18F-FDG PET/CT and 99mTc-MDP Bone Scintigraphy Findings of Multifocal Desmoid Fibromatosis.

ABSTRACT: Desmoid fibromatosis, also called desmoid tumors, is a group of locally aggressive fibromatous proliferative disorders. They represent less than 3% of all soft tissue sarcoma and are multifocal in approximately 10% of cases. However, there are only a few cases in the literature describing 18F-FDG PET/CT and 99mTc-MDP bone scan features of extra-abdominal desmoid fibromas, and all were solitary bone lesions. Herein, we presented a unique case of multifocal desmoid fibromatosis of bone illustrating the prospective value of 18F-FDG PET/CT and 99mTc-MDP bone scan in the evaluation of desmoid tumors.

Extraosseous distribution of 99mTc-diphosphonates during bone scintigraphy: review of the literature with case series presentation.

PURPOSE: Technetium-99m (99mTc)-diphosphonates represent the most common radiopharmaceutical used for bone scintigraphy. Even if the uptake in bone tissue has been widely explored, atypical uptake could be seen in soft tissue malignancies during bone scintigraphy. Increased vascularization and endothelium permeability represent front-row players in the biodistribution of the tracer, albeit other causes have been identified such as trauma, necrosis, the presence of calcification in metastasis, the pH of the tissue and consequently the type of ion concentration. CONCLUSION: The aim of this paper is to summarize the state of art of atypical soft tissue uptake seen in cancer tissues. The research was conducted on PubMed. The analysis of the literature suggests that calcium metabolism and ionic saturation have a pivotal role in the biodistribution of bone tracers. This phenomenon ranks in a complex scenario that includes carcinogenesis and cancer environment aspects. We also report two cases in our Institution in which atypical uptake in cancer tissues was observed.

Fibrous Dysplasia With Atypical Bilateral Upper Extremity Pattern.

ABSTRACT: Fibrous dysplasia (FD) typically presents unilaterally in the lower limbs, or in the skull, mandible, or pelvis. Bilateral presentation is rarely reported. Most cases are diagnosed in the teens with 75% of patients diagnosed before the age of 30 years. In this case, a 63-year-old woman with suspected diagnosis of malignancy was referred to 99mTc-MDP scan and found to have polyostotic FD in bilateral upper extremities. Nuclear medicine can play an important role in diagnosing FD cases with atypical presentation and help risk stratification for more aggressive transformation.

A Unique Case of Familial Expansile Osteolysis: Findings on 99mTc-MDP Bone Scan.

ABSTRACT: Familial expansile osteolysis is an exceedingly rare autosomal dominant bone dysplasia, which can have overlapping features with Paget disease and expansile skeletal hyperphosphatasia. We present a novel case of familial expansile osteolysis evaluated on 99mTc-MDP bone scan with correlative radiographs and CT.

Extraosseous Uptake and Multiple Metastases of Splenic Composite Hemangioendothelioma on 99m Tc-MDP Scintigraphy.

ABSTRACT: Composite hemangioendothelioma is a rare disease that exhibits biological potency ranging from benign to low-grade malignancy, and hepatic and bone metastases are even rarer. Here, we present the imaging findings of a 65-year-old man with splenic composite hemangioendothelioma and multiple metastases. A bone scan revealed abnormal uptake of 99m Tc-MDP in multiple bones and spleen, whereas enhanced CT demonstrated splenic lesions with low density and mild enhancement. Based on pathological examination, the patient was diagnosed with splenic composite hemangioendothelioma with bone metastasis.

Diagnostic Utility of 99m Tc-MDP Bone Scintigraphy for Nivolumab-Induced Inflammatory Arthritis.

ABSTRACT: Immune checkpoint inhibitors can revive exhausted helper T-cells, and inflammatory cell reactivation may cause autoimmune disease-like conditions. Drug-induced arthritis is an immune-related adverse event, but the diagnostic approach is undefined. We present the diagnostic utility of 99m Tc-MDP bone scintigraphy for nivolumab-induced inflammatory arthritis. A 67-year-old man with hypopharyngeal carcinoma presented bilateral multiple metacarpophalangeal joint pain and swelling at each nivolumab administration. Regular imaging findings were atypical for inflammatory arthritis and did not fulfill the criteria for rheumatoid arthritis. We diagnosed nivolumab-induced inflammatory arthritis based on clinical symptoms and the symmetrical moderate uptake of the affected joints on 99m Tc-MDP bone scintigraphy.

Radiopharmaceutical extravasation in bone scintigraphy: a cross-sectional study.

