Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy?

The aim of this paper was to compare the value of bone scintigraphy and radiography in the early diagnosis of post-fracture reflex sympathetic dystrophy (RSD). Thirty-seven adult patients with post-fracture RSD (28 in the first and nine in the second clinical stage of RSD), as well as seven patients with fracture but without RSD (control group), were investigated by radiography and bone scintigraphy. All of them were immobilized (duration of immobilization: 4–22 weeks). In 21 persons three phase bone scintigraphy was performed. The best distinction between the control group and the RSD patients was achieved by delayed bone scintigrams. The sensitivity (97%), positive predictive value (97%) and accuracy (95%) of delayed bone scintigraphy were very high compared to the values for radiography, which were 73%, 90% and 70% respectively. Bone scintigraphy also displayed higher specificity (86%) and negative predictive value (86%) than radiography (57% and 29% respectively). In the first clinical stage the difference between the accuracy of bone scintigraphy (97%) and radiography (63%) was greater than for the whole group. In the second stage of RSD the accuracy of bone scintigraphy (86%) and radiography (81%) was similar. Three-phase bone scintigraphy is not necessary for the diagnosis of post-fracture RSD: it is sufficient to perform delayed bone scintigraphy. It is concluded that bone scintigraphy is to be preferred to radiography for the early diagnosis of post-fracture RSD in the first clinical stage. In the second stage the diagnostic capabilities of bone scintigraphy and radiography are more comparable.     

Multiple myeloma evaluated with 201Tl scintigraphy compared with bone scintigraphy.

The purpose of this study was to investigate the clinical usefulness of 201Tl chloride scintigraphy in the diagnostic evaluation of 20 patients with multiple myeloma (19/20 patients) or extramedullary plasmacytoma (1/20 patients) in comparison with bone scintigraphy. METHODS: Both 201Tl and bone scintigraphy were performed to obtain planar images on the same instrument. RESULTS: 201Tl scintigraphy showed increased uptake in 15 of 20 patients (75%) and was negative in 5 of 20 patients (25%). In addition, 201Tl scintigraphy of multiple myeloma was more useful in detecting the lesions in 11 of 17 patients and less useful in 6 of 17 patients than bone scintigraphy. CONCLUSION: The combination of 201Tl and bone scintigraphy, compared with bone scintigraphy alone, shows promise in more accurately diagnosing multiple myeloma.     

Bone metastases in carcinoid tumors: clinical features, imaging characteristics, and markers of bone metabolism.

The purpose of this study was to describe the clinical presentation of bone metastases in patients with carcinoid tumors and to determine the diagnostic value of imaging techniques and markers of bone metabolism. METHODS: This retrospective study was performed on the entire group of patients with carcinoid tumors treated in our hospital from January 1992 to May 1999. Only patients with metastasized tumors were included. RESULTS: Eleven of 90 patients (12%) (95% confidence interval [CI], 5%-19%) with a metastasized carcinoid tumor had symptomatic bone metastases. All bone metastases occurred in 55 patients with midgut carcinoids (20%; 95% CI, 9%-31%). Plain radiography had a sensitivity of 44% (95% CI, 12%-76%); MRI, 100% (95% CI, 61%-100%); bone scintigraphy, 90% (95% CI, 72%-100%); and octreotide scintigraphy, 60% (95% CI, 35%-93%). In 9 patients, both octreotide scintigraphy and bone scintigraphy were performed. Of 45 bone lesions, 22 (49%) were visualized by both modalities, 13 (29%) were visualized with octreotide scintigraphy but not with bone scintigraphy, and 10 (22%) were visualized with bone scintigraphy but not with octreotide scintigraphy. In 2 patients, octreotide scintigraphy and bone scintigraphy provided complementary results. Markers of bone metabolism could not discriminate carcinoid patients from those without bone metastases. The markers of bone metabolism did not reflect the osteolytic or osteoblastic appearance of metastases. CONCLUSION: Pain is the principal symptom of bone metastases in patients with carcinoid tumors. Plain radiography and markers of bone metabolism do not contribute to the diagnosis of bone metastases. MRI has a high sensitivity for bone metastases. Both bone scintigraphy and octreotide scintigraphy have acceptable sensitivity and can provide complementary results.     

