• The Korean Journal of Nuclear Medicine
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• v.34 no.5
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• pp.433-435
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• 2000

A 6000-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the ether represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.$^{1-4)}$ A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.$^{4)}$ Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.3
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• pp.260-262
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• 2007

A 68-year-old man with small cell carcinoma of the lung and adenocarcinoma of the prostate underwent Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bilateral symmetrical photon defects in both parietal bones of the skull were observed. The radiographs of the skull demonstrates biparietal thinning in the same area of the abnormality identified on bone scintigraphy. Although these findings in cancer patients can be mistaken for skeletal metastases, the symmetry and location of the photon defects are generally indicative of biparietal thinning.

• Nuclear Medicine and Molecular Imaging
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• v.40 no.5
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• pp.275-278
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• 2006

We report the case of a 73-year-old man who had prostate cancer with bone metastases. Tc-99m HDP Whole body bone scan revealed multiple areas of increased bony uptake consistent with widespread bone metastases. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) demonstrated mild F-18 FDG uptake in the lymph nodes of neck, abdomen, and pelvis. However, abnormal F-18 FDG uptake was not seen in the skeletal system. Biopsy and immunohistochemical stains of left supraclavicular mass showed metastatic prostate adenocarcinoma. Currently, there are a few reported cases of F-18 FDG PET/CT evaluation of bone metastases in prostate cancer. We discuss the discrepancy between F-18 FDG PET/CT and bone scan in the detection of osseous metastases of prostate cancer.

• The Korean Journal of Nuclear Medicine
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• v.27 no.1
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• pp.98-103
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• 1993

The present study was purposed to evaluate the incidence and the characteristics of metastatic "cold" lesions in $^{99m}Tc$-MDP bone scans of adult patients with solid malignancies. There were 29 cold lesions in 24 patients. The incidence of cold lesions was about 1% of total cases of bone scans for the patients with malignancy, or 2.5% of cases with bone metastases. Th primary sites of malignancies were lung (four cases), uterine cervix (three cases), kidney, nasopharynx, thyroid, urinary bladder, prostate, lymphoma (two cases each other), liver, breast and others (one case each other). But the relative incidence of cold lesion in lung cancer and breast cancer was low. The most frequent site of cold lesion was spine, and pelvis, skull and rib were followed. The incidence of cold lesion was related to the regional incidence of bone metastases. The size of the cold lesions was greater than that of the hot. There were six cases of single cold lesion without any other abnormalities and two cases of cold lesion which were initially hot. So it should be considered that bone metastases might be presented as cold lesions in bone scan.

• 대한핵의학회:학술대회논문집
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• 2000.05a
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• pp.68.2-68.2
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• 2000

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.3357-3362
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• 2013

The human skeleton is the most common organ to be affected by metastatic cancer and bone metastases are a major cause of cancer morbidity. The five most frequent cancers in Malaysia among males includes prostate whereas breast cancer is among those in females, both being associated with skeletal lesions. Bone metastases weaken bone structure, causing a range of symptoms and complications thus developing skeletal-related events (SRE). Patients with SRE may require palliative radiotherapy or surgery to bone for pain, having hypercalcaemia, pathologic fractures, and spinal cord compression. These complications contribute to a decline in patient healthrelated quality of life. The multidimensional assessment of health-related quality of life for those patients is important other than considering a beneficial treatment impact on patient survival, since the side effects of treatment and disease symptoms can significantly impact health-related quality of life. Cancer treatment could contribute to significant financial implications for the healthcare system. Therefore, it is essential to assess the health-related quality of life and treatment cost, among prostate and breast cancer patients in countries like Malaysia to rationalized cost-effective way for budget allocation or utilization of health care resources, hence helping in providing more personalized treatment for cancer patients.

• Nuclear Engineering and Technology
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• v.55 no.1
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• pp.254-260
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• 2023

Skeletal metastases are common in patients suffering from various primary cancers. Radiopharmaceuticals are an effective option for bone pain palliation. In this work, the radiation absorbed dose of ¹⁷⁷Lu-EDTMP radiopharmaceutical was estimated for adult man based on biodistribution data in Wistar rats. The MIRD dose calculation method and the Sparks and Aydogan methodology were applied. The results shows that about 46% of injected activity is cumulated on the surface of the trabecular and cortical bones. Radiation absorbed doses of red bone marrow and osteogenic cells were estimated to about 1.1 and 6.2 mGy/MBq, respectively. The maximum administrated activity was obtained 27 MBq/kg of body weight with an effective dose of 0.23 mSv/MBq. The results were compared with other available data from literature. This study indicated that ¹⁷⁷Lu-EDTMP provides therapeutic efficacy for achieving bone pain palliation with low undesired dose to other normal organs.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.9
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• pp.4335-4340
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• 2016

