Clinical comparison of 99mTc-HMDP and 99mTc-MDP. A multicenter study

99mTc-Hydroxymethylene diphosphonate (HMDP) was compared to 99mTc-methylene diphosphonate (MDP) with respect to image quality, lesion detectability, and the uptake ratios of normal bone to soft tissue (B/S), metastatic bone to soft tissue (M/S) and bone metastases to normal bone (M/B) at 2 and 3 h after injection in the same subjects. Thirty-three patients with bone metastases were examined in six nuclear-medicine departments, with each center using its usual bone-scanning protocol which was identical for both compounds in the same patient. The uptake of 99mTc-HMDP in normal bone (B/S) was significantly higher than that of MDP at 2 and 3 h, but there were no significant differences between the two compounds with regard to the M/S or M/B ratios. The M/B of HMDP at 2 h was not significantly different from that of MDP at 3 h, the latter showing a significantly higher B/S and M/S ratio. All lesions were detected with both compounds, even at 2 h. The image quality was rated as follows (in decreasing order): HMDP (3 h), MDP (3 h), HMDP (2 h), and MDP (2 h). HMDP was shown to be a useful bone-imaging agent, especially when shorter intervals between injection and recording are required.     

Muscular injury in a child diagnosed by 99mTc-MDP bone scan

An 11-year-old boy had bone scanning to rule out an osscous lesion of the right arm. He presented progressive pain and hard swelling of the right arm. His past medical history and general physical examination were unremarkable. He trained for karate. The scan demonstrated considerable muscular uptake in both arms. CPK and CPK MB levels were both abnormally high, suggesting muscle injury. After a 10-day rest period the bone scan returned to normal.     

Scintigraphic findings on99mTc-MDP,99mTc-sestamibi and99mTc-HMPAO images in Gaucher's disease

Gaucher's disease is an autosomal recessive lysosomal storage disease characterized by the specific deficiency of glucocerebrosidase that leads to accumulation of insoluble glucocerebroside in the reticuloendothelial system, particularly the bone marrow, liver, spleen and lymph nodes. Direct scintigraphic visualization of lipid deposits in Gaucher's disease has recently been described, based on the use of the lipid-soluble xenon-133. We report here on the use of the lipophilic cat-ionic complex technetium-99m sestamibi (^99mTc-MIBI), employed as an indicator of increased cellular density and metabolic activity, to evaluate Gaucher cell infiltrates in the bone marrow;^99mTc-hexametazime (^99mTc-HMPAO) was also employed, as a pure indicator of lipidic infiltration in the bone marrow. A 67-year-old patient with known type 1 Gaucher's disease presented with a painful left hip and knee and difficulty in gait subsequent to traumatic fracture of the left femoral neck that had required implant of a fixation screw-plaque. Bone scan with^99mTc-methylene diphosphonate revealed reduced uptake at the distal metaphyseal-epiphyseal femoral region. In addition, whole-body maps and spot-view acquisitions of the thighs and legs were recorded at both 30 min and 2.5 h after the injection of^99mTc-MIBI: the scintigraphic pattern clearly showed increased uptake at several sites involved by Gaucher deposits in the bone marrow (both knees, with variable intensity in different areas), matching the bone changes detected by conventional x-ray. The target to non-target ratios slowly decreased with time, from an average value of 2.25 in the early scan to an average value of 2 in the delayed scan. The lipid-soluble agent^99mTc-HMPAO exhibited a superimposable scintigraphic pattern of accumulation at the involved sites, though with lower target to non-target ratios (1.27–1.48). The results obtained in this patient suggest a potential role of^99mTc-MIBI in the scintigraphic evaluation of Gaucher's lipid deposits in the bone marrow. If the results are confirmed in other patients, this radiopharmaceutical would offer clear advantages over¹³³Xe because of its wider availability and greater practicality (i.v. administration of^99mTc-MIBI versus inhalation of¹³³Xe, and use of a single gamma camera instead of two as with¹³³Xe).     

Splenic hemangioma detection on a technetium-99m mdp bone scan

While relatively rare, the most common benign tumor of the spleen is the hemangioma. We report a case of a noncalcified splenic hemangioma found incidentally on a technetium-99m methylene diphosphonate (Tc99m MDP) bone scan. Tc-99m MDP may have been accumulated by iron, which was deposited extensively within the hemangioma.     

