Bone scintigraphy in patients with bipartite patella

This study was performed to assess the diagnostic value of bone scintigraphy to differentiate symptomatic bipartite patella from asymptomatic bipartite patella. Thirty-seven bipartite patellae (15 symptomatic and 22 asymptomatic) were evaluated by bone scintigraphy. Bone scintigraphic activity in bipartite patella was classified into the following four groups. Group A: Eleven bipartite patellae (10 symptomatic and 1 asymptomatic) demonstrated physiological and marked uptake at the epiphysio-metaphysial junction of the distal femur in bone scintiscans. Therefore, high scintigraphic uptake in the bipartite patella was difficult to distinguish from such uptake due to overlap. Group B: Five bipartite patellae (4 symptomatic and 1 asymptomatic) demonstrated both physiologically high scintigraphic uptake at the epiphysio-metaphysial junction of the distal femur and high scintigraphic uptake in the bipartite patella. Group C: Seventeen bipartite patellae (1 symptomatic and 16 asymptomatic) demonstrated abnormally high scintigraphic uptake in the bipartite patella. Group D: Four asymptomatic bipartite patellae did not demonstrate an abnormally high scintigraphic uptake. After excluding Group A, the proportion of positive bone scans in bipartite patella was 84.6% (22 of 26 patellae). Similarly, after excluding Group A, the proportion of positive bone scans in symptomatic bipartite patella was 100% (5 of 5 patellae) and in asymptomatic bipartite patella 81.0% (17 of 21 patellae). Statistical analysis using Fisher's exact test showed no significant differences in the proportion of positive bone scans between both groups (P = 0.5457). In conclusion, abnormally high scintigraphic uptake is frequent findings in both symptomatic and asymptomatic bipartite patella, and bone scintigraphy is not useful to differentiate between them. Therefore, surgical treatment should not be considered based only on scintigraphic findings.     

Angiography and scintigraphy in patients with possible liver malignancy.

Angiography and 99Tcm-scintigraphy were performed in 100 adult patients with suggested primary or secondary liver malignancy. The results were compared to the final diagnosis obtained by biopsy, surgery, autopsy or long term clinical follow up. The reasons for false positive and negative diagnoses are discussed in detail.     

Bone scintigraphy and somatostatin receptor scintigraphy in pediatric patients with bone involvement in Langerhans cell histiocytosis

Langerhans cell histiocytosis (LCH) is a granulomatous disease which can involve multiples sites of the body. Diagnostic imaging is of utmost importance in the management of these patients. Up to now radiographic skeletal survey and bone scintigraphy (BS) have been used to assess bone involvement (both with low specificity). Magnetic resonance imaging (MRI) and CT have been used to assess visceral involvement but with the limitation that they cannot give information about the functional status. Recently somatostatin receptor scintigraphy (SSRS) has been proposed to detect active lesions and to monitor response to treatment. The aim of this study is to assess bone and somatostatin receptor scintigraphy in the detection of bone involvement in LCH in children. Twenty scintigraphies (12 SSRS and 8 BS) were performed in seven patients (3 girls and 4 boys) aged at diagnosis: 18 month-12 years (mean age 6 years). The findings obtained in the scintigraphies were compared with clinical evolution and other imaging techniques. Bone scintigraphy detected all the LCH bone lesions, and discovered one unknown lesion. SSRS scintigraphy visualised the active lesions in 3 patients (clinical and other imaging techniques were also positive). SSRS was negative in one patient classified as disease free and another in clinical remission. SSRS detected 2 new unknown bone lesions, but could not detect LCH bone lesions confirmed in other imaging techniques in 2 patients. Somatostatin receptor and Bone scintigraphy can be used to detect active LCH bone lesions in children and can help to monitor response to treatment. Further studies with more patients are needed to confirm the diagnostic usefulness of these techniques.     

Hodgkin's disease with hypercalcemia detected by thallium-201 scintigraphy

A 53-yr-old man with hypercalcemia was referred after an unsuccessful operative attempt to find a parathyroid adenoma. Metabolic evaluation showed relatively suppressed levels of parathyroid hormone with an elevation of serum 1,25-dihydroxyvitamin D. Thallium-technetium dual isotope imaging revealed localized mediastinal thallium uptake. A vascular mediastinal lesion was then demonstrated by arteriography, with subsequent surgical removal of a mass that proved to be lymphocyte predominant Hodgkin's disease. This case is noteworthy for the finding of isolated lymphocyte predominant Hodgkin's disease in the chest, the association of elevated serum 1,25-dihydroxyvitamin D with hypercalcemia that resolved postoperatively, and the uptake of thallium by the tumor.     

Bone scintigraphy: differentiating benign cortical irregularity of the distal femur from malignancy

Two cases of benign cortical irregularity of the distal femur ( BCIDF ), which radiologically simulate malignancy, are presented. The use of bone scintigraphy in differentiating this entity from malignancy is described.     

Bone scintigraphy in patients suspected of having meniscus tears

The sensitivity and specificity of bone scintigraphy in the evaluation of meniscus tears was investigated in a prospective study of 44 younger patients referred for arthroscopy with a suspected meniscus tear. We found a sensitivity of 0.74 and a specificity of 0.76 for pure meniscus pathology; thus, the test cannot so far be recommended as a routine in evaluating meniscus pathology. However, the test was highly sensitive if used to divide the patients into 2 groups: a potential surgery-demanding group with meniscus pathology, osteochondritis, degenerative joint disease or rotational instability, and a group with synovitis, hot patella or a healthy knee where surgery (arthroscopy) could be avoided. The accuracy in this division was 0.92. We find the test valuable if used this way.     

Bone scintigraphy in chondroblastoma

Scintigraphy in 3 patients with chondroblastoma showed that the tumors were hyperemic and avidly accumulated the radionuclide. These changes were also present in adjacent normal bone, but to a lesser degree. This suggest that radionuclide uptake in chondroblastoma is a function of the blood supply to the tumor rather than primary matrix extraction.     

Bone scintigraphy in common tumors with osteolytic components

Osteolytic lesions are frequently encountered in clinical practice. Radionuclide bone scans with technetium-99m-labeled diphosphonates are often performed in the evaluation of both solitary and multiple osteolytic lesions. In this pictorial review, we critically evaluate the current role of bone scan in common osteolytic tumors including aneurysmal bone cyst, simple bone cyst, fibrous dysplasia, nonossifying fibroma, giant cell tumor, eosinophilic granuloma, enchondroma, chondrosarcoma, osteosarcoma, Ewing sarcoma, myeloma, and metastases. The merits and limitations of bone scanning are emphasized.     

Bone scintigraphy in tuberculous sacroiliitis

Radionuclide bone imaging is becoming increasingly important in the evaluation of musculoskeletal pain of uncertain cause. A case in which Tc-99m MDP bone imaging was employed to investigate complaints of low back pain is presented. Scan abnormalities directed clinicians towards appropriate further workup and diagnosis of unilateral tuberculous sacroiliitis.     

Bone scintigraphy in testicular tumors

PURPOSE: Testicular tumors do not occur frequently. Primary treatment is surgical, and radiotherapy and chemotherapy can play important roles in cases of metastatic disease. Bone scintigraphy is used largely for early detection of skeletal metastases from several tumors, and conventional radiographic studies are less sensitive than the nuclear technique for such a purpose. The aim of this study was to identify the role of bone scintigraphy in cases of testicular tumors, regardless of the grade. MATERIALS AND METHODS: The authors examined 28 patients (8 to 52 years old) with proved testicular tumors using Tc-99m MDP (750 MBq; 20 mCi) injected intravenously. Whole-body images were obtained 2 hours later, at 500,000 counts per image. Radiographic studies were obtained to investigate abnormal areas noted on scintigraphy. RESULTS: The results of bone scintigraphy were abnormal in seven cases, consisting of variable but diffuse uptake in the iliac bone on the same side as the affected testicle. MDP uptake was substantial in five of these patients (four seminomas, one nonseminoma; only two radiographic studies were abnormal), and the two other patients had moderate uptake of the radiopharmaceutical (two seminomas; radiographic studies were normal). Metastases were confirmed by biopsy in three cases. DISCUSSION: Early metastases from seminomas can occur through the lymphatic drainage toward the iliac lymph node chain. This could explain these findings. The scintigraphic aspects of the affected iliac bones seem characteristic. CONCLUSIONS: Early detection of metastases is very important to ensure the efficacy of radiotherapy and chemotherapy. Bone scintigraphy may play an important role in such cases and seems to be more sensitive than conventional radiography. Testicular tumor metastases should be considered when iliac involvement is observed. Paget's disease should be included in a differential diagnosis.     

Bone scintigraphy in nasopharyngeal carcinoma

One hundred and forty-three patients (Group 1) with histologically proven nasopharyngeal-carcinoma (NPC) had bone scintigraphy with 99Tcm methylenediphosphonate (MDP) or dihydroxypropanediphosphonate (DPD) within 2 months of the initial diagnosis. A further 162 patients (Group 2) had bone scans during the course of follow-up if there were symptoms of bone pain or evidence of metastases at other sites. Twenty-three per cent (33/143) of the newly diagnosed NPC patients (Group 1) had evidence of bone metastases. Of these 143 patients, 101 were T0-T2, 16 were T3 and 25 were T4. Thirty-six patients had no neck nodes (NO), 44 were N1, 25 N2 and 38 N3. Of the 162 patients in Group 2, 96 (59%) had a positive bone scan. The commonest sites for bony metastases from NPC were the spine, ribs, pelvis and lower limbs in order of frequency. There is a highly significant association with the nodal stage but no association with the UICC T staging which is not adequate in nasopharyngeal carcinoma. In our part of the world, bone metastases from NPC are a common cause of an abnormal bone scan.     

Bone scintigraphy in drug addiction

In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations.All patients underwent bone scintigraphy with 17–20 mCi of ^99mTc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs.One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin.Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections.