technetium-tc-99m-sulfur-colloid and Leukemia

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

This study aimed to confirm localized residual leukaemia in the abnormal expanded peripheral bone marrow (e-PBM) of the extremities using Tc-sulfur colloid imaging and bone marrow aspirations.. Whole-body bone marrow scintigraphy was performed in 420 adult and 48 childhood leukaemia patients using Tc-sulfur colloid (370 MBq). Central bone marrow (CBM) from the iliac crest and e-PBM from the proximal epiphyseal line of the tibia were aspirated at the time of routine examination and compared.. The expansion rate of the PBM in the non-remission stage of acute leukaemia was 73.1%, and it decreased to 38.4% in the complete remission stage. The most common site of PBM expansion was the epiphysis of the knee joint (74.5%). Cytological examination of the e-PBM at the complete remission stage revealed 30.9% localized residual leukaemia. The complete remission period (69+/-23 days) of PBM expansion was significantly greater than that of CBM depletion (43+/-31 days) (P<0.01). Localized residual leukaemia of the e-PBM could not be detected in the childhood acute leukaemia patients and in the patients without e-PBM. The difference in the relapse rate and time was statistically significant between patients with e-PBM (29.1%) and without e-PBM (3.5%) (P<0.01).. These findings suggest that induction chemotherapy does not always have a synchronous and parallel effect on CBM and PBM. The e-PBM is less sensitive to chemotherapy and can easily exist in localized residual leukaemia. The detection of residual leukaemia in the e-PBM by bone marrow scintigraphy is very important in the treatment of leukaemia.

Topics: Adolescent; Adult; Bone Marrow Neoplasms; Extremities; Female; Humans; Leukemia; Male; Middle Aged; Neoplasm Recurrence, Local; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid

Topics: Acute Disease; Adolescent; Adult; Bone Marrow; Female; Humans; Leukemia; Male; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The concentration of granulocyte-macrophage colonies in culture (CFU-c) in bone marrow cells was estimated, and bone marrow radionuclide scans were performed in a group of 15 cancer patients prior to bone marrow harvest for autologous transplantation. Preharvest CFU-c counts on iliac-crest bone marrow aspirates correlated very well with CFU-c counts from fresh and frozen-thawed bone marrows. Technetium-99m-sulfur colloid radionuclide scans showed that the distribution of total-body bone marrow and increased peripheral radionuclide uptake correlated with higher preharvest and harvest CFU-c counts. Bone marrow scan results were available in 1 h, whereas CFU-c counts took 14 days to obtain. Bone marrow scans may facilitate the clinical estimation of hemopoietic activity in patients under consideration for autologous bone marrow transplantation.

Topics: Bone Marrow; Breast Neoplasms; Carcinoma, Small Cell; Colony-Forming Units Assay; Hematopoiesis; Humans; Leukemia; Lung Neoplasms; Lymphoma; Male; Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Testicular Neoplasms

Four children with acute leukemia and surgically documented candidiasis of the liver and/or spleen were examined with a combination of diagnostic imaging modalities including 99mTc-sulfur colloid and 67Ga-citrate scintigraphy, gray-scale ultrasound, and body computed tomography (CT). Abnormalities were detected in every individual examined. 99mTc-sulfur colloid scintigraphy revealed "cold" areas in the liver or spleen. With 67Ga scintigraphy, these areas were "cold" in some individuals and "hot" in others. Gray-scale ultrasound demonstrated hypoechoic lesions with central areas of increased echogenicity in hepatic involvement, and hypoechoic replacement of the spleen in splenic involvement. CT in one patient revealed low-density areas without contrast enhancement within the hepatic parenchyma and unsuspected renal involvement.

Topics: Adolescent; Candidiasis; Child, Preschool; Female; Gallium Radioisotopes; Humans; Infant; Leukemia; Liver Abscess; Male; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

A 43-year-old man with acute undifferentiated leukemia developed high fever and stomatitis followed by severe abdominal pain after completion of a first course of chemotherapy. A 99mTc-sulfur colloid (SC) scan showed multiple, irregular defects in an enlarged spleen. A 67Ga-citrate scan showed uniform tracer distribution except for a large defect in the upper portion of the spleen. The size of the spleen in the 67Ga-scan was much larger than in the SC scan. At surgery an abscess cavity was found between the spleen and the greater gastric curvature with multiple smaller abscesses on the splenic capsule and throughout the splenic parenchyma. A hematoma was present in the upper pole of the spleen. The disparate splenic size and seemingly discordant distribution patterns of tracer in the 99mTc- and 67Ga-scans were fully explained by histopathological study of the surgically resected spleen.

Topics: Abscess; Acute Disease; Adult; Aspergillosis; Gallium Radioisotopes; Humans; Leukemia; Male; Radionuclide Imaging; Splenic Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Three patients had chest radiographs suggesting pathology associated with the right hemidiaphragm. The patients' histories included trauma in one case, recently diagnosed leukemia in a second, and Hodgkin's disease in the third. In all three cases, the Tc-99m-sulfur colloid liver scan provided a noninvasive identification of the nature of the diaphragmatic densities seen on the chest radiographs, thus affecting patient management.

Topics: Adolescent; Diagnosis, Differential; Diaphragm; Female; Hodgkin Disease; Humans; Leukemia; Liver; Male; Middle Aged; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Wounds and Injuries

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