核素骨显像与MRI检测脊柱转移瘤的对比研究

目的：比较核素骨显像与MRI对脊柱转移瘤的诊断价值。方法；对76例经病理证实为恶性肿瘤的患者进行骨显像与MRI检查，比较骨显像与MRI对脊柱部位病变的检查情况。结果：骨显像、MRI对脊柱转移瘤的阳性病例及阳性病灶数的检出率拉近，阳性病例检出率为68／81和61／81，阳性病灶检出率为167／536和156／536。二者我椎转移为好发段，MRI对胸椎病灶的检出率优于骨显像，检出率分别为83／237和64／237；二者对腰椎的检出率无差别，骨显像对颈椎、骶椎的检出率优于MRI（颈椎分别为15／63和6／63，骶椎分别为23／78和10／78）。对多发病灶的检出MRI优于骨显像，检出率分别为143／237和116／237。结论：在显示脊柱肿瘤骨转移方面，总体的敏感性二者接近，在具体部位二者各有优势，在多发病灶上MRI优于骨，骨显像因其简单易行，仍为肿瘤患者病情初始评价的选择，在其对临床问题解释不够充分时，则应采用MRI作为补充。     

SPECT/CT联合三相骨显像对骨骼良恶性病变鉴别诊断的增益价值

目的 探讨三相骨显像联合SPECT/CT对骨骼良恶性病变鉴别诊断较单纯三相骨显像的增益价值.方法 回顾分析2008年7月至2011年9月间临床怀疑骨肿瘤、并行三相骨显像联合SPECT/CT显像的45例患者,其中男28例,女17例,年龄11～82(44.1±21.2)岁.病灶均经外科手术治疗或穿刺活组织检查获得病理诊断.2位核医学科医师先分析三相骨显像图,判断病变良恶性;在其基础上,结合SPECT/CT融合图像分析,再次判断病变良恶性.与病理诊断结果比较,分别对单纯三相骨显像和SPECT/CT联合三相骨显像对患者病灶良恶性诊断效能进行分析.采用SPSS 16.0软件,以x2检验比较2种方法诊断的准确性.结果 病理诊断恶性病变29例,良性病变16例.三相骨显像和SPECT/CT联合三相骨显像对骨骼良恶性病变的诊断灵敏度分别为96.6％(28/29)和100％(29/29),特异性分别为37.5％(6/16)和81.2％(13/16),阳性预测值分别为73.7％(28/38)和90.6％(29/32),阴性预测值分别为6/7和100％(13/13).三相骨显像诊断准确性为75.6％(34/45),SPECT/CT联合三相骨显像诊断准确性提高至93.3％(42/45),两者差异有统计学意义(x2=4.145,P＜0.05).结论 SPECT/CT联合三相骨显像对骨骼病灶良恶性病变判断的准确性较三相骨显像明显提高,具有增益价值.     

Comparison of18FDG-PET with99mTc-HMDP scntigraphy for the detection of bone metastases in patients with breast cancer

OBJECTIVE: Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients. METHODS: Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards. RESULTS: On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%). CONCLUSIONS: This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.     

MRI与同位素骨扫描对骨转移瘤诊断价值的比较

目的：比较ＭＲＩ和同位素骨扫描对骨转移瘤的诊断价值。方法：对６４例同时进行了ＭＲＩ和同位素骨扫描检查并确诊为骨转移瘤的病例,以ＭＲＩ扫描野内脊柱和骨盆骨为观察目标,比较ＭＲＩ与同位素骨扫描对该部位病变的显示情况。结果：６４例患者,ＭＲＩ共检查了７３个部位（骨盆３０,腰椎１９,胸椎１６,颈椎８）,在ＭＲＩ扫描范围内,以病灶数为统计单位,确诊为骨转移瘤的共２０１个病灶。在ＭＲＩ上,真阳性１９８个,假阴性３个,无假阳性,其诊断敏感性为９８．５％。在同位素骨扫描,真阳性１５４个,假阴性４７个,假阳性４８个,其诊断敏感性为７６．６％。结论：在显示骨转移瘤方面,ＭＲＩ较同位素骨扫描具有更高的敏感性,但受到扫描范围的限制。     

Clinical usefulness of 99mTc-PMT whole body scans in the diagnosis of bone metastases from hepatocellular carcinoma]

The diagnostic value of whole body scanning using 99mTc-N-pyridoxylmethyltryptophan (PMT) was evaluated in 16 patients with bone metastases from hepatocellular carcinoma, in comparison with 99mTc-MDP. Of the 72 known lesions of bone metastases, 63 (87.5%) were detected by 99mTc-PMT scintigraphy, which demonstrated increased uptake of radionuclide. However, 99mTc-MDP bone scintigraphy detected only 45 lesions (62.5%), which were shown as increased, decreased, or mixed patterns of uptake. Thus 99mTc-PMT scintigraphy was more sensitive than 99mTc-MDP bone scintigraphy. In addition, the latter showed poor specificity because of its high false positive rate due to degenerative change. All lesions undetected by 99mTc-PMT scintigraphy were located in areas that overlapped the liver or bowel activity. In conclusion, it is recommended that whole body 99mTc-PMT scintigraphy be combined with 99mTc-MDP bone scintigraphy for the detection of bone metastases from hepatocellular carcinoma.     

Detection of obstructive uropathy by bone scintigraphy

We prospectively evaluated routine bone scintigraphs to determine the prevalence of radiotracer retention in the renal collecting system, and to test the reliability of this finding as an indicator of obstructive uropathy. Post-diuretic renal washout was also measured, to evaluate the use of this procedure after bone scintigraphy. Stasis occurring only in the supine position was excluded by obtaining upright images. The findings on bone scintigraphy were compared with the results of renal sonography. Patients showing persistent pelvicaliceal concentration in the upright position after bone scintigraphy were found to have evidence of obstructive uropathy by sonography or other studies. Furosemide administration was followed by washout of the bone tracer from all kidneys with proven partial ureteral obstruction. Persistent renal pelvicaliceal concentration, in upright images after bone scintigraphy, appears to be a reliable indicator of obstructive uropathy. However, measurement of post-diuretic renal washout, after bone scintigraphy, does not reliably detect obstructive uropathy, and may be misleading if interpreted in the same way as the standard diuretic renogram.     

Comparative detectability of bone metastases and impact on therapy of magnetic resonance imaging and bone scintigraphy in patients with breast cancer.

OBJECTIVE: to evaluate the comparative impact of magnetic resonance imaging and bone scintigraphy in bone metastases of breast cancer. METHODS AND PATIENTS: in 81 patients with histologically proven breast cancer magnetic resonance imaging of the axial skeleton and whole-body bone scintigraphy had been performed. Images were retrospectively reviewed and compared for detection of metastases, extent of metastatic disease and therapeutic implications according to the patients' records. RESULTS: about 54/81 (67%) patients revealed bone metastases. In 7/54 (13%) patients with bone metastases, scintigraphy was false negative. In one patient a solitary sternal metastases was seen. In 26/53 [49%] patients with spinal metastases, magnetic resonance imaging showed more extensive disease. Local radiotherapy or surgery was indicated in ten patients with metastases not evident in bone scintigraphy, in 20 patients with positive results by both imaging modalities and in six patients with metastases of pelvis imaged by bone scintigraphy only. CONCLUSION: magnetic resonance imaging of the axial skeleton and pelvis appears superior for staging as only one patient had metastases merely outside the axial skeleton and local therapy was indicated even in spinal regions negative in bone scintigraphy.     

The contribution of bone scintigraphy in occupational health or medical insurance claims: a retrospective study.

Patients with a suspicion of bone damage following an industrial or traffic accident are often referred for bone scintigraphy as part of an occupational health or medical insurance investigation. The aim of this study was to assess the contribution and the potential role of bone scintigraphy compared with X-ray investigations in the aforementioned situation. To this end we evaluated 70 consecutive patients referred for bone scintigraphy during 1996 and 1997 by occupational health or medical insurance physicians. The most common reasons for referral were the exclusion of occult fractures of hands and feet, whiplash injuries, reflex sympathetic dystrophy or avascular necrosis, or the differentiation between an old and a recent vertebral fracture. X-rays were only available for comparative review of 53 patients, so only those were analysed. The results of bone scintigraphy were compared with X-rays, and their contribution and potential role in occupational health or medical insurance investigations assessed. In 31 out of the 53 patients investigated, bone scintigraphy findings concurred with X-rays as to the number and location of abnormalities. For 19 of the 53 patients, bone scintigraphy showed clinically relevant additional foci when compared with X-rays, predominantly involving lesions to hands/wrists and feet/ankles. Among these 19 patients, scintigraphic diagnoses were subsequently confirmed in ten cases by means of X-ray or computed tomography. In four patients, supplementary radiological investigations revealed no abnormalities, and in five patients no further investigations were undertaken. Finally, in three of the 53 patients, X-rays revealed bone damage (burst fractures) whilst the corresponding bone scintigraphy was negative, thus excluding recent injury. In conclusion, in 22 patients, representing 42% of the cases analysed, bone scintigraphy was conclusive compared with X-ray imaging in the final diagnosis and in this way in detecting occult or excluding active bone damage after a traffic or industrial accident. This makes bone scintigraphy a useful investigation in situations where a full or partial disablement claim has to be confirmed, extended or terminated.     

The diagnostic value of bone scintigraphy in patients with low back pain

Bone scintigraphy has been studied in two groups of patients presenting with low back pain. In one group of 38 patients suffering "nonspecific" back pain, bone scintigraphy and laboratory findings were negative in 24. There were abnormal laboratory findings in all of the remaining 14 and 7 had positive bone scans indicative of clinically significant disease. Selection of patients for bone scintigraphy in this group should therefore be influenced by abnormal laboratory findings and elevation of the erythrocyte sedimentation rate in particular. By comparison, the bone scans were reviewed from another group of patients suffering previously known malignancy. Out of 138 patients, nearly 40% showed a positive bone scan due to subsequently proven metastasis. Bone scintigraphy was positive in a further 14% as a result of osteoporotic rib fracture and vertebral body collapse. In half of these, it was not possible to exclude malignancy by scintigraphy. The present findings indicate that bone scintigraphy is not a useful procedure in patients with long-standing low back pain who have normal radiographs and normal laboratory findings.     

Detectability of metastatic bone tumor by Ga-67 scintigraphy

Ga-67 scintigrams in patients with malignant diseases sometimes reveal uptake of the tracer in the bone metastases. Detectability of Ga-67 scintigraphy for metastatic bone tumors and benign bone lesions was compared with that of Tc-99m bone scintigraphy. Countable bone metastases detected by bone scintigraphy were evaluated whether the lesion showed apparent, faint, or negative Ga-67 uptake. Of 47 lesions 23 (49%) showed apparent uptake and 17 (36%) showed negative uptake. On the other hand, of 71 benign bone lesions, only 7 (10%), mostly fracture/osteotomy, showed apparent uptake of the tracer. Uptake in the other benign lesions such as trauma of the ribs, spondylosis deformans, and arthrosis deformans was rather faint. In patients with multiple bone metastases, 9 patients (82%) out of 11 showed more prominent abnormal findings in Tc-99m MDP bone scintigraphy than in Ga-67 scintigraphy; that is, Ga-67 scintigraphy was not able to reveal all metastatic bone lesions. In patients with untreated or recurrent tumors, relation between Ga-67 uptake in the tumors and that in the bone metastases was evaluated. Of 7 patients with negative Ga-67 uptake in the primary tumors, 5 showed positive Ga-67 uptake in the bone metastases; that is, there seemed to be little relation between Ga-67 affinity to the primary tumors and that to the bone metastases. Mechanisms of the Ga-67 uptake in the bone metastases were discussed. Not only the tumor cells or tissues in the bone metastases but also bone mineral or osteoclasts might be the deposition sites of Ga-67.     

The contribution of bone scintigraphy in occupational health or medical insurance claims: a retrospective study

Patients with a suspicion of bone damage following an industrial or traffic accident are often referred for bone scintigraphy as part of an occupational health or medical insurance investigation. The aim of this study was to assess the contribution and the potential role of bone scintigraphy compared with X-ray investigations in the aforementioned situation. To this end we evaluated 70 consecutive patients referred for bone scintigraphy during 1996 and 1997 by occupational health or medical insurance physicians. The most common reasons for referral were the exclusion of occult fractures of hands and feet, whiplash injuries, reflex sympathetic dystrophy or avascular necrosis, or the differentiation between an old and a recent vertebral fracture. X-rays were only available for comparative review of 53 patients, so only those were analysed. The results of bone scintigraphy were compared with X-rays, and their contribution and potential role in occupational health or medical insurance investigations assessed. In 31 out of the 53 patients investigated, bone scintigraphy findings concurred with X-rays as to the number and location of abnormalities. For 19 of the 53 patients, bone scintigraphy showed clinically relevant additional foci when compared with X-rays, predominantly involving lesions to hands/wrists and feet/ankles. Among these 19 patients, scintigraphic diagnoses were subsequently confirmed in ten cases by means of X-ray or computed tomography. In four patients, supplementary radiological investigations revealed no abnormalities, and in five patients no further investigations were undertaken. Finally, in three of the 53 patients, X-rays revealed bone damage (burst fractures) whilst the corresponding bone scintigraphy was negative, thus excluding recent injury. In conclusion, in 22 patients, representing 42% of the cases analysed, bone scintigraphy was conclusive compared with X-ray imaging in the final diagnosis and in this way in detecting occult or excluding active bone damage after a traffic or industrial accident. This makes bone scintigraphy a useful investigation in situations where a full or partial disablement claim has to be confirmed, extended or terminated. Received 17 December 1998 and in revised form 19 April 1999     

18F-NaF PET/CT骨显像在甲状旁腺功能亢进性骨病中的应用

目的 探讨甲状旁腺功能亢进性骨病18F-NaF PET/CT骨显像的影像学特点及其应用价值。 方法 收集30例经临床及术后病理证实为甲状旁腺功能亢进症患者[男性11例、女性19例,年龄18～71（52.3±13.5）岁]的18F-NaF PET/CT骨显像及99Tcm -亚甲基二膦酸盐（99Tcm-MDP）全身骨显像资料,回顾性分析其18F-NaF PET/CT骨显像特点,对比两种骨显像方法对该病局部骨骼病灶的检出情况,并根据Mirels评分标准对棕色瘤进行评分。 结果 两种骨显像方法定性结果一致,即骨显像阴性15例,阳性15例。甲状旁腺功能亢进性骨病在18F-NaF PET图像上大部分表现为以全身多骨弥漫性骨代谢增高为主的多种代谢性骨病征象,并发棕色瘤、骨硬化及病理性骨折等时表现为单发或多发局灶性显像剂异常分布,其中棕色瘤表现为局灶性显像剂浓聚、显像剂稀疏或病灶中心显像剂分布缺损伴边缘显像剂不均匀浓聚;同机CT图像上均表现为全身多骨多种形式的骨质吸收,其中,表现为广泛骨质疏松13例、伴棕色瘤7例、骨质硬化6例、骨质软化3例、病理性骨折3例。15例甲状旁腺功能亢进性骨病患者共检出局部骨骼病灶（棕色瘤、骨硬化、病理性骨折、假骨折）53个,其中,18F-NaF PET/CT骨显像全部检出,99Tcm-MDP全身骨显像检出32个。7例甲状旁腺功能亢进性骨病患者伴棕色瘤,位于长骨的棕色瘤病灶数共24个,其中9个Mirels评分大于9分。 结论 甲状旁腺功能亢进性骨病在18F-NaF PET/CT骨显像上的全身骨代谢及解剖学表现有一定的特征性表现,18F-NaF PET/CT骨显像结合同机CT上全身骨骼病灶的详细信息,在甲状旁腺功能亢进性骨病的诊断、鉴别诊断及病情严重程度评估中有更好的应用价值。     

What is the value of Tc-99m hydroxymethylene diphosphonate scintigraphy for the etiological diagnosis of mild rhabdomyolysis?

AIMS: We tested whether bone scintigraphy could help in the etiological diagnosis in patients with mild rhabdomyolysis, because different patterns of soft tissue radiotracer uptake have been found on bone scintigraphy in patients presenting with severe rhabdomyolysis, with a localized asymmetric pattern in traumatic lesions and a more diffuse and symmetric pattern in nontraumatic lesions. However, the performance of bone scintigraphy in mild rhabdomyolysis is unknown. The etiological diagnosis of rhabdomyolysis can be difficult, particularly in alcohol abusers who deny a recent alcoholic binge. MATERIAL AND METHODS: Bone scintigraphy was performed in 16 patients presenting with acute renal failure secondary to mild rhabdomyolysis (creatinine kinase levels < or =36,000 IU), with obvious causes in 10 cases and with uncertain etiologies in the remaining 6 patients. RESULTS: In 5 cases with evident traumatic rhabdomyolysis, and in 4 patients with uncertain etiologies, bone scintigraphy showed localized asymmetric soft tissue radiopharmaceutical uptake compatible with traumatic lesions. None of the 5 patients with nontraumatic rhabdomyolysis had significant soft tissue radiopharmaceutical uptake. In 1 patient with traumatic rhabdomyolysis, bone scintigraphy performed only 11 days after the initial insult was negative. One patient with an uncertain etiology also had a negative scintigraphy. CONCLUSIONS: Bone scintigraphy, when performed early in the course of the disease, may contribute to the etiological diagnosis of rhabdomyolysis if it shows asymmetric localized soft tissue radiopharmaceutical uptake compatible with traumatic lesions. However, bone scintigraphy is often negative in mild nontraumatic lesions.     

Usefulness of bone scintigraphy on diagnosis of malignant fibrous histiocytoma of bone

We examined the roentgenographical features of 5 patients who were diagnosed histopathologically as malignant fibrous histiocytoma (MFH) of bone, especially on the imaging of bone scintigraphy. Two patients had multiple lesions on the initial examination, and two of 3 patients who showed solitary lesion on the first examination could be detected more pathological sites by bone scintigraphy which was studied within two months of the first investigation. On bone scintigraphy, the mixture of hot and cold lesions which was coincident with the osteolytic change on plan X-P could be noticed, and with the progression of osteolysis it had a tendency to increase the area of cold lesions. These features are similar to metastatic bone tumor which is the most questionable disease on diagnosis, and we conclude that bone scintigraphy will be absolutely necessary when MFH of bone is highly suspected in the clinical course.     

A comparative study of<Superscript>2O1</Superscript>T1 scintigraphy and three-phase bone scintigraphy following therapy in patients with bone and soft-tissue tumors

OBJECTIVE: The purpose of this study was to evaluate the usefulness of 201Tl scintigraphy in comparison with three-phase bone scintigraphy in the differentiation of residual/recurrent tumors from post-therapeutic changes, in patients previously treated for bone and soft-tissue tumors. METHODS: Thirty-five 201Tl and three-phase bone scintigraphy scans were obtained for 30 patients with a history of bone or soft-tissue tumor who had undergone chemotherapy, radiation therapy, tumor resection, or a combination of these treatments. The planar 201Tl images were acquired 10 mins (early) and 2 hrs (delayed) after the intravenous injection of 111 MBq 201Tl-chloride. Three-phase bone scintigraphy was performed using 740 MBq 99mTc-HMDP at the same lesion site as for 201Tl imaging. The blood flow images were obtained every 10 sec for 2 mins and were immediately followed by the blood pool image after 5 mins. Three to 4 hrs later, bone images were obtained. 201Tl and three-phase bone scintigraphies were correlated with the histopathologic findings and/or clinical follow-up of more than 3 months. RESULTS: Of the 35 cases, 15 were free of disease and 20 had residual or recurrent tumors. Of the 20 residual or recurrent cases, all had true-positive 201Tl early and delayed scans, while bone scintigraphy was true-positive on the blood flow, blood pool and bone images in 16, 18 and 12 cases, respectively. 201Tl early and delayed images and 99mTc-HMDP blood flow and blood pool images were false-positive in one patient. The histology of this false-positive case showed the presence of lymph proliferative tissue. CONCLUSIONS: Although 201Tl uptake after treatment does not always indicate recurrence, 201Tl scintigraphy may still be more useful than three-phase bone scintigraphy in the follow-up of patients with bone and soft-tissue tumors following therapy.     

Tc-99m PMT whole-body scintigraphy for evaluated of therapeutic effect and for monitoring bone metastasis in a patient with hepatocellular carcinoma

Detection of metastatic lesions by bone scintigraphy is highly sensitive but has a low rate of specificity. Often bone metastases from hepatocellular carcinoma are not detected by bone scintigraphy because of low uptake or a photopenic area in the tumor. In contrast, Tc-99m Sn-N-pyridoxy-5-methyltryptophan (Tc-99m PMT) whole-body scintigraphy reflects tumor viability, and the specificity of detection is so high that tumor structure can be shown well. Tc-99m PMT whole-body scintigraphy was helpful for evaluating the response to therapy and monitoring the course of the patient described here with bone metastasis from hepatocellular carcinoma.