We present images of an 83-year-old female with a history of osteoporosis and bilateral total knee replacement arthroplasty, referred for bone scintigraphy and single-photon emission computed tomography (SPECT)/computed tomography (CT), owing to left knee pain. No trauma to, or intense exercise of, the kneewas reported. The bone scan and SPECT/CT revealed a focally increased Tc-99m methylene diphosphonate (MDP) uptake in the medial cortex of the left femoral diaphysis with matched linear radiolucency on CT images. This was misinterpreted as atypical femoral stress fracture; however, focal stress reaction injury to the nutrient foramen was confirmed on contrast-enhanced magnetic resonance imaging.
Aged, 80 and over ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Diaphyses ; Female ; Fractures, Stress ; Humans ; Knee ; Magnetic Resonance Imaging ; Osteoporosis ; Radionuclide Imaging ; Technetium Tc 99m Medronate ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

Bone scan is a sensitive imaging procedure for cancer patients who are at high risk for bone metastases. Despite the high sensitivity, Tc-99m methylene diphosphonate (MDP) is not a specific tracer and its increased uptake may also be seen in extra-osseous areas. In cases where localization of extra-osseous sites of MDP uptake on planar imaging prove to be difficult, single photon emission computed tomography with computed tomography (SPECT/CT) may be useful. A known lung cancer patient was referred for whole body bone scan to detect bone metastasis. Planar images showed tracer accumulation in the left area of the head, suspicious for skull metastasis. SPECT-CT imaging of the head was done for further evaluation, which showed Tc-99m MDP uptake in the left temporoparietal lobe. Magnetic resonance imaging (MRI) of the brain was subsequently done, which showed a subacute brain infarct corresponding to the Tc-99m MDP-avid focus. Thus, SPECT-CT was helpful in proper anatomical localization of the focal Tc-99m MDP uptake in the head, which otherwise might have been easily mistaken for skull metastasis should only planar imaging was used.

Bone scan is a sensitive imaging procedure for cancer patients who are at high risk for bone metastases. Despite the high sensitivity, Tc-99m methylene diphosphonate (MDP) is not a specific tracer and its increased uptake may also be seen in extra-osseous areas. In cases where localization of extra-osseous sites of MDP uptake on planar imaging prove to be difficult, single photon emission computed tomography with computed tomography (SPECT/CT) may be useful. A known lung cancer patient was referred for whole body bone scan to detect bone metastasis. Planar images showed tracer accumulation in the left area of the head, suspicious for skull metastasis. SPECT-CT imaging of the head was done for further evaluation, which showed Tc-99m MDP uptake in the left temporoparietal lobe. Magnetic resonance imaging (MRI) of the brain was subsequently done, which showed a subacute brain infarct corresponding to the Tc-99m MDP-avid focus. Thus, SPECT-CT was helpful in proper anatomical localization of the focal Tc-99m MDP uptake in the head, which otherwise might have been easily mistaken for skull metastasis should only planar imaging was used.

According to the inclusion and exclusion criteria, we searched for relevant original articles in some big Chinese and English databases. The qualities of the studies were evaluated with QUADAS quality assessment tool. A software program, Meta-disc, was used to obtain the pooled estimates and heterogeneity test for sensitivity, specificity, SROC curve, and so on. Finally the 17 article were included. On a per-patient basis, the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR+), negative likelihood ratio (LR-), diagnostic odds ratio (DOR), Q*, SROC area under curve for 99mTc-MDP bone scan and computed tomography (CT) were 0. 87 and 0.99, 0.81 and 0.98, 3.88 and 13.86, 0.2 and 0.03, 27.73 and 612.17, 0.8418 and 0.9732, 0.9097 and 0.9952, respectively. On a per-focus basis, the pooled SEN, SPE, LR+, LR-, DOR, Q*, SROC area under curve for 99mTc-MDP bone scan was 0.86, 0.97, 13.32, 0.16, 102.4, 0.8944, 0.9528, respectively. For CT, only 1 article were included. This paper demonstrate: whether 99mTc-MDP or CT both have high diagnostic efficiency for bone metastase of breast cancer.
Bone Neoplasms ; diagnosis ; secondary ; Breast Neoplasms ; pathology ; Female ; Humans ; Sensitivity and Specificity ; Technetium Tc 99m Medronate ; Tomography, X-Ray Computed

Adult T-cell leukemia/lymphoma (ATLL) is a highly aggressive disease that is geographically clustered, mirroring areas endemic for human T-cell lymphotropic virus type 1 infection. Most patients with ATLL present with aggressive manifestations such as severe hypercalcemia, lymphadenopathy, hepatosplenomegaly, and bone marrow involvement with progressive thrombocytopenia. We herein report a case of a patient with ATLL exhibiting increased uptake in both lungs as shown on a bone scan using 99mTc-methylene diphosphonate. This finding is thought to have been caused by metastatic calcification associated with ectopic parathyroid hormone production.
Adult* ; Bone Marrow ; Calcinosis ; Humans ; Hypercalcemia ; Leukemia-Lymphoma, Adult T-Cell ; Lung ; Lymphatic Diseases ; Parathyroid Hormone ; T-Lymphocytes* ; Technetium Tc 99m Medronate ; Thrombocytopenia

STUDY DESIGN: A retrospective study. PURPOSE: The aims of this study were to investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in PET/computed tomography (CT) in the evaluation of spinal metastatic lesions. OVERVIEW OF LITERATURE: Recent studies described limitations regarding how many lesions with abnormal 18F-FDG PET findings in the bone show corresponding morphologic abnormalities. METHODS: The subjects for this retrospective study were 227 patients with primary malignant tumors, who were suspected of having spinal metastases. They underwent combined whole-body 18F-FDG PET/CT scanning for evaluation of known neoplasms in the whole spine. 99mTc-methylene diphosphonate bone scan was performed within 2 weeks following PET/CT examinations. The final diagnosis of spinal metastasis was established by histopathological examination regarding bone biopsy or magnetic resonance imaging (MRI) findings, and follow-up MRI, CT and 18F-FDG PET for extensively wide lesions with subsequent progression. RESULTS: From a total of 504 spinal lesions in 227 patients, 224 lesions showed discordant image findings. For 122 metastatic lesions with confirmed diagnosis, the sensitivity/specificity of bone scan and FDG PET were 84%/21% and 89%/76%, respectively. In 102 true-positive metastatic lesions, the bone scan depicted predominantly osteosclerotic changes in 36% and osteolytic changes in 19%. In 109 true-positive lesions of FDG PET, osteolytic changes were depicted predominantly in 38% while osteosclerotic changes were portrayed in 15%. CONCLUSIONS: 18F-FDG PET in PET/CT could be used as a substitute for bone scan in the evaluation of spinal metastasis, especially for patients with spinal osteolytic lesions on CT.
Biopsy ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Positron-Emission Tomography ; Positron-Emission Tomography and Computed Tomography ; Retrospective Studies ; Spine ; Technetium Tc 99m Medronate

Humans ; Osteoporosis ; drug therapy ; Technetium Tc 99m Medronate ; therapeutic use

Dystrophic calcifications themselves in the breast are classified as typically benign according to the Breast Imaging Reporting and Data System. However, we experienced a patient with invasive ductal carcinoma surrounding large dystrophic calcifications that could be regarded as long-standing benign conditions such as fat necrosis or hematoma. A 61-year-old woman presented with two large dystrophic calcifications within an irregular mass in the right upper outer breast on mammography. Ultrasonography revealed an irregular mass with dense calcifications showing strong posterior acoustic shadowing. On contrast enhanced magnetic resonance imaging, an irregular mass showed a persistent enhancement pattern and high signal intensity on a diffusion weighted image with non-enhancing areas corresponding to the calcifications. No abnormal uptake was observed on Tc-99m methylene diphosphonate bone scan. Invasive ductal carcinoma was observed on ultrasonography-guided core needle biopsy. In this case, we conclude that typical dystrophic calcifications within a breast mass cannot guarantee a benign diagnosis if the imaging characteristics of the mass are suspicious.
Acoustics ; Biopsy, Large-Core Needle ; Breast* ; Carcinoma, Ductal ; Diagnosis ; Diffusion ; Fat Necrosis ; Female ; Hematoma ; Humans ; Information Systems ; Magnetic Resonance Imaging ; Mammography ; Middle Aged ; Shadowing (Histology) ; Technetium Tc 99m Medronate ; Ultrasonography

Bisphosphonates are potent inhibitors of bone resorption and widely used to treat osteoporosis. Extensive studies have shown that therapy with bisphosphonates improves bone density and decreases fracture risk. However, concerns have been raised about potential over-suppression of bone turnover during long-term use of bisphosphonates, resulting in increased susceptibility to and delayed healing of non-spinal fractures. We report a patient who sustained non-traumatic stress fractures in bilateral femoral shafts with delayed healing after long-term bisphosphonate therapy. She underwent open reduction and surgical internal fixation. Although bisphosphonates effectively prevent vertebral fractures, and their safety has been tested in randomized trials, we must emphasize the need for awareness of the possibility that long-term suppression of bone turnover with bisphosphonates may eventually lead to an accumulation of fatigue-induced damage and adverse skeletal effects such as delayed fracture healing.
Bone Density/drug effects ; Diaphyses/drug effects/injuries ; Diphosphonates/*adverse effects ; Female ; Femoral Fractures/*chemically induced/diagnosis/surgery ; Fracture Fixation, Internal ; Fracture Healing/drug effects ; Fractures, Spontaneous/*chemically induced/diagnosis/surgery ; Fractures, Stress/*chemically induced/diagnosis/surgery ; Humans ; Middle Aged ; Osteoporosis/*drug therapy ; Radiopharmaceuticals/diagnostic use ; Technetium Tc 99m Medronate/analogs & derivatives/diagnostic use ; Treatment Outcome ; Whole Body Imaging

Parosteal osteosarcoma (POS) is the most common form of surface osteosarcoma. Its symptoms are insidious and its duration prior to diagnosis is considerably longer than that of other types of osteosarcoma. We report a case of POS with a growing mass but no evidence of metastasis. This tumor, which was diagnosed as calcified hematoma with benign characteristics, was incompletely resected in our hospital 21 years before the diagnosis of recurrence. The patient underwent a wide en bloc resection in our hospital and was free of symptoms, with no signs of tumor recurrence or metastasis during a 53-month follow-up.
Adult ; Bone Neoplasms ; diagnosis ; pathology ; surgery ; Diagnostic Errors ; Follow-Up Studies ; Humans ; Humerus ; Magnetic Resonance Imaging ; Male ; Neoplasm Recurrence, Local ; Osteosarcoma, Juxtacortical ; diagnosis ; pathology ; surgery ; Radiopharmaceuticals ; Technetium Tc 99m Medronate ; Tomography, Emission-Computed ; Tomography, X-Ray Computed