Visualization of uveal amelanotic melanoma with technetium-99m(V) dimercaptosuccinic acid

The possibility of using technetium-99m(V) dimercaptosuccinic acid, Tc-99m DMSA, in the evaluation of uveal amelanotic melanoma was assessed in this study. Both planar and SPECT images clearly demonstrated the tumor. Following confirmation of our results by contemporaneous ultrasonography and MRI the patient was treated with Iodine-125 brachytherapy. In combination with other diagnostic tests, Tc-99m(V) DMSA scintigraphy may play a role in the detection of uveal melanoma and its possible systemic metastases.     

99Tc(m)(V)DMSA scintigraphy in skeletal metastases and superscans arising from various malignancies: diagnosis, treatment monitoring and therapeutic implications

Skeletal metastases arising from a wide variety of malignancies including a few cases with superscan appearance were evaluated using (99)Tc(m) MDP bone scanning and (99)Tc(m)(V)DMSA scintigraphy. Whole body planar scans were obtained at 3 h and 24 h after injection of 740 MBq (99)Tc(m) MDP and 5 days later at similar times after injection of 555 MBq of (99)Tc(m)(V)DMSA. A qualitative as well as quantitative comparison was made between the (99)Tc(m) MDP bone scan and the (99)Tc(m)(V)DMSA scan in detection of osseous metastases. The reference methods used for discordant or equivocal lesions were correlative morphological imaging modalities, for example additional conventional radiography, CT or MRI. The present pictorial review deals with the results of qualitative analysis of the study. A total of 75 cases have been evaluated. The vignettes illustrated in the present article demonstrate avid (99)Tc(m)(V)DMSA concentration in skeletal metastases from a wide variety of malignancies and thus expand the potential therapeutic indications for 188/186 Re(V)DMSA. The study also demonstrates the valuable supporting role a (99)Tc(m)(V)DMSA scan can play in the confirmation as well as evaluation of the extent of malignant infiltration in a suspected superscan in routine skeletal scintigraphy. In addition, a (99)Tc(m)(V)DMSA scan detected a number of metastatic lesions in and around joints and regions with previous surgical intervention that were inconclusive in the bone scan. The results in a few patients who were available for repeat scintigraphy following treatment, support the convincing evidence that (99)Tc(m)(V)DMSA accumulation may be a sensitive indicator of patient response to therapy. This might have an important bearing in the context of increasing "cold" bisphosphonate usage in the treatment of skeletal metastases, where skeletal scintigraphy with a radiolabelled bisphosphonate derivative can often be fallacious because of competitive inhibition by the non-labelled form.     

Observations on the sequential use of Tc-99m phosphonate and Ga-67 imaging in untreated primary and secondary malignant tumors of the head and neck

Scintigraphy using both Tc-99m phosphonate and Ga-67 was performed in 55 cases of untreated primary and secondary tumors of the head and neck. In 21 patients with primary tumors of jaws, eye, tongue, or parotid gland, Ga-67 scintigraphy visualized the primary tumor in all cases and metastases in 12. Scintigraphy using Tc-99m phosphonate disclosed primary bone involvement in 12 cases and skeletal metastases in two. In eight of 13 patients with metastatic lesions of jaws and skull, bone scintigraphy showed skeletal metastases. In seven of these patients, Ga-67 scintigraphy detected the primary tumor and in 11 cases detected metastases. Bone scintigraphy disclosed skeletal metastases in six of 21 patients with malignant neck tumors. In 13 of these patients, Ga-67 scintigraphy visualized the primary tumor, whereas it showed metastases in seven. It is concluded that Ga-67 scintigraphy should be used in the investigation of untreated primary or secondary malignant tumors of the head and neck. Bone scintigraphy may be indicated as an additional study in selected cases only.     

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.     

The role of Tc-99m (V) DMSA scintigraphy in the evaluation of superscan on bone scintigraphy

PURPOSE: This study evaluated the biodistribution of Tc-99m (V) DMSA in patients with superscans on bone imaging and defined its role in differentiating the underlying cause. METHODS: Nine patients (five with metastatic and four with metabolic bone disease) with classical superscans were entered into the study. All patients had the necessary radiologic and biochemical studies and a final diagnosis was reached accordingly. Tc-99m (V) DMSA scintigraphy was performed 1 week after Tc-99m MDP whole-body bone imaging. RESULTS: In four of five patients with widespread skeletal metastases, Tc-99m (V) DMSA scan showed diffusely increased bone uptake. In the remaining patient, the Tc-99m (V) DMSA scan showed a normal distribution pattern. All patients with metabolic bone disease had increased bone uptake on Tc-99m (V) DMSA scans. CONCLUSION: Tc-99m (V) DMSA shows increased bone uptake in patients having a superscan appearance in metastatic or metabolic bone disease. Tc-99m (V) DMSA imaging may play a role in the evaluation of patients with equivocal bone scan findings for a superscan.     

99Tcm-tetrofosmin在乳腺癌及其转移灶显像中的应用

99Tcm-tetrofosmin作为亲肿瘤显像剂,对乳腺癌原发病灶和腋窝淋巴结转移的诊断有良好的灵敏度、特异性和准确率,可应用于乳腺癌全身骨转移和术后复发的诊断,其应用于乳腺癌前哨淋巴结转移的诊断、作为P-糖蛋白功能显像剂和三维立体定位引导孔针型活检等领域有着良好的发展前景.99Tcm-tetrofosmin乳腺癌及转移灶显像可与其他乳腺癌检查方法相结合提高乳腺癌诊断的准确率.     

^99mTc（V）—DMSA骨显像诊断骨转移瘤的临床价值

目的：评价99mTc（V）－DMSA显像在骨转移瘤诊断中的意义。材料和方法：对91例疑骨转移瘤患者行99mTc（V）DMSA全身显像，并与99mTc-MDP全身骨显像及其它检查对比。结果：74例证实存在骨转移瘤者，99mTc．MDP骨显像均显示异常放射性浓聚，99mTc（V）-DMSA显像72例显示了与99mTc-MDP显像某些相同部位的放射性浓聚，2例99mTc（V）DMSA显像阴性。17例骨良性病变，99mTc－MDP骨显像显示轻度异常放射性浓聚，而99mTc（V）-DMSA显像却未见异常的放射性浓聚。结论：99mTc（V）－DMSA诊断骨转移瘤的特异性比99mTc-MDP骨显像高，在骨良恶性肿瘤鉴别诊断中具有重要的临床价值。     

Comparison of 18F-FDG PET and bone scintigraphy in detection of bone metastases of thyroid cancer.

We compared the efficacies of (18)F-FDG PET and (99m)Tc-bone scintigraphy for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC). METHODS: We examined 47 patients (32 women, 15 men; mean age +/- SD, 57.0 +/- 10.7 y) with DTC who had undergone total thyroidectomy and were hospitalized to be given (131)I therapy. All patients underwent both whole-body (18)F-FDG PET and (99m)Tc-bone scintigraphy. The skeletal system was classified into 11 anatomic segments and assessed for the presence of bone metastases. Bone metastases were verified either when positive findings were obtained on >2 imaging modalities--(201)Tl scintigraphy, (131)I scintigraphy, and CT--or when MRI findings were positive if vertebral MRI was performed. RESULTS: Bone metastases were confirmed in 59 of 517 (11%) segments in 18 (38%) of the 47 study patients. The sensitivities (visualization rate) for bone metastases on a segment basis using (18)F-FDG PET and (99m)Tc-bone scintigraphy were 50 of 59 (84.7%) and 46 of 59 (78.0%), respectively; the difference between these values was not statistically significant. There were only 2 (0.4%) false-positive cases in a total of 451 bone segments without bone metastases when examined by (18)F-FDG PET, whereas 39 (8.6%) were false-positive when examined by (99m)Tc-bone scintigraphy. Therefore, the specificities of (18)F-FDG PET and (99m)Tc-bone scintigraphy were 449 of 451 (99.6%) and 412 of 451 (91.4%), respectively; the difference between these values was statistically significant (P < 0.001). The overall accuracies of (18)F-FDG PET and (99m)Tc-bone scintigraphy were 499 of 510 (97.8%) and 458 of 510 (89.8%), respectively; the difference between these was also statistically significant (P < 0.001). CONCLUSION: The specificity and the overall accuracy of (18)F-FDG PET for the diagnosis of bone metastases in patients with DTC are higher than those of (99m)Tc-bone scintigraphy, whereas the difference in the sensitivities of both modalities is not statistically significant. In comparison with (99m)Tc-bone scintigraphy, (18)F-FDG PET is superior because of its lower incidence of false-positive results in the detection of bone metastases of DTC.     

Assessment of non-small cell lung cancer viability and necrosis with three radiopharmaceuticals

Assessment of tumor viability and necrosis of non-small cell lung cancer and detection of distant metastases are important for diagnosis, staging, monitoring the response to treatment and planning long-term management. We performed scintigraphy on patients with non-small cell lung cancer to determine the utility of three tumor targeting tracers for diagnosing primary lung cancer, for differentiating viable from necrotic tumor tissue and for detecting distant bone and soft tissue metastases. Our patients were divided into groups. Group A consisted of 27 patients, 25 male and 2 female, mean age 59 years, range from 35 to 72 years. These patients underwent radioimmunoscintigraphy (RIS) using monoclonal antibody against human milk fat globule labeled with technetium-99m ((99m)Tc). Group B consisted of 23 patients, 21 male and 2 female, mean age 56 years, range: 37 to 70 years. Group C consisted of 24 patients, 20 male and 4 female, mean age 58 years, range: 35 to 74 years. Both Groups B and C underwent chest and whole-body scintigraphy with 555 MBq of (99m)Tc-sestamibi ((99m)Tc-S) and 111 MBq of thallium-201 chloride ((201)TlCl), respectively. Tumor to non-tumor ratio was calculated. Our findings show that RIS had 52% sensitivity in detecting primary non-small cell lung cancer. In contrast, the sensitivity of (99m)Tc-S and of (201)Tl scintigraphy was 87% and 88%, respectively. High uptake of all three radiopharmaceuticals was found in 6 patients with distant soft tissue and bone tissue metastases and in 1 patient with brain metastasis. Mean tumor to non-tumor ratios were similar: for RIS 1.7+/-0.4, for (99m)Tc-S 1.6+/-0.3 and for (201)Tl 1.6+/-0.2. In conclusion: (99m)Tc-S and (201)Tl scintigraphy are superior to RIS for detecting non-small primary lung cancers and potentially clinically useful methods for detecting primary lung cancer as above, as well as bone and soft tissue metastases.     

Uptake of pentavalent technetium-99m dimercaptosuccinic acid in idiopathic synovial chondromatosis

We reported two Tc-99m(V) DMSA scintigrams in patients with idiopathic synovial chondromatosis which affected the metacarpo-phalangeal joint and shoulder joint. Tc-99m(V) DMS A accumulated markedly and diffusely in the tumor. Tc-99m(V) DMSA scintigraphy would be valuable for deciding the optimal site for biopsy.     

Pentavalent [99mTc]DMSA, [131I]MIBG, and [99mTc]MDP--an evaluation of three imaging techniques in patients with medullary carcinoma of the thyroid

Nine patients with histologically proven medullary carcinoma of the thyroid (MCT) were imaged using pentavalent [99mTc]dimercaptosuccinic acid [(V)DMSA], [131I] metaiodobenzylguanidine (MIBG) and [99mTc]methylene diphosphonate (MDP). Technetium-99m (V)DMSA demonstrated most of the tumor sites in eight patients with proven metastases, with an overall sensitivity of 95% in lesion detection. Iodine-131 MIBG showed definite uptake in some of the tumor sites in three of the nine patients imaged, with equivocal uptake seen in a further one patient, with sensitivity of only 11% for lesion detection. Technetium-99m MDP demonstrated bony metastases only, in four of the patients imaged yielding a sensitivity of 61%. Technetium-99m (V)DMSA has been demonstrated in this study to be a useful imaging agent in patients with MCT, showing uptake in significantly more lesions and with better imaging qualities than [131I]MIBG, and with the ability to detect soft tissue as well as bony metastases.     

(99m)Tc-EDDA/HYNIC-octreotate - a new radiotracer for detection and staging of NET: a case of metastatic duodenal carcinoid

Somatostatin receptor scintigraphy (SRS) has become a routine imaging method for the diagnostics of neuroendocrine tumours (NET). (99m)Tc-EDDA/HYNIC-octreotate (Polatom, Poland) is a new radiotracer with high affinity for SSTR2 and similar physiological biodistribution to (111)In-Octreoscan. We present a case of a 47-year-old man with disseminated duodenal carcinoid. The patient had been operated due to the tumour mass detected in pancreatic head area. Histopathology revealed carcinoid of the duodenal wall with local lymph node and liver metastases. The patient was qualified for chemotherapy stopped due to severe leucopenia. (99m)Tc EDDA/HYNIC-octreotate scintigraphy was performed for staging and to determine SSTR status of the tumour before planned 90Y-DOTATATE therapy. The multiple metastatic lesions were detected all over the body. The high quality images with high target/non target ratio were obtained. (99m)Tc-MDP scintigraphy confirmed multiple bone metastases. On the basis of SRS result the patient was qualified for 90Y-DOTA-TATE therapy. In conclusion, (99m)Tc EDDA/HYNIC-octreotate can be regarded as a promising tracer for staging and to determine SSTR status of NET.     

F-18 fluorodeoxyglucose positron-emission tomography in the diagnosis of tumor recurrence and metastases in the follow-up of patients with breast carcinoma: a comparison to conventional imaging

AIM: To evaluate the role of F-18-fluorodeoxyglucose positron-emission tomography (F-18 FDG PET) in the follow-up of breast carcinoma in case of clinical suspicion of local recurrence or distant metastases and/or tumor marker increase in correlation to conventional imaging. MATERIAL AND METHODS: Retrospective analysis of the results of F-18 FDG PET (ECAT ART(R), Siemens CTI MS) of 62 patients (age 58.5 +/- 12.8) with surgically resected breast carcinoma (time interval after surgery, 86 +/- 82 months, mean follow-up 24 +/- 12.6 months). Patient- and lesion-based comparison with conventional imaging (CI) including mammography (MG), ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI), radiography (XR) and bone scintigraphy (BS). Furthermore, we evaluated the influence on tumor stage and therapeutic strategy. A visual qualitative evaluation of lesions was performed. RESULTS: On a patient base, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting local recurrence or distant metastases were calculated to be 97%, 82%, 87%, 96% and 90% compared with 84%, 60%, 73%, 75% and 74% with CI. On a lesion base, significantly more lymph node (84 vs. 23, P < 0.05) and fewer bone metastases (61 vs. 97, P < 0.05) could be detected by using F-18 FDG PET compared with CI. Sclerotic bone lesions were predominantly detected by BS. On the other hand, there were several patients with more FDG positive bone lesions and also mixed FDG positive/Tc-99m methylenediphosphonate (MDP) negative and FDG negative/Tc-99m MDP positive metastases. In case of normal tumor markers, sensitivity, specificity, PPV, NPV and accuracy for detecting local recurrence or distant metastases were calculated to be 100%, 85.0%, 78.6%, 100% and 90.3% for FDG PET and 80%, 50%, 50%, 80% and 61.5% for CI. An upstaging could be observed in 9.7% (6/62) and downstaging in 12.9% (8/62), leading to a change in therapeutic regimen in 13 patients (21%). CONCLUSIONS: F-18 FDG PET demonstrates apparent advantages in the diagnosis of metastases in patients with breast carcinoma, compared with conventional imaging on a patient base. On a lesion base, significantly more lymph node and less bone metastases can be detected by using F-18 FDG PET compared with conventional imaging, including bone scintigraphy. In patients with clinical suspicion but negative tumor marker profile, too, F-18 FDG PET seems to be a reliable imaging tool for detection of tumor recurrence or metastases. Considering the high predictive value of F-18 FDG PET, tumor stage and therapeutic strategy will be reconsidered in several patients.     

Identification of Warthin tumor: magnetic resonance imaging versus salivary scintigraphy with technetium-99m pertechnetate

OBJECTIVE: The aim of this study was to evaluate the accuracy of technetium-99m (Tc-99m) pertechnetate scintigraphy and magnetic resonance (MR) imaging in the diagnosis of Warthin tumor. METHODS: Sixteen cases of Warthin tumor and 17 cases of non-Warthin tumor were examined by Tc-99m pertechnetate scintigraphy with lemon juice stimulation and MR imaging, including T1-weighted, T2-weighted, short inversion time inversion recovery, diffusion-weighted, and contrast-enhanced dynamic images. We used the receiver operating characteristic (ROC) curve to evaluate diagnostic accuracy. RESULTS: The mean area under the ROC curves of MR imaging in the diagnosis of Warthin tumor (0.97) was higher than that of Tc-99m pertechnetate scintigraphy (0.88). CONCLUSION: Magnetic resonance imaging is more useful in the evaluation of Warthin tumor than Tc-99m pertechnetate scintigraphy.     