A clinical comparison of 99mTc-DPD and two 99mTc-MDP agents

European Journal of Nuclear Medicine and Molecular Imaging - Two hundred and fifty-seven patients were studied with bone-seeking radiopharmaceuticals. They were randomly divided into three groups....     

Determination of bone turnover by urinary excretion of 99mTc-MDP

Two metods of estimating bone turnover were investigated. The 24 h whole body retention (WBR) of intravenously injected ^99mTc methylene disphosphonate (^99mTc-MDP), a precise, accurate, and generally accepted method, was compared with a new, simple, measurement involving assessment of the 24 h urinary excretion (UE) of ^99mTc-MDP. The WBR and UE were measured in 50 normal subjects, 10 patients with thyrotoxicosis, and 10 patients with chronic renal failure. The precision was 4.8% and 2.7%, respectively, and the two methods were highly significantly correlated (r=0.99, SEE=2.9%, p<0.001). In addition, urinary ^99mTc-MDP excretions at 0 h–4 h (UE₄) and 0 h–8 h (UE₈) after injection were calculated in 49 subjects. The estimation of WBR from UE₄ or UE₈ was considerably poorer than from UE (for UE₄: r=-0.83, SEE=8.7%, and for UE₈: r=-0.90, SEE=6.8%) and the precision of UE₄ and UE₈ was 7.2% and 7.8%, respectively, and greater than those of both UE and WRR. It is concluded that the UE bone turnover measurement may become a simple, radiation dose-saving method to diagnose and monitor the treatment of metabolic bone diseases.     

99MTc-MDP全身骨显像对骨转移瘤的诊断价值

目的：探讨^99mTc-MDP全身骨显像对骨转移瘤的诊断价值。方法：对300例肿瘤患者静脉注射^99mTc-MDP 15～20mci行SPECT全身骨显像，并对结果进行比较。结果：阳性结果为121例，阳性率为40．3％，其中的75例与X线检查对照，骨显像阳性而X线阴性者12例。结论：SPECT全身骨显像对骨转移瘤早期诊断治疗，预后的观察具有一定的临床价值。     

Extraosseous accumulation of99mTc-HMDP to radiation nephropathy, mimicking recurrent neuroblastoma

OBJECTIVE: The aim of this study is to clarify the period of extraosseous accumulation of (99m)Tc-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 underwent (99m)Tc-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 of (99m)Tc-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.     

Comparison of CVA imaging with 99mTc phosphates, 99mTc pertechnetate,and computed tomography

Summary A retrospective study was made of 111 patients who underwent computed tomography (CT) and nuclear brain scans, with both pertechnetate and phosphate bone agents (PHOS), within 7 days of each other. Specifically, 78 patients who had a recent cerebral vascular accident (CVA) were compared. There were no significant sensitivity differences between the methods. While these studies appear complementary, the most important criterion is the time after onset when the studies were performed. The axiom if the intensity of the phosphate scan exceeds that of the pertechnetate, the lesion must be a CVA is true, only if the study is performed within 4 weeks of onset. The most economical method for optimum detection of CVA, with avoidance of frequent errors, is an early CT followed by a PHOS brain scan about 14 days after ictus in those that have an initial negative CT.     