OBJETIVES: Tc-99m Hydroxymethylene diphosphonate (HMDP) bone scintigraphy is commonly used to diagnose bone disorders. We aimed to quantify and characterize the occurrence of radiopharmaceutical extravasation in bone scintigraphy, using Tc-99m HMDP, as well as to compare the visual classification of the events with an independent analysis using image processing software. METHODS: We conducted a cross-sectional study, using data from a total of 400 (9.1%) exams, randomly selected from all the procedures performed in 2018 in the Portuguese Institute of Oncology of Porto, Portugal. Prevalence estimate and the corresponding 95% confidence interval (CI) was computed for the presence of extravasation. Odds ratios and 95% CI were computed to quantify the association between demographic and clinical characteristics, and the occurrence of extravasation. RESULTS: The prevalence of Tc-99m HMDP extravasation was 26.5% (95% CI: 22.4-31.0). Those from an inpatient setting had almost seven-fold higher odds of extravasation than those from an outpatient setting. When the wrist was used for administration, there was three times more odds of extravasation when compared to the use of hand. There were statistically significant differences in the median scores of extravasations severity obtained from image processing software according to the different grades attributed by visual appreciation ( P  < 0.001). CONCLUSION: Tc-99m HMDP extravasation occurred in one out of four patients, being more frequent among those from an inpatient setting and when the wrist was used for administration. Visual appreciation of the extravasation seems to be acceptable to classify its severity.

Spectrum of technetium-99m methylene diphosphonate (99mTc MDP) uptake in Osteosarcoma.

Osteosarcoma is a frequently occurring primary skeletal malignancy in the adolescent population. It arises from primitive mesenchymal bone forming cells and frequently involves long bones near the metaphyseal growth plate. Multiple imaging modalities are used for complete staging workup at the time of presentation; including magnetic resonance imaging (MRI) for local disease extent, computed tomography (CT) scan to rule out pulmonary metastasis, and bone scan to look for distant osseous metastases. We present the case of a young boy with osteosarcoma of left tibia, showing additional findings on MDP bone scan acquired for initial staging work up.

Vertical Appearance of Urinary Bladder on Bone Scintigraphy Might Not Always Suggest Adjacent Pathology.

ABSTRACT: Previous publications suggested that vertical appearance of the urinary bladder on 99m Tc-MDP whole-body bone scintigraphy was likely due to an adjacent abnormality. Here we report bone scan findings of a vertical appearance of the urinary bladder in a 66-year-old man with lung cancer without corresponding pathology nearby.

Deep learning enhanced ultra-fast SPECT/CT bone scan in patients with suspected malignancy: quantitative assessment and clinical performance.

Objectives. To evaluate the clinical performance of deep learning-enhanced ultrafast single photon emission computed tomography/computed tomography (SPECT/CT) bone scans in patients with suspected malignancy.Approach. In this prospective study, 102 patients with potential malignancy were enrolled and underwent a 20 min SPECT/CT and a 3 min SPECT scan. A deep learning model was applied to generate algorithm-enhanced images (3 min DL SPECT). The reference modality was the 20 min SPECT/CT scan. Two reviewers independently evaluated general image quality, Tc-99m MDP distribution, artifacts, and diagnostic confidence of 20 min SPECT/CT, 3 min SPECT/CT, and 3 min DL SPECT/CT images. The sensitivity, specificity, accuracy, and interobserver agreement were calculated. The lesion maximum standard uptake value (SUVmax) of the 3 min DL and 20 min SPECT/CT images was analyzed. The peak signal-to-noise ratio (PSNR) and structure similarity index measure (SSIM) were evaluated.Main results. The 3 min DL SPECT/CT images showed significantly superior general image quality, Tc-99m MDP distribution, artifacts, and diagnostic confidence than the 20 min SPECT/CT images (P< 0.0001). The diagnostic performance of the 20 min and 3 min DL SPECT/CT images was similar for reviewer 1 (pairedX2= 0.333,P= 0.564) and reviewer 2 (pairedX2= 0.05,P= 0.823). The diagnosis results for the 20 min (kappa = 0.822) and 3 min DL (kappa = 0.732) SPECT/CT images showed high interobserver agreement. The 3 min DL SPECT/CT images had significantly higher PSNR and SSIM than the 3 min SPECT/CT images (51.44 versus 38.44,P< 0.0001; 0.863 versus 0.752,P< 0.0001). The SUVmaxof the 3 min DL and 20 min SPECT/CT images showed a strong linear relationship (r= 0.991;P< 0.0001).Significance.Ultrafast SPECT/CT with a 1/7 acquisition time can be enhanced by a deep learning method to achieve comparable image quality and diagnostic value to those of standard acquisition.

Unexpected Solitary Subcutaneous Metastasis From Esophageal Carcinoma Revealed by MDP Bone Scintigraphy.

ABSTRACT: A 60-year-old man with back pain underwent 99m Tc-MDP to evaluate bone metastases from newly esophageal carcinoma. No bone metastasis was found on the whole-body bone scan. Unexpectedly, subcutaneous metastasis revealed increased 99m Tc-MDP activity.

Alternative Isotope Options for Amyloidosis Imaging: A Technologist's Perspective.

The recent pyrophosphate shortages can limit the availability of 99mTc-pyrophosphate scans for cardiac amyloidosis. However, another radiotracer is available: 99mTc-hydroxymethylene diphosphonate (HMDP). 99mTc-HMDP, widely available in the United States for bone scanning, has effectively been used in Europe to diagnose transthyretin amyloidosis. 99mTc-HMDP and 99mTc-pyrophosphate have comparable blood clearance and sensitivity. The imaging protocols for 99mTc-HMDP and 99mTc-pyrophosphate are similar, except 99mTc-HMDP is imaged 2-3 h after injection and whole-body imaging is optional. The interpretation is also essentially the same; however, caution is needed because of the high soft-tissue uptake with 99mTc-HMDP, which can affect heart-to-contralateral-lung ratios.

Generalized Muscular Uptake of 99m Tc-MDP on Bone Scan in a Patient With Scleromyxedema-Associated Myopathy.

ABSTRACT: A 62-year-old man presented with a 5-year history of progressive myasthenia, myalgia, and skin changes. Upon laboratory testing, elevated serum creatine kinase and lactate dehydrogenase, as well as monoclonal immunoglobulin Gκ, were observed. A bone scan revealed generalized muscular uptake of 99m Tc-MDP, whereas 18 F-FDG PET/CT demonstrated only mild hypermetabolism of the muscles. A muscle biopsy showed myofibrillary vacuolar degeneration, and a skin biopsy indicated scleromyxedema. Based on these findings, the patient was diagnosed with scleromyxedema-associated myopathy.

Renal tumoural calcinosis: Extensive and multifocal form.

Renal tumoural calcinosis is rare, but the incidence is rising with increasing life expectancy due to dialysis. Whole body skeletal scintigraphy with 99mTc- MDP is a sensitive method to detect sites of osseous involvement. We share an interesting image of the bone scan, in a patient with extensive renal tumoural calcinosis.

99mTc-MDP Bone Scan and 18F-FDG PET/CT Imaging of Primary Hepatic Osteosarcoma.

A 65-year-old man presented with abdominal bloating, pain, and nausea for 5 days. Abdominal CT revealed a heterogeneous mass with a large area of calcification, and rupture of the mass was seen around the capsulafibrosa. According to pathological examination after percutaneous puncture biopsy, the histopahological and immunohistochemical findings were suggestive of metastatic or primary hepatic osteosarcoma. Whole body bone scintigraphy demonstrated elevated 99mTc-MDP activity in hepatic mass, but no skeletal lesions. The diagnosis of primary hepatic osteosarcoma was finally confirmed. PET/CT showed hepatic mass with heterogeneous high-uptake, and multiple metastases in portacaval lymph nodes, lungs and the third thoracic vertebra were considered.

Comparison of 99m Tc-methylenediphosphonate and 68 Ga-BPAMD PET/computed tomography imaging in bone metastasis.

OBJECTIVE: Bone is considered as the third most common site of metastases, besides lung and liver. Early detection of skeletal metastases aids in better management of skeletal-related events. In the present study cold kit-based 2,2 ' ,2 '' -(10-(2-((diphosphonomethyl)amino)-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl) triacetic acid (BPAMD) was labeled with 68 Ga. The radiolabeling parameters and clinical evaluation in patients with suspected bone metastases were compared with routinely used 99m Tc-methylenediphosphonate ( 99m Tc-MDP). METHODOLOGY: The kit components of MDP were incubated with at room temperature for 10 min, followed by radiochemical purity testing using thin-layer chromatography. For radiolabeling of BPAMD, the cold kit components reconstituted in 400 µL of HPLC grade water were transferred and incubated with 68 GaCl 3 in the reactor vessel of the fluidic module at 95°C for 20 min. Radiochemical yield and purity were determined with instant thin-layer chromatography using 0.5 M sodium citrate as mobile phase. For clinical evaluation, patients ( n = 10) with suspected bone metastases were enrolled. 99m Tc-MDP and 68 Ga-BPAMD scans were performed on two different days in random order. Imaging outcomes were noted and compared. RESULTS: Radiolabeling of both tracers is facile using cold kit, although BPAMD requires heating. The radiochemical purity was observed to be greater than 99% for all preparations. Both MDP and BPAMD detected skeletal lesions; however, additional lesions were detected in total of seven patients which were not visualized clearly on 99m Tc-MDP scan. CONCLUSION: BPAMD can be easily tagged with 68 Ga using cold kits. The radiotracer is suitable and efficient for detection of bone metastases using PET/computed tomography.