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 evaluation of 123I-MIBG scintigraphy in medullary thyroid carcinoma (MTC)

The diagnostic value of 123-I-MIBG (meta-iodobenzylguanidine) scintigraphy was investigated in six patients with recurrence and/or metastatic spread of a medullary thyroid carcinoma. In no case was there MIBG storage in tumor tissue. Thus, our results show that MIBG scintigraphy is not suitable as a screening method either in the primary diagnostics or the follow-up of medullary thyroid carcinoma. If, however, inoperable metastases have been detected by other diagnostic methods, MIBG scintigraphy is indicated in order to test a potential therapeutic application in these patients. In the imaging diagnostics and follow-up of medullary thyroid carcinoma, the examination with 99mTc(V)-DMSA (technetium-99m-dimercaptosuccinate) is markedly superior to MIBG scintigraphy. High-resolution cervical sonography is of major importance in the hands of an experienced examiner.     

In-111 octreotide scan in a case of a neuroendocrine tumor of unknown origin

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.     

Warthin's tumor of parotid gland on Tc-99m pertechnetate scintigraphy with lemon juice stimulation: Tc-99m uptake, size, and pathologic correlation

The aim of this study was to evaluate the usefulness of technetium-99m (Tc-99m) pertechnetate scintigraphy with lemon juice stimulation in the diagnosis of Warthin's tumor and its correlation with Tc-99m uptake, tumor size, and histologic subtype. Tc-99m pertechnetate scintigraphy before and after lemon juice stimulation and pathologic specimens of 34 Warthin's tumors and 47 non-Warthin's lesions were retrospectively evaluated. Tc-99m uptake of Warthin's tumors before and after stimulation was visually graded as follows: absent; indeterminate; low grade; definite; and strong. Tumor size was defined as maximum diameter of the tumor measured from the surgical specimen. Warthin's tumors were classified into three histologic subtypes according to the ratio of epithelial and lymphoid stromal components: predominant epithelial; intermediate; and low-grade epithelial types. Eighteen of 34 (53%) Warthin's tumors and one benign lymphoepithelial cyst showed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy before lemon juice stimulation. Thirty-two of the 34 (94%) Warthin's tumors, one benign lymphoepithelial cyst, one pleomorphic adenoma, and one oncocytoma revealed higher uptake than that of the normal parotid gland on Tc-99m scintigraphy after lemon juice stimulation. The mean size was 37 mm in strong uptake Warthin's tumors, 24 mm in definite uptake tumors, 19 mm in low-grade uptake tumors, and 12 mm in low-grade uptake tumors excluding those tumors with large cystic component. There was a significant correlation between tumor size and degree of Tc-99m uptake after lemon juice stimulation. However, there was no correlation between histologic subtype and Tc-99m uptake, and histologic subtype and tumor size in Warthin's tumors. Our study concludes that Tc-99m pertechnetate scintigraphy with lemon juice stimulation is useful for the detection and diagnosis of Warthin's tumor. The degree of uptake in Warthin's tumor on Tc-99m scintigraphy with lemon juice stimulation depends mainly on tumor size and the presence of large cystic component in it.     

Technetium-99m diphosphonate imaging of psammocarcinoma of probable ovarian origin: case report and literature review

Technetium-99m methylene diphosphonate (Tc-99m MDP) bone scans have long been used by clinicians to diagnose osseous metastases in patients with cancer. However, in several benign and malignant diseases, notably those characterized by extensive soft tissue calcification, Tc-99m MDP may be taken up by the tumor itself. We present a case of a stage IIIC psammoma-rich low-grade serous carcinoma of the ovary, whose identity and extent of disease were first suggested by Tc-99m MDP scintigraphy. The literature concerning this form of cancer, and the use of Tc-99m MDP bone scans to image soft tissue lesions, are reviewed.     

99mTc(V)-DMSA and99mTc-MDP uptake and no67Ga-citrate uptake in a case of primary pulmonary leiomyosarcoma

Tumor scintigraphy with 67Ga-citrate, 99mTc(V)-DMSA and 99mTc-MDP were performed on a patient with rare primary pulmonary leiomyosarcoma. While 67Ga-citrate accumulation to the tumor was not recognized, 99mTc(V)-DMSA and 99mTc-MDP scintigraphy showed relatively intense localization of the tracers in the lesion, and were very useful in suggesting the characteristics of the tumor.