technetium-tc-99m-sulfur-colloid and Anemia--Aplastic

Bone marrow aspiration and biopsy are excellent techniques for evaluating bone marrow, but this evaluation is limited to a small part of the total blood-forming organ. With the introduction of radionuclide bone marrow imaging, a simple technique became available that overcomes marrow sampling errors by giving a total body view of functioning marrow. Furthermore, the procedure is noninvasive and provides an atraumatic method for evaluating a number of clinical problems including a discrepancy between bone marrow histology and clinical status (possible marrow sampling error), the determination of amount of active marrow after radiation and chemotherapy when further therapy is being considered, detection of sites of extramedullary hematopoiesis, location of the optimal sites for bone marrow biopsy, the diagnosis and staging of diffuse hematologic disorders, detection of metastases, the diagnosis of bone marrow infarcts in hemolytic anemias, and detecting avascular necrosis of the femoral heads. There are two major classes of bone marrow agents: (1) those that are incorporated into the erythroid precursors such as radioiron and (2) colloids that are taken up by the reticuloendothelial system (RES). Indium-111 chloride was originally considered to be an erythropoietic agent but appears to share some properties of RES labels. The best label to use is dependent on the disease being evaluated.

Topics: Anemia, Aplastic; Anemia, Hemolytic; Anemia, Sickle Cell; Bone Marrow; Bone Marrow Diseases; Bone Neoplasms; Erythropoiesis; Femur Head Necrosis; Gold Colloid, Radioactive; Hematopoiesis; Humans; Indium; Iron Radioisotopes; Leukemia; Lymphoma; Mononuclear Phagocyte System; Polycythemia; Primary Myelofibrosis; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

To diagnose equivocal aplastic anemia(AA) patients by the combination of clinical data and bone marrow scintigraphy.. Bone marrow scintigraphy using 99mTc-sulfer colloid 370-550 MBq was analysed in 47 patients, including 28 cases of AA, 12 of myelodysplastic syndromes(10 MDS-RA and 2 MDS-RAEB) and 7 of AA-PNH syndrome.. Pancytopenia, hypercellular bone marrow associated with uneven disappearance of marrow image or focal hematopoiesis were found in 28 AA and 2 of 30 MDS-RA cases. Marrow imaging showed uneven low accumulation of radioactivity in 12 and focal patterns in 18 patients. Normal or high activity and expanded periphery of bone marrow was found in MDS patients (8 RA and 2 RAEB cases). Changes of activity and distribution of bone marrow during the transforming course were noticed in 4 AA-PNH syndrome patients.. Patch distribution and focal hemopoiesis is the outstanding features of AA marrow. The imaging features as well as expanded manner and increased activity of bone marrow are helpful to the differential diagnosis, evaluation of clinical status and explanation of marrow aspirate results.

Topics: Adolescent; Adult; Anemia, Aplastic; Bone Marrow; Child; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Myelodysplastic Syndromes; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Aplastic anaemia affects the entire bone marrow. Current methods of assessment of bone marrow function, like bone marrow biopsy or peripheral blood examination are either invasive or inadequate and cannot be expected to represent fully the changes in the entire bone marrow tissue. This prospective study was undertaken to develop and standardise a new Nuclear Medicine technique called 'Dynamic Bone marrow Imaging'. Eleven patients and ten controls were studied. Serial images of the pelvis were obtained in frame mode following intravenous injection of 185-370 mBq of 99mTc S. Colloid, and an index, called the Bone Marrow Uptake Index (P) was calculated by taking into consideration the time activity curve obtained over the iliac crest. This was followed by static imaging of the entire bone marrow in all cases. It was possible to obtain excellent information regarding topographic distribution of bone marrow as well as detect early changes in bone marrow function following treatment. An attempt was also made to correlate bone marrow cellularity as obtained by bone marrow biopsy with the results of dynamic bone marrow scintigraphy. On the basis of the encouraging results obtained in the present study, the authors feel that dynamic bone marrow imaging is an excellent technique for the objective evaluation of bone marrow in aplastic anaemia. Aplastic anaemia affects the entire bone marrow tissue. Although much progress has been made in the management of this disease, many aspects of it await better understanding. There is almost total lack of knowledge regarding the distribution of functioning marrow in various phases of aplastic anaemia, such as in relapse and remission. Current methods of assessment of marrow function rely mainly on bone marrow biopsy and peripheral blood examination. Bone marrow biopsy is invasive and cannot be expected to represent fully the changes in the entire tissue. Changes in peripheral blood picture lag behind the changes in the bone marrow. Thus, there is a need for an investigation which is safe, simple, sensitive, non invasive and capable of assessing the global function of bone marrow. Radio-nuclide imaging of bone marrow requires labelling of one or more components of this widely dispersed tissue. The reticuloendothelial and erythropoietic components can be labelled with radio-colloids and radio-iron respectively. Experimental studies have shown that the reticuloendothelial and erythropoietic elements are invariably found together

Topics: Adolescent; Adult; Anemia, Aplastic; Bone Marrow; Humans; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds

Bone marrow scintigraphy was performed in 29 patients with hemopoietic depletion states of various etiology. Two tracers were used for visualization of the marrow: 99mTc-sulphur-colloid and 111InCl3, some patients being examined by both indicators. 111InCl3 is bound on transferrin and is adsorbed on the surface of reticulocytes and erythroblasts). The scintillation camera PHO GAMMA SEARLE IV fitted with moving table and computer CLINCOM was used, so that whole body images were obtained. The comparison of all scans and marrow puncture smears was done. In patients with aplastic anemia with both hyperplastic or hypoplastic marrow good correlation of bone marrow scans and sternal puncture smears was found. In several cases the scintigraphic examination helped to establish a diagnosis of marrow depletion state. A peculiar disadvantage of the imaging method with either 99mTc-sulphur-colloid or 111InCl3 is that it shows the disorders in erythropoietic and reticuloendothelial cells, whereas the defects in myelopoietic cell series and platelet precursors are not provable. According to literature data, great attention is paid to the prognostic value of scintigraphic examination in aplastic anemia.

Topics: Adult; Anemia, Aplastic; Bone Marrow; Bone Marrow Diseases; Humans; Indium; Male; Middle Aged; Primary Myelofibrosis; Radioisotopes; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Anemia, Aplastic; Bone Marrow; Humans; Leukemia; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid