Ipsilateral craniofacial uptake of Tc-99m MDP in nasopharyngeal carcinoma: incidence and implication

A five year review of 224 Tc-99m methylene diphosphonate (MDP) scintiscans of 194 patients with proven nasopharyngeal carcinoma revealed evidence of craniofacial asymmetry in 73.7 per cent. In virtually all instances tracer accumulation corresponded to the side of the primary lesion, cervical node enlargement and or cranial nerve dysfunction. It was concluded that the high frequency of asymmetric ipsilateral MDP accumulation about the face may be attributed to one or all of the following; tumour extension into contiguous structures, localised inflammatory or necrotic changes or even tracer uptake by the tumour itself.     

Increased cerebral blood flow in MELAS shown by Tc-99m HMPAO brain SPECT

We report cerebral SPECT studies on two siblings with the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Tc-99m HMPAO brain SPECT was performed 8, 19 and 30 days after a stroke-like episode in one case and 10 days after a stroke-like episode, 6 h after a partial seizure and as a follow-up study in the other. Increased blood flow was seen in both these patients with stroke-like episodes due to MELAS. The cause of the increased blood flow is uncertain, but it may be related to the decreased pH created by local increase in lactic acid. Received: 30 December 1997/Accepted: 18 March 1999     

Unexplained transient splenic uptake of Tc-99m MDP in bronchogenic carcinoma

A patient with squamous cell carcinoma of the lung had splenic uptake of Tc-99m MDP on two consecutive bone scans, but not on a third. There was no intervening therapy. At autopsy the spleen was grossly and microscopically normal.     

Focal uptake of Tc-99m MDP in a gossypiboma

A 51-year-old Korean woman with a history of breast cancer underwent screening bone scintigraphy, which revealed minimal soft tissue uptake of Tc-99m methylene diphosphonate (MDP) in the right lower quadrant. CT and plain films confirmed that the uptake was due to a retained surgical sponge or gossypiboma. The incidence of gossypibomas has been reported at high as 1 in 1000 to 15,000 intra-abdominal operations. The natural progression of an aseptic gossypiboma is a foreign body reaction and granuloma formation. This inflammatory granulomatous reaction is the most likely cause of the extraosseous accumulation of Tc-99m MDP. This entity should be added to the already extensive list of etiologies of extraosseous MDP accumulation.     

Tc-99m MDP uptake in a calcified bladder tumor

A 68-year-old man with a history of prostate carcinoma and increasing levels of prostate-specific antigen was referred for a radionuclide bone scan. In addition to a probable metastatic lesion in the right femoral head, focal radiotracer accumulation was seen overlying the left aspect of the urinary bladder. Plain radiographs and pelvic computed tomography confirmed the presence of a calcified mass in the bladder. Cystoscopic examination revealed an exophytic bladder lesion. Biopsy indicated low-grade papillary transitional cell carcinoma, and the patient successfully underwent transurethral resection of this tumor.     

Ivory vertebra appearing photopenic on Tc-99m MDP bone scan: demonstration by SPECT/CT

We report the case of a 72-year-old man with prostate cancer, in whom Tc-99m MDP bone scintigraphy revealed a "superscan" pattern, except in a dorsal vertebra, which appeared photopenic. A low-dose SPECT/CT acquisition demonstrated that the lack of tracer uptake corresponded to a blastic lesion with no lytic component. Surprisingly, the cold vertebra appeared as an "ivory vertebra" on the CT part of the SPECT/CT acquisition. In the present case, the photopenic appearance is thought to be due to a concomitant blastic lesion and spine infarct.     

Relapsing polychondritis diagnosed by Tc-99m MDP bone scintigraphy.

PURPOSE: Relapsing polychondritis is a generalized recurring disease of cartilage that involves joints, trachea, bronchi, laryngeal cartilages, costal cartilages, and cartilages of the ear and nose. It is associated with autoimmune diseases, including Hashimoto disease in some cases. METHODS: The authors evaluated a 29-year-old man with relapsing polychondritis who had symptoms and signs of a common cold for 2 months and anterior chest pain near the sternum for 1 month. RESULTS: After the diagnosis, the authors found that the patient had a history of thyroid therapy for hyperthyroidism 15 years before. Tc-99m MDP bone scintigraphy performed to evaluate anterior chest pain showed diffusely increased accumulation of radioactivity in all costocartilages and sternoclavicular joints. Based on that information, relapsing polychondritis was diagnosed. Ga-67 citrate scintigraphy was preformed to determine the optimum biopsy site of the cartilage. The diagnosis was histologically supported by the results of the open biopsy. CONCLUSIONS: In this case, Tc-99m MDP bone scintigraphy was useful for diagnosing relapsing polychondritis, and Ga-67 citrate scintigraphy was helpful in determining the biopsy site.