Diffuse hepatic and splenic uptake of Tc-99m methylene diphosphonate on bone scintigraphy after intravenous administration of gadolinium-containing MRI contrast

Three patients with known lung cancer came on different days to our department to have a bone scan to evaluate possible osseous metastatic disease. The bone scan images showed increased Tc-99m methylene diphosphonate (Tc-99m MDP) activity in the liver and to a lesser degree in the spleen, whereas bone scan images from other patients on the same days showed no abnormal activity in the liver or spleen. On the same day, shortly before the bone scan, all 3 patients had a magnetic resonance imaging scan with an intravenous injection of Magnevist (Gadolinium-DTPA), which was not previously known to cause an altered Tc-99m MDP distribution. In the follow-up bone scans performed within 1 week of the initial bone scintigraphy, images from none of these 3 patients showed abnormal liver or spleen activity. The findings indicated that the increased Tc-99m MDP activity in the liver and spleen in the early studies was indeed an effect of Gadolinium-containing magnetic resonance imaging contrast. This effect was further confirmed by an animal experiment.     

A crossover study comparing the effect of particle size on the distribution of radiocolloid in patients

Two radiocolloid preparations, differing in particle size by a factor of 5 to 20, were compared in each of 15 patients. The smaller colloid, measuring less than 80 nm, showed a relative decrease in the calculated target to background ratios for the liver and spleen and an increase for the bone marrow. The increased uptake of the smaller particle in the bone marrow, as measured by the bone marrow to soft-tissue background ratio, was about 50% higher than that of the larger colloidal particles. Comparable marrow images can be obtained in a half to a third of the time with the smaller particle size for a given administered dose.     

Radiocolloid scintigraphy in Felty's syndrome

The Tc-99m sulfur colloid liver-spleen scintigrams of nine patients with Felty's syndrome (a triad of rheumatoid arthritis, splenomegaly, and neutropenia) were reviewed. The characteristic scintigraphic findings include (1) moderate or severe splenomegaly, (2) the reversal of liver-to-spleen uptake ratio despite normal liver function tests, and (3) virtually no visualization of the bone marrow uptake and no pulmonary radiocolloid sequestration. In a late stage of cirrhosis of the liver, moderate-to-severe splenomegaly with the reversal of liver-to-spleen uptake ratio almost always accompanies abnormal liver function, and sometimes there may be associated pulmonary radiocolloid uptake. It was therefore concluded that in a proper clinical setting, a radiocolloid scintigraph may differentiate between Felty's syndrome and cirrhosis of the liver in a late stage.     

Bone and liver images in medullary carcinoma of the thyroid gland: concise communication

Thirty-four patients with surgically documented medullary carcinoma of the thyroid (MCT) and elevated serum calcitonin levels had Tc-99m phosphate bone and/or Tc-99m sulfur colloid liver images for suspected metastases. Liver images demonstrated metastatic lesions in nine of 32 patients (28%). Bone images were positive for metastases in eight of 30 patients (27%). Four of these eight abnormal bone studies detected only skeletal lesions, two demonstrated only extraosseous metastases, and two showed both kinds. Of 18 patients with both radionuclide bone studies and skeletal radiographs, four demonstrated skeletal metastases, and lesions were recognized on both examinations. This study demonstrates that radionuclide bone and liver images frequently detect metastatic lesions in patients with MCT and elevated serum calcitonin levels, and that some nonskeletal metastases in patients with this tumor display an unusual affinity for bone-seeking radiotracers.     

Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT

OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.     

骨外软组织异常摄取骨显像剂的临床意义

目的探讨骨外软组织异常摄取骨显像剂的临床意义.方法将全身骨显像示软组织异常摄取骨显像剂^99Tc^m-亚甲基二膦酸盐（MDP）的30例患者显像结果与其手术病理和（或）CT、MRI、X线、超声及肠镜等检查结果对照,分析异常摄取^99Tc^m-MDP的临床意义.结果30例患者中肝摄取9例,其中弥散性摄取7例（6例为巨块型肝癌,1例为肝癌并结节性肝硬化）,局灶性摄取2例（1例为转移性肝癌,1例为原发性肝癌）;肺摄取5例,均为局灶性,4例为肺癌,1例为转移性肺癌;结肠摄取5例,1例弥散性伴局灶性摄取增高为血吸虫病,余4例原因不明;皮下摄取4例,2例对称性摄取者为多发性骨髓瘤患者钙磷代谢异常引起的转移性微小钙化灶,2例不对称摄取者1例为血管瘤,1例为脓肿;胸膜摄取3例,均为转移癌;腹部摄取3例,1例为网膜转移,1例为椎旁软组织转移,1例原因未明;乳腺摄取1例为乳腺癌.结论多种原因均可致骨外软组织异常摄取^99Tc^m-MDP,应结合临床或其他检查综合判断.     

Radiocolloid liver imaging in hepatic steatosis

In a review of 60 patients with fatty infiltration of the liver documented by Xe-133 imaging, 43% had normal radiocolloid liver images, and 57% had abnormal images with various combinations of hepatomegaly, mottling, splenomegaly, and splenic shift of radioactivity. None, however, showed focal defects. Fatty infiltrates do not simulate mass lesions on the radiocolloid study of the liver, and an area of photon deficiency in the presence of hepatic steatosis points to an additional pathologic process. The interpretation of the radiocolloid liver image is unhindered by fatty infiltration when searching for discrete space-occupying lesions.     

Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings

PURPOSE: To correlate magnetic resonance (MR) images of a bone marrow edema pattern with histologic findings in osteoarthritic knees. MATERIALS AND METHODS: Sixteen consecutive patients (age range, 43-79 years; mean, 67 years) referred for total knee replacement were examined with sagittal short inversion time inversion-recovery (STIR) and T1- and T2-weighted turbo spin-echo MR imaging 1-4 days before surgery. Tibial plateau abnormalities on MR images were compared quantitatively with those on histologic maps. RESULTS: The bone marrow edema pattern zone (ill-defined and hyperintense on STIR images and hypointense on T1-weighted MR images) mainly consisted of normal tissue (53% of the area was fatty marrow, 16% was intact trabeculae, and 2% was blood vessels) and a smaller proportion of several abnormalities (bone marrow necrosis [11% of area], abnormal [necrotic or remodeled] trabeculae [8%], bone marrow fibrosis [4%], bone marrow edema [4%], and bone marrow bleeding [2%]). The bone marrow edema pattern zone and the zone with a normal MR imaging appearance differed significantly in the presence of bone marrow necrosis (P =.021), bone marrow fibrosis (P =.014), and abnormal trabeculae (P =.011) but not in the prevalence of bone marrow edema (P =.069). Bone marrow edema also was found in zones with an unremarkable MR appearance (perifocal zone, 5% edema; control zone, 2% edema). CONCLUSION: A bone marrow edema pattern in osteoarthritic knees represents a number of noncharacteristic histologic abnormalities. Edema is not a major constituent of MR imaging signal intensity abnormalities in such knees.     

Systemic mastocytosis: MRI of bone marrow involvement

Systemic mastocytosis (SM) is an abnormal proliferation of mast cells, located in different structures: skin, bone marrow, spleen, liver and lymph nodes. Magnetic resonance imaging was prospectively performed in ten patients diagnosed by bone marrow biopsy in order to describe the different patterns of bone marrow involvement. Coronal T1-weighted spin-echo images were obtained in vertebral, pelvic, humeral and femoral bones. Depending on the extension of the cell infiltration, three patterns of bone marrow involvement were used: normal/no involvement (N), non-homogeneous (NH) and homogeneous (H). All ten patients presented bone infiltration. The patterns observed were: spine (50 % NH, 50 % H), pelvis (70 % NH), humerus 100(NH) and femur 40 % (NH). T1-weighted MR imaging is a sensitive technique for detecting marrow abnormalities in patients with systemic mastocytosis. There is no correlation between percentage of mast cells in bone marrow biopsy and extent or pattern of bone marrow involvement. Received: 5 June 1998; Revision received: 23 November 1998; Accepted: 15 January 1999     

Correlation between bone marrow edema and collapse of the femoral head in steroid-induced osteonecrosis

OBJECTIVE: The purpose of this study was to clarify whether bone marrow edema is detectable on initial MR imaging of steroid-induced osteonecrosis of the femoral head. SUBJECTS AND METHODS: Forty-eight hips with osteonecrosis were examined consecutively with MR imaging and radiography. In a previously reported screening program, osteonecrosis was diagnosed on MR imaging when subchondral bands of abnormal signals were present. In the screening program, the MR images of 200 hips of 100 patients receiving high-dose steroid therapy were examined prospectively. Subchondral bands were detected in 48 hips at a mean of 14 weeks after the initiation of steroid therapy. RESULTS: On follow-up MR imaging of 47 hips (one hip excluded) bone marrow edema was initially observed in 13 hips after the onset of hip pain. MR imaging of the remaining 34 hips did not reveal bone marrow edema and the patients were all asymptomatic. MR imaging of 31 of the 34 hips continued to show subchondral bands and MR imaging of the other three hips indicated that the subchondral bands had disappeared. When bone marrow edema was detectable, abnormal findings on radiography were slight but 11 (85%) of the 13 hips progressed to advanced osteonecrosis. Bone marrow edema was highly correlated with the subsequent collapse of the femoral head (p<0.0001). CONCLUSION: Bone marrow edema was not present on initial MR imaging of osteonecrosis. Bone marrow edema should be considered a marker for potential progression to advanced osteonecrosis, and careful examinations for osteonecrosis are necessary when bone marrow edema is seen.     

Splenic fluorodeoxyglucose uptake increased by granulocyte colony-stimulating factor therapy: PET imaging results.

Using PET, we investigated the change in 18F-fluorordeoxyglucose (FDG) uptake in the spleen after granulocyte colony-stimulating factor (G-CSF) treatment. METHODS: Forty-two FDG PET scans in 12 patients with locally advanced breast cancer who received G-CSF treatment were studied (12 baseline, 10 during G-CSF, 20 after G-CSF treatment). The PET images obtained at 50-60 and 60-70 min after intravenous FDG (370 MBq) injection were assessed visually and were compared with those before G-CSF treatment. For a semiquantitative index of FDG uptake, we determined the standardized uptake value calculated on the basis of predicted lean body mass (SUL) on these images, and we calculated the SUL ratios normalized to their baseline SUL values. RESULTS: During G-CSF treatment (n = 10), 9 scans (90%) showed increased splenic FDG uptake (3 slightly, 6 substantially). After G-CSF treatment (n = 20), 13 (65%) showed no change, 7 (35%) showed slightly increased uptake, but no case showed substantially increased FDG uptake in the spleen (P = 0.0003). Out of 30 PET scans obtained during and after G-CSF treatment, 16 (53%) showed increased FDG uptake in the spleen (10 slightly, 6 substantially), whereas 26 (87%) showed increased bone marrow FDG uptake (14 slightly, 12 substantially). The FDG uptake in other normal organs (liver, blood and lung) showed no change during or after G-CSF treatment. Similar to the change in the bone marrow, the SULs in the spleen significantly increased during G-CSF treatment (baseline, 1.50+/-0.31, versus during G-CSF, 2.69+/-0.84; P = 0.0004), then decreased after discontinuation of G-CSF (1.65+/-0.23). There was a significant correlation between the SUL ratios in the spleen and those in the bone marrow (r = 0.778, P < 0.0001), whereas there were no correlations between those in other organs and those in the bone marrow. CONCLUSION: Substantially increased FDG uptake was observed in the spleen during and after G-CSF treatment, although this change was less frequent and not as marked as the change observed in the bone marrow. The recognition and understanding of this phenomenon will be increasingly important when interpreting FDG PET images in cancer patients to avoid confusing this normal phenomenon with pathological splenic (tumor) involvement.     

Splenectomy for splenic metastasis from carcinoma of colon

An 81-year-old woman with carcinoma of the colon had a normal liver-spleen radiocolloid image at the time of surgery. Two years later, a defect was noted in the spleen on a follow-up radiocolloid study. A repeat examination showed that the mass was increasing in size. An abdominal CT examination also revealed an intrasplenic mass with spring of the liver. After splenectomy for a metastatic carcinoma of the colon, the patient has survived for over a year without symptoms referable to tumor spread. Mention is made of the apparent splenic "immunity" from metastases.     

Evaluation of subjective assessment of liver function from radionuclide images

The appearance of non-hepatic uptake in 99Tcm-colloid images is an important indicator of poor liver function. We undertook this study to evaluate the ability of experienced observers to assess liver function from radionuclide images. A simple model was used to simulate the changing distribution of 99Tcm-colloid in the liver, spleen and bone marrow as the liver function and mass were varied. Suitable images of these three organs were isolated from real studies and used as "templates" to create realistic simulated 99Tcm-colloid images, with the count densities of liver, spleen and bone marrow determined by the model. These images were presented in random order to several observers, who were asked to assess liver function. Comparison of the estimated with the true function shows that visual assessment is systematically inaccurate, with underestimation of poor function and overestimation of good function. It is also imprecise, especially for livers with only midly impaired function. Observers were also affected by changing liver mass and were more likely to judge small livers to be abnormal. We suggest that objective assessment using a quantitative technique should be used as an adjunct to visual inspection for the evaluation of liver function.     

儿童神经母细胞瘤颅面骨转移的影像表现

目的 探讨儿童神经母细胞瘤颅面骨转移的影像表现.方法 回顾性分析12例经组织学证实的儿童神经母细胞瘤的影像表现.其中 10例患儿行CT平扫,6例行MRI,7例行全身SPECT骨扫描.结果 行CT检查的10例患儿中,9例表现为颅面骨溶骨性骨质破坏伴软组织肿块,其中8例可见骨膜反应,3例表现为特征性的针状骨膜反应;另l例cT未发现异常但骨扫描显示异常.行MR检查的6例患儿均表现为颅面骨骨髓腔信号异常伴周围软组织肿块,其中5例行增强扫描,骨髓腔异常信号影和软组织肿块呈明显不均匀强化.7例行全身骨扫描,均可见颅面部放射性浓聚区,其巾6例伴有全身其他部位的骨转移.结论神经母细胞瘤颅面骨转移有一定的影像特征,可提示诊断.     

Bone marrow extension and pelvic bone marrow activity in alcoholic liver disease. A RES scintigraphic investigation.

Red bone marrow extension and increased central bone marrow activity were found in 21 patients with alcoholic liver disease investigated with scintigraphy of the reticuloendothelial system. The patients had no concurrent disease known to alter red bone marrow distribution. The bone marrow extension and the increased pelvic bone marrow activity may be explained as being secondary to a decreased radiocolloid uptake in the liver and could thus be a sign of decreased reticuloendothelial capacity.     

Comparison of In-111 granulocytes and Tc-99m albumin colloid for bone marrow scintigraphy by the use of quantitative SPECT imaging

A comparison of In-111 oxinate labeled autologous granulocytes and Tc-99m albumin colloid for bone marrow scintigraphy is reported. The aim of this report was to determine if the intense uptake in the liver and spleen with nano-sized colloids, which hampers the evaluation of the skeletal parts surrounding the liver, is reduced by the use of radiolabeled granulocytes. This study is based on a retrospective analysis of 19 abdominal tomographic examinations with In-111 granulocytes performed to detect septic foci. After correction for attenuation and scattering of photons was performed, the uptake in the bone marrow of the lumbar spine was seen to be related to the liver, spleen, and tissue background activity. The results in this study were compared with corresponding data from 20 normal liver/spleen tomographic examinations performed with Tc-99m nanocolloid, which is routinely used for bone marrow scintigraphy. The bone marrow/liver activity ratio for granulocytes varied, but it exceeded the corresponding mean ratio for colloid in all examinations. The mean values for granulocyte uptake 3 and 20 hours after injection was, respectively, about 6 and almost 10 times higher than were those for colloid. The activity ratios between bone marrow and spleen as well as between bone marrow and tissue background was not improved and or may even have been reduced by the use of granulocytes. It is suggested that granulocytes labeled in vitro by Tc-99m hexamethylpropylene amineoxime (HMPAO) or in vivo by monoclonal antigranulocyte antibodies may provide techniques for improved bone marrow imaging.     

Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging

Forty-two patients with laryngeal carcinomas were examined with computed tomography (CT) and magnetic resonance (MR) imaging. The accuracy of both CT and MR imaging in the depiction of cartilage invasion was evaluated in 16 patients by comparing findings at CT and MR with pathologic findings. Calcified cartilage that has been invaded by cancer is frequently seen on CT scans as having an intact contour. Tumor approaching nonossified cartilage may simulate cartilage invasion. On T1-weighted MR images, invaded marrow of ossified cartilage is of intermediate signal intensity, allowing it to be differentiated from normal bone marrow. On proton-density images, tumor is of increased signal intensity, which allows it to be differentiated from nonossified cartilage. In our experience, the specificities of CT and MR imaging were approximately equal (91% and 88%, respectively), but CT had a considerably lower sensitivity than MR (46% vs. 89%). Gross movement artifacts, which resulted in nondiagnostic images, occurred in 16% of the MR examinations. MR imaging is recommended as the modality of choice in the diagnosis of cartilage invasion.     

Imatimid-induced bone marrow necrosis detected on MRI examination and mimicking bone metastases

Imatinib has revolutionized the treatment and prognosis of patients with gastrointestinal stromal tumors (GIST). In contrast to liver and/or abdominal involvement, bone metastases are an uncommon event in GIST. We report here two patients with metastatic GIST who developed pelvic bone marrow focal lesions visible on MRI examinations, while Imatinib dramatically improved other tumor sites. A biopsy in one patient diagnosed bone marrow necrosis. The other patient had a favorable follow-up over several years, without bone metastases. Focal bone marrow abnormalities, detected on MRI examinations and mimicking bone metastases in patients who were otherwise responding, should be considered as probable bone marrow necrosis.     

Small cell lung cancer: staging with MR imaging

Small cell lung cancer is an aggressive neoplasm; metastases are detected in two-thirds of patients at diagnosis with use of conventional staging, which includes bilateral bone marrow biopsy, bone scintigraphy, and computed tomography (CT) of the head and abdomen. In 25 patients, small cell lung cancer was staged prospectively with both conventional staging and a magnetic resonance (MR) imaging protocol that included 1.5-T MR imaging of the pelvis, abdomen, spine, and brain. According to conventional staging, 14 patients had extensive disease and 11 patients had limited disease; according to staging with MR, 19 patients had extensive disease and six had limited disease. All metastatic disease sites seen with conventional staging were identified on MR images. MR images showed additional metastatic involvement in bone (four patients) and liver (three patients) not detected at conventional staging. A low-attenuation hepatic lesion on a CT scan was identified as a hemangioma on MR images. These preliminary data suggest that small cell lung cancer may be accurately staged with use of a single MR imaging study.     

Generalized increase of arterial blood flow to the liver observed at visceral radiocolloid angiography

Visceral radiocolloid angiography was performed in 1230 consecutive patients studied with scintigraphy of the reticuloendothelial system (RES). The hepatic arterial flow was considered increased if an early and obviously increased accumulation of the radiocolloid occurred in the liver during the visceral radionuclide angiography, i.e. that the early part of the liver time-activity curve coincided with the early parts of the kidney and spleen time-activity curves with respect to time and steepness. A generalized increase of arterial blood flow to the liver was found in 70 patients, of whom 54 per cent had alcoholic liver disease. 20 per cent metastatic liver disease, 19 per cent had various diagnoses, and in 7 per cent no certain diagnosis was found. Generalized increase of arterial blood flow to the liver gives a typical appearance in radiocolloid angiography and the corresponding time-activity curves. It may be a sign of severe disease, most often localized in the liver, but in some cases it may be of extrahepatic origin. In 27 per cent it was the only obvious pathologic finding. It was in a few cases a reversible condition. Generalized increase of arterial blood flow to the liver is a clinically important finding that could escape detection if radionuclide angiography is not included in the RES scintigraphy.