A computer program to assess the bone scan index for Tc-99m hydroxymethylene diphosphonate: evaluation of jaw pathologies of patients with bone metastases using SPECT/CT

PURPOSE: This study aimed to evaluate the jaw pathologies of patients with bone metastases using a computer program to assess the bone scan index (BSI) for Tc-99m hydroxymethylene diphosphonate (HMDP) with single-photon emission computed tomography/computed tomography (SPECT/CT). METHODS: Ninety-seven patients with jaw pathologies (24 with bone metastases and 73 without) were evaluated. High-risk hot spots and BSI in the patients were evaluated using the VSBONE BSI (ver.1.1) analysis software for Tc-99m HMDP that scanned SPECT/CT and automatically defined the data. The two groups were compared using the Pearson chi-square test and Mann-Whitney U test for high-risk hot spots and BSI, respectively. A P value of <0.05 was considered statistically significant. RESULTS: High-risk hot spot occurrence was significantly correlated to bone metastases [sensitivity, 21/24 (87.5%); specificity, 40/73 (54.8%); accuracy, 61/97 (62.9%); P < 0.001]. The number of high-risk hot spots was higher in patients with bone metastases (5.96 ± 10.30) than in those without (0.90 ± 1.50; P < 0.001). Furthermore, the BSI for patients with bone metastases (1.44 ± 2.18%) was significantly higher than for those without (0.22 ± 0.44%; P < 0.001). CONCLUSION: A computer program that assessed BSI for Tc-99m HMDP may be useful in the evaluation of patients with bone metastases using SPECT/CT.

Quantitative assessment of 99mTc-methylene diphosphonate bone SPECT/CT for assessing bone metastatic burden and its prognostic value in patients with castration-resistant prostate cancers: initial results in a single-center retrospective study.

PURPOSE: To evaluate the prognostic value of the quantitative assessment of 99mTc-methylene diphosphonate (99mTc-MDP) bone SPECT/CT in castration-resistant prostate cancer (CRPC) patients with bone metastases. METHODS: A total of 103 patients who underwent 99mTc-MDP bone SPECT/CT imaging from the neck to the proximal femur were included. First, in 65 patients without bone metastases, the normal range of standardized uptake value (SUV) of non-pathological bone was evaluated to determine an SUV threshold to reliably exclude most normal osseous activity. Then, in 38 CRPC patients with bone metastases, lesion uptake volume (LUV), which is the extracted volume of bone metastases exhibiting high accumulation above the SUV threshold, was calculated. The relation between LUV and prostate-related mortality was statistically evaluated. RESULTS: Based on the SUV measurements of non-pathological bones, the optimal SUV threshold, which defines abnormal bone SPECT uptake, was determined to be 8. Median LUV was 39 mL (interquartile range 4.0-104.3 mL) in the CRPC subjects with bone metastases. Kaplan-Meier survival analysis showed a significant relation between prostate cancer-specific survival and LUV (cut-off value, 19.95 mL; P = 0.001). Multivariate analysis revealed LUV as an independent prognostic factor for the survival (P = 0.008, hazard ratio 23.424). Global chi-square test showed that LUV had significant incremental prognostic value in addition to prostate-specific antigen and the interval from progression to CRPC until bone SPECT/CT (P = 0.022). CONCLUSION: Quantitative assessment of 99mTc-MDP bone SPECT images can provide valuable prognostic information in CRPC patients with bone metastases.

Intense Axillary Accumulation of 99m Tc-MDP Due to Perspiration.

ABSTRACT: Prostate cancer was newly diagnosed in a 73-year-old man. He underwent bone scintigraphy to assess any skeletal involvement. No abnormal uptake was observed in the skeletal system, whereas intense radioactivity was seen in the bilateral axillary regions. Physical examination found large amounts of sweat. Repeat images revealed no axillary activity after washing. This case illustrated axillary accumulation of 99m Tc-MDP due to perspiration.