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Almeida LS, de Souza SPM, de Souza FVP, Reis F, Ramos CD. Multimodality Molecular Imaging in Arthropathy Associated with Multiple Myeloma. Indian J Nucl Med 2022; 37:290-292. [PMID: 36686291 PMCID: PMC9855246 DOI: 10.4103/ijnm.ijnm_205_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/12/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022] Open
Abstract
We report a patient with multiple myeloma (MM) and polyarthritis of large joints. During the staging of the disease, bone marrow diffusely involved by MM was clearly demonstrated by 99mTc-2-methoxy-isobutyl-isonitrile (MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT) but not by 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT images. On the other hand, a very intense uptake of 18F-FDG was detected in periarticular tissues of multiple joints, with nonabnormal 99mTc-MIBI accumulation. Rheumatology tests were negative. A subsequent bone scintigraphy demonstrated radiolabeled bisphosphonate accumulation in periarticular tissues, suggesting amyloid arthropathy.
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Affiliation(s)
- Ludmila Santiago Almeida
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | | | | | - Fabiano Reis
- Department of Radiology, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Celso Dario Ramos
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
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The Relationship between Multiple Myeloma with Renal Failure and Metastatic Calcification. Case Rep Hematol 2018; 2018:7819792. [PMID: 30026990 PMCID: PMC6031209 DOI: 10.1155/2018/7819792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/27/2018] [Indexed: 01/27/2023] Open
Abstract
While cases of multiple myeloma (MM) with metastatic calcification have been reported, the mechanisms for this calcification have yet to be explained. We observed a case of MM in a patient with end-stage renal failure who developed vascular and pulmonary calcification. A 51-year-old male was diagnosed with Bence-Jones type MM and required maintenance hemodialysis. He was treated with bortezomib-dexamethasone, vincristine-doxorubicin-dexamethasone, the M2 protocol, and lenalidomide-dexamethasone (Rd) therapy. During the sixth cycle of Rd therapy, he complained of pain in both lower legs. Well-demarcated ulcers with severe pain had developed on the right lower leg, both exterior thighs, and penis. We found that the patient's serum intact parathyroid hormone level was elevated, while it had previously been permissively controlled. Computed tomography scan showed widespread centrilobular opacities of the bilateral lungs and high-density lesions along small blood vessels in the trunk and all four extremities. Histological calcifications were identified in small blood vessels and the alveolar walls. The risk of metastatic calcification in MM appears to be associated with renal failure, but not with MM itself.
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Significant 99mTc-MDP but Unimpressive 18F-NaF Gastric Activity in a Patient With Multiple Myeloma. Clin Nucl Med 2016; 41:740-2. [DOI: 10.1097/rlu.0000000000001311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Demirel K, Sadic M, Korkmaz M, Comak A, Atilgan HI, Koca G. Diffuse Myocardial Uptake of (99m)Tc-HDP in Multiple Myeloma. Nucl Med Mol Imaging 2014; 47:208-11. [PMID: 24900110 DOI: 10.1007/s13139-013-0209-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
Abstract
Soft tissue uptake is a rare finding in bone scintigraphy, with an incidence of 2%. Although the mechanism has not yet been fully clarified, several causes have been reported for this unusual uptake pattern. This paper presents a case of diffuse myocardial accumulation of technetium-99m hydroxymethylene diphosphonate ((99m)Tc-HDP) without either solid/visceral organ or soft tissue with multiple myeloma (MM) in skeletal scintigraphy. A 93-year-old man with hypertension and chronic heart failure for 14 years underwent bone scanning due to a 2-month history of back pain within a 1-year period of MM. Three hours later, (99m)Tc-HDP late static images showed diffuse myocardial radiotracer accumulation and there were no other sites of abnormal soft tissue or visceral uptake. Myocardial accumulation had disappeared on 24-h delayed static images. This accumulation was thought to be related with AL-type amyloidosis associated with MM.
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Affiliation(s)
- Koray Demirel
- Department of Nuclear Medicine, Ministry of Health Ankara Training and Research Hospital, Ulucanlar Street, 06340 Ankara, Turkey
| | - Murat Sadic
- Department of Nuclear Medicine, Ministry of Health Ankara Training and Research Hospital, Ulucanlar Street, 06340 Ankara, Turkey
| | - Meliha Korkmaz
- Department of Nuclear Medicine, Ministry of Health Ankara Training and Research Hospital, Ulucanlar Street, 06340 Ankara, Turkey
| | - Aylin Comak
- Department of Nuclear Medicine, Ministry of Health Ankara Training and Research Hospital, Ulucanlar Street, 06340 Ankara, Turkey
| | - Hasan Ikbal Atilgan
- Department of Nuclear Medicine, Ministry of Health Ankara Training and Research Hospital, Ulucanlar Street, 06340 Ankara, Turkey
| | - Gökhan Koca
- Department of Nuclear Medicine, Ministry of Health Ankara Training and Research Hospital, Ulucanlar Street, 06340 Ankara, Turkey
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Marked gastric uptake of Tc-99m methylene diphosphonate (MDP) in a patient with myeloma and hypercalcemia. Radiol Case Rep 2012; 7:659. [PMID: 27330591 PMCID: PMC4899550 DOI: 10.2484/rcr.v7i4.659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A 59-year-old man presented with a 7-month history of increasing left shoulder pain. The initial plain films showed near absence of the left scapula and scattered lucent changes in the left humerus. A CT scan confirmed the presence of widespread lytic bony lesions, with a large soft-tissue mass centered around the left scapula. An isotope bone scan demonstrated marked uptake of MDP in the stomach and nasal mucosa. Further laboratory investigations revealed marked hypercalcemia and the presence of Bence-Jones protein in the urine. An ultrasound-guided biopsy of the soft-tissue mass confirmed the diagnosis of multiple myeloma.
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Sasaki T, Okizaki A, Takahashi K, Mineta M, Nagasawa K, Fujimoto Y, Kohda K, Aburano T. Absent skeletal uptake of (99m)Tc-hydroxymethylene diphosphonate in the presence of AL-type amyloidosis associated with multiple myeloma. Jpn J Radiol 2011; 29:595-7. [PMID: 21928004 DOI: 10.1007/s11604-011-0596-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 04/03/2011] [Indexed: 11/24/2022]
Abstract
A 66-year-old woman with congestive heart failure suspected to have multiple myeloma underwent bone scintigraphy. The bone scintigraphy using technetium-99m hydroxymethylene-diphosphonate showed the following interesting findings: absent skeletal uptake; increased gastrointestinal, myocardial, and soft tissue uptake; migration of radionuclide to bilateral pleural effusions. Histopathological examination revealed that the patient suffered from AL-type amyloidosis associated with multiple myeloma. Extraosseous uptake is often observed on bone scintigraphy in amyloidosis patients, but in many cases skeletal uptake is preserved. The simultaneous presentation of these findings is rare.
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Affiliation(s)
- Tomoaki Sasaki
- Department of Radiology, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Japan.
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Sood A, Seam RK, Sethi S, Gupta M. Diffuse hepatic and splenic Tc-99m MDP tracer uptake in case of multiple myeloma. Indian J Nucl Med 2011; 25:70-2. [PMID: 21188069 PMCID: PMC3003289 DOI: 10.4103/0972-3919.72692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tc-99m methylene diphosphonate (MDP) bone scintigraphy has long been used for the evaluation of benign as well as malignant skeletal conditions. However, non-osseous tracer uptake on a bone scan is an unusual finding. There is a need to understand the pathophysiological basis of the non-osseous uptake, which may have a clinical relevance or deteriorating effect on the quality of the bone scan. We describe a case of multiple myeloma, where extraosseous uptake in the form of diffuse hepatic and splenic uptake, with almost normal skeletal tracer distribution, has been seen on the bone scan.
