Extrahepatic hepatocellular carcinoma metastasis demonstrated by technetium-99 HIDA scan

Summary A patient presented with a 10-cm mass in the left lobe of the liver. Liver biopsy revealed hepatocellular carcinoma with abundant bile staining. A chest roentgenogram showed a 13-mm nodule in the right mid-lung field.A⁹⁹Tc HIDA scan was ordered for the evaluation of the pulmonary nodule. Intense uptake of the radionuclide was noted in the location of the nodule.The findings in this case suggest that the⁹⁹Tc HIDA scan may be a useful staging agent after the diagnosis of hepatocellular carcinoma has been documented.     

99mTc-MDP骨显像与X线、CT联合诊断SAPHO综合征

目的  比较分析SAPHO综合征X线、CT 和核素骨显像影像特征,提高本病正确诊断率。 方法  通过对该病22例的X线、CT 和核素骨显像图像分析,总结各自的影像学特性,并对比各自的优缺点。 结果  SAPHO综合征在各种成像上都有特征性的表现,但X线、CT特征性更突出,而核素骨显像敏感性更高。 结论  对可疑SAPHO综合征患者,应及早行X线或CT检查,必要时加做核素骨显像来提高诊断准确率。     

Heterotopic peripancreatic spleens presenting as possible tumors of the body and tail of the pancreas

Accessory spleens are found in about 10% of routine postmortem autopsies, usually near the hilum of the spleen and the tail of the pancreas. In 16% of cases, the accessory spleen may be found within the pancreatic tail.¹ Its importance arises when computed tomography (CT) scan reveals a tumor in or about the tail of the pancreas. The diagnosis of intrapancreatic accessory spleen may be suggested when the CT scan, following intravenous contrast injection, shows the mass to be enhanced in a manner characteristic of that of a spleen. Accessory spleen can be identified using technetium 99m(^99m)Tc)-labelled heated red cells or^99mTc sulfur colloid.² We report a patient with heterotopic spleens, questioned by CT scan for pancreatic tumors, but accurately diagnosed by^99mTc sulfur colloid scan.     

Clinical utility of (99mTc)‐TRODAT‐1 scans to differentiate Parkinsonian syndromes: case studies and commentary

The differential diagnosis of Parkinsonian syndromes is challenging, especially in the elderly as they often have complex presentations. Nuclear imaging modalities can increase diagnostic accuracy. Single‐photon emission tomography (SPECT) using the ligand (^99mTc)‐TRODAT‐1 is used overseas but is yet to be approved in Australia. Three pilot cases of clinically unclear Parkinsonian syndromes from the Royal North Shore Hospital Aged Care Department who underwent (^99mTc)‐TRODAT‐1 scans are described. From experience overseas, the (^99mTc)‐TRODAT‐1 scan has clinical utility in the differential diagnosis of Parkinsonian syndromes. (^99mTc)‐TRODAT‐1 has a lower cost and greater availability than other ligands. Our initial scan findings are largely consistent with the clinical picture, but low specific binding can affect scan interpretation. (^99mTc)‐TRODAT‐1 is a potential tool in the differential diagnosis of Parkinsonian syndromes. Further experience regarding its effect on patient outcomes and cost effectiveness is required before routine clinical use can be recommended.     

Radiological features of long bones in synovitis, acne, pustulosis, hyperostosis, osteitis syndrome and their correlation with pathological findings

The purpose of this study was to demonstrate the radiological features of long bones in synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and to correlate these with the clinical findings. Eleven long bone lesions in seven cases of SAPHO syndrome were examined. The patients ranged in age from 6 to 63 years, with a mean of 47 years. In all seven cases, radiography, ^99mtechnetium bone scintigraphy, CT scan, and magnetic resonance imaging (MRI) were performed. In six of the cases, bone biopsy and bone culture were carried out for 7 long bones. Seven of the involved lesions were from the shaft of the femur, one each was from the neck and the shaft of the humerus, and one was from the proximal tibia. These lesions showed radiologically hyperostosis, osteolysis, and bone infarction-like lesion. Osteolysis was occasionally accompanied by sclerotic change. Hyperostosis usually showed diaphyseal involvement, presenting low signal intensity on T₁- and T₂-weighted MR images. Histologically, these findings corresponded to massive bone necrosis, new bone formation, fibrosis, or a mixture of these associated with mild inflammatory cell infiltration. Osteolysis involved dyaphysis, metaphysis, or epiphysis associated with arthritis, and presented low signal intensity on T₁-weighted images, nonhomogeneous signal intensity lower than fat on T₂-weighted images, and high signal intensity on fat suppression images. These findings corresponded to fibrosis, granulation, and inflammatory cell infiltration with lymphocyte aggregation. Bone infarction-like lesion was observed in the shaft or neck of the femur and the humerus and accompanied by calcification and cystic change. Bone cultures were negative in all cases in which bone biopsy was performed. Although hyperostosis is thought to be a characteristic bone lesion in SAPHO syndrome, the long bone lesion can occasionally show not only hyperostosis but also osteolytsis and bone infarction-like lesions. Received: April 17, 2001 / Accepted: August 2, 2001     

Intrathoracic splenosis: superiority of technetium Tc 99m heat-damaged RBC imaging.

Intrathoracic splenosis is a rare diagnosis that is usually made following an invasive procedure. Although radiographic and CT findings are nonspecific, these findings combined with a history of splenic injury should suggest the possibility of this diagnosis. We present a patient with intrathoracic splenosis diagnosed on the basis of a technetium Tc 99m heat-damaged RBC scan following false-negative technetium Tc 99m sulfur colloid scan results.     

A ‘Made in One Piece’ Skeleton in a 22-Year-Old Man Suffering from Sickle Cell Anaemia

A 22-year-old African male with known sickle cell anaemia was referred by a Congolese medical centre with a request to improve his poor physical condition. He was unable to walk, stand or sit because his large joints and his spine were either ankylosed or very rigid. Radiographs showed joint fusion from the third to the fifth cervical vertebrae, of both hips, of the left knee, and a bilateral osteonecrosis of the humeral head. There was no scintigraphic evidence for an active osteomyelitis (^99mTc-MDP (methyldiphosphonate) bone scan, ^99mTc monoclonal antigranulocyte scan and ^99mTc sulphur colloid scan). To improve his mobility the right femoral head was resected in June 1997; 14 days later the left femoral head was resected. Four months after the resection of the right hip, a right uncemented total hip prosthesis was implanted on this side. One month later the same type of hip arthroplasty was performed on the left side. During the postoperative rehabilitation period the patient regained autonomy. We have found no previous reports of such severe and multiple joint complications in a single patient suffering from sickle cell anaemia. Received: 24 September 1999 / Accepted: 18 January 2000     

Intravenous pamidronate in the treatment of sternoclavicular hyperostosis

The SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) is a rare clinical entity in which osteosclerosis and osteolysis are consistent radiological findings. We present a patient with SAPHO syndrome manifesting as painful sternoclavicular hyperostosis treated successfully with pamidronate. For the first time, a reduction in isotope bone scan activity was documented in parallel to a favourable clinical response. Bisphosphonates have potent antiosteoclastic and anti-inflammatory effects. By virtue of their dual effects on bone remodelling and inflammation, they seem an appropriate therapy in the management of SAPHO syndrome. This case demonstrates the efficacy of pamidronate, both clinically and radiologically, as first line therapy for patients with isolated hyperostosis.     

Erythrocyte Destruction and Reticuloendothelial Function in the Autoimmune Hemolytic Disease of NZB Mice1

Abstract. New Zealand Black (NZB) mice spontaneously develop Coombs positive autoimmune hemolytic anemia. The pathogenesis of the hemolytic anemia was investigated through radioisotopic methods using chromium-labeled (⁵¹Cr) syngeneic erythrocytes to measure the chromium disappearance rate. Chromium disappearance was monitored in both the presence and absence of ‘bound’ autoantibodies. Technetium-labeled colloidal sulfide (^99mTc) was injected i.v. to assess the phagocytic activity of the reticuloendothelial system. The mean rate of disappearance of chromium from the circulation of Coombs negative NZB mice was comparable to that of a control CBA strain. Coombs positive NZB mice had a greater destruction rate with the rate being proportional to the degree of autoantibody sensitization. The hepatic technetium uptake in Coombs positive NZB mice was about 50% greater than in Coombs negative NZB mice. The spleen and bone marrow had a greater uptake and the liver a smaller uptake of ^99mTc in Coombs negative NZB mice than in a control group of mice. It is concluded that both erythrocyte autoantibodies and increased reticuloendothelial activity influence the destruction of erythrocytes in Coombs positive NZB mice.     

Bone metastasis versus bone marrow metastasis? Integration of diagnosis by 18F-fluorodeoxyglucose positron emission/computed tomography in advanced malignancy with super bone scan: Two case reports and literature review

Super scan pattern on technetium-99m methyldiphosphonate (Tc-99m MDP) bone scintigraphy is a special condition of extremely high bone uptake relative to soft tissue with absent or faint renal radioactivity visualization, which is usually seen in diffuse bone metastases or discrete endocrine entities. Here, two cases with super bone scan are presented. One was a young man diagnosed with gastric cancer. The other was a middle-aged woman with a history of breast cancer with recent recurrence. Both cases had 18-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) diagnosis simultaneously. Based on imaging of ¹⁸F-FDG PET/CT, diffusely incremental ¹⁸F-FDG avidity in spine/pelvis on PET and subtle erosion of cortical bone on CT were seen. The cytological results of bone marrow biopsy showed evidence of malignant metastasis. However, there were several focal discrepant findings between the ¹⁸F-FDG PET/CT and Tc-99m MDP bone scan. According to integration of both imaging findings and the result of bone marrow biopsy, we believe that the disseminated malignant spread in bone marrow is a primitive alternation in the super bone scan and that it is also as a result of neoplasm-related endocrine factors.     

Synovitis,acne, pustulosis,hyperostosis, osteitis syndrome with invisible organizing pneumonia: A case report

We report the case of a 59-year-old female patient, presenting with pustular rash on both hands and pain in the lumbosacral part and left lower limb. A magnetic resonance imaging examination of the left leg was undertaken and the result showed that a malignant lesion with bone destruction of the left femoral shaft could not be excluded. Subsequently, bone tumor was excluded by pathological examination. Lung computed tomography scan showed patchy consolidation and cord shadow in the middle left lung. Subsequently, lung cancer was excluded by pathological examination, and the histopathological changes of lung were consistent with those of organized pneumonia. Blood tests revealed elevated C-reactive protein and erythrocyte sedimentation rate. Antinuclear antibody, rheumatoid factor, and human leukocyte antigen-B27 were unremarkable. Whole body bone scintigraphy via technetium 99m-methyl diphosphonate showed increased radionuclide uptake in the left middle femur. Based on her clinical manifestations, imaging results and bone scintigraphy, the patient was diagnosed as having synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Loxoprofen and Tripterygium wilfordii Hook F led to impressive clinical and radiologic improvement.     

Synovitis,acne, pustulosis,hyperostosis, osteitis (SAPHO), and chronic recurrent multifocal osteomyelitis (CRMO): A tale of two cases

BackgroundSAPHO (Synovitis Acne Pustulosis Hyperostosis Osteitis) and CRMO (Chronic Recurrent Multifocal Osteomyelitis) are chronic relapsing osteoarticular disorders with common dermatological manifestations.Aim of the workTo describe a case of SAPHO in an adult and CRMO in a child.Cases presentationCase 1: A 32-year old man presented with dull aching low back pain for 2 years with morning pain/stiffness. On examination there were acneform lesions on the face, tenderness over thoracic spine and swelling of left sternoclavicular joint. Plain x-rays showed sclerosis/widening/irregularity of sternoclavicular joint, sclerosis/irregularity of endplate, loss of disc space with syndesmophytes in mid/lower dorsal spine (D6-11) and sclerosis in middle of left tibia. Magnetic resonance imaging (MRI) spine showed cortical erosions and marrow edema (D6-L1) with findings suggestive of aseptic/inflammatory spondylodiscitis. A bone scan showed increased uptake D7-D12 and mid-third tibia (hyperostosis). Biopsy from D6/D7 showed normal histopathology. Case 2: A 10-year-old girl presented with pain/swelling of right foot for 2 months, pain/swelling of left shoulder and sternoclavicular joint with pustular acne on the face. There was swelling/tenderness over right 5th metatarsal base and left sternoclavicular joint as well as tenderness over proximal humerus. ESR was 65 mm/1^sthr. Plain x-rays showed punched-out lytic lesions surrounded by sclerosis in metatarsal base and metaphysis of humerus. Patient was diagnosed as CRMO.ConclusionSAPHO and CRMO are rare and their diagnosis is sometimes not easy. SAPHO can present as aseptic spondylodiscitis. Both conditions can be diagnosed with clinical and radiological features. A biopsy is necessary for ruling out other conditions.     

Preliminary experience of 99mTc-Aprotinin scintigraphy in amyloidosis

Background and aim: Radio‐labelled Aprotinin has been shown to bind with amyloid fibrils in vitro as well as in vivo. The aim was to test the usefulness of ^99mTc‐Aprotinin imaging in systemic amyloidosis. Methods: Thirty‐five cases who had ^99mTc‐Aprotinin scans for the assessment of systemic amyloidosis were reviewed retrospectively. Eighteen had biopsy‐proven amyloidosis and 17 were controls (amyloidosis was excluded by negative biopsies and non‐invasive tests). Five of 18 patients with amyloidosis had final diagnosis of cardiac amyloid. Results: Physiological uptake of ^99mTc‐Aprotinin was noted in the urinary tract (kidneys and bladder) and in the liver of all patients and controls; and non‐specific uptake of ^99mTc‐Aprotinin was visualised in the spleen and oro‐facial structures in the majority of both groups. Myocardial ^99mTc‐Aprotinin uptake was noted in all five patients with final diagnosis of cardiac amyloidosis and in none of the 30 subjects who did not have cardiac amyloid. The median heart to background uptake ratio was 2.0 in cardiac amyloid patients and 1.1 in subjects without cardiac amyloid (P = 0.0004). Single Photon Emission Tomography (SPECT) studies of the thorax confirmed that the site of uptake lay within the myocardium. In the amyloidosis group, site‐specific ^99mTc‐Aprotinin uptake was also identified in the subcutaneous tissue of the legs and in a breast nodule shown to be positive for amyloidosis on biopsy. Conclusions: ^99mTc‐Aprotinin imaging may be a useful non‐invasive method for the assessment of the presence and extent of extra‐abdominal amyloid, particularly cardiac amyloidosis. It has little role in diagnosis of amyloidosis involving the oro‐facial and abdominal structures.     

The role of scintigraphy with technetium-99m nanocolloid in patients with peripheral joint pain

We studied 51 patients with peripheral joint pain to assess the ability of technetium-99m-nanocolloid (^99mTc NC) scintigraphy to distinguish patients with active joint disease from those without, irrespective of their underlying aetiology. Patients with peripheral joint pain due to various causes were clinically categorised as either having objective signs of active joint disease or not. Their clinical diagnoses were not made known to the nuclear physician until after scanning. Each patient was given an intravenous injection of 555 MBq of ^99mTc NC 1 h prior to taking spot views of the peripheral joints. Seventeen patients with low backache but without peripheral joint pain were imaged in an identical manner to exclude peripheral joint involvement. The latter formed a control group. ^99mTc NC scintigraphy demonstrated a sensitivity of 89% for identifying at least one affected joint per patient, a specificity of 87.5%, a negative predictive value (npv) of 87.5%, a positive predictive value (ppv) of 89%, and overall accuracy of 88%. There were three false negative and three false positive cases. The scan was negative in all control subjects. ^99mTc NC scintigraphy proved to be sensitive in patients with active joint disease and demonstrated a good correlation with clinical assessment. The value of the high specificity, npv and negative controls together made the test highly discriminatory in excluding patients without active peripheral joint disease. Received: 20 October 2000 / Accepted: 15 March 2001     

A case of SAPHO syndrome with destructive spondylodiscitis suspicious of tuberculous spondylitis

We report a rare case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in which the differential diagnosis included tuberculous spondylitis and the patient ultimately required reconstructive spinal surgery. The patient was a 60-year-old woman who presented with severe low-back and leg pain after treatment for tuberculosis. Roentgenography and magnetic resonance imaging of the lumbar spine revealed destructive changes suggestive of tuberculous spondylitis. [¹⁸F]-fluoro-2-deoxyglucose positron emission tomography/computed tomography showed uptake in the cervical spines, lumbar spines, and sacroiliac joints from which she was suspected of having SAPHO syndrome without skin manifestations. However, as her symptoms did not respond to conservative treatment, we performed reconstructive surgery of the lumbar spine. Spinal specimens obtained surgically showed nonspecific inflammation and fibrous hypertrophy of the bone marrow, confirming a diagnosis of the SAPHO syndrome. Her symptoms improved markedly after surgery, although she required occasional prednisolone for moderate polyarthralgia and leg pain.     

