The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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The Usefulness of Measurement of Whole Body Count in Assessing Bone Marrow Metastasis in Cancer Patients with Increased Periarticular Bone Uptake on Follow-up Bone Scan: A Comparison with Bone Marrow Scan

암환자의 추적 골스캔에서 관절주위 섭취증가시 전신골섭취계수 측정이 골수전이 평가에 도움이 되는가-골수스캔과의 비교

  • Jin, Seong-Chan (Department of Diagnostic Radiology Hanyang University College of Medicine) ;
  • Choi, Yun-Young (Department of Nuclear Medicine Hanyang University College of Medicine) ;
  • Cho, Suk-Shin (Department of Nuclear Medicine Hanyang University College of Medicine)
  • 진성찬 (한양대학교 의과대학 진단방사선과학교실) ;
  • 최윤영 (한양대학교 의과대학 핵의학 교실) ;
  • 조석신 (한양대학교 의과대학 핵의학 교실)
  • Published : 2003.12.30
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Abstract

Purpose: Increased periarticular uptake could be associated with peripheral bone marrow expansion in cancer patients with axial bone marrow metastasis. We compared bone scan and bone marrow scan to investigate whether the increased whole body count in patients with increased periarticular uptake on bone scan is useful in the diagnosis of axial marrow metastasis, and evaluate the role of additional bone marrow scan in these cases. Materials and methods: Twelve patients with malignant diseases who showed increased periarticular uptake on bone scan were included. Whole body count was measured on bone scan and it is considered to be increased when the count is more than twice of other patients. Bone marrow scan was taken within 3-7 days. Results: Five hematologic malignancy, 3 stomach cancer, 2 breast cancer, 1 prostate cancer and 1 lung cacner were included. All three patients with increased whole body count on bone scan showed axial marrow suppression and peripheral marrow expansion. Eight of 9 patients without increased whole body count showed axial marrow suppression and peripheral marrow expansion. One turned out to be blastic crisis of chronic myelogeneous leukemia, and seven showed normal axial marrow with peripheral marrow expansion in chronic anemia of malignancy. The last one without increased whole body count showed normal bone marrow scan finding. Conclusion: Increased whole body count on bone scan could be a clue to axial bone marrow metastasis in cancer patients with increased periarticular uptake, and bone marrow scan is a valuable method for differential diagnosis in these cases.

목적: 암환자의 추적 골스캔에서 관절주위 섭취증가를 보이는 경우 관절염 이외의 원인으로 말초골수 확장에 의한 이차적 골섭취 증가를 생각할 수 있다. 이 때 막초골수 확장의 원인으로. 즉 중심골수 침범에 의한 이차적 말초골수 확장과 만성빈혈에의한 이차적 골수확장의 감별에 골스캔상 전신골섭 취계수 증가 소견이 도움을 주는지 알아보기 위해 본 연구에서는 암환자의 골스캔상 관절주위 섭취증가 소견을 보인 12명의 환자에서 골스캔과 골수스캔 소견을 비교 분석하였다. 대상 및 방법: 추적 골스캔에서 관절주위 섭취증가를 보인 12명의 암환자에서 1 주일 이내에 Tc-99m colloid 골수스캔을 시행하였다. 골스캔상 전신골섭취계수 증가 여부를 알아보고 골수스캔에서는 중심골 섭취감소 여부와 말초골수 확장여부를 각각 알아 보았다. 임상적으로 관절염, 관절통 여부와 빈혈이 동반되는지 알아 보았다. 결과: 원발암의 진단명은 혈액암 5례, 위암 3례, 유방암 2례, 전립선암 1례, 폐암 1례였다. 남녀비는 7:5 이고 평균연령은 47.5 14.3세였다. 골스캔에서 전신골섭취계수 증가는 3례에서 관찰되었으며 모두 골수스캔상 중심골수 섭취감소 소견과 말초골수 확장 소견을 보여 전신 골수전이로 진단되었다. 골스캔상 전신골섭취계수 증가를 보이지 않았던 9례 중 1례는 중심골수 섭취가 감소되고 말초골수가 확장되었으며 만성골수성백혈병의 급성기로 진단되었다. 7례는 중심골수 섭취는 정상이었고 말초골수 확장이 관찰되었으며 빈혈이 동반되어 있어 악성질환의 만성빈혈로 추정되었다. 결론: 암환자의 추적 골스캔에서 관절주위 섭취증가와 함께 전신골섭취계수가 증가된 경우 전신 골수전이에 의한 이차적 말초골수 확장을 고려해야 하며 이의 감별진단에 골수스캔이 유용한 검사이다.

Keywords

References

  1. Silberstein EB, Elgazzar AH, Fernandez-Ulloa M, Nishiyama H. Skeletal scintigraphy in non-neoplastic osseous disorders. In: Henkin RE, Boles MA, Dillehay GL, Halama JR, Karesh SM, Wagner RH, et al, editors. Nuclear Medicine. St.Louis: Mosby-Year Book, Inc; 1996. p.1141-97
  2. Stokkel MP, Valdes Olmos RA, Hoefnagel CA, Richel DJ. Tumor and therapy associated abnormal changes on bone scintigraphy old and new phenomena. Clin Nucl Med 1993;18:821-8 https://doi.org/10.1097/00003072-199310000-00001
  3. Kim CK, Reske SN, Alavi A. Bone marrow scintigraphy. In: Henkin RE, Boles MA, Dillehay GL, Halama JR, Karesh SM, Wagner RH, et al, editors. Nuclear Medicine. St.Louis: Mosby-Year Book, Inc; 1996. p.1223-47
  4. Lentle BC, Worsley DF, Coupland DB. Radionuclide imaging of bone marrow. In: Collier BD, Fogelman I, Rosenthall L, editors. Skeletal nuclear medicine. St.Louis: Mosby-Year Book, Inc; 1996. p.137-48
  5. Rudberg U, Uden R, Ahlback SO. Colloid scintigraphy showing red bone marrow extension in patients with prostatic carcinoma. Acta Radiologica 1992;33:97-102 https://doi.org/10.1177/028418519203300203
  6. Podoloff DA, Kim EE. Sub-super scan manifestation of bone marrow metastases? Clin Nucl Med 1989;14:597-602
  7. Berna L, Torres G, Carrio I, Estorch M, Germa JR, Alonso C.. Antigranulocyte antibody bone marrow scans in cancer patients with metastatic bone superscan appearance. Clin Nucl Med 1994;19: 121-8 https://doi.org/10.1097/00003072-199402000-00009
  8. Folli F, Perego L, Ponzoni M, Girardi AM, Bosi E, Ferreri AJ, et al. Autoantibodies against a 72-kDa ductal cell membrane glycoprotein in a patient affected by Sjogren's syndrome and gastric MALT lymphoma. Ann Hematol 2002;81:597-602 https://doi.org/10.1007/s00277-002-0533-9
  9. Pope JE, Joneja M, Hong P. Anti-androgen treatment of prostatic carcinoma may be a risk factor for development of rheumatoid arthritis. J Rheumatol 2002;29:2459-62
  10. Funauchi M, Ohno M, Nozaki Y, Kinoshita K, Sugiyama M, Kanamaru A. Two injections of interferon-alpha could trigger the development of rheumatoid arthritis. Clin Exp Rheumatol 2002;20:871
  11. Kay CJ, Rosenberg MA. Positive $^99m$Tc-polyphosphate bone scan in a case of secondary hypertrophic osteoarthropathy. J Nucl Med 1974;15: 312-3
  12. Uchisako H, Suga K, Tanaka N, Nishigauchi K, Matsumoto T, Matsunaga N, et al. Bone scintigraphy in growth hormone-secreting pulmonary cancer and hypertrophic osteoarthro- pathy. J Nucl Med 1995;36:822-5
  13. Younes M, Hayem G, Brissaud P, Grossin M, Kahn MF, Meyer O. Monoarthritis secondary to joint metastasis. Two case reports and literature review. Joint Bone Spine 2002;69:495-8 https://doi.org/10.1016/S1297-319X(02)00436-0
  14. Beckers C, Foidart J, Thiry A, Malaise MG. Synovial metastasis from colonic cancer presenting as arthritis of the knee. Characterization by $^18$FDG PET scan. Rev Med Leige 2002;57:467-74
  15. Robin M, Guardiola P, Dombret H, Baruchel A, Esperou H, Ribaud P, et al. Allogenic bone marrow transplantation for acute myeloblastic leukemia in remission: risk factors for long-term morbidity and mortality. Bone Marrow Transplant 2003;31: 877-87 https://doi.org/10.1038/sj.bmt.1704027
  16. Bernbeck B, Krauth KA, Scherer A, Engelbrecht V, Gobel U. Aseptic osteonecrosis in a child with nephroblastoma healed by hyperbaric oxygen therapy. Med Pediatr Oncol 2002;39:47-8 https://doi.org/10.1002/mpo.1366
  17. Levien MG. Osteonecrosis as a complication of treating acute lymphoblastic leukemia in children: a report from the Children's Cancer Group. Clin Pediatr 2002;41:63-4 https://doi.org/10.1177/000992280204100114
  18. Winquist EW, Bauman GS, Balogh J. Non-traumatic osteonecrosis after chemotherapy for testicular cancer: a systematic review. Am J Clin Oncol 2001;24:603-6 https://doi.org/10.1097/00000421-200112000-00015
  19. Kraemer M, Weissinger F, Kraus R, Beer M, Kunzmann V, Wilhelm M. Aseptic necrosis of both femoral heads as first symptom of chronic myelogenous leukemia. Ann Hematol 2003;82:44-6
  20. Gulenchyn KY, Papoff W. Technetium-99m MDP scintigraphy. An insensitive tool for the detection of bone marrow metastases. Clin Nucl Med 1987;12:45-6 https://doi.org/10.1097/00003072-198701000-00011
  21. Duncker CM, Carrio I, Berna L, Estorch M, Alonso C, Ojeda B, et al. Radioimmune imaging of bone marrow in patients with suspected bone metastases from primary breast cancer. J Nucl Med 1990;31:1450-5
  22. Rieker O, Grunwald F, Layer G, Kurbacher CM, Hotze AL, Menzel C, et al. Disseminated bone marrow metastases from primary breast cnacer: detection and follow-up by radioimmune bone marrow scintigraphy. J Nucl Med 1994;35:1485-7
  23. Bathmann J, Moser E. Comparison of skeletal scintigraphy and bone marrow scintigraphy in detection of osseous metastases. Radiologe 1995;35:8-14
  24. Chung JK, Yeo J, Lee DS, Park S, Lee MC, Kim BK, et al. Bone marrow scintigraphy using technetium-99m-antigranulocyte antibody in hematologic disorders. J Nucl Med 1996;37:978-82
  25. Sayle BA, Helmer RE 3rd, Birdsong BA, Balachandran S, Gardner FH. Bone-marrow imaging with indium-111 chloride in aplastic anemia and myelofibrosis: concise communication. J Nucl Med 1982;23:121-5
  26. Dazen H, Velimir I, Wolf-Stefan R, Dieter LM. Immunoscintigraphy of the bone marrow: normal uptake values of technetium-99m-labeled monoclonal antigranulocyte antibodies. J Nucl Med 1997;38:1755-8