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Objective: to specify frequency, patterns and diagnostic significance of extraosseous soft tissue findings in 99mTc-pyrophosphate skeletal scintigraphy. Material and methods. Results of skeletal scintigraphy from 1060 patients (447 men, 613 women) were analyzed. Scanning in "whole body" mode started in 3–4 hours after 740 MBq of radiotracer activity intravenous administration, and performed in anterior and posterior projections in continuous table motion mode at rate of 6–8 cm per minute. Single photon emission computed tomography/ computed tomography (SPECT/CT) was additionally performed when necessary. Results. Extraosseous scintigraphic findings were discovered in 161 (15.2%) patients, they can be divided into three categories: nephrourological (7.7%), soft tissue (5.4%) and artifacts (2.1%). First category included anatomical and functional changes in the urinary system (kidney location anomalies and nonobstructive uropathies). SPECT/CT was performed to differentiate calycostasis in the projection of the upper group of calyces and focal changes of the ribs. Soft tissue extrarenal findings included diffuse or focal RP hyperfixation within breasts (29 patients), thyroid glands (15), myocardium (5), scrotum (4) and abdominal cavity (4). Symmetrical increased RP accumulation in breast or thyroid lobes was accepted as normal. Pathologic soft tissue findings in 11 patients were verified by history or instrumental data: breast cancer (2), testicular cancer (1), nodular goiter (2), uterine fibroids (2), primary cancer with liver metastases (1), association of "hot kidney" phenomenon with chemotherapy (2), and "superscan" phenomenon with myelofibrosis (1). Causes of radiotracer artifacts in the liver and spleen (14) were of radiopharmaceutical factors, in axillary lymph node (7) – partially infiltrative radiopharmaceuticals administration, in the colon (1) – previous myocardial perfusion scintigraphy. Conclusion. Analysis and interpretation of abnormal extraosseous findings in skeletal scintigraphy is an essential component of additional diagnostic information, that can influence subsequent diagnostic and therapeutic tactics.

A clinical observation of focal accumulation of 99mTcpyrophosphate in aortic aneurysm, simulating skeletal pathology of the lumbar vertebra in planar scintigraphy mode, is presented. Additional single-photon emission computed tomography combined with computed tomography-something view allowed to confirm that the radiotracer uptake focus was localized in the distal part of the aneurysm, in the zone of lumen subocclusion by a calcified thrombus. It is suggested that the local tracer accumulation is not only due to calcification but also due to inflammatory, a factor that plays a role in the genesis of an aortic aneurysm

Objective: The aim of this study is to clarify the period of extraosseous accumulation of99mTc-hydroxymethylenediphosphonate (HMDP) to radiation nephropathy mimicking recurrent or remnant neuroblastoma in the pararenal region. Methods: We reviewed five neuroblastoma and one ganglioneuroblastoma patients (2 boys and 4 girls aged 1–9 years) who underwent99mTc-HMDP bone scintigraphies periodically before and after radiation therapy. Results: Increased renal uptake coincident with the radiation port appeared in 5 of 6 patients from 0 to 3 months (mean 1.7 months), and persisted up to 7 months after the completion of radiotherapy. Renal uptake of99mTc-HMDP was gradually decreased, and eventually became accumulation defects in 5 of 6 patients from 6 to 17 months (mean 8.9 months) after radiotherapy. Conclusion: When extraosseous accumulation is found after radiation therapy in neuroblastoma patients, radiation nephropathy would be a candidate in the differential diagnosis besides recurrent or remnant tumor. [ABSTRACT FROM AUTHOR]

We report a case of esophageal carcinoma that showed extraosseous accumulation of99mTc-MDP in lymph node metastases to the cervical and paracardial lymph nodes. There are few cases showing abnormal extraosseous accumulation of99mTc-MDP in esophageal cancer lesion. The patient was a 53-year-old man with advanced esophageal cancer. Bone scintigraphy demonstrated extraosseous accumulations in left supraclavicular and paracardial lymph node metastases. The histopathological diagnosis was small cell carcinoma of the esophagus, which is a rare disease with aggressive behavior and poor prognosis. Our patient underwent 2 courses of systemic chemotherapy (CDDP + VP16), but died of rapidly growing systemic metastases 5 months after the initial treatment. [ABSTRACT FROM AUTHOR]

Although 201Tl chloride (Tl) SPECT has been used in the differential diagnosis between recurrence of malignant brain tumor and necrosis after treatment, it is not generally recognized as a definite modality to distinguish them. We conducted a preliminary study using Tl SPECT and 99mTc-MDP or 99mTc-HMDP (Tc) SPECT because it has been said that extraosseous accumulation was caused by calcium deposits in necrotic tissues. In our study, for the purposes of clarifying the mechanism of extraosseous uptake and the correlation between extraosseous accumulation of bone-scanning agent and tumor viability in malignant brain tumors, we compared whether Tc uptake was correlated with the histopathological findings and further performed semi-quantitative evaluation between Tc SPECT and Tl SPECT. The correlation coefficients between the ratio of tumor to normal skull count obtained from Tc SPECT (Tc-T/N) and those of tumor to normal brain count (T/N) and to normal scalp count (T/S) both obtained from Tl SPECT were calculated. Using contrast enhanced CT (CE-CT) or contrast enhanced MRI (CE-MRI), 8 of 10 cases showed intensely ring-enhanced tumor with necrotic lesion. Histopathologically, 7 of 8 cases whose tumor had been resected before treatment had necrosis with increased vascularity or bleeding. Of the remaining 2 cases one case, malignant lymphoma had only hypervascularity by biopsy, while the other one was excluded for resection after treatment. Three of these 8 cases whose CE-CT or CE-MRI showed necrotic lesions exhibited Tc and Tl accumulations in the area corresponding to necrosis. In contrast, 2 showed no Tc nor Tl uptake. Tc-T/N had no significant correlation with any of early-, delayed-T/N or T/S. In conclusion, there was no significant correlation between Tc and Tl uptakes by malignant brain tumors in semi-quantitative evaluation. [ABSTRACT FROM AUTHOR]

Although extraosseous accumulations of99mTc phosphate complexes are phenomena which can often be seen, no case showing extraosseous accumulation to brain tumor on SPECT has been reported. We report here two cases of primary brain tumor showing extraosseous accumulation of99mTc phosphate in bone SPECT.201Tl SPECT also showed increased201Tl uptake by the tumor. Comparing bone SPECT with201Tl SPECT, the regions of abnormality of both SPECTs were very similar in the case of glioblastoma, but in the case of malignant lymphoma the region showing intense uptake of99mTc-MDP was smaller than that on201Tl SPECT. It was revealed that bone SPECT is more useful in the assessment of extraosseous accumulation to a primary brain tumor than conventional bone scintigraphy. [ABSTRACT FROM AUTHOR]

66-y-old lady was sent to our department for a bone scan as a part of an investigation of a tumor of unknown origin. She cooperated;  she  was  afebrile,  without  dyspnea  or  icterus. She suffered from dysorexia but she did not loss her weight. She  had  a  hypertension; diabetes compensated with oral antidiabetics; and hypothyroidism compensated with a treatment. Her oncological history was negative. Basic physical examination was normal except obesity. Chest X-ray was negative, abdominal sonography suspected liver cirrhosis with an ascites, proved cholecystolithiasis. Gastroscopy detected hiatal hernia and ulcer on the large curvature with mucosal infiltration but histology was negative regarding a tumor. Gynaecological work-up including sonography was also negative. Central venous catheter into the right subclavian vein was inserted due to an obesity and a poor venous access. Whole-body bone scan was performed routinely 3 hours after injection of 800 MBq of 99mTc-HDP on a gamma camera BrightView XCT (Philips). Radiopharmaceutical was administered into the catheter which was flushed with 20 ml of normal saline before and after injection. Focally increased accumulation in the right sternoclavicular joint and in the dorsal right 5th rib paravertebrally was detected except of physiological accumulation in the bone tissue of an axial skeleton and large joints. (Fig. 1) We performed a SPECT/CT of the thorax for better specification. (Fig. 2) The focally increased accumulation was evident near the end of the catheter; no accumulation  was detected in the sternoclavicular joint or in the right 5th rib; these foci were detected due to shining through to the detectors only. We concluded that the bone scan is physiological without signs of metastases. Renal failure with a mineral breakup progressively occurred and the patient died under the picture or a cardiopulmonary failure 4 weeks after an admission. Primary tumor was not detected, oncological therapy was not provided. [ABSTRACT FROM AUTHOR]

A 51-year-old man was found to have hepatic metastasis from colon carcinoma. Bone scintigraphy withTc-hydroxymethylene diphosphonate showed a ringlike accumulation corresponding to the hepatic mass, which was without calcification on computed tomography. Treatment with chemotherapeutic agents was started. After 4 months, computed tomography showed that the mass was smaller than before and that the margin was calcified. The extraosseous accumulation of the radionuclide may be evidence supporting earlier speculation on calcification that could not yet be detected by computed tomography. [ABSTRACT FROM AUTHOR]