technetium-tc-99m-medronate and Thalassemia

We report the case of a 45-year-old man with thalassemia major referred for a bone scan as a workup for generalized bone pain. Tc-MDP SPECT CT showed multiple elongated soft tissue masses along the inner aspects of ribs and along both sides of dorsal spine with calcification and mild tracer uptake. There was also a large lobulated presacral soft tissue mass displacing the bladder and involving the adjacent pelvic bone. Biopsy of mildly avid tracer uptake in pelvic soft tissue mass was extramedullary hematopoiesis confirmed by biopsy.

Topics: Biological Transport; Biopsy; Hematopoiesis, Extramedullary; Humans; Male; Middle Aged; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Thalassemia

The kinetics of 99mTc(Sn) methylene diphosphonate [99mTc(Sn)MDP] were evaluated by means of compartmental analysis in 5 normal children and 17 thalassemic subjects. Blood and urine activity were analyzed with a computer program which generates intercompartmental rate constants by an iterative least-square method providing a best-fit to the input data. The amount of tracer in each compartment (corrected for decay) was determined as a function of time. The transfer rate of 99mTc(Sn)MDP from blood to extracellular fluid and lamellar bone (K1-3) was about 20% higher in thalassemic subjects than in normal children. The transfer rate of 99mTc(Sn)MDP from blood to woven bone (K1-4) was about 57% higher in thalassemic subjects. A faster rate of spread into woven bone appears to be the major cause of higher bone uptake of 99mTc(Sn)MDP in thalassemic subjects, which suggests that in these patients bone tissue reoccupies the space previously replaced by hyperplastic marrow. Moreover, the increased bone extraction rate revealed a correlation between anemia and bone metabolic activity.

Topics: Adolescent; Blood Transfusion; Bone and Bones; Child; Humans; Image Processing, Computer-Assisted; Radionuclide Imaging; Technetium Tc 99m Medronate; Thalassemia

The osteoarticular complications of drepanocytosis-thalassemia (DT) include: 1) bone infarction, or avascular necrosis (AVN), common at all ages; 2) acute septic arthritis and hematogenous osteomyelitis, that usually affect infants and children. Early diagnosis and treatment of the osteoarticular infectious complications is imperative, to maximize the chances of a favorable outcome, and to prevent the sequelae, ie pathological fractures, chronic osteomyelitis. Early roentgenographic features of involved areas are similar in acute osteomyelitis and in AVN--both of which cause painful bone crises, so as to make osteomyelitis (OM) a diagnostic challenge. Four cases of DT are reported. The patients, 17 to 37 years old, presented with bone infarcts. One of them (the youngest) had also multiple osteomyelitis of long bones. The 99m-Tc-MDP bone scans, performed only on the youngest patient, affected by OM, revealed increased uptake in both AVN and in OM locations, without differential diagnostic features. After a review of the literature, a diagnostic protocol is suggested, based on 99m-Tc colloid marrow scintigraphy for the early differential diagnosis between acute OM (normal or slightly-increased uptake), chronic OM (markedly increased uptake), and AVN (decreased uptake). Furthermore, MR imaging is stressed as the most promising tool, in the next future, for this kind of differential diagnosis.

Topics: Adolescent; Adult; Anemia, Sickle Cell; Arthritis, Infectious; Bone and Bones; Diagnosis, Differential; Humans; Infarction; Joint Diseases; Osteomyelitis; Radionuclide Imaging; Technetium Tc 99m Medronate; Thalassemia; Tomography, X-Ray Computed

Topics: Adolescent; Bone and Bones; Child; Humans; Kinetics; Radionuclide Imaging; Technetium Tc 99m Medronate; Thalassemia

Topics: Adult; Anemia, Sickle Cell; Diphosphonates; Female; Humans; Radionuclide Imaging; Spleen; Technetium; Technetium Tc 99m Medronate; Thalassemia