 4-point diagnostic scale (1, benign; 2, likely benign; 3, likely malignant; 4, malignant), and the inter-reviewer agreement and the agreement of the SPECT and SPECT/CT diagnoses with the pathology results were evaluated by κ scores.. The pathology results revealed 39 malignant bone tumors and 17 benign lesions. In the malignant cases, 20 were bone metastases and 19 were malignant tumors of another histological type. The reviewers rated 67.9% of lesions as equivocal (grade 2-3) by SPECT, but only 19.6% as equivocal by SPECT/CT. The κ scores for inter-reviewer agreement were 0.467 for SPECT and 0.905 for SPECT/CT (both P<0.0001). The κ scores for the agreement of the interpretation of SPECT and SPECT/CT with the pathology results were 0.493 and 0.689, respectively (both P<0.0001).. Compared with SPECT imaging, SPECT/spiral CT hybrid imaging significantly reduced the number of lesions judged to be equivocal. This reduction allowed for a definitive diagnosis to be made by imaging in the majority of patients.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, Spiral Computed; Whole Body Imaging; Young Adult

Osteoid osteoma is a benign skeletal neoplasm composed of osteoid and woven bone. The majority of the lesions arise in the cortex of long bones. Osteoid osteoma of the spine is a rare primary spine tumor and those located at the thoracal spine are even rarer. The usual treatment involves complete resection, including the nidus, or alternatively radiofrequency percutaneous ablation is performed. The authors present a 32-year-old female with an unusual localization of the osteoid osteoma in the thoracal spine where imaging modalities were not conclusive for the diagnosis. The T1 vertebra lesion was successfully resected via a posterior approach with T1 laminectomy, including right side C7 and T1 foraminotomies, and vertebroplasty were performed. Histopathology reported the lesion as an osteoid osteoma.

Topics: Adult; Biopsy; Catheter Ablation; Female; Humans; Laminectomy; Magnetic Resonance Imaging; Osteoma, Osteoid; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

To analyze the radiogenic distribution in the sacrum in whole-body bone scanning.. A total of 212 patients receiving whole-body bone scanning without any explicit bone metastases were divided into different age and gender groups. The radioactive distribution in the sacrum in whole-body bone scanning was analyzed statistically.. Of these cases, 31.1% presented with thin radioactive distribution in the sacrum and 11.3% exhibited increased radioactive distribution. Normal radioactive distribution in the sacrum was found in 57.6% of the cases. In both male and female elderly patients (>70 years), the rate of normal radioactive distribution in the sacrum was obviously reduced with increased rate of thin radioactive distribution. The female elderly patients showed higher rate of increased radioactive distribution in the sacrum than male elderly patients.. The radioactive distribution in the sacrum is similar between female and male patients. Elderly male patients over 70 years have generally thin radioactive distribution in the sacrum due to the presence of osteoporosis, which is also associated with latent fracture of the sacrum to result in increased radioactive distribution in the sacrum in whole-body bone scanning.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Neoplasms; Radionuclide Imaging; Sacrum; Spinal Neoplasms; Technetium Tc 99m Medronate; Whole Body Imaging; Young Adult

The spine is a common site of various pathologic changes. On bone scans, differential diagnosis between metastasis and benign changes is not always easy. We describe a characteristic bone scan appearance of facet osteoarthritis most often seen at the fifth lumbar level. The lesion typically appears oval/elongated in shape, located along the lateral margin of the spine; its superior end is usually outside (lateral to) or just at the margin of the spine, and the inferior end is just at or inside (medial to) the margin, yielding a pattern of slightly oblique activity.. Bone scans performed in 448 patients with known malignancy and interpreted as having some sort of spinal abnormalities were reviewed. Of these, the scans in 36 patients were judged to show the facet osteoarthritis sign (FOS). Follow-up was available in 28 of the 36 patients. The presence or absence of metastasis at the site of the FOS was determined by a minimum of 6-month follow-up by chart review and correlation with plain radiographs, computed tomography (CT), magnetic resonance imaging, and/or serial bone scans.. None of the 28 patients had metastasis at the site of the FOS. CT and/or plain radiographs performed in 13 patients invariably showed facet disease.. When planar bone scan images show the FOS, further evaluation of this region with SPECT imaging or other imaging, ie, plain radiography, CT, or magnetic resonance imaging, would be unnecessary because this sign has an extremely high negative predictive value for metastasis (100% in this series).

Topics: Adult; Aged; Aged, 80 and over; False Negative Reactions; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoarthritis; Prognosis; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Risk Assessment; Risk Factors; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Zygapophyseal Joint

Neuroblastoma is the third most common malignancy of childhood. 131I-MIBG scintigraphy must be performed in patients with neuroblastoma at the time of staging. The aim of this study is to identify the role of 131I-MIBG scintigraphy in neuroblastoma patients in correlation with other diagnostic modalities for staging of the disease.. Twenty six patients provisionally diagnosed by clinical and imaging criteria to have neuroblastoma were included. On histopathologic verification 5 of these 26 patients were rediagnosed as non-neuroblastoma. Each patient had imaging by ultrasound, CT and/or MRI. In all cases, 131I-MIBG scintigraphy was performed, among them 15 patients had additional 99mTc-MDP bone scan.. The outcome demonstrated that CT and MRI were able to detect lesions in 19 out of 21 patients; while in 2 patients no lesions were detected. 131I-MIBG showed active lesions in 16 out of the above 19 patients, while in 3 patients 131I-MIBG was negative. There were no false positive result by 131I-MBG scan. Accordingly, 131I-MIBG is able to detect neuroblastora lesions with an overall sensitivity of 84.2%, specificity of 100% and an accuracy of 85.7%. Detection of primary lesions by 131I-MIB was significantly better than 99mTc-MDP bone scanning (92.31% vs. 61.54% respectively) (P < 0.05). For skeletal metastases, 131I-MIBG scan has a higher ability to detect more lesions than 99mTc-MDP bone scan (P = 0.023).. 131I-MIBG scintigraphy has an excellent ability to discriminate between neuroblastonia and other small round cell paediatric tumours. 131I-MIBG was found to be significantly superior to conventional bone scanning in revealing both primary and metastatic osseous lesions.

Topics: 3-Iodobenzylguanidine; Adolescent; Adrenal Gland Neoplasms; Bone Marrow Neoplasms; Brain Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Iodine Radioisotopes; Liver Neoplasms; Male; Mediastinal Neoplasms; Neoplasm Staging; Neuroblastoma; Radionuclide Imaging; Radiopharmaceuticals; Retroperitoneal Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

The purpose of this study was to reassess whether the Honda sign (HS) and its variants on bone scans can be used to differentiate an insufficiency fracture (IF) of the sacrum from a metastasis and to evaluate extrapelvic tracer accumulation in patients suspected of having a sacral IF.. We retrospectively reviewed 34 bone scans of 26 patients suspected of having a sacral IF between January 1998 and June 2003.. Twenty-four of the patients had a sacral IF and 1 had a sacral metastasis from prostate cancer and another from lung cancer. The bone scans of only 15 (63%) of the 24 patients with a sacral IF exhibited the HS, 8 (33%) scans exhibited variants, and 4 (4%) scans showed whole-sacrum uptake. One of the 2 patients with metastasis exhibited the HS and the other exhibited a variant. The sensitivity and positive predictive value of HS plus its variants as diagnostic criteria for sacral IF were 96% and 92%, respectively. Seventeen patients (71%) had extrasacral accumulation. The most common site was the pubic bone (50%, 12 of 24), and the second most common site was the spine (46%, 11 of 24), where the accumulation was the result of a compression fracture or degenerative joint disease of the spine.. A "Honda sign or variation" with evidence of fractures elsewhere or no evidence of other metastatic disease should be strong evidence for a sacral insufficiency fracture. The likelihood of having a solitary metastasis to the sacrum is small.

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sacrum; Sensitivity and Specificity; Spinal Fractures; Spinal Neoplasms; Technetium Tc 99m Medronate

A case of atypical osseous tuberculosis (TB) mimicking multiple secondary metastases on radiologic and nuclear imaging is presented.. To emphasize the contribution of nuclear bone scanning for the assessment of osseous tuberculosis in typical and atypical presentations.. Skeletal locations of TB mostly involve the dorsolumbar spine and diagnosis is often delayed. The presence of multiple TB sites can mimic secondary metastases and biopsy remains the mainstay for final diagnosis.. Clinical symptoms, lab tests, and imaging data are presented. Possible diagnoses are discussed. A review of imaging characteristics in cases of typical and atypical presentations of osseous TB is proposed.. A dorsal spine spondylitis was first diagnosed on a 56-year-old patient presenting neurologic deficit of the left arm. Fine needle aspiration identified bacterial infection but was negative for Mycobacterium tuberculosis. Whole-body bone scan allowed the identification of an asymptomatic sacroiliac lesion, which was accessible to biopsy and gave a final diagnosis.. Nuclear bone scanning should be kept in mind when assessing spinal pain in patients at high risk of TB infection or reactivation.

Topics: Africa, Northern; Arm; Back Pain; Biopsy, Fine-Needle; Diabetes Complications; Diagnosis, Differential; Epidural Abscess; False Negative Reactions; Humans; Lumbar Vertebrae; Male; Middle Aged; Mycobacterium tuberculosis; Osteolysis; Paralysis; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Sacroiliac Joint; Sacrum; Spinal Neoplasms; Spondylitis; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tuberculoma; Tuberculosis, Osteoarticular

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: Artifacts; Cervical Vertebrae; Diagnosis, Differential; Diagnostic Errors; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Middle Aged; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thyroid Gland; Tissue Distribution; Tomography, Emission-Computed, Single-Photon

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

In a young patient with differentiated thyroid carcinoma (DTC), previously submitted to total thyroidectomy and I-131 therapy for ablation of thyroid remnant, a follow-up 1-131 diagnostic whole body scan (WBS) demonstrated four small abnormal I-131 uptake areas. Two of these were projected over the thoracic region and corresponded to lung nodules, as later demonstrated by lung computerized tomography (CT)-scan. The remaining two areas were found in the lumbar-pelvic region, but their precise location could not be determined. Standard bone Rx examination and bone scan were negative. After I-131 therapy, we simultaneously acquired a I-131 WBS and a Tc-99m oxidronate bone scan by setting a dual window on the gamma camera. Comparing the I-131 and bone images we were able to identify the 4th lumbar vertebra and right ilium as the bone segments to be studied by a radiological approach. Eventually, the thin slice CT-scan demonstrated the presence of two small osteolytic lesions in these areas. In conclusion, the simultaneous acquisition of images both from I-131 and a bone-seeking agent may be useful to locate functioning bone metastases from DTC.

Topics: Adult; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, X-Ray Computed

Topics: Child; Cranial Fossa, Posterior; Humans; Image Processing, Computer-Assisted; Male; Neuronavigation; Odontoid Process; Osteoblastoma; Sensitivity and Specificity; Skull Base Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The case of a vertebral osteoid osteoma localized in the arch and pedicle of the fourth lumbar vertebra in a young girl is described. The condition was manifested by the development of scoliosis, which was also the initial diagnosis. Because of painful muscle contractions and persistent pain at night, osteoid osteoma was suspected and then confirmed by scintigraphy. In order to minimize resection of the posterior stabilizing structures and to ensure removal of the complete nidus, surgery was carried out with the use of a surgical gamma probe. The method is based on administration of a radionuclide (99m Techneciumlabeled methylenediphosphonate) 2 to 3 h before the operation and intraoperative detection of the intensity of radiation directly in the operative wound. The values of impulses recorded over the nidus were more than ten-times higher than the background values, i.e., the impulses over the surrounding, unaffected bone. The nidus was exactly localized and removed as a whole. Posterolateral fusion without instrumentation was carried out. The patient was almost immediately free from night pain. After fixation with TLSO for 3 months, the patient started physical therapy. One year later she was without any complaints, fusion was healed and she had no relapse. The aim of this study was to draw attention to this less known and therefore less frequently employed method that may enable the surgeon to detect conditions otherwise difficult to localize. This method can also be used for other body sites if the lesion treated accumulates radionuclides.

Topics: Adult; Female; Humans; Intraoperative Period; Lumbar Vertebrae; Osteoma, Osteoid; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate

Topics: Adult; Female; Hemangioma; Humans; Radiopharmaceuticals; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

To document the varied radiological features before, during, and after treatment of non-Central Nervous System Primitive Neuroectodermal Tumours (PNETs), which are rare tumours of childhood.. Thirty-three children with PNETs have been treated at our institution between 1990 and 1999. Full radiological and clinical follow-up was obtained in 29 (17 females, 12 males). Imaging was retrospectively reviewed, with particular attention to Computed Tomography (CT) and Magnetic Resonance Imaging (MRI).. Age range at diagnosis was 0-16 years old (mean 4.4 years). There were five main sites of tumour: head and neck (n = 7), scapula/axilla (n = 2), chest (n = 11), abdomen (n = 3), and spinal/paraspinal (n = 6). Overall mortality was 62%. Tumours of the scapula or paraspinal region appear to show better survival than other sites. Of 23 patients who had Tc99m-methylene diphosphonate (MDP) bone scans at diagnosis, four patients showed widespread distant metastases, seven showed focal increased uptake in an adjacent bone only, and 12 had normal examinations. CT was performed in 25 patients and MRI in 20, both at diagnosis and follow-up. Average size of tumours at presentation was 4.5 cm in the paraspinal, head and neck and scapular regions and 7.5 cm in the chest and abdomen. Tumours were typically of soft tissue density on CT with the larger (>5 cm) masses tending to be more heterogeneous in character. The lesions were slightly higher signal than muscle on T1-weighted (T1W) MRI and all masses were heterogeneous on T2W sequences. Calcification was uncommon (n = 6) and generally sparse. Tumours tended to displace adjacent soft tissue structures such as vessels and bronchi rather than invade or encase them. Tumours rarely crossed the midline. Local or bony invasion was seen in 12 patients at diagnosis. Metastases were identified in the lung (n = 5), pleura (n = 2), brain (n = 4), bone (n = 4), lymph nodes (n = 2), liver (n = 2), subcutaneous tissues (n = 2), kidney (n = 1) and peritoneum (n = 1).. Imaging characteristics of non-CNS PNETs are described. Tumours tend to displace rather than encase adjacent structures; local invasion occurred in 43%. Tumour calcification is uncommon. Poor prognostic features included the presence of distant metastases at diagnosis (all four patients with distant metastases at diagnosis died), but even patients without metastatic disease have a relatively poor prognosis.

Topics: Abdominal Neoplasms; Adolescent; Child; Child, Preschool; Disease-Free Survival; Female; Head and Neck Neoplasms; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neuroectodermal Tumors, Primitive, Peripheral; Prognosis; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Neoplasms; Tomography, X-Ray Computed

The purpose of this study was to investigate whether the location and size of vertebral body metastases influence the difference in detection rates between MR imaging and bone scintigraphy.. We retrospectively evaluated the vertebral body lesions detected on MR imaging in 74 patients with known widely disseminated metastatic disease. Three radiologists independently reviewed the MR images and bone scintigraphs. MR imaging findings included lesion size and its spatial relationship to the bony cortex (intramedullary, subcortical, and transcortical) and results were correlated with those of planar technetium 99m bone scintigraphy.. Findings on bone scans were negative for all intramedullary lesions without cortical involvement shown on MR imaging, regardless of their size. Findings on bone scans (71.3% for transcortical and 33.8% for subcortical) were frequently positive for lesions with cortical involvement (trans- or subcortical), and the probability of positive findings on bone scans was also influenced by the lesion size. Statistical analysis showed a positive correlation among cortical involvement, lesion size, and positive findings on bone scintigraphy (p < 0.0001).. Location (the presence of cortical bone involvement on MR imaging) and size of the vertebral body metastases appear to be important contributing factors to the difference in detection rates between MR imaging and bone scintigraphy. Cortical involvement is likely the cause of positive findings on bone scans. Early vertebral metastases tend to be small and located in the medullary cavity without cortical involvement, and therefore, findings may be positive on MR images but negative on bone scans.

Topics: Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: 3-Iodobenzylguanidine; Adult; Humans; Iodine Radioisotopes; Male; Paraganglioma, Extra-Adrenal; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Adenocarcinoma; Aged; Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Male; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.

Topics: Bone Neoplasms; Carcinoid Tumor; Follow-Up Studies; Humans; Indium Radioisotopes; Liver Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasms, Unknown Primary; Octreotide; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Receptors, Somatostatin; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

Topics: Fracture Healing; Hemangioma; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Spinal Fractures; Spinal Neoplasms; Technetium Tc 99m Medronate

Topics: Angiography; Diagnosis, Differential; Diagnostic Imaging; Hemangioendothelioma, Epithelioid; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Male; Middle Aged; Photons; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Shoulder; Spinal Neoplasms; Sternum; Technetium Tc 99m Medronate; Thoracic Neoplasms

Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable difficulty is encountered in the vertebral region due to the complexity of structures and the fact that other benign lesions, especially degenerative changes, are very common there. Single-photon emission tomography (SPET) has been reported to be useful in the differentiation of benign from malignant conditions. Here we report our experience with bone SPET in the diagnosis of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecutive patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained. Of teh 174 patients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis of the patients' clinical histories and the findings with other imaging techniques such as magnetic resonance imaging, computed tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic criterion of vertebral metastasis. SPET had a sensitivity of 87%, a specificity of 91%, a positive predictive value of 82%, a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity of 81%, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral metastasis. Except with regard to the negative predictive value, SPET performed statistically better than planar imaging. Only 9/147 (6.4%) lesions involving the vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral metastases and is superior to planar imaging in this respect.

Topics: Aged; Female; Humans; Low Back Pain; Lumbar Vertebrae; Male; Predictive Value of Tests; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

A retrospective study was made to evaluate the usefulness of bone SPECT of the dorsolumbar spine in identifying benign and malignant lesions. A study was made of oncological patients who presented active images in the spinal column visible on planar radionuclide scans who also underwent SPECT. The average follow-up period was 25+/-13 months.. In 43 neoplastic patients 55 visible lesions on SPECT were evaluated, of which 29 were benign and 26 metastatic. The criteria for benign lesions were the absence of change or involution without treatment in the follow-up period. The criteria for classifying metastases were: 1. Positive biopsy. 2. Neurological complications derived from the lesion. 3. Increased extension and tracer uptake by the lesion, and the appearance of other bone metastases.. Twelve of 15 lesions located in the vertebral body or pedicle and 11/16 located in the body with extension toward the pedicles were metastases. Twenty-one of 24 lesions located on the anterior face of the vertebral body, articular processes, lamina, or intervertebral disk were benign.. Bone SPECT was useful for locating the vertebral lesion, which in many cases allows differentiation of benign and metastatic lesions.

Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Evaluation Studies as Topic; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Neoplasms; Osteoarthritis; Retrospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

Lymphangiomatosis is an extremely rare congenital disorder affecting visceral organs and/or the skeletal system. In bone is is usually characterized by multiple lytic lesions with a lacelike pattern and sclerotic margins of various thickness. In this case report we demonstrate the rare sclerotic variant of lymphangiomatosis. We report the development of predominantly sclerotic lesions at different sites by serial radiographs with a long-term follow-up, and show the MRI findings of lymphangiomatosis of the spine.

Topics: Adult; Bone Neoplasms; Female; Follow-Up Studies; Humans; Liver Neoplasms; Lymphangioma; Magnetic Resonance Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors

Topics: Adult; Gallium Radioisotopes; Humans; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Male; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Adenocarcinoma; Bone Neoplasms; Brain Neoplasms; Female; Humans; Middle Aged; Pelvic Bones; Radionuclide Imaging; Radiopharmaceuticals; Ribs; Skull; Spinal Neoplasms; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate

Magnetic resonance (MR) imaging showed high reliability in detecting spine metastases with spin-echo (SE) sequences, T1-weighted sequences being generally more sensitive than T/-weighted ones. We investigated the value of T2*-weighted gradient-echo (GE) sequences in studying spine metastases.. Twenty patients with established diagnosis of primary carcinoma and clinically suspected thoracic and/or lumbosacral spine metastases underwent .5-T MR imaging and 99mTc-HDP bone scan. The disagreement of GET2*- versus SET2-weighted images as well as versus bone scan and the disagreement of total MR results versus bone scan results were evaluated by McNemar test. The agreement of GET2*- versus SET1-weighted images was evaluated by Cohen's kappa.. Of a total of 111 MR signal abnormalities consistent with metastasis, 109 (98.2%) were T2*-hyperintense, whereas only 50 (45.1%) were T2-hyperintense (p < .0001) and 51 (45.9%) were detected with bone scan (p < .0001). Of a total of 121 MR and/or bone scan findings consistent with metastasis, 111 (91.7%) were MR positive, with high disagreement with 61 (50.4%) positive at bone scan (p < .00001). T2*-hyperintensity associated with T1-hypointensity (with or without T2-hyperintensity) was the most frequent pattern (104/111), 93.7%).. T2*-weighted GE sequences seem to be more effective than T2-weighted SE sequences and as effective as T1-weighted SE sequences. MR imaging confirms its ability in detecting abnormalities consistent with spine metastases.

Topics: Adult; Aged; Aged, 80 and over; Evaluation Studies as Topic; Female; Gamma Cameras; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sacrum; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

The complete removal of a lesion which resembles, or is covered by adjacent tissue may be difficult. Therefore, the capacity of certain lesions to specifically concentrate a radiopharmaceutical has been used to orient progress during surgery. Usually, the measurements of radioactivity in the operative field are carried out by means of small, handy radiation-detecting probes which can be sterilized. "Intra-operative nuclear medicine" or "radionuclide-guided surgery" has steadily gained in importance. However, this technique is not being taught. Our study, based on radionuclide-guided surgery of 175 orthopaedic patients suspected of having osteoid osteoma, is well suited to teach the particularities of intra-operative radiation detection, as well as the collaboration between the nuclear physician and the surgeon in the operating theatre.

Topics: Adult; Bone Neoplasms; Femoral Neoplasms; Humans; Intraoperative Care; Lumbar Vertebrae; Osteoma, Osteoid; Radiation Protection; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Tibia

Determining the etiology of a focal lesion seen on bone scan in patients with primary tumors usually requires the use of other imaging procedures or biopsy. Single positron emission computed tomography (SPECT) with high resolution multidetector systems can localize the specific site of a vertebral lesion and in this way potentially differentiate between benign and metastatic disease. SPECT images of the lower thoracic and lumbar spine were reviewed for lesion location and intensity by two experienced interpreters. Follow-up data were adequate to ascertain the cause of 71 lesions seen on SPECT in 29 patients. Twenty-six of these lesions were not seen on planar images. Of the 71 lesions, 44 were benign and 27 metastatic. Of the 15 lesions where the pedicle was involved, 11 were found to metastatic. There were a total of 14 facet lesions, 9 of which were present in vertebra with no lesions at sites other than the facets. All 9 of these isolated facet lesions turned out to be benign. Lesion intensity did not distinguish benign from malignant disease. We conclude that SPECT imaging is useful in determining the etiology of focal lesions seen on bone scan in patients with a known primary tumor referred for evaluation of metastatic disease.

Topics: Colonic Neoplasms; Diagnosis, Differential; Diagnostic Imaging; Follow-Up Studies; Humans; Image Enhancement; Lumbar Vertebrae; Lung Neoplasms; Male; Osteoarthritis; Prostatic Neoplasms; Sensitivity and Specificity; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

A total of 75 prostate cancer and 67 lung cancer patients with positive bone scintigrams were studied. The patterns of spread of tumors to various bones were different between the 2 groups. The differences in the distribution of bony metastases between the prostate and lung are explained by the role of Batson's vertebral venous plexus.

Topics: Bone and Bones; Humans; Lung Neoplasms; Male; Neoplastic Cells, Circulating; Prostatic Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Veins

In this retrospective study plain radiographs, radionuclide bone scans, computed tomography (CT) and magnetic resonance (MRT) examinations of 115 patients with metastatic carcinoma of the spine were analyzed. In 32 patients metastases were proven histologically and in the remainder by follow-up studies. Altogether, 513 vertebrae were evaluated. Forty-one patients had histologically proven breast cancer, 14 renal cell carcinoma, 11 prostate cancer, 8 melanoma. 8 tumors of the gastrointestinal system and 7 bronchial carcinoma. Evaluation of the plain films showed that the initial site of metastasis (n = 463) was the vertebral body in 441 cases and the pedicles in 294 cases. In CT scans most of the lesions confined to one part of the vertebral body (36 of 98) were localized in the posterior part. Twelve percent of the metastases were diagnosed with conventional radiography and 17% of those diagnosed with CT were not detected in skeletal scintigraphy. MRI was rarely used in diagnosing occult vertebral metastases (n = 37); 22% of the metastases demonstrated by MRI were not detected in skeletal scintigraphy. We concluded that only in 63.8% was the pedicle sign the initial site of metastasis on plain films. Bone scans and plain films are the most important diagnostic procedures for detecting and monitoring vertebral metastases. CT and MRI are only needed in patients with neurological symptoms and persistent pain.

Topics: Diagnostic Imaging; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The purpose of this study was to evaluate the usefulness of SPECT bone imaging in targeting the precise location of vertebral abnormalities to ascertain whether such knowledge would help in differentiating between metastatic and benign lesions. SPECT images of the thoracolumbar spine in 50 patients were correlated with plain x-rays, CT, MRI, PET, and bone scans and 6-month clinical follow-ups. SPECT images revealed 110 lesions, 35 of which were metastases. Twenty-four of 25 lesions involving the vertebral body with extension into posterior elements were metastases, as well as 10 of 39 lesions found in the vertebral body and 1 of 4 found in the spinous process. All lesions limited to the anterior aspect of the vertebral body (13/13), facet joints (23/23), and intervertebral disk space (6/6) were benign. In conclusion, SPECT imaging of the thoracolumbar spine is helpful in determining the precise anatomic location of vertebral abnormalities, and knowledge of the location can be used to determine whether these abnormalities in cancer patients are benign entities or metastases.

Topics: Diagnostic Imaging; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Lumbar Vertebrae; Male; Middle Aged; Prospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Time Factors; Tomography, Emission-Computed, Single-Photon

Although bone scintigraphy is an extremely sensitive method for the detection of focal bone disease, small lesions below the resolution of planar imaging may be missed. This is a report of a patient with carcinoma of the breast who showed tumor progression 1 year after initial treatment. Complete evaluation was performed in order to detect the origin of increased level of a tumor marker. Although planar bone scintigraphy could not demonstrate any lesion in the spine, multiple metastases were detected in the lumbar and the thoracic spines on SPECT imaging. Only some of these lesions were seen with MRI. Repeat planar bone imaging 6 weeks later showed multiple bone lesions in the lumbar and thoracic areas.

Topics: Adenocarcinoma; Biomarkers, Tumor; Breast Neoplasms; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Middle Aged; Mucin-1; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, Emission-Computed, Single-Photon

Topics: Aged; Bone and Bones; Humans; Kidney; Lumbar Vertebrae; Male; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

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

Topics: Adult; Erythrocytes; Female; Hemangioma; Humans; Lumbar Vertebrae; Radiography; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Acquisitions of 360 degrees are usually performed for bone single photon emission computed tomography (SPECT). However, the spine is a peripheral and median structure, it therefore seemed interesting to compare the 360 degrees and the posterior 180 degrees SPECT images. In a phantom study and in 25 adult patients, the 360 degrees SPECT images were compared with the posterior 180 degrees images obtained during the same acquisition: the posterior 180 degrees images are at least equivalent to the 360 degrees images. With a reduction in the examination time, SPECT could become easier to perform, especially in patients suffering from back pain.

Topics: Adult; Aged; Aged, 80 and over; Back Pain; Female; Follow-Up Studies; Gamma Cameras; Humans; Male; Middle Aged; Models, Structural; Osteitis Deformans; Spinal Diseases; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

Although bone scintigraphy with 99mTc-MDP is a sensitive diagnostic method to detect bone metastasis, it is not specific for malignancy. A radioactive substance which accumulates specifically into metastatic lesions should be of value. 123I-IMP and bone scintigraphy with 99mTc-MDP were consecutively performed in patients with vertebral bone metastases from hepatocellular carcinoma and lumbar spondylosis deformans in a 7-day interval or shorter. The intensity of uptake was compared. Eighteen of the 20 metastatic lesions (90%) were classified as increased uptake areas in 123I-IMP scintigraphy. MDP-scintigraphy disclosed 16 metastatic lesions (80%), 9 as "hot" lesions (56%) and 7 as "cold" lesions (44%). 123I-IMP scintigraphy was negative in all 12 lesions of lumbar spondylosis deformans. Compared to MDP-scintigraphy, 123I-IMP scintigraphy was more sensitive in detecting vertebral bone metastases of hepatocellular carcinoma with smaller rates of false-positive and false-negative findings.

Topics: Amphetamines; Carcinoma, Hepatocellular; Female; Humans; Iodine Radioisotopes; Iofetamine; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

Topics: Breast Neoplasms; Delayed-Action Preparations; Female; Goserelin; Humans; Middle Aged; Radiography; Spinal Neoplasms; Technetium Tc 99m Medronate

Three patients (ages 12, 13, and 15 years) had histologically verified osteoid osteomas of the spine (specifically in the facet processes of L3, L2, and C5) which were localized preoperatively with nuclear scintigraphy utilizing technetium 99m diphosphonate. Intraoperative nuclear scintigraphy utilizing the mobile gamma camera was essential in both localizing the tumor during surgical excision and ensuring adequacy of excision. The authors strongly recommend intraoperative scintigraphy, and en bloc resection rather than shelling out and curettage. All three patients required facet process excision for successful tumor removal, and therefore required local fusion with internal fixation.

Topics: Adolescent; Cervical Vertebrae; Child; Female; Gamma Cameras; Humans; Internal Fixators; Intraoperative Care; Lumbar Vertebrae; Male; Osteoma, Osteoid; Radionuclide Imaging; Spinal Fusion; Spinal Neoplasms; Technetium Tc 99m Medronate

A retrospective comparison was made between 99mTc-MDP bone scans and corresponding spine MR images in 35 patients who had complementary studies within 2 mo. Bone scans were performed with planar imaging of the entire body and MRI was performed with a 1.5 tesla signal scanner using standard techniques with T1- and T2-weighted images. There were 18 male and 17 female patients diagnosed with cancer prior to these studies. Cancer diagnoses included 14 prostate, 12 breast, 1 bladder, 2 renal, 2 lung, 1 each of esophagus, melanoma, myeloma and adenocarcinoma of unknown primary cancer. Of the regions compared, 69 were positive for bony metastases by MRI and 63 regions by bone scans. Thirty-eight regions were concordantly positive and 56 regions concordantly negative. No patients with entirely positive bone scans were negative by MRI, but one patient was entirely positive by MRI but negative by a bone scan. At least one region was discordantly read in 21 patients. Distribution of positive regions was similar on bone scan and MRI. The greatest number and proportion of discordant readings occurred in the lumbar regions and more frequently in patients with prostate cancer. Considering its widespread availability and the ease of performing a whole-body survey for metastasis, radionuclide bone scanning remains the study of choice for initial evaluation of patients with cancer. However, MRI is an excellent complementary technique when bone scan findings are inadequate for answering clinical questions. MRI appears to be quite sensitive and probably more specific for metastasis in certain locations of the spine.

Topics: Female; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Retrospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate

Reduced uptake of 99mTc-methylene bisphosphonate (99mTc-MBP) was found in irradiated bone in all of 13 tumour-free patients who had undergone radiotherapy (30-40 Gy) due to seminoma 3-8 years prior to bone scintigraphy. Decreased uptake of 99mTc phosphate compounds can not per se be interpreted as a sign of absence of metastases or reduced tumour burden.

Topics: Acetabulum; Adult; Aorta; Dysgerminoma; Humans; Lumbar Vertebrae; Lymph Nodes; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Aged; Diagnosis, Differential; Humans; Hyperostosis, Diffuse Idiopathic Skeletal; Male; Prostatic Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

To assess the value of magnetic resonance imaging (MRI) in the investigation of patients with suspected but nonproven vertebral metastases 45 consecutive patients referred in a 6 month period with known primary malignancy and back pain in whom an isotope bone scan was reported as equivocal were studied. All patients had abnormal isotope uptake localized to the spine. Twelve patients were shown to have bony metastases on plain X-ray. In the remainder, where X-rays showed normal or benign appearance, MRI of the spine was offered. Twenty-four patients underwent MRI examination which showed vertebral metastases in 11 cases. Magnetic resonance imaging is shown to be a useful, noninvasive, complementary investigation for evaluation of patients known to have malignant disease and suspected of having vertebral metastases on bone scintigraphy.

Topics: Back Pain; Humans; Magnetic Resonance Imaging; Prospective Studies; Spinal Neoplasms; Technetium Tc 99m Medronate

Topics: Adolescent; Diagnosis, Differential; Humans; Lumbar Vertebrae; Male; Osteoma, Osteoid; Radionuclide Imaging; Spinal Neoplasms; Spondylolysis; Technetium Tc 99m Medronate

Topics: Child; Contrast Media; Diagnosis, Differential; Gadolinium; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Organometallic Compounds; Osteoma, Osteoid; Pentetic Acid; Radionuclide Imaging; Scoliosis; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Seventeen men with prostatic carcinoma were investigated with quantitative bone scintigraphy and quantitative computed X-ray tomography before orchiectomy and up to 6 months after this operation. The uptake of 99Tcm-labelled methylene disphosphonate (99Tcm-MDP) and bone mineral density (BMD) were determined for each vertebra from Th10 to L4. Ten patients had normal scintigrams. No change in MDP uptake or BMD was seen after 6 months in these patients. Of the seven patients with abnormal scintigrams, one patient had a clinical sign of progression with an increase in both MDP uptake and BMD. The remaining six patients showed stable or improved clinical status. For their abnormal vertebrae a decrease in MDP uptake was seen, while BMD varied in different ways after 6 months. For the normal vertebrae in these patients with metastatic involvement, no change in MDP uptake was seen. However, the BMD values showed a decrease, indicating a generalized increase in bone resorption at sites distant from the metastases.

Topics: Aged; Aged, 80 and over; Bone Density; Follow-Up Studies; Humans; Male; Orchiectomy; Prostatic Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

In a double-blind, prospective study, the authors analyzed bone scintigrams and magnetic resonance (MR) images of the spine in 71 patients with histologically proved skeletal metastases. Bone scintigrams and MR images were separately reviewed by four independent observers. Bone scintigraphy permitted identification of 499 abnormal vertebrae and MR imaging, 818 abnormal vertebrae. MR imaging depicted additional abnormal vertebrae in 49 patients. The authors conclude that MR imaging is more sensitive than bone scintigraphy in detection of vertebral metastases.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Biopsy; Bone Marrow; Breast Neoplasms; Double-Blind Method; Female; Gamma Cameras; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Spinal Neoplasms; Technetium Tc 99m Medronate

Various causes for cold defects on bone scans (e.g., avascular necrosis) have been described. A case is presented in which a cold defect on a technetium-99m-methylene diphosphonate bone scan was the result of malignant fibrous histiocytoma.

Topics: Aged; Histiocytoma, Benign Fibrous; Humans; Male; Radionuclide Imaging; Retroperitoneal Neoplasms; Soft Tissue Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Lung Neoplasms; Radionuclide Imaging; Ribs; Skull Neoplasms; Spinal Neoplasms; Technetium Tc 99m Medronate

Topics: Aged; Colonic Neoplasms; Humans; Male; Neoplasm Recurrence, Local; Radionuclide Imaging; Sacrum; Spinal Neoplasms; Technetium Tc 99m Medronate; Urinary Bladder Neoplasms

Dynamic quantitative bone scintigraphy was performed on 31 men with prostatic carcinoma before orchiectomy as well as 2 weeks, 2 and 6 months postoperatively. After injection of technetium methylene diphosphonate Tc 99m (99mTc-MDP) the count rate was recorded as serial images over the lower thoracic and all the lumbar vertebrae from 1 to 240 min post-injection. Thirteen men had normal bone scintigrams with no changes in 99mTc-MDP content at the four different investigation times. Eighteen men had skeletal metastases. Throughout the study half of the abnormal vertebrae in these patients showed an abnormal count rate after only 6 min post-injection. After 1 h it was possible in almost all abnormal vertebrae to predict abnormal bone uptake. In response to therapy a "flare phenomenon" with an increase in count rate was seen 2 weeks after orchiectomy followed by a decrease 2 months postoperatively in most of the abnormal vertebrae. The count rate decreased even below the pre-operative level after 6 months. Also, the normal vertebrae in the patients with skeletal metastases showed a tendency towards the flare phenomenon, which was not seen in patients with normal bone scintigrams.

Topics: Aged; Humans; Lumbar Vertebrae; Male; Middle Aged; Orchiectomy; Postoperative Period; Prostatic Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

Bone scanning and X-ray imaging are complementary diagnostic procedures providing different information on morphology and function. This is true for diseases of the spine. For further evaluation of lesions that have already been localized, bone scanning should be performed after X-ray examinations if any questions are still open (e.g., extent of disturbed bone metabolism, viability, age of a spine fracture, response to therapy). Typical scintigraphic patterns specific for few bone diseases are exceptional, being confined to Paget's diseases and degenerative changes in the cervical spine. As a first imaging modality, however, bone scanning should be employed in the follow-up of patients with malignancies and the probability of bone metastases. In a second step, bone lesions identified by scintigraphy should be checked by X-ray imaging. In this order and context, the high sensitivity of bone scanning and the high specificity of X-ray imaging optimize the accuracy of the diagnoses achieved with the different radiological modalities.

Topics: Bone and Bones; Diphosphonates; Etidronic Acid; Humans; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Spinal Diseases; Spinal Injuries; Spinal Neoplasms; Spondylitis; Technetium; Technetium Tc 99m Medronate; Whole-Body Counting

We recently performed [99mTc]MDP bone and 111In-labeled leukocyte scintigraphy on a patient receiving radiation therapy to the lower cervical and upper thoracic spine. While the bone images revealed only minimally increased activity in the radiation port, leukocyte images revealed diffuse, intensely increased uptake in this same region. Radiation therapy should be included in the differential diagnosis of increased bone marrow activity on 111In leukocyte images.

Topics: Aged; Bone Marrow; Diagnostic Errors; Female; Humans; Indium Radioisotopes; Leukocytes; Organometallic Compounds; Oxyquinoline; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

In order to evaluate the diagnostic efficacy of pinhole collimator (PHC) imaging combined with an X-ray for vertebral metastasis, our prospective study has employed receiver operating characteristics (ROC) analysis in 21 patients, 11 with osseous metastasis and 15 with degenerative joint disease in the lumbar vertebrae. PHC imaging provided better anatomic information on the extent of 99mTc-MDP accumulation. PHC vertebral scintigraphy had a considerable impact on the decision-making process, although with variations and not very satisfactory results among the physicians with little experience. Our study suggests that PHC imaging and X-ray film are useful in differentiating between osseous metastasis and degenerative joint disease in the vertebra.

Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; ROC Curve; Spinal Neoplasms; Spinal Osteophytosis; Technetium Tc 99m Medronate

A patient with breast metastases is presented showing increased nodular renal uptake of tracer on bone scintigraphy that also demonstrated rib metastases and a large metastasis in the pelvis. However, vertebral body metastases were not shown when clearly demonstrated on CT with even partial compression on a thoracic spine film. Most of the renal lesions were hypoechoic on sonography, showed hypoattenuation areas on plain CT and after contrast enhancement but no calcification could be demonstrated. This case once again illustrates the value of scrutinizing the soft tissues on scintigraphy but also the possibility of showing some metastases on CT not visible on scintigraphy.

Topics: Adult; Bone and Bones; Breast Neoplasms; Female; Humans; Kidney; Kidney Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Ultrasonography

The relation of radionuclide uptake by bone and rate of calcification has been studied in normal vertebrae and in vertebral metastases from cancer of the prostate. Specifically, the determination of 99Tcm-MDP uptake by radionuclide scanning and the estimation of calcium concentration of trabecular bone by dual-energy computed tomography have provided the means of obtaining a relation between these parameters which was similar to that found in an animal model, in which the dependence of radionuclide uptake on the rate of mineralization was established. This relationship has enabled the experimental findings to be extrapolated to those in patient studies and has shown that in sclerotic bone lesions, the increase in 99Tcm-MDP uptake accompanying the progression of the metastases was proportional to the rate of calcification.

Topics: Aged; Bone and Bones; Calcification, Physiologic; Calcium; Humans; Lumbar Vertebrae; Male; Middle Aged; Minerals; Prostatic Neoplasms; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

Radionuclide bone scans in two patients with breast cancer and concurrent chemotherapy treatment revealed increased band-like uptake of [99mTc]methylene diphosphonate along the medial upper renal cortex corresponding to the portions of the kidneys included within the radiation field. The latency of onset of abnormal uptake was 5 to 9 mo following completion of radiation in one patient, peaked near 13 to 14 mo for both patients, and returned to baseline after 20 to 27 mo. Transient serum creatinine level elevations were also detected. These findings suggest that transient subclinical renal impairment may occur and be detected on bone scans following inadvertent inclusion of renal cortex in radiation fields.