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Affiliation(s)
- Ashwani Sood
- Department of Radiotherapy and Oncology, Nuclear Medicine Center, Indira Gandhi Medical College, Shimla - 171 001, India
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Esser JP, Oei HY, Kwekkeboom DJ, Krenning EP. Diffuse lung and stomach uptake of Tc-99m oxidronate (HDP). Clin Nucl Med 2004; 28:845-6. [PMID: 14508280 DOI: 10.1097/01.rlu.0000090934.83420.72] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jan-Paul Esser
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Berk F, Demir H, Hacihanefioglu A, Arslan A, Erdincler O, Isgoren S, Aktolun C. Hepatic and splenic uptake of Tc-99m HDP in multiple myeloma: additional findings on Tc-99m MIBI and Tc-99m sulfur colloid images. Ann Nucl Med 2002; 16:137-41. [PMID: 12043908 DOI: 10.1007/bf02993717] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors present a case of multiple myeloma with intense hepatic and splenic uptake on Tc-99m HDP bone scan and discuss its clinical implications and possible uptake mechanisms. Tc-99m MIBI and Tc-99m sulfur colloid were used to demonstrate bone marrow involvement and focal lesions of multiple myeloma.
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Affiliation(s)
- Fatma Berk
- Department of Nuclear Medicine, Kocaeli University Medical School, Derince, Turkey
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Kaye J, Hayward M. Soft tissue uptake on 99mTc methylene diphosphonate bone scan imaging: pictorial review. AUSTRALASIAN RADIOLOGY 2002; 46:13-21. [PMID: 11966582 DOI: 10.1046/j.1440-1673.2001.00989.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
99mTechnetium methylene diphosphonate (MDP) bone isotope may accumulate in many extra-osseous sites due to a variety of both benign and malignant conditions. This finding on a bone scan can be crucial to the diagnosis and may not be apparent in other imaging or the clinical evaluation of the patient. We present a pictorial review sampling some of the many causes of extra-osseous 99mTc MDP accumulation.
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Affiliation(s)
- J Kaye
- Medical Imaging Department, Women's & Children's Hospital, North Adelaide, South Australia, Australia
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Evans JC, Murphy M, Eyes B. Extensive soft tissue uptake of 99Tcm methylene diphosphonate in a patient with multiple myeloma. Br J Radiol 2000; 73:1018-20. [PMID: 11064661 DOI: 10.1259/bjr.73.873.11064661] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone scintigraphy is not usually performed in multiple myeloma (MM), as marrow deposits characteristically show no tracer uptake. However, metastatic bone disease often mimics MM both clinically and biochemically, resulting in a substantial number of MM patients undergoing bone scintigraphy. Variable appearances in these cases have been reported, ranging from normal to a superscan, the latter a result of massive tracer uptake within bone. Soft tissue uptake has been documented, often when MM is complicated by secondary amyloidosis. This usually results in mainly solid organ uptake of tracer. We report a case of MM where massive soft tissue uptake occurred, primarily within muscles, with very little isotope elsewhere.
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Affiliation(s)
- J C Evans
- Department of Radiology, University Hospital Aintree, Liverpool, UK
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Zwas ST, Shpilberg O, Huszar M, Rozenman J. Isolated ectopic lung uptake of technetium 99m methylene diphosphonate on bone scintigraphy in primary amyloidosis. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1990; 17:282-5. [PMID: 2083563 DOI: 10.1007/bf00812371] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary deposition of technetium 99m methylene diphosphonate was found on a bone scan of a patient with undiagnosed primary AL amyloidosis. Unusual clinical manifestations during the course of the disease led to a post-mortem diagnosis. The mechanisms for pulmonary and other ectopic soft tissue bone scan tracer depositions, as well as their significance in the diagnosis of amyloidosis, are discussed.
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Affiliation(s)
- S T Zwas
- Department of Nuclear Medicine, Chaim Sheba Medical Centre, Tel Hashomer, Israel
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