Diphosphonate intestinal activity seen on two bone images in neuroblastoma. McCarthy K E,Heyman S Clinical nuclear medicine Neuroblastoma is well recognized as a cause of soft tissue uptake of Tc-99m MDP. Two cases of neuroblastoma arising in the midline from the celiac axis are reported. Bone imaging performed on two separate days showed not only typical soft tissue uptake, but also the appearance of the radiopharmaceutical in the bowel. At surgery, a midline upper abdominal neuroblastoma was found in both patients without evidence of involvement of the liver, kidneys, bowel, gallbladder or mesentery. It became apparent with delayed images in the second patient that this activity was in the bowel and moving around the abdomen in a typical large bowel pattern. Bowel activity was not seen in other patients having bone scans at this time. Follow-up bone imaging on the first patient after resection of the tumor did not demonstrate diphosphonate activity in the bowel. These authors have never seen or read of this finding previously in this condition, and report it in these two patients. 10.1097/00003072-198607000-00010
    Hypophosphatemic osteomalacia demonstrated by Tc-99m MDP bone scan: a case report. Kim S,Park C H,Chung Y S Clinical nuclear medicine Hypophosphatemic osteomalacia, a familial or rarely acquired disorder, is characterized biochemically by hypophosphatemia, decreased renal tubular reabsorption of phosphate, decreased intestinal absorption of calcium, and normal serum calcium. This report concerns a rare case of hypophosphatemic osteomalacia of unknown cause that was shown on Tc-99m MDP bone scanning. 10.1097/00003072-200005000-00003
    Kock continent ileal urinary reservoir. Anatomy and potential pitfalls of radionuclide imaging. Barakos J A,Colletti P M,Siegel M E,Ralls P W,Halls J M Clinical nuclear medicine The Kock continent ileal urinary reservoir (Kock pouch) is a new form of urinary diversion that, due to its advantages over previous techniques of urinary bypass, will probably become widespread in urologic practice. When bone imaging is performed in the presence of the Kock pouch, the unusual configuration of the pouch may obscure or simulate osseous lesions. An understanding of the surgical anatomy as well as the planar and SPECT scintigraphic appearances of the Kock pouch is necessary to avoid errors during interpretation. This series of 51 bone images reports on the variable scintigraphic appearance of the Kock pouch. In addition, the incidence and type of potentially avoidable pitfalls in the interpretation of bone imaging when this form of urinary diversion is used are evaluated. 10.1097/00003072-198709000-00016
    Visualization of the liver, gallbladder, and intestine on bone scintigraphy. Sherkow L,Ryo U Y,Fabich D,Patel G C,Pinsky S M Clinical nuclear medicine Images of the liver, gallbladder, and/or intestine were visualized on bone scans on several occasions. Radiopharmaceutical quality control data, including molybdenum-99 and aluminum ion content in the Tc-99m eluate, free unbound Tc-99m, and hydrolyzed reduced Tc-99m in the labeled MDP, were all satisfactory. A minor defect in the quality of the Tc-99m generator was considered to be the probable cause of the unusual localization of the bone imaging agent. 10.1097/00003072-198408000-00004
    [Intestinal accumulation of 99mTc-HMDP: an unusual finding in bone scintigraphy]. Weismüller S,Baum R P,Zöller A,Hör G Nuklearmedizin. Nuclear medicine In a 61-year old female with a history of breast cancer the whole-body scan (4 h p.i.) after intravenous injection of 576 MBq 99mTc-HMDP showed an accumulation of activity in the stomach and the whole intestines. The reason was an oral urine intake ("uropotia") taking place between the injection and the whole-body bone scan.
    Protein-losing enteropathy detected by Tc-99m-MDP abdominal scintigraphy. Uzuner Ovsev,Ziessman Harvey A Pediatric radiology This case report describes the incidental finding of intestinal leakage during bone scan imaging with Tc-99m methylene diphosphonate (MDP) in a patient with previously diagnosed protein-losing enteropathy (PLE). Most radiopharmaceuticals reported in the literature that are useful for making this diagnosis are not generally available for clinical use in the United States. This report suggests that Tc-99m-MDP is useful for confirming the diagnosis of PLE although further investigations are indicated to determine the accuracy of this method. 10.1007/s00247-008-0924-8
    Relationship between extraosseous accumulation in bone scintigraphy with 99Tcm-HMDP and histopathology. Flores L G,Nagamachi S,Jinnouchi S,Ohnishi T,Futami S,Nakahara H,Tamura S Nuclear medicine communications We assessed the relationship between 99Tcm-HMDP extraosseous accumulation (EOA), the histopathology of primary lesions and various laboratory findings. In 155 of 4824 patients, 163 EOA were noted. Of these, 33.7% were in the abdomen, 27.6% in the chest, 22.7% in the extremities, 9.8% in the pelvic area and 6.1% in the head and neck area. We found that 72.4% of EOA were due to malignant processes and 27.6% to benign processes. In the abdomen, 36.6% of the EOA were due to hepatocellular carcinoma and intestinal carcinoma. In the chest, 46.7% of EOA were a result of breast carcinoma. In the extremities, 28.7% of the EOA were due to sarcoma. The mean white blood cell count was elevated (8.0 +/- 6.3 x 10(3)) in patients with malignant processes. The mean serum haemoglobin and haematocrit in benign and malignant processes, for both males and females, were below normal values. All other laboratory findings were within normal limits. Significant differences in serum haemoglobin and haematocrit were noted between male and female patients with benign processes (P = 0.04 and P = 0.04, respectively). No other significant differences between benign and malignant processes were noted. Therefore, EOA is more frequently associated with malignant processes of primary lesions and is often accompanied by leukocytosis and anaemia.
    A possible cause of misinterpretation on radionuclide imaging: Chilaiditi's syndrome. Ozgen Kiratli P,Erbas B Revista espanola de medicina nuclear The authors of this work present two patients, diagnosed with lymphoma and prostate cancer, referred to nuclear medicine department for a gallium-67 scan and a bone scan, respectively. The abnormal accumulation of the radioactivity gave rise suspicion for possible other pathologies. Successive computed tomographic imaging revealed that the patients had had Chilaiditi's syndrome. The authors present these cases to draw attention for the possibility of misinterpretation of the scans due to distribution of radioactivity in this syndrome. 10.1016/s0212-6982(07)75280-1
    Intestinal uptake of (99m)Tc-MDP: a case report of protein-losing enteropathy correlated with pathology findings from autopsy. Martinez-Sanchis Begoña,Cortés-Vizcaíno Virginia,Frontado-Morales Lorena,Sopena-Novales Pablo Annals of nuclear medicine We present a case of a 60-year-old man with a history of severe hypoproteinemia and constitutional syndrome, suspected to have protein-losing enteropathy (PLE). Bone scintigraphy ((99m)Tc-MDP) performed to rule out the presence of bone metastases incidentally showed abnormal uptake in abdominal soft tissue. The patient unexpectedly died of heart failure, and autopsy revealed microscopic alterations consistent with PLE exclusively in the right colon, corresponding to the area of abnormal uptake. Few similar cases have been published, but none of them reported correlative pathological findings affecting the area of abnormal tracer uptake. In this case of PLE, (99m)Tc-MDP scintigraphy was a useful imaging method for localizing the site of protein loss, showing a focal area of alteration in the right colon. This finding could also have been of great help in case that surgery had been finally performed to control the protein loss. 10.1007/s12149-010-0445-z
    Incidental vesicocolic fistula on routine bone scintigraphy: Value of additional delayed images and direct radionuclide cystography. Sohn Myung-Hee,Tae Lim Seok,Jin Jeong Young,Wook Kim Dong,Jeong Hwan-Jeong,Yim Chang-Yeol Clinical nuclear medicine An unexpected vesicocolic fistula can be detected incidentally on routine bone scintigraphy. A 55-year-old man who had a radical colectomy for carcinoma of the sigmoid colon 1 year previously underwent bone scintigraphy to evaluate bone metastasis. Whole-body images showed an abnormal accumulation of radioactivity in the right lower quadrant of the abdomen, but the radioactivity did not precisely define a structure. Additional delayed images obtained after 15 and 24 hours of the initial image localized a vesicocolic fistula. Subsequent radionuclide cystography confirmed leakage of the radioactivity from the bladder. 10.1097/RLU.0b013e3181ea345b
    A report on the incidence of intestinal 99mTc-methylene diphosphonate uptake of bone scans and a review of the literature. Ergün Eser L,Kiratli Pinar O,Günay Emel C,Erbaş Belkis Nuclear medicine communications BACKGROUND:In addition to well-known specific conditions for soft-tissue uptake of bone-seeking radiotracers, there is a limited number of reports on intestinal uptake of (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) on bone scans. AIM:To describe the incidence of intestinal accumulation of (99m)Tc-MDP on bone scans in adult patients, define the patterns of this unusual finding and review the literature on its causes. METHODS:Two thousand, one hundred and forty-four consecutive patients have been evaluated for intestinal (99m)Tc-MDP uptake on bone scans. Intestinal uptake was observed visually 3-4 h after the administration of the radiopharmaceutical. A whole-body bone scan and various spot views of the abdomino-pelvic region were obtained with a dual-headed gamma camera to evaluate the intestinal uptake. Delayed scans were also obtained as well as co-relative imaging and/or colonoscopic studies in some of intestinal uptake patients. Six patients had delayed scans of the abdomino-pelvic region. Fourteen patients had comparable scans either a year before or a year later. The positive intestinal uptake scans were further grouped according to the localization and intensity (mild uptake: lower than iliac bone; moderate uptake: equal to iliac bone; significant uptake: higher than iliac bone). RESULTS:Twenty-two (17 female, five male) patients out of 2144 with a mean age of 57 years showed intestinal (99m)Tc-MDP uptake. The localization was mainly (20/22) in the right abdomino-pelvic region projecting on and in the configuration of ascending colon while one patient showed intestinal uptake all over the abdomen and one displayed diffuse intestinal radioactivity in his right hemithorax. The majority of the cases showed moderate to intense intestinal uptake (18/22). Six patients showed a decrease, disappearance or alteration in the intestinal uptake on the delayed images. Re-evaluation bone scans in five patients 1 year later showed no intestinal uptake this time. Among nine patients with prior bone scans 1 year before, intestinal uptake was negative in seven at that time. No significant pathology was obtained on the correlative images. CONCLUSION:(99m)Tc-MDP uptake can be observed in the intestines in 1% of bone scans with a prominent localization in the ascending colon and rarely all over the intestines or in thorax due to Chilaiditi's syndrome, as well. The mechanism of intestinal uptake is still unclear in some of the patients. Delayed imaging, additional spot views and SPECT studies help in the differentiation of this finding from possible misinterpretation. Intestinal (99m)Tc-MDP uptake on bone scan could be an intermittent process and should be included among other well-known reasons of soft-tissue uptake. 10.1097/01.mnm.0000237991.44948.13
    Incidental 99mTc MDP uptake in the intestines and intravenous CT contrast. Kim Soo J,Choi Joon Y,Lee Joo H,Hyun Seung H,Cho Young S,Moon Seung H,Choe Yearn S,Lee Kyung-Han,Kim Byung-Tae Nuklearmedizin. Nuclear medicine AIM:We evaluated the association between intestinal visualization on bone scintigraphy and IV CT contrast in patients with breast cancer. PATIENTS, METHODS:452 patients with breast cancer underwent a 99mTc methylene diphosphonate (MDP) bone scan for surveillance of bone metastasis. Presence, site and intensity of intestinal uptake were visually assessed. For patients with intestinal visualization, medical records were reviewed to identify the alleged potential causes. When IV CT contrast was administrated on the same day as bone scan, the time between IV CT contrast injection, 99mTc MDP administration and bone scan was assessed. RESULTS:Intestinal 99mTc MDP uptake was observed in 44 of the 452 patients (9.7%). Bone scans showed no thyroid or gastric uptake that suggested free pertechnetate. There were no patients with documented causes of intestinal uptake except for one patient with vesicoenteric fistula. Of the 452 patients, 149 (33.0%) underwent IV contrast-enhanced CT on the same day as bone scan. Forty of the 44 patients (90.9%) with intestinal uptake on bone scan underwent IV contrast-enhanced CT on the same day, whereas 109 of 408 (26.7%) patients without intestinal uptake on bone scintigraphy underwent IV contrast-enhanced CT on the same day (p < 0.001). The patients who underwent IV contrast injection between Tc-99m MDP administration and acquisition of bone scans had significantly more frequent intestinal uptake than patients who underwent IV contrast injection either before 99mTc MDP administration or after bone scanning (42.4% vs. 1.8%, p < 0.001). CONCLUSIONS:IV CT contrast injection administered on the same day as bone scintigraphy is significantly associated with 99mTc MDP uptake in the intestines among patients with breast cancer. 10.3413/Nukmed-0768-15-09
    Interesting image. Imaging postoperative bile leaks and assessing integrity of biliary-enteric anastomoses with fusion HIDA SPECT/CT scintigraphy. Tian Yue Kok,Pin Lin Kei,Goh Soon Whatt Anthony Clinical nuclear medicine 10.1097/RLU.0b013e3181f49a7f
    Incidental detection of a vesicocolonic fistula on renal scintigraphy with SPECT/CT. Mete Uttam Kumar,Manohar Kuruva,Bhattacharya Anish,Goyal Reema,Mittal Bhagwant Rai Clinical nuclear medicine Urinary-enteric fistula is a rare cause of recurrent urinary tract infection (UTI). Therefore, delayed/incidental diagnosis is the rule. The authors present an image of a vesicocolonic fistula incidentally detected during SPECT/CT renal scintigraphy with 99mTc-DTPA in a female patient with recurrent UTI. The diagnosis was subsequently confirmed by cystoscopy and surgery. 10.1097/RLU.0b013e318266d06f
    Multiple Heterotopic Ossification of the Intestine Detected by 99mTc-MDP Bone Scan in a Patient With Primary Peritoneal Cancer. Zhang Ruiguo,Dong Feng,Meng Zhaowei,Tan Jian Clinical nuclear medicine Heterotopic ossification is a rare phenomenon that refers to formation of bone outside the skeletal system. We present a 61-year-old woman who suffered from peritoneal cancer surgery 2 years ago, referred for Tc-MDP bone scan because of higher serum CA-125 level, which showed multiple intense tracer activities in her abdominal and pelvic region without other abnormalities. SPECT/CT revealed the activities were loaded in the intestine but not in the bone. A wait-and-see policy was adopted because of no abdominal discomfort. After 1-year follow-up, another bone scintigraphy showed the tracer uptake was significantly decreased. 10.1097/RLU.0000000000002234
    Extensive heterotopic gastric mucosa of the small intestine: imaging with Tc-sodium pertechnetate SPECT/CT enterography. Schapiro Andrew H,Lin Tom K,Frischer Jason S,Silverman Ayaka,Trout Andrew T Pediatric radiology Extensive heterotopic gastric mucosa of the small intestine is a rare, but potentially life-threatening condition characterized by multifocal or long-segment heterotopic gastric mucosa within the bowel lumen that is often associated with other anomalies including malrotation and annular pancreas. Although the imaging findings are characteristic, this entity may be unrecognized due to its unusual imaging appearance and rarity. CT or MR enterography and Tc-sodium pertechnetate scintigraphy can provide complementary information that enables specific diagnosis and accurate assessment of disease extent. We present a case of extensive heterotopic gastric mucosa of the small intestine imaged by simultaneous, combined Tc-sodium pertechnetate single photon-emission computed tomography (SPECT)/CT enterography to both familiarize the reader with the condition and describe an imaging strategy that enables specific diagnosis and assists with treatment planning. 10.1007/s00247-016-3687-7
    Spontaneous perforation and intraabdominal abscess due to Meckel's diverticulum revealed on SPECT/CT with 99m-technetium pertechnetate: A case report. Zhu Yangjun,Dong Mengjie,Weng Wanwen,Yang Jun Medicine RATIONALE:Meckel's diverticulum (MD) is common congenital abnormality of gastrointestinal tract, only about 6.4% of patients become symptomatic. A smaller minority develop potential fatal complications such as hemorrhage, perforation, abscess, and bowel obstruction. PATIENT CONCERNS:A 15-year-old boy with history of appendicitis was admitted due to worsening abdominal pain and nausea for 1 day. The physical examination showed the abdomen was soft, with the diffuse tenderness to palpation and voluntary guarding. DIAGNOSIS:Abdominal computed tomography showed a probable MD in the distal ileum. Single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging revealed the focal concentration at the right lower quadrant of abdomen region. INTERVENTION:After the initial management including antibiotic administration and intravenous fluid resuscitation, MD with perforation and localized suppurative peritonitis was confirmed in surgery. The patient underwent a diverticulectomy. Histological examination was confirmed as MD with focal heterotopic gastric tissue. OUTCOMES:After surgery, the patient had uneventful recovery during 3 months follow-up. LESSONS:Spontaneous perforation and intraabdominal abscess due to MD is very rare. Accurate diagnosis of MD remains challenging as clinical symptoms from these complications occur nonspecifically. SPECT/CT fusion imaging is critical for prompt recognition and accurate diagnosis in the successful management of this rarely life-threating complication. 10.1097/MD.0000000000013004