Topics: Breast Neoplasms; Female; Humans; Kidney; Middle Aged; Radionuclide Imaging; Radiotherapy; Spinal Neoplasms; Technetium Tc 99m Medronate

The bone scan findings of 160 consecutive cases of breast cancer metastatic to bone presenting to Guy's Hospital between 1982-1987 were retrospectively assessed for number and distribution of lesions. Twenty-one percent of patients relapsed with a solitary bone metastasis. The spine was the commonest site for both solitary (52% of cases) and multiple (87%) metastases. Solitary bone metastases are more common than previously thought.

Topics: Bone Neoplasms; Breast Neoplasms; Female; Humans; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate

Two distinct osteoid osteomas occurred near each other in the same lumbar vertebra of an 18-year-old man. The tumors exhibited different levels of maturation in roentgenographic appearance and scintigraphic activity. Two surgical procedures were required to resect the lesions.

Topics: Adolescent; Humans; Lumbar Vertebrae; Male; Neoplasms, Multiple Primary; Osteoma, Osteoid; Spinal Neoplasms; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

The authors retrospectively compared magnetic resonance images and bone scintigraphy obtained from 144 patients. Fifty-six patients having a known primary malignancy were evaluated for metastases (Group 1), and 88 patients were evaluated for back pain (Group 2). Interpretation was normal in 36/144 patients (11 in Group 1 and 25 in Group 2), and similar abnormal foci were visualized in the osseous spine in 54/144 patients (32 in Group 1 and 22 in Group 2). Magnetic resonance imaging showed abnormalities in the osseous spine that were not visualized on bone scintigraphy in 43/144 patients (10 in Group 1 and 33 in Group 2); these included bone metastasis, benign neoplasm (hemangioma), Schmorl's node, intervertebral disk disease, and bone disease (osteophyte, spondylolisthesis, facet hypertrophy). In addition, magnetic resonance imaging showed epidural or paravertebral extension of the tumor or infection in 37/144 patients (30 in Group 1 and 7 in Group 2). Bone scintigraphy demonstrated abnormalities not visualized on magnetic resonance imaging in 11/144 patients (3 in Group 1 and 8 in Group 2). Bone scintigraphy showed abnormalities in locations not evaluated by magnetic resonance imaging but relevant to the symptomatology or disease in 42/144 patients (37 in Group 1 and 5 in Group 2). These data indicate that magnetic resonance imaging and bone scintigraphy are complementary. Bone scintigraphy remains the best screening procedure to show the location of abnormal areas in the spine and elsewhere in the skeleton. Magnetic resonance imaging is useful in differentiating neoplasm, infection, intervertebral disk disease, and, in some instances, degenerative bone disease.

Topics: Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Retrospective Studies; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate

Solitary abnormalities located within the spine from 75 bone images with Tc-99m MDP were reviewed. For the sake of convenience, patients were grouped in three classes of age: 15-50, 51-65, and 66-90 years. In 67 cases, the diagnosis was apparent from clinical studies, x-ray examinations, or biopsies. In eight cases, no diagnosis could be made. The maximum percentage of lesion sites were within the lumbar spine (45 cases). Metastatic lesions were the most common solitary abnormalities within the spine (29.3%). Osteoporosis was second (24%) with the maximum percentage in age group 66-99 years (83%) with a greater female predominance (67%).

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate

In searching for disease on skeletal images it is important to identify areas of increased activity and cold lesions, which are usually more difficult to identify. Focal photon-deficient lesions are due to metastatic disease in over 80% of cases. They may occur if the tumor is extremely aggressive, if there is disruption of the blood supply to the bone, or if there is significant marrow involvement, particularly in a vertebral body. Some of the common causes of a photopenic lesion are avascular necrosis, malignant bone tumors such as multiple myeloma, metastasis, radiation therapy, attenuation artifacts such as prosthesis or pacemaker, and early osteomyelitis. A case of hemangioma of the dorsal vertebra, a rare cause of photopenic lesion, is reported here.

Topics: Aged; Bone Neoplasms; Hemangioma; Humans; Lung Neoplasms; Male; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Adult; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Radionuclide Imaging; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae; Tomography, X-Ray Computed

Topics: Adult; Humans; Lymphoma; Magnetic Resonance Spectroscopy; Male; Radiography; Radionuclide Imaging; Spinal Neoplasms; Spine; Technetium Tc 99m Medronate

Over the past 6 years, the authors evaluated 300 patients with hepatoma as part of phase 1 and 2 treatment protocol trials. Analysis of the available clinical data and radiographic studies revealed 22 patients (7.3%) with skeletal metastases demonstrated by radiography, computed tomography (CT), and/or nuclear scintigraphy. The plain film appearance of skeletal metastases from hepatoma was osteolytic in all cases. CT scanning best demonstrated the expansile, destructive nature of these metastases, which were often associated with large, bulky soft-tissue masses. Skeletal metastases from hepatomas demonstrated increased radiotracer uptake on standard bone scans and were gallium avid, similar to the hepatoma itself. In addition, they could be targeted therapeutically with I-131 antiferritin immunoglobulin. The most frequent sites of skeletal metastases were the ribs, spine, femur, pelvis, and humerus. An initial symptom in ten patients was skeletal pain corresponding to the osseous metastases. In five patients, pathologic fractures of the proximal femur or humerus developed and required total hip replacement or open-reduction internal fixation. Patients with long-standing cirrhosis or known hepatocellular carcinoma who also have skeletal symptoms should be evaluated for possible osseous metastases.

Topics: Adult; Aged; Bone Neoplasms; Carcinoma, Hepatocellular; Female; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Liver Neoplasms; Male; Middle Aged; Radiography; Radionuclide Imaging; Ribs; Spinal Neoplasms; Technetium Tc 99m Medronate

Topics: Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteoporosis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium Tc 99m Medronate; Thoracic Vertebrae

In a patient with synovial sarcoma, routine bone survey showed no abnormality, while bone marrow scintigraphy with Tc-99m sulfur colloid revealed a defect in the fifth lumbar vertebra. At surgery, tumorous invasion was noted in the fifth lumbar vertebra and the surrounding tissues. It was suggested that the bone marrow scintigraphy was particularly useful in the detection of tumorous invasion into the bone marrow at the early stage before the destruction of skeletal tissue.

Topics: Adolescent; Bone Marrow; Diphosphonates; Foot Diseases; Humans; Lumbar Vertebrae; Male; Neoplasm Metastasis; Radionuclide Imaging; Sarcoma, Synovial; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

A comparison is made between the sensitivity of detection of focal abnormalities in radionuclide bone images by visual examination and by using simple quantification. The quantitative method calculates the ratio of radiopharmaceutical uptake in a region of interest drawn around a lesion to that in an area of normal bone. Quantification is found to be far more sensitive than visual examination in detecting focal metastases. The use of "baseline" images improved the precision of quantitation of rib lesions, but appeared not to alter the sensitivity of visual detection. This method of quantification is therefore limited more by the inability of observers to notice suspicious areas to which it should be applied than by inaccuracies inherent in the method itself. Further work should concentrate more on image enhancement than on improving quantitative techniques.

Topics: Bone Neoplasms; Breast Neoplasms; Diphosphonates; Female; Humans; Radionuclide Imaging; Ribs; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

The uptake of [99mTc]MDP in metastatic lesions of the vertebrae was compared with the uptake in normal vertebrae. The ratio of these lesion-to-nonlesion uptakes at 4 and 24 hr was called the 24-hr/4-hr ratio (TF ratio). A similar ratio was measured for lesions in the spine due to degenerative bone disease. Lesions in vertebrae with degenerative bone disease and treated metastases had a significantly lower TF ratio than lesions in vertebrae with untreated bone metastases. These findings suggest that the TF ratio might be a reliable method for separating metastatic lesions from degenerative changes in the vertebral column, and could be especially useful in cancer patients whose bone scans demonstrate a single lesion in the spine.

Topics: Adult; Aged; Diphosphonates; Female; Humans; Male; Middle Aged; Osteoarthritis; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Spinal Osteophytosis; Technetium; Technetium Tc 99m Medronate; Time Factors

This report describes the bone-scan appearance of significantly increased activity in a lumbar transverse process of a 15-year-old boy; we believe it represents a normal variant related to the secondary ossification center.

Topics: Adolescent; Diagnosis, Differential; Diphosphonates; Humans; Lumbar Vertebrae; Male; Ossification, Heterotopic; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A patient in whom metastatic medullary thyroid cancer was diagnosed underwent a scintigraphic examination using [131I]MIBG. Multiple hot lesions and diffuse hepatic uptake were noted corresponding to bone and liver metastases. Iodine-131 MIBG may prove to be useful for scintigraphic localization and for the treatment of medullary thyroid cancer as in pheochromocytoma and neuroblastoma.

Topics: 3-Iodobenzylguanidine; Diphosphonates; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Diphosphonates; Humans; Lumbar Vertebrae; Magnetic Resonance Spectroscopy; Radionuclide Imaging; Spinal Diseases; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

One of the explanations of a cold lesion on static bone imaging is the presence of an aggressive, destructive lesion. This is the first reported case of such a lesion with an aggressive nature that was confirmed by abnormal flow and pool images.

Topics: Adenocarcinoma, Bronchiolo-Alveolar; Aged; Diphosphonates; Female; Humans; Lung Neoplasms; Radionuclide Imaging; Sacrum; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

The double-density sign, seen on radionuclide bone scans, is described for diagnosing osteoid osteomas and for localizing the nidus. Its use in differentiating the nidus of an osteoid osteoma from osteomyelitis is also described. The utility of computed tomography in localization of the nidus is also illustrated. The double-density sign was helpful in diagnosing seven cases of surgically confirmed osteoid osteoma.

Topics: Adolescent; Adult; Bone Neoplasms; Diphosphonates; Female; Femoral Neoplasms; Humans; Humerus; Male; Osteoma, Osteoid; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

Twenty patients with known metastatic cancer or high-risk primary cancer developed new lesions on Tc 99m bone scans and had normal plain radiographs. Spinal computed tomography (CT) was performed on all new bone-scan-positive lesions in minimal examination time. Fifteen patients had extensive metastatic vertebral disease and received local radiotherapy. One patient with new metastatic vertebral disease on CT was treated only with chemotherapy and developed acute spinal cord compression. Four patients had discogenic disease or degenerative disease but no evidence of metastases. Radionuclide bone scans are more sensitive but less specific than plain radiographs in detecting early bone metastases. Early and accurate diagnosis of metastasis is particularly important in the axial spine to prevent epidural compression and fracture. Spinal CT is valuable for identifying the presence and extent of vertebral metastases, as well as the presence of benign disease in cancer patients.

Topics: Diphosphonates; Female; Humans; Male; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Adult; Diphosphonates; Humans; Lumbar Vertebrae; Male; Osteoma, Osteoid; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, Emission-Computed

A 24-year-old man with persistent low back pain and right sciatica, was found to have an osteoid osteoma of the right pedicle of the second lumbar vertebra. 99mTc-MDP bone scan and CAT scan produced an early diagnosis of the lesion. Intraoperative 99mTc-MDP in vitro combined with imaging and quantitative activity measurements were useful for accurate localization and complete removal. The method is simple and can be performed in every nuclear medicine department, with no need for special operating room facilities.

Topics: Adult; Diphosphonates; Humans; Intraoperative Care; Male; Osteoma, Osteoid; Preoperative Care; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

A circumscript accumulation of 99mTc-MDP in the spine of a patient, presenting with back pain and negative radiographs, was histologically confirmed to be an osteoid osteoma. As radiological procedures failed to localize the lesion, this was accomplished by means of posterior and lateral view bone scintigrams as well as by single photon emission tomography. The role of scintigraphy in patients suspected of having osteoid osteoma and the possibility of localizing the lesion before and during surgical intervention are underlined.

Topics: Adult; Diphosphonates; Humans; Male; Methods; Osteoma, Osteoid; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Focal uptake was seen in the cervical vertebral column of 61 patients in the course of routine bone scintigraphy. These focal increases were subjected to close analysis. In 60 of these patients (98.4%) degenerative lesions became manifest as the cause of the scintigraphic finding already by the bone scintigraphy pattern (paravertebral localisation in the posterior projection and dorsal localisation in the lateral. Two typical examples of metastatic changes are presented to facilitate differentiation. The bone scintigraphic pattern in arthrosis of the intervertebral joint is so typical that x-ray control examinations to confirm the diagnosis can be omitted in many cases.

Topics: Aged; Cervical Vertebrae; Diagnosis, Differential; Diphosphonates; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

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

Topics: Aged; Diagnosis, Differential; Diphosphonates; Female; Hemangioma; Humans; Male; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

A case of chondrosarcoma of the spine in a 45-year-old woman is described. The bone scan performed after the intravenous injection of Tc-99m-MDP not only confirmed the solitary nature of the tumor, but also demonstrated its extent within the spinous process of the second dorsal vertebra. Preoperative bone scan in the management of chondrosarcoma is advocated as a safe, noninvasive technique for assessing the extent of the tumor.

Topics: Chondrosarcoma; Diphosphonates; Female; Humans; Middle Aged; Radiography; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate

Two cases are described in which there was absence of uptake in hemivertebra on a Tc-99m methylene diphosphonate bone scan. In one of these patients, the bone image had been normal 56 days previously. Radiographs of the vertebrae were normal in both cases. Data are presented suggesting that the findings can most probably be explained in terms of compromise of blood supply to the hemivertebra; each half of a vertebra usually has a separate arterial contribution.

Topics: Aged; Child; Child, Preschool; Diagnosis, Differential; Diphosphonates; Humans; Male; Radiography; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Thoracic Vertebrae

Topics: Diphosphonates; Humans; Male; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Tomography, X-Ray Computed