The scintigraphy of sacroiliac joints. A comparison of 99mTc-DPD and 99mTc-MDP

The accumulation of 99mTc-methylene diphosphonate (99mTc-MDP) and 99mTc-dicarboxypropane diphosphonate (99mTc-DPD) in sacroiliac (si) joints was evaluated as a function of imaging time in 22 control patients and 5 patients with sacroiliitis. The controls were injected with either 99mTc-DPD or 99mTc-MDP (12 and 10 patients, respectively) and the patients with sacroiliitis with both agents within 5 days. Both the anterior and posterior views of the si joints were taken. The sacroiliac joint-to-sacrum (SI/S) ratio was calculated with the region of interest method. No statistically significant differences between these bone-seeking agents were found in the SI/S ratios of the control or the diseased patients. A clear overlap of indices (mean +/- SD) was found between the control patients and the patients with sacroiliitis. When the inflamed si joint was divided into three small adjacent areas and the SI/S ratios calculated for these areas, a statistically significant (P less than 0.001) increase in the SI/S ratio was noticed when compared with the SI/S ratio of the whole joint. Comparison of control patients and patients with sacroiliitis showed the most significant differences in the anterior views as well as in the P value: P less than 0.001 in all patients injected with 99mTc-DPD and in most patients injected with 99mTc-MDP. In the posterior views, the significance was less marked. In every case, the inflamed part of the si joint was visible in the anterior views. The background subtraction had the greatest effect on the SI/S ratio of anterior images, but in the posterior views no significance was found.(ABSTRACT TRUNCATED AT 250 WORDS)     

Clinical utility of fluoride-18 positron emission tomography/CT in temporomandibular disorder with osteoarthritis: comparisons with 99mTc-MDP bone scan

Objectives:

The purpose of this study was to compare the clinical utility of fluoride-18 positron emission tomography (¹⁸F-PET)/CT with that of conventional ^99mTc-methylene diphosphonate (MDP) bone scan in temporomandibular disorder (TMD) with osteoarthritis.

Methods:

24 patients with TMD who underwent both ¹⁸F-PET/CT and ^99mTc-MDP bone scans for diagnostic work-up were enrolled. The temporomandibular joint (TMJ)-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on ¹⁸F-PET/CT and the TMJ uptake ratio on bone scan were measured.

Results:

Of the 48 TMJs in 24 patients, 35 TMJs were diagnosed as TMD with osteoarthritis, 8 TMJs as TMD with anterior disc displacement (ADD), and the remaining 5 TMJs showed no evidence of TMD (NED). All three uptake ratios on ¹⁸F-PET/CT and the TMJ uptake ratio on the bone scan tended to be higher in TMD with osteoarthritis than in TMD with ADD or NED. Receiver operating characteristic (ROC) curve analysis for detecting TMD with osteoarthritis indicated that the TMJ-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on PET/CT (0.819, 0.771 and 0.813, respectively) showed higher area under the ROC curve value than the TMJ ratio on bone scan (0.714). The TMJ-to-skull uptake ratio on PET/CT showed the highest sensitivity (89%) and accuracy (81%) of all uptake ratios.

Conclusions:

¹⁸F-PET/CT can help diagnose TMD with osteoarthritis with superior diagnostic ability and is a suitable alternative modality to a conventional ^99mTc-MDP bone scan.     

Clinical significance of technetium-99m methylene diphosphonate myocardial uptake: association with carcinoma of the prostate

Benign myocardial uptake of technetium-99m labelled phosphates, not related to cardiac or metabolic disorders, has been documented except in the case of^99mTc-methylene diphosphonate (MDP). The aim of this study was to assess the frequency of myocardial uptake and its possible association with malignant tumours in general and prostatic carcinoma in particular. We reviewed bone scintigrams performed with either^99mTc-hydroxydiphosphonate (HDP) or^99mTc-MDP over a period of more than 2 years for all patients with prostatic carcinoma and a matching group of patients suffering from other malignant and non-malignant disorders. A total of 965 scintigrams of 812 patients (males=559, females=253; age range 50–91 years, average age 69.2 years) were reviewed. Increased myocardial uptake was detected in 19 scintigrams (MDP=13, HDP=6) of 18 patients (17 males, one female). Most of the male patients with increased myocardial uptake had prostatic carcinoma (13/17) and were over 80 years of age (12/17). All patients were free of any cardiac or noncardiac disorder that might account for such uptake. When scintigraphy was repeated in the same patient, the uptake of^99mTc-HDP was more diffuse and of higher grade than that of^99mTc-MDP Benign myocardial uptake of^99mTc-MDP is more common than previously thought. Although uptake of radiophosphates is attributed to asymptomatic atherosclerotic changes associated with old age, a strong association with prostatic carcinoma exists which may indicate variations in the bone: soft tissue affinity of different MDP complexes.     

Ectopic accumulation of99mTc-HMDP in primary lung cancer in comparison with CT findings

The purpose of this study was to evaluate the frequency and the extent of extraosseous^99mTc-HMDP accumulation in 412 patients with primary lung cancer. CT scanning was also performed and we compared the extraosseous uptake by lung cancer with the internal structure of the tumor on CT scans. The extent of ectopic^99mTc-HMDP accumulation was classified as low, moderate or high. CT scans were used to evaluate the size and internal structure of the tumor, including calcification and necrosis. Ectopic^99mTc-HMDP accumulation in primary lung cancer was found in 32 patients (7.7%), and included 2 cases (0.5%) of high uptake, 8 cases (1.9%) of moderate uptake, and 22 cases (5%) of low uptake. No difference in uptake was observed among the histological types, but a relationship between tumor size and^99mTc-HMDP extraosseous accumulation was observed. CT scans of the 32 tumors exhibiting ectopic^99mTc-HMDP accumulation revealed 5 cases of calcification in the tumor and 18 cases of tumor necrosis. The factors promoting ectopic^99mTc-HMDP accumulation were considered to be tumor size and calcification or necrotic change. In patients with neither calcification nor necrosis, other factors such as increased calcium metabolism and altered vascular permeability may be involved.     

A comparison between the diagnostic efficacy of 99mTc-MDP, 99mTc-DPD and 99mTc-HDP for the detection of bone metastases

We have investigated the clinical efficacy for the detection of bone metastases of two recently marketed bone-seeking radiopharmaceuticals, HDP and DPD, compared with traditionally used MDP. Twenty patients received 15 mCi 99mTc-MDP; after assessment ten of these patients later received 15 mCi 99mTc-DPD and ten other patients of this group were injected with 15 mCi 99mTc-HDP. Scintigraphy took place 3 h after tracer injection. Quantitative analysis included the calculation of normal bone to soft tissue ratios, lesion to soft tissue ratios and lesion to normal bone ratios for all three radiopharmaceuticals. Visual inspection of the scintiphotos revealed the same number of bone lesions at the same localisations. Statistical evaluation of our quantitative data showed that the lesion to normal bone ratio was significantly higher for MDP than for DPD. No further significant differences in the uptake in normal bone or in the metastatic lesions were found between all three radiopharmaceuticals. It is concluded that the new bone-seeking agents DPD and HDP do not possess clinical advantages over MDP for the detection of skeletal metastases.     

Relationship of 99mTc-MDP uptake to regional osseous circulation in skeletally immature and mature dogs

Uptake of intravenously injected ^99mTc-MDP in multiple regions of healthy skeletally immature and mature dogs was correlated with regional chondro-osseous blood flow determined by radioactively labeled microspheres. Compared to the microsphere distribution, the distribution of ^99mTc-MDP indicated that blood flow is an important, but not exclusive, factor in the uptake of bone-seeking tracers. Other factors such as the affinity of the tracer for the various types of chondro-osseous tissues must also affect tracer uptake. A measure of the relative affinity of ^99mTc-MDP for bone was derived by the ratio of the percentage of tracer uptake to the percentage of blood flow. The juxta-ephyseal region demonstrated the greatest affinity for the tracer, followed in decreasing affinity, by the cortical bone, epiphyseal cartilage, trabecular bone of the metaphysis and secondary ossification center, and marrow space. Within the spongiosa, affinity generally increased as the proportion of osseous trabeculae relative to marrow space increased. ^99mTc-MDP uptake is disproportionately increased in areas of active bone growth and remodeling where the surface area of hydroxyapatite crystals available for adsorption is probably highest.     

Clinical approach to renal study incidental to99mTc-MDP bone scintigraphy

In order to investigate the feasibility of the assessment of renal function with 99mTc-MDP, we compared renographical images, renogram patterns and the glomerular filtration rate (GFR) obtained by means of a modified Gates' method and 200 MBq of 99mTc-MDP with those obtained by means of 99mTc-DTPA. Because 19 of 20 patients had malignant tumors in the genitourinary tract, there was no difference between the two tracers in identifying a parenchymal defect corresponding to renal cancer. Of eight patients with hydronephrosis, four had a defect or decreased uptake with a dilated pelvis, whereas the other four had marked radioisotope retention in the renal pelvis or the whole kidney on serial images. There was also no difference between the two tracers in identifying hydronephrosis. Of 38 paired renograms 35 showed the same renogram patterns with both tracers. Of three patients with different renogram patterns, two had hydronephrosis. In 20 patients including three patients with bone metastasis, total GFR and split GFR obtained with both tracers correlated with a correlation coefficient of r = 0.920 (p < 0.001) and r = 0.944 (p < 0.001), respectively. Excluding bone metastasis from the analysis, a linear-regression analysis showed excellent agreement between the two measurements with a correlation coefficient of r = 0.960 (p < 0.001) and r = 0.963 (p < 0.001), respectively. The linear regression equations were Y = 1.009X - 0.111 and Y = 1.034X - 0.714, respectively. In conclusion, 99mTc-MDP can be used as a supplement to evaluate renal function incidental to the survey of bone metastases in patients with malignant tumor.     

Techetium 99m methylene diphosphonate bone scanning in osteoarthritic hands

In this prospective study, the radiological features characteristic of osteoarthritis of the hand were compared with the radionuclide bone scan images. A total of 32 patients was assessed at 6-monthly intervals for 18 months. Microfocal radiographs were taken at each visit. The high magnification and resolution of this technique permitted direct measurement of joint space width, subchondral sclerosis, osteophyte number and area and juxta-articular radiolucency area for each joint in the hand. Four-hour technetium 99m methylene diphosphonate bone scans were taken at 0 and 12 months and the activity of tracer uptake at each joint scored. The latter was compared with each X-radiographic feature at every visit and the changes between visits analysed. The scan scores did not correlate with any of the X-radiographic features other than osteophyte size. During the study the size of growing and remodelling osteophytes increased significantly at joints with raised or increased isotope uptake. Offprint requests to: J.C. Buckland-Wright, Department of Anatomy, Guy's Hospital Medical School, London Bridge, London SE1, 9RT, UK     

Usefulness of technetium-99m hydroxymethylene diphosphonate scans in localizing bone metastases of differentiated thyroid carcinoma

Iodine-131 is uniquely able to demonstrate iodine uptake of differentiated thyroid carcinoma (DTC), but precise localization may be difficult, especially in the thorax, due to the quality of image resolution with 1311 and the lack of anatomical landmarks. When bone metastases do not show radioiodine uptake, bone scintigraphy can be used to detect them. We studied two groups of patients. In group 1, 15 patients with known bone metastases of DTC were treated with 3.7 GBq ¹³¹I. After 4 or 5 days, technetium-99m hydroxymethylene diphosphonate (HMDP; 740 MBq) was injected and a whole-body scan with simultaneous acquisition of ¹³¹I and ^99mTc-HMDP images was carried out using a large field of view gamma camera fitted with a high-energy collimator. Technetium uptake was abnormal in 47 of 63 localizations, being increased in 29 foci, decreased in 7 and heterogeneous in 11. The superimposition of ¹³¹I and ^99mTc-HMDP scans permitted an accurate localization in 80% of spine metastases and in 46% of osseous thoracic localizations, even in the presence of lung metastases. In group 2, 9 patients, who had bone pain, neurological signs or elevated serum thyroglobulin, had DTC bone metastases without iodine uptake. They received a diagnostic dose of ^99mTc-HMDP 3h prior to scintigraphy with a large field of view gamma camera fitted with a low-energy collimator. Technetium uptake was abnormal in 37 of 38 localizations, being increased in 34 foci and decreased in 3. One false-negative was found in a skull metastasis. In both groups of patients, ^99mTc-HMDP scans were useful. The procedure allows accurate localization of bone metastases and can be used as a guide for subsequent radiological investigations.     

Unusual extraosseous tumoral accumulation of 99mTc-MDP

Three cases (rhabdomyosarcoma, lymphoma, and metastatic malignant melanoma) of unexpected increased uptake of methylenediphosphonate labelled by technetium 99m sodium pertechnetate (^99mTc-MDP) are described. The possible mechanisms of the extraosseous tumoral accumulation of ^99mTc-MDP in these malignancies are discussed. The usefulness of this method for the diagnosis, localization, and follow-up of some extraosseous tumors is evaluated.