'Exaggerated adrenarche' in children presenting with premature adrenarche

OBJECTIVE Previous reports of endocrinological profiles in children presenting with premature adrenarche have not shown consistent abnormalities. We therefore aimed to review the clinical and biochemical aspects of a large number of patients presenting with premature adrenarche without virilization and determine the relation between clinical and biochemical characteristics and the frequency of adrenal steroid disorders. DESIGN AND PATIENTS Eighty-eight patients presenting with adrenarche without virilization during 1985-1992 were retrospectively reviewed. There were 72 girls and 16 boys. All were normotensive and had either prepubertal breasts or testes < 4 ml. in patients with high adrenal androgen levels, adrenal tumours had been excluded by either adrenal ultrasound or CT scan. MEASUREMENT We recorded clinical manifestations, auxological data, bone age, biochemical results including basal 17OH-progesterone (b17OHP), dehydro-epiandrosterone sulphate (DHEAS), androstenedione (Δ⁴A), testosterone, cortisol and stimulated 170HP and cortisol. ACTH stimulation tests (using soluble Synacthen 250 μg intramuscularly and collecting blood at 0, 30 and 60 minutes) were performed when clinically Indicated. 17OH-Pregnenoione (17OHPreg) was also measured during ACTH stimulation tests in 13 individuals to look for abnormalities of 3 β-hydroxysteroid dehydrogenase (3β-HSD). RESULTS The age of onset ranged from 3 to 9·5 years (mean 6·8 ± 1·3). There were no significant differences by sex for height SDS, weight SDS or % ideal body weight, but bone age advancement was greater in males (P < 0·02). The most common presenting clinical manifestation was premature appearance of pubic hair in 93·8%, the other 6·2% presenting with body Odour, acne and/or hirsutism. Twelve patients had b17OHP > 6 nmol/l of whom 5 were diagnosed as having congenital adrenal hyperplasia (CAH) resulting from 21-hydroxylase deficiency after ACTH stimulation tests. A further 33 patients who had b17OHP < 6 nmol/l had normal 17OHP and cortisol responses to ACTH stimulation. Patients, after excluding those with CAH, were divided on the basis of their DHEAS levels into prepubertal (< 1·5 μmol/l), pubertal (1·5-6 μmol/l) and above pubertal range (> 6 μmol/l). The 8 patients with DHEAS values above the pubertal range were described as having ‘exaggerated adrenarche’. There were no significant clinical differences between these 3 groups, but Significant differences were found for bone age advancement and the steroids, b17OHP, Δ⁴A and testosterone. There was a strong correlation between DHEAS and Δ⁴A(r= 0·623, P < 0·001). The ‘exaggerated adrenarche’ group had higher 17 OHPreg/17OHP ratios at 60 minutes after stimulation but these were not diagnostic for 3β-HSD deficiency. CONCLUSION The value of assessing basal steroids in children presenting with premature adrenarche Is demonstrated in this series with 5·7% being diagnosed with 21-hydroxyiase deficiency and 9·1% with ‘exaggerated adrenarche’. No relation was found between adrenal steroids and clinical features except for the acceleration of bone age. The relation between ‘exaggerated adrenarche’ and future ovarian hyperandrogenism needs further evaluation.     

The SAPHO syndrome: a clinical and imaging study

The purpose of this study is to describe the clinical and radiological manifestations of patients with the synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Retrospective study (1984–2007) was performed in a single center. All patients with the SAPHO syndrome were included. Fifty-two patients were included: 26 male, mean age at diagnosis is 42±12 years. Ostearticular involvement was present before cutaneous involvement in 59.6% of patients and concomitantly in 23.5%. Anterior chest pain was the commonest clinical manifestation, it was present in 38 patients (73%), followed by peripheral arthritis in 17 patients (32%), and sacroliliac pain in 14 patients (26.9%). Cutaneous involvement was present in 33 patients (63.5%). HLA B27 antigen was present in eight patients (17.7%). Bone scintigraphy showed an increased uptake in 42 patients (93.3%). The location of the uptake was mainly in sternoclavicular and manubriosternal joints. CT scan was performed in all “hot joints” showing sclerosis, erosions, hyperostosis, and soft tissue involvement. Refractory patients were treated mainly with pamidronate. Although SAPHO syndrome is an entity that share features that fit into a variety of established disease categories, the present study has a homogenous clinical and radiological pattern that gives support to believe that the SAPHO syndrome is an isolated clinical entity.     

Technetium Tc 99m diphosphonate bone scan. False-normal findings in elderly patients with hematogenous vertebral osteomyelitis

Hematogenous osteomyelitis is usually diagnosed by an abnormal technetium Tc 99m diphosphonate bone scan in symptomatic patients who have positive blood cultures. False-normal 99mTc bone scans have been described recently in neonates with biopsy-proved osteomyelitis. This phenomenon seems to be extremely rare in adults. Two elderly patients with hematogenous vertebral osteomyelitis had normal technetium Tc 99m diphosphonate bone scans when first evaluated. In both cases the bone scans became abnormal four to six weeks after onset of symptoms and two to four weeks after the initial normal results of the study. When suggested by the clinical picture, hematogenous osteomyelitis cannot be ruled out by a normal 99mTc bone scan at any age. Gallium scan, computed tomographic scan, or bone biopsy can be helpful in such cases.     

A case of SAPHO (synovitis-acne-pustulosis-hyperostosis-osteomyelitis) syndrome in which [<Superscript>18</Superscript>F]fluorodeoxyglucose positron emission tomography was useful for differentiating from multiple metastatic bone tumors

We report the case of a 50-year-old Japanese woman with SAPHO (synovitis-acne-pustulosis-hyperostosis-osteomyelitis) syndrome. Radiographs showed osteosclerosis of the cervical and lumbar vertebrae, as well as osteosclerosis and osteolysis of the right femoral neck, resembling multiple metastatic bony lesions. Arriving at a diagnosis required hematological and imaging tests. Whole-body bone scintigraphy identified diffuse uptake from the lower cervical vertebrae to the lumbar vertebrae and marked uptake in the right femoral neck. However, with [¹⁸F]fluorodeoxyglucose positron emission tomography ([¹⁸F]FDG-PET) scanning, abnormal [¹⁸F]FDG uptake was not detected in cervical and lumbar spine, or in the femoral neck. Bone biopsy showed signs of chronic nonspecific inflammation, rather than tumor or infection. Based on these findings, the patient was diagnosed with SAPHO syndrome unaccompanied by skin lesions, and administration of non-steroidal anti-inflammatory drugs provided pain relief.     

Technetium-99m 2-methoxy-isobutyl-isonitrile uptake scintigraphy in detection of the bone marrow infiltration in multiple myeloma: correlation with MRI and other prognostic factors

Whole-body scintigraphy with Technetium-99m 2-methoxy-isobutyl-isonitrile (^99mTc-MIBI) has been proposed as a useful method for demonstrating the areas of active bone marrow infiltration in multiple myeloma (MM). In this study, we compared the ^99mTc-MIBI scan with magnetic resonance imaging (MRI), skeletal X-ray survey, and biochemical markers of disease activity in MM to determine its potential in predicting the extension of the disease. Twenty-four myeloma patients had undergone to the ^99mTc-MIBI scan. Only two patients showed negative results in the ^99mTc-MIBI scan; one had clinically active disease, and the other was on remission. MRI was performed to 18 clinically active patients, and 16 of them showed positive myelomatous bone marrow involvement. No significant difference was found between the ^99mTc-MIBI scan and MRI in predicting the extension of bone marrow infiltration in MM (p = 0.11). ^99mTc-MIBI scores were correlated with bone marrow neoplastic plasma cell ratio (p = 0.005), serum paraprotein level (p < 0.001), serum lactate dehydrogenase (p = 0.031), and beta-2 microglobulin (p = 0.045). The ^99mTc-MIBI scan showed disease activity better than the skeletal X-ray survey (x ²  = 5.299, p = 0.021). A significant decrease was found in posttreatment ^99mTc-MIBI scores of the patients with positive overall response (p = 0.016). The ^99mTc-MIBI scan is a noninvasive test that can show the extension of the disease in MM. It seems that the ^99mTc-MIBI scan and MRI show extension and intensity of the myelomatous bone marrow infiltration equally well. The ^99mTc-MIBI scan can be an alternative to MRI when it is not available or if there is any limitations for its usage.