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

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

Topics: Abdominal Pain; Aged; beta-Thalassemia; Diagnosis, Differential; Hematopoiesis, Extramedullary; Humans; Lumbosacral Region; Lymphoma; Male; Mononuclear Phagocyte System; Spine; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Aged; Diagnosis, Differential; Female; Hematopoiesis, Extramedullary; Humans; Liver; Lymphoma; Radiopharmaceuticals; Spleen; Splenic Diseases; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

In 63 patients with primary extramedullary malignant lymphoma or plasmacytoma, a study was performed in order to evaluate bone marrow involvement. All patients underwent a 99mTc microcolloid bone marrow whole body imaging (scintigraphy), using a gamma camera interfaced with a computer, followed by nuclear magnetic resonance bone marrow imaging (MRI), (1.5 Tesla). MR images were made of the lumbosacral region, the pelvic region, both femoral and other parts of the skeleton, according to focal lesions in the scintigraphy. A posterior iliac crest bone marrow biopsy was used as a standard reference. In the present study, both scintigraphy and MRI showed a dissiminated or focal involvement or a combination of both. In 53 of the 63 patients (84%) the results were in accordance. Pathological MR signals or pathological findings in scintigraphy did not always correspond to tumorous bone marrow involvement, and were shown to reflect reactive changes in the central part of the skeleton in combination with a periphery radionuclide extention interpreted as a periphery compensatory hematopoietic proliferation. The negative predictive value of scintigraphy and MRI was 92% and 100%, respectively. When combining the results of both examinations, the positive predictive value increased from 49% to 58%, if the bone marrow biopsy is accepted as gold standard. The results indicate that bone marrow investigation performed simultaneously using scintigraphy and MRI is superior both to the use of either of the methods alone and to the traditional iliac crest bone marrow biopsy.

Topics: Adolescent; Adult; Aged; Bone Marrow; Bone Marrow Diseases; Female; Humans; Lymphoma; Magnetic Resonance Imaging; Male; Middle Aged; Plasmacytoma; Predictive Value of Tests; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Whole-Body Counting

Topics: Adolescent; Adult; Aged; Female; Humans; Lymph Nodes; Lymphography; Lymphoma; Male; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Three clinically unsuspected malignant pericardial effusions were discovered during routine dynamic hepatic scintigraphy. The only common clinical feature shared by the patients was dyspnea. Static scintigrams alone would not have detected these effusions, which points out again the importance of including dynamic scintigraphy in routine radionuclide evaluations of the liver.

Topics: Aged; Breast Neoplasms; Female; Humans; Liver; Lung Neoplasms; Lymphoma; Male; Middle Aged; Pericardial Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A patient exhibited an unusual constellation of findings: His extraosseous lymphoma sequestered [99mTc]MDP, a bone-seeking agent, while at the same time it appeared to produce a factor that caused hypercalcemia. The dispersed lymphoma cells took up more [99mTc]MDP in vitro than did cultured lymphoblasts suggesting that the in vivo sequestration may have been, at least in part, an active intracellular process.

Topics: Cells, Cultured; Diphosphonates; Humans; Hypercalcemia; Liver; Liver Neoplasms; Lymphocytes; Lymphoma; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

A 70 year old woman had a [99mTc]sulfur colloid liver/spleen scan that showed splenomegaly and multiple intrasplenic defects. The lesions failed to concentrate radiogallium. Thirteen days later, after being on steroid therapy, the spleen had decreased in size and the lesions were only barely apparent. The intrasplenic process, due to non-Hodgkin's lymphoma, was thus markedly sensitive to steroids. It is uncertain if such rapid regression can be employed as a prognostic indicator in non-Hodgkin's lymphoma and suggests the need for further monitoring. The differential diagnosis of the rapid response of intrasplenic lesions to steroids is a limited one, and likely includes sarcoidosis.

Topics: Aged; Female; Gallium Radioisotopes; Humans; Lymphoma; Methylprednisolone; Methylprednisolone Hemisuccinate; Radionuclide Imaging; Splenic Neoplasms; 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

The scintigraphic findings from eight patients who underwent splenectomy for splenomegaly secondary to diffuse large-cell lymphoma are described. Large focal photopenic areas were found in all cases, either solitary or multiple. The appearance is relatively typical for large-cell lymphoma, which should be strongly considered in a nontraumatized patient who presents with painful splenomegaly of unknown origin.

Topics: Diagnosis, Differential; Humans; Liver; Lymphoma; Radionuclide Imaging; Spleen; Splenectomy; Splenic Neoplasms; Splenomegaly; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

We recently evaluated a patient with a huge asymptomatic abdominal mass which eventually proved to be an ectopic spleen. Pathology revealed a well-differentiated lymphoma involving the entire spleen and hilar nodes. Before her operation, a series of radiographic procedures was carried out which demonstrated the nature of the mass. The radiographic findings and diagnostic modalities used to establish the diagnosis form the basis of this report.

Topics: Aged; Diagnosis, Differential; Female; Humans; Lymphoma; Radiography; Spleen; Splenectomy; Splenic Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

The difficulty of clinical and radiographical diagnosis of hepatoma is discussed. A case of hepatoma is reported. Both the primary tumor and distant metastases showed strong avidity for 99mTc-HIDA, which normally is concentrated by parenchymal cells of the liver. The potential of using 99mTc-HIDA for the noninvasive investigation of patients suspected of having hepatoma is discussed. The association between tumor avidity for 99mTc-HIDA and the bile-forming ability of tumor cells is of interest.

Topics: Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Gallium Radioisotopes; Hemangioma; Humans; Imino Acids; Iodine Radioisotopes; Liver; Liver Neoplasms; Lung Neoplasms; Lymphoma; Male; Radionuclide Imaging; Rose Bengal; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

In routine Tc-99m sulfur colloid (SC) liver-spleen imaging, relatively increased splenic uptake when compared with liver uptake is frequently seen. Commonly this is due to decreased hepatic uptake secondary to liver disease, but often it is because of increased uptake in the hyperfunctioning spleen. Reported is a case of lymphoma of the tonsil, with a "hot" spleen which was free of tumor. Possible etiology of the "hot" spleen is discussed and the known causes listed according to their prevalence.

Topics: Adult; Humans; Liver; Lymphoma; Male; Radionuclide Imaging; Spleen; Splenic Neoplasms; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tonsillar Neoplasms

Two hundred six technetium-99m sulfur colloid bone marrow scans in 110 pediatrics patients were reviewed. The normal distribution of sulfur colloid in the lower extremities in various age groups was established. There was progressive loss of uptake with increasing age from less than two years to greater than ten years. Tumor replacement was seen as regions of decreased radioactivity, and the extent of the scan defect paralleled the response of the disease to therapy. Both chemotherapy and irradiation resulted in an extension of the Tc-99m SC to peripheral marrow sites. In irradiated areas, marrow scan defects were demonstrated and generally recovered normal activity by six months after the completion of therapy. Marrow scan abnormalities caused by tumor replacement were present in four patients despite normal bone scans and radiographs. Ultimate confirmation of tumor involvement was by needle aspiration or biopsy. Persistent marrow defects were seen in two patients with neuroblastoma who had remission of their disease: biopsy revealed myelofibrosis. Technetium-99m sulfur colloid bone marrow scanning is a sensitive monitor of altered marrow activity associated with pediatric hematologic or oncologic diseases.

Topics: Bone Marrow; Child; Child, Preschool; Hodgkin Disease; Humans; Lymphoma; Neoplasms; Neuroblastoma; Prospective Studies; Radionuclide Imaging; Reference Values; Sarcoma, Ewing; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Wilms Tumor

Topics: Colloids; Gold Radioisotopes; Humans; Lymph Nodes; Lymphoma; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A patient with postpolycythemic myeloid metaplasia developed an enlarging abdominal mass documented on TCT scanning. To distinguish between lymphoma and extramedullary hematopoiesis, marrow elements were imaged with indium-111 chloride and technetium-99m sulfur colloid. Because the mass failed to accumulate either tracer, a presumptive diagnosis of lymphoma was made and exploratory surgery was performed. The excised mass was found to consist of enlarged lymph nodes containing extramedullary hematopoiesis. Caution should be exercised in the use of In-111 or Tc-99m SC bone-marrow scans to diagnose sites of extramedullary hematopoiesis.

Topics: Bone Marrow; Diagnostic Errors; Hematopoiesis; Humans; Indium; Lymphoma; Male; Middle Aged; Primary Myelofibrosis; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Thirty seven patients with lymphomatous disease were studied to detect abdominal lymph nodes involvement by means of lymph nodes scan with 99Tcm-sulfur-microcolloid, ultrasounds scans, lymphangiographies. Lymphangiography was considered as reference standard in patients which explorative laparotomy was not performed in. Isotopic method demonstrated high sensitivity, despite low specificity. Opposite results were obtained by ultrasounds. We concluded that isotopic abdominal lymph nodes scan is a clinically valuable test, if negative, while ultrasounds are, if positive. Both methods, specially if associated, proved quite useful in restaging after therapy, where important parameters are low risk and stress for the patients, easy execution, low costs.

Topics: Aged; Female; Hodgkin Disease; Humans; Lymph Nodes; Lymphoma; Middle Aged; Neoplasm Staging; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tomography; Ultrasonography