Background: Bone metastasis is a single condition but presents with various patterns and severities. Skeletal-related events (SREs) deteriorate overall performance status and reduce quality of life. However, guidelines for early detection and management are limited. This study includes a survey of the prevalence of bone metastasis in cases with common cancers in Thailand as well as a focus on survival patterns and SREs. Materials and Methods: A retrospective cohort analysis was conducted using a database of the Chiang Mai Cancer Registry and the Musculoskeletal Tumor Registry of the OLARN Center, Chiang Mai University. The prevalence of bone metastasis from each type of primary cancer was noted and time-to-event analysis was performed to estimate cancer survival rates after bone metastasis. Results: There were 29,447 cases of the ten most common cancers in Thailand, accounting for 82.2% of the entire cancer registry entries during the study period. Among those cases, there were 2,263 with bone metastases, accounting for 7.68% of entries. Bone metastasis from lung, liver, breast, cervix and prostate are common in the Thai population, accounting for 83.4% of all positive cases. The median survival time of all was 6 months. Of the bone metastases, 48.9% required therapeutic intervention, including treatment of spinal cord and nerve root compression, pathological fractures, and bone pain. Conclusions: The frequency of the top five types of bone metastasis in Thailand were different from the frequencies in other countries, but corresponded to the relative prevalence of the cancers in Thailand and osteophilic properties of each cancer. The results of this study support the establishment of country specific guidelines for primary cancer identification with skeletal lesions of unknown origin. In addition, further clinical studies of the top five bone metastases should be performed to develop guidelines for optimal patient management during palliative care.

• The Korean Journal of Nuclear Medicine
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• v.30 no.4
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• pp.524-531
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• 1996

Purpose : To evaluate the pattern- of skeletal metastases and to classify the pattern of renal uptakes on bone scans in renal cell carcinoma. Materials and Methods : We reviewed the bone scans of 158 patients with RCC established pathologically. In order to identify individual scan lesion as a bone metastasis, we reviewed all available correlative radiological studies, follow-up bone scans, and biopsies for each lesion. The metastatic bone lesions were divided into seven anatomic regions; skull, spine, shoulder girdle, sternum, ribs, pelvis, and long bones of extremities. The individual scan lesions were divided into two groups as the pattern of uptakes, hot and cold lesion. In addition, the contours and uptakes of kidneys with RCC were classified into 6 groups ; normal uptake, photon-deficient lesion, faint up-take with enlargement, uneven uptake with enlargement, lateralization with crescentic shape, and increased uptake. Results : Twenty out of 158(12.7%) patients with RCC at varying stages showed 71 metastatic bone lesions at presentation and on follow- up bone scans. Nearly 80% of all metastatic lesions were in the axial skeleton with predominantly increased uptake of the radioactivity However a considerable number(22.5%) showed cold lesions on bone scan. A half of bone scans revealed abnormal uptake of involved kidney and much more(82.4%) in case of bone metastases. Two common patterns of abnormal renal uptake were photon-deficient lesion (50%) and faint uptake with enlargement(24.3%). In four patients with bone pain or pathologic fracture, bone scans were useful for the serendipitious localization of previously unrecognized primary lesion of RCC as well as for the detection of bone metastases from RCC. Conclusion : The understanding of the pat-terns of skeletal metastases and renal uptakes on bone scans in RCC is important for the useful information about primary lesion(RCC) as well as detection of bone metastases.

• Tuberculosis and Respiratory Diseases
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• v.55 no.3
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• pp.280-286
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• 2003

Background : $^{99m}Technetium$ methylene diphosphonates($^{99m}Tc$ MDP) bone scintigraphy is current method of choice for the detection of bone metastases, but whole body $^{18}F$-fluoro-deoxy-D-glucose positron emission tomography($^{18}FDG$ PET) offers superior spatial resolution and improved sensitivity. So we compared whole body $^{18}FDG$ PET with $^{99m}Tc$ MDP bone scintigraphy in patients with skeletal metastases from lung cancer. Patients and Methods : Ninety-two patients with lung cancer taken $^{18}FDG$ PET together with a $^{99m}Tc$ MDP bone scintigraphy within 1 month between March 2000 and March 2003 were investigated retrospectively. Results : The sensitivity, specificity and accuracy of the $^{99m}Tc$ MDP bone scintigraphy versus $^{18}FDG$ PET for the detection of bone metastases in lung cancers were 59% vs 82%, 71% vs 94%, and 68% vs 91%, respectively. In the diagnosis of bone metastases from lung cancer, $^{18}FDG$ PET was statistically superior to $^{99m}Tc$ MDP bone scintigraphy in its specificity and accuracy(p<0.0001). Conclusions : Whole body $^{18}FDG$ PET may be useful in detecting bone metastases among patients with